Need help quickly
I have just joined your group today and am looking for help.
I have a 9 year old gelding that was diagnosed with IR and Metabolic syndrome and no cushings back in Sept 2021. I have been working with several Vets since he became laminitic March 6th, 2022.
The Vet still has me giving him bute twice a day and gabapentin once a day. I have tried to reduce and he becomes worse.
Now where I board the Family is vey stressed and feels I should put him down as it is too much trouble for them. I need to possibly relocate him because I am not giving up on him. I have boarded him there for 8 years.
My biggest question is because he is still so lame after all this time and I would like to be off the bute to start the J Herb I really don't know what to expect. I need the support of my boarding facility and go out everyday for 4 or 5 hours but it is a 2 hour drive there and back. The trimmer said she has never seen a hoof grow back peeling the way it is doing. She believes there is something else going on because he has been so bad for so long.
The Vet was out when he had a colic episode near end of May 2022. He said let him be a horse and graze early mornings. I know that shot his insulin up and have tried to explain to the barn that he needs exercise but also should not be grazing. He was around 1,400 lbs but has lost significant weight in the last 2 months due to herbal supplements. He looks great now and needs to leave more but am working on it.
What is my next move???
Shelley C MB Canada
Hi Shelley and welcome to the group!
I'm sorry your boy is struggling right now but we'll do what we can to help. Since this is your first post, I will be sending your welcome message along, it is quite a bit to read, but it will help you immensely while navigating through this. The hyperlinks will provide you with even more information on the subject, just please take a breath and read it when you can.
First off, we really need a case history with all his test results, x-rays and pictures of his feet and body just as soon as you can manage. We really need as much information on him that you can provide, even if you have to do it a little at a time.
It's very important to keep him off grass completely, if you feel he "just needs to be a horse", please get him a sealed muzzle for turn out. Although exercise is the best insulin buster there is, if he is in pain and not moving freely by himself, please don't force it.
Now then, NSAID'S are not recommended here, you don't say what breed he is but there are a lot of thrifty breeds that are genetically predisposed to IR, so diet and exercise is very important for these horses, and since high insulin can result in laminitis (which isn't inflammatory), any NSAID may hinder his recovery, I will include some information on getting him off the Bute and provide you with pain alternatives instead. We don't recommend gabapentin as most members here have not seen a difference with this medication either, if his trim is good, you can certainly give him Jiaogulan.
What is diet like otherwise? I would get him on the emergency diet first thing, and if you haven't already get his hay balanced.
Again, if you can provide pictures, we can better help you.
We have a lot of members that board that have had the same issues, we know for some it just isn't possible to have their horses at home, but maybe you could move him somewhere closer to a facility that would be more inclined to follow your wishes? I for sure would insist on the no grass. What herbal supplements are you feeding him? All the details matter. Are you able to get Uckele products there? You can also use Devils claw for pain just be sure to taper the bute if you take him off.
How to Taper Off NSAIDs.pages (groups.io)
Why NSAIDs & Icing Are Not Recommended .pdf (groups.io)
Pain Relief Alternatives to Bute and Banamine (groups.io)
Uckele Phyto-Quench Pellets 5lb
Uckele LaminOx 3.3 lb
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
Eleanor Kellon, VMD
I'm sure you have seen how little an effect the bute has on his pain. However, when used long term like this you have to wean off slowly because if you don't there will be a rebound effect, which is probably what you are seeing. The other thing that can happen is they prevent abscess collections from mobilizing so actually are prolonging his pain. No one here has seen any significant effects from gabapentin either - and that is THOUSANDS of members.
He hasn't lost weight from herbal supplements. It's from chronic pain. As your welcoming post said, this has to be approached in a comprehensive fashion.
D: Diagnosis: We need to see you blood work and there may even be something else going on
D: Diet and Drugs: To control insulin and PPID
T: Trim: Very, very important and often the thing people have the most trouble accomplishing
E: Exercise, when sound. Until then, movement as he feels comfortable doing but in a sealed muzzle.
Eleanor in PA
dont give up.. I had same issue years ago when Jesse had laminitis.. 3 weeks later he was cantering in the arena??? are u using easycare boots etc?? you can make emergency boots with styrofoam and duct tape. your horse wont remember these painful times once you get him better.. but u need to do what is suggested here.. local vets dont know much..
LJ Friedman Nov 2014 Vista, Northern San Diego, CA
Shelly - If you aren't using boots get some right away. The difference might be night and day. I personally like Easy Care Clouds, but there are several others (I think I've tried half of them!!) Use whatever makes him comfortable. I currently use a different pad in my Clouds, because that is what my horse likes.
For arthritis, I have had very good results with a product that hadn't been mentioned here. But for your horse, right now, I would take one thing at a time...following the emergency plan, and not add anything else into the mix that isn't recommended for the emergency diet.
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
what is the product you have had good luck with that has not been mentioned?
LJ Friedman Nov 2014 Vista, Northern San Diego, CA
The product is Equithrive.
Here are all the posts from the archives about this product back to 2009.
There is also a reference to this product under the resveratrol info in the files.
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer 2021-2022