Welsh 18 year old pony mare (copied message)
New to group, hope this is where I post questions-
Hello Jamie and welcome to the group, I completely understand your confusion and I will do my best to address your concerns, you may also hear from some of our other experienced mods or Dr.Kellon as well. I will be sending along your official welcome message since this is your first time posting, its full of information that will help you to help your horse, the blue links will take you even further into the subject, we realize it's a lot to go over but please take time to read it when you can and keep it handy for reference.
The groups philosophy is based on the DDT/E protocol, diagnosis, diet, trim and exercise.
I'm glad you were able to talk to Dr.K about the J-herb and you know that it's not advisable to feed NASIDS while your horse is experiencing laminitis pain, the good thing is you now know what to do in the winter months to keep her legs and feet warm.
We do not consider her ACTH at over 45 to be normal, we want to see it in the low twenties or even better the teens, lab reference ranges are just that, ranges. Please see this article.
Dr. Kellon on lab reference ranges.pdf (groups.io)
I would keep her on the medication and re-check before fall, if not you will be chasing the rise and it will be harder to get her ACTH under control. We agree with your vet about exercise it is the best way to help with the high insulin but only if she is able, bad hay is not the answer, you need good quality grass hay that tests under 10% starch and sugar. You will need to get it tested (info in your message) and some horses require hay to be even lower. If you cannot source appropriate hay, please check out our safe feeds list. Which brings me to the Purina, it's too high in sugar and starch for a IR horse. To get those numbers down, we suggest the emergency diet as outlined in your welcome message. You can do this! Most members are equines that have been able to live long healthy happy lives while having PPID/IR.
It would be really helpful to our team if you could get a case history filled out as well as photo's. and x-rays if available.
Now on to your message !
Welcome to the group!
The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.
Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.
Orienting information, such as how the different ECIR sections relate to each other, message etiquette, what goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have.
Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.
DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.
The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".
In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk
*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.
*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now.
Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed.
No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:
We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse.
*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it). The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers.
There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it.
What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only.
No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.
We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.
TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.
Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet.
You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.
EXERCISE: The best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.
There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.
If you have any technical difficulties, please let us know so we can help you.
Bobbie and Maggie
Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response
Acth should be at its lowest in the spring so that number is high enough that, yes, your pony needs pergolide/Prascend. Retest her ACTH, insulin, and glucose after 3 weeks on the desired dose of Prascend to make sure it's effective. Subtle problems with coat shedding may show up early but the obvious coat signs are late stage PPID and it's better for your pony to start treatment before it gets that advanced.
Elevated ACTH can cause insulin to go up, too, but it does not work in reverse. Starting Prascend should help lower insulin, too, but with insulin that high you also need to make some dietary adjustments to get it down asap as it is well into the zone for acute laminitis. Please take a look at our emergency diet detailed in the welcome letter from Bobbie and implement it. Her hay should be soaked until you test it to confirm its safe. Legumes in hay seem to worsen IR or cause unexplained hoof pain in some horses so sourcing a grass could also help. My horse had elevated insulin on a grass-clover hay that wasn't actually very high in sugar and starch (10.2%, just over our upper recommended limit) and I was soaking it, too!
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
Thank you for this wonderful info, I am changing her diet asap and ordering the prascend, until I can get hay anilized I'd like to give the soaked beet pulp with soaked hhay-if I usually give her 10 lbs of hay a day is the ratio 6lbs of hay 1 lb of bp a day?
Berlin, WI 2022
There's not necessarily a ratio of hay to beet pulp unless you're not able to soak hay. If you can soak hay - you want to figure out how much she should be eating per day and then use a minimal amount of beet pulp to get supplements in and the balance should be hay.
You want to feed 1.5% of current weight or 2% of ideal weight - whichever is greater. As an example - if she's currently 600lbs and her ideal weight is 500lbs you would do some calculating and see 1.5% of 600lbs is 9lbs and 2% of 500lbs is 10lbs so she should eat 10lbs per day TOTAL. So if you feed 1lb of beet pulp the other 9lbs would be hay.
Beet pulp should be rinsed/soaked/rinsed.