Help for my mare Alaska
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Hi there, I have just joined this group and hope I am posting in the right spot! I am in desperate need of help with my beautiful mare Alaska.We have struggled with sub clinical lamanitis since we got her 6 years ago.Recent xrays have shown inflammation again and very slight rotation on her right front.She has heat in all feet some day and others none and sometimes just one. We have seen so many vets and can't get to the bottom of how to help her.Diet and hoof care hasn't helped her,you name it we have tried it.Her bloods are very confusing for me to understand but vets tell me they are in conclusive. She was trialled on pergolide just incase it helped but she became so much worse within 3 days and developed ventral edema and was very sick.We have recently tried a new drug called Ertuglifozin with zero improvement.She flares up over winter(we are in South Australia)and is much better in the summer but still not 100%.She also has issues with painfully cycles and her left ovary twisting.Please help! and info or advice would be greatly appreciated.Eli and Alaska
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-- Eli South Australia 2022 |
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These issues are all very familiar to use. Please get a case history up ASAP.
-- Eleanor in PA www.drkellon.com |
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Hello Eli and welcome to the group.
I will be including your new member message below which is full of very important information to help you through this time with Alaska, (very beautiful name BTW). Please take note that there are hyperlinks included that will take you even deeper into the subject. The basis of the ECIR'S protocols is DDT/E which stands for Diagnosis, Diet, Trim and Exercise (but only if the horse is willing and able). I see that Dr.Kellon commented on your post, it's almost impossible for us to give you advise without more information on Alaska. We want to help you through this, but we need a case history. you don't say what her age is, her breed etc. 1- You mention she has sometimes had heat in her feet and sometimes not? And hoof care hasn't helped her? What do you mean by this? We need to see pictures of her feet if at all possible and all x-rays that have been taken. What is her trim like? 2 - Diet, what exactly is her diet? Also mentioned as not helping, but we need to know what measures you have taken, what kind of hay? Has it been tested to be below our 10% recommendations? If not, are you soaking it? Also look at our safe feeds list in your message. 3 - Blood work was "inconclusive", and are confusing to you? Can you contact your vet's office and have those results sent to you? We need to have her numbers to be able to comment. 4 - How long was she on the Pergolide? Dr. Kellon has commented on this many times, this is just one message but if you put "edema" in the search bar you will see many more. https://ecir.groups.io/g/main/message/275492 5 - Ertugliflozin, can you give us more information as to why your vet prescribed this medication? 6- Cold weather, we see a lot of cold induced foot pain, you can put her in boots (if she's not already) with a sock for warmth and get some lined shipping boots on her to help her to stay warm. some horses can't tolerate anything below 40-50 degrees. You can also try Jiaogulan for increased circulation if her trim is in order. 7- We've had a lot of discussions regarding ovaries, but I will bow to Dr.Kellon on that subject, some members also come to mind, hopefully they will chime in as well. As promised your welcome message is below, please don't hesitate to reach out if you have problems with your case history, we want to be able to give you the guidance needed to help Alaska, as soon as we have more information, we can get you the help you need. Hello 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. PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose. 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. DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions. 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. For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources. 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 https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie https://ecir.groups.io/g/CaseHistory/album?id=271156 https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi https://ecir.groups.io/g/CaseHistory/album?id=78821 |
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Thank you for your reply, I have now added her case history I think!I hope it is in the right spot. I have filled it in as best I can but some things I did not know. I am working of getting hoof photos to upload and waiting on recent x rays from my vet to come through. Currently working with vet and farrier to get her trim right but it is a real issue to find a good farrier in our area especially one who works well with the vets.In the past we have been through corrective shoeing,casting,pour in pads etc with no improvements.She is now bare foot and has boots to walk outside the paddock.
Alaska is a 15 yr old Paint bred mare. I bought her when she was 10. Her diet is adlib netted meadow hay. Near impossible to find suitable hay in our area but this is the best I have come across sugar wise although nutritional value low. Horse DE: 6.7mj/kg DM Dry matter:94.5% Moisture:5.5% Crude Protein:2.6% Acid detergent fibre:43.8% Neutral detergent fibre:76.7% Digestability:43% Metabolisable energy:5.8mg/kg WSC:8.5% Fat:1.8% Ash:4.8% Total starch:0.8% Total free sugars:4.6% 250g Lucern chaff(have tried removing all lucern for a 6 month period with no changes-seems better on it. 300g micronised lupin hulls 25g balanced equine hoof xtra 35g balanced equine amino Vit e caps 2000iu She is in a dirt paddock paradise with no access to grass. She has a salt lick(was adding salt but last bloods vet said high sodium so stopped adding) She always becomes her worst as soon as winter starts-we occasionally vet nights of 2 degrees but rare,our winters are fairly mild. She was on the Pergolide twice for about 2 weeks but because of her reaction to it(laying down,ventral edema,sweating,rapid breathing,disoreinted)the vet said to stop it both times.Plus bloods don't really indicate PPID(wrote results in history).One test in the grey area was the wrong time of year from what I understand. Her ACTH levels have always been normal at varying times.We also did a oral sugar test which came back neg for EMS. My vet hasn't mentioned a lot of the tests that are on the case history form. They may not be available here? I feel her feet everyday when I pick them out. Sometimes all her feet feel like they are on fire,the next day it may be only one that is hot.She also gets puffy corinet bands. She is very sensitive to touch all over and hates being brushed. All of this goes away in summer. She has painful cycles and problems with twisting ovaries, during the warmer months when she is cycling her feet seem better in between and can flare during her cycle.During winter they are always sore but she stops cycling which doesn't make sense to me. Vet recomended Ertuglifozin because diet has not helped her with the lamanitis and has proven a tricky case.She has been on it 3 weeks with no improvement yet. Is there a time frame for this medication?I'm unsure weather she even needs it. I hope this gives better info and the case history is loaded ready to see. I will add to it as I gather more info. Thankyou! Eli and Alaska -- Eli South Australia 2022 |
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Hi Eli,
Please add the link to your Case History folder to your auto-signature: https://ecir.groups.io/g/CaseHistory/files/Alaska%20case%20history You said you had an oral sugar test done but there are no results in your Case History. It would be good to see the numbers. The OST can have false negatives. I'm assuming you have not had a baseline (non-fasting) insulin and glucose test done? Please read the Diagnosis section of your welcome letter and arrange to have these tests done. We prefer non-fasting because we want to know what insulin and glucose are doing in response to the actual diet. This gives us a lot of information about laminitis risk. Horses do not live in a fasted state, they usually have food in their stomach, so we want to know what their insulin response is to their food, not to sugar after a fast. If she was negative for the oral sugar test, and if her non-fasting insulin is not high she should not be on Ertugliflozin. This is a new drug and given her diet I don't think it's safe for her to be on it. Horses on these drugs need unrestricted calories to avoid high triglycerides in their blood and your hay is not going to provide that even fed ad lib because it is so low in calories. If it was working you would see a reduction in hoof pain by now, after 3 weeks on it. Sometimes it's overnight, but other horses show improvement over time (days to weeks). I personally would take her off the Ertugliflozin and do our recommended blood tests 1-2 weeks after removing it. I'm sorry to say you are going to have to find a new hay. 2.6% protein is way too low and you'd have to supplement it extensively, which would be very hard to do, plus it looks very indigestible so she will not even be able to absorb most of the nutrients in it let alone get adequate energy. I'd be surprised if there was anything other than straw in this hay. You should look for 8-10% protein, but can go as low as 6% if you supplement it. Whether she has EMS and/or PPID, she still needs to be on a decent quality hay that will meet most of her nutritional needs, with the additional of minerals that are balanced to that particular hay. I hope Dr Kellon will comment on the possibility of PPID and her reaction to pergolide. Alaska is definitely a tough case and she's lucky you are so dedicated to helping her. -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Thank you Kirsten!
I have requested a copy of her oral sugar test from the vet so can hopefully share results soon. I have spoken to a couple vets in our area about running insulin and glucose bloods in the past but they have told me they are non diognostic. I didn't now enough about it to explain my reasons, perhaps I can mention it again and share the info from the diagnosis section. I will take her off the Ertugliflozin. I was very nervous about starting this medication without knowing if she actually has excess glucose to get rid off particularly since she tends to react to most medications in a negative way,I even have trouble with worming her. Ahhhh they hay dilemma!we have exhausted all options available for suitable meadow hay,we have also been buying in and sending off for testing ourselves but have had no luck with ideal analysis. There is some teff hay available near by, is there a way to add a photo of the full test papers?. Crude protein 9% WSC 9% ESC 8.5% Starch 1.5% I was reluctant to try teff again as last time we tried this type although low sugar she stacked on the weight and became sore within a couple weeks. This was not fed adlib, we were weighing out nets for her.Could she have had a sensitivity to the particular type of grass? I feel so helpless and like we can't do anything right for her but it's not through a lack of trying! In the mean time would it be suitable to add a biscuit of lucern to her diet to give her some more nutrients and protein while we try to source another hay? -- Eli South Australia 2022 |
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Sherry Morse
Pictures can go in your photo album on the case history sub group. That teff would need to be soaked to be suitable as the ESC+starch is right at 10%. Do you know if that test as well as the other were done via wet chem or NIR?
-- Thanks, PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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I wonder if that teff hay was higher in calories (and sugars or protein) and more digestible. Were you weighing that hay or was it fed ad lib? In addition to high ESC and starch, high protein hays (>12%) can also cause sore feet, especially if it's high in nitrates. If you have a hay test gir the previous teff hay, we could maybe help you pick out the problem.
It would be an improvement nutritionally to mix the teff and meadow hay 50:50, very thoroughly so she can't pick out the teff hay from the Meadow hay, and continue to soak it. Feed it in a small hole net so she can't pull out the teff and leave the meadow. It's still not ideal as that will give you only 5.8% protein, so she will still her diet reviewed by a hay balancer and supplementary protein added. In Australia we recommend Carol Layton. If lucerne does not make her footsore then you could add that, too, but also mix it thoroughly, soak, and feed in a net so she can't eat the lucerne only. If she is already foot sore it might be hard to tell if the lucerne is part of her problem though. We generally don't advise lucerne, but I know my horse is fine with a little bit mixed in to his grass hay, and we know that not all metabolic horses get foot sore from it. My horse has not done well with high amounts of clover (and some lucerne) in his hay, but he seems to be fine with up to 10% 'ish lucerne/alfalfa. This is where it would be really good to know her baseline insulin. If you can test her after 1 week on the mixed hay diet, it will give you a much better idea as to what she can handle eating and whether or not you need to continue soaking. Ideally you'll find a suitable hay eventually and can switch her to that. However, as it stands we don't even know if she has EMS because there's no supporting bloodwork, and you said her OST was negative, so please do try to get that done. Once she is off the Ertugliflozin and she's at BCS of 4.5 / 9 (your Case History reports her as a "3" but I think you are using a different scale than the one we use? If so, can you please switch to the Henneke scale?) you can start limiting her hay. Feed 2% of ideal body weight. If she starts bulking up too much, you can drop that to 1.5% of current body weight to try and keep her at a BCS of 4.5-5 out of 9. But remember that your meadow hay is lower in digestible energy and soaking will also reduce calories a bit more because it pulls out some sugar, so you should not have to go as low as 1.5% of current body weight. -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Eli,
It's true most of your bloodwork doesn't indicate PPID, but the post-stim TRH test in July 2020 does show an anomalously high value and that would have been AFTER your seasonal rise ended. That bloodwork is consistent with an early PPID diagnosis and indicates that Alaska should be on pergolide at least through your seasonal rise (January to June in Australia). I know your July 2021 TRH was normal, but given the issues starting in your autumn and the 2020 result, I would aim to trial her on pergolide through a seasonal rise and see if she does better. It's critical the post TRH blood be pulled at exactly 10 min after administration. 9 or 11 min will give inaccurate results. That might explain the discrepancy between your 2 tests? When you started pergolide, what dose did you start at? We usually recommend starting at 1/4 mg a day, and working up to the prescribed dose by adding 1/4 mg every 3-4 days. Some horses are more sensitive and have fairly extreme side effects so need to start at 1/8 mg and take 1-2 weeks before the next increase. You can split the Prascend pill in half or in 1/4s then dissolve in water and give just enough of the syringe to make a 1/8 mg dose, and refrigerate the syringe to use for the next day's dose. If you start now and go very slowly you should be able to have Alaska at a reasonable starting dose of 1 mg before your next seasonal rise starts. -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Thanks Kirsten,
The positive test was done in Feb 2020 and the negative was done July 2021. When inaccurate results present is it most often a false negative or can it be a false positive? between to two tests I feel the July 2021 would be most accurate-I was present and the vet came to our property. They set a timer and I know the blood was collected with no delay and it was a clean easy draw. The Feb 2020 test was taken while Alaska was in hospital at the clinic, she had been on a stressful float ride, spent the day being poked and prodded, had some sedation and was very stressed. I know that the students from the university were working with her, and I am unsure if something could have gone a miss. If stress was a factor, would you expect the resting value to be higher and the response to the stimulation increased? or should the response be the same regardless? Would it be suggested to test again to confirm? and what would the ideal month to test in be for South Australia? If the seasonal rise is between January and June would you expect her resting ACTH to be higher during this time? or is this more consistent with later stage PPID? Does it make sense for her ACTH to be 14.7 in August (outside of the rise) and 25 in April (during the rise)? Is there somewhere I can find more info on the specifics of the rise and fall in South Australia? When she started on the Pergolide on both occasions we started with 1/4 1mg tab once a day, she became unwell on day 2 both times. It was so horrible, and I feel so scared to try her on it again. We progressed for 2 weeks, she was down the first time with edema and rapid breathing, the vet advised to stop. The second time was the same but so much worse, I thought we were going to lose her, the vet came out as an emergency during the night and told us we just had to get her off of the medication. Do you know of any other medication we could try or an herbal remedy for early PPID? I have tried her once on McDowells Metabolic S tonic and I saw a huge difference in her but discontinued as I couldn't keep up with the cost. I have added dorsal and lateral views of her feet showing the cannon bone as well as her recent x-rays (these were taken prior to her last trim which is now adjusted to the vets' recommendations from the x-rays. Initially she was very sore and couldn't walk at all but the second trim she is happier, still tender but walking around. I could also be that the season is starting to change as well, and she tends to come good around September. The vets report stated: Left fore: long toes, thin sole, flat palmar angle, low heel, small osteophyte formation on the tip of P3, mild medial and lateral flaring of the hoof wall. Right fore: long toes, thin sole, flat palmar angle, low heel, small osteophyte formation on the tip of P3, mild medial and lateral flaring of the hoof wall. For future farrier visits, I would ask the farrier to shorten the length of toe, correct the flaring and aim to roll the toe to ease the breakover. Clogs or rocker shoes could also be considered to help if the farrier thinks these may be beneficial. Are Osteophytes common with chronic laminitis? I this something I should be worried about, or I can do anything about? Also, in regard to your question about the insulin and glucose bloods-these were taken in the afternoon, the vet got me to remove her from hay for a few hours, I then fed the sugar syrup in beet pulp prior to the blood being taken. I asked if a base line reading prior was required but advised not necessary Is there another way these bloods should be done? I am sure whatever is going on with her is also affecting her cycles and causing her pain and twisting of her ovary-is there any evidence that suggests mares with PPID suffer with hormonal and cycle issues as a result? and is there anything I can do to ease this for her? Thank you so much Eli and Alaska -- Eli South Australia 2022 https://ecir.groups.io/g/CaseHistory/files/Eli%20and%20Alaska https://ecir.groups.io/g/CaseHistory/album?id=277144 |
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Sherry Morse
Hi Eli, Given the circumstances of both tests I think the negative is more likely to be the correct one as we do know stress can have an effect on test results. To do a TRH Stim test again it needs to be outside the seasonal rise so your winter or spring would be best. We do expect ACTH to be higher in all horses during the rise so your numbers are in line with that. You can find the Liphook chart transposed for the Southern Hemisphere here: ACTH Chart from Liphook Transposed to Southern Hemisphere.pdf (groups.io) and the original article here: Microsoft Word - Seasonal Changes in ACTH Secretion.docx (groups.io) and one more Liphook chart for normal vs. PPID horses (although for northern hemisphere) here: Microsoft Word - Pituitary pars intermedia dysfunction.docx (groups.io) which will all hopefully be helpful to you. It sounds like your insulin test was done using the oral sugar test (OST) which we do not recommend. What we do recommend is a basic blood draw at least 4 hours after the first meal of the day with hay in front of the horse until the blood is drawn (info on that is in your welcome message as well as here: https://www.ecirhorse.org/DDT+E-diagnosis.php Was the current hay tested via NIR or Wet Chem? Have you tried soaking it before feeding? Although we recommend below 10% ESC+starch some horses will get footy even on that amount and need to have less to be comfortable. As far as the rest of her diet I know you said you had her off the lucerne for 6 months with no change, but was the trim addressed at that time? We look at the whole picture and were she mine I'd want to make sure I was doing everything I could to get the diet as tight as possible as well as the trim addressed. I would err on the side of caution and remove the lucerne now as you're addressing the trim and see if you notice a change. As far as the trim - it's been improved since the x-rays but growing sole is going to take a while. Do you have her in boots now? If not, she should be. We do not recommend shoes as that impedes doing trims on a more frequent basis (3 - 4 weeks) which most horses need as they're recovering from laminitis. If you'd like Lavinia to comment on the trim you'll need to start a new email chain titled "Request for trim markups Lavinia" so she knows you need a trim evaluation. Dr. Kellon can address your question about the cycling but we definitely have seen issues in mares with PPID and IR with cycling.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Eli,
You are in the southern hemisphere so your peak of the seasonal rise will be six months off ours - instead of September, it's March. Considering the circumstances of the two tests, there is no question the July test would be most accurate. If you want to repeat it, the same time of year would be good but she doesn't sound like a good candidate for pergolide with those severe reactions. Cabergoline is another option but we only have information on an injectable sustained release form here. There was a vet in AU using oral cabergoline but I lost his contact information. In any case PPID can't cause laminitis unless insulin resistance is induced by it. We really need to see those insulin numbers. Your radiographs don't have any convincing evidence of laminitis. I don't see any rotation of the coffin bone - just a capsular rotation from a long toe. She also has very poor ground clearance (aka sole depth), medial lateral imbalance and you can see the ghosts/outlines of developing sidebone which may be a source of pain. The LF pastern joint has arthritic changes. The best herbal supplement for mare issues is Vitex agnus-castus - Chastetree berry. https://www.greenpet.com.au/product/chaste-tree-berry-vitex-agnus-castus/ -- Eleanor in PA www.drkellon.com |
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Thankyou Eleanor,
Her oral sugar test results were: Insulin 12mu/l (<42) Glucose 4.7mmol/l (3.3-6.7) Would it be advised to ask my vet for resting Insulin and Glucose bloods? I read that the oral sugar test is no longer recommended. If she did have insulin resistance caused by PPID or not would you expect the Ertuglifozin to have made a difference? Can high ACTH levels alone cause hoof pain? the consensus from my vet was that she gets worse during the winter because she presumably has early PPID and that's why she is ok during the summer months. This did not make a lot of sense to me. In your opinion could her hoof pain simply be caused by her very thin soles? during winter they become softer and wet making her more uncomfortable? If so, do you have any recommendations to grow and support a thicker sole? I suppose making sure there are no gaps in her diet and keeping her moving as best I can when she's not to painful. Is there anything available similar to a pour in pad that doesn't require a shoe to hold it in place? We have tried pour in pads, but she is very painful when the nails go in for shoes and always seems more uncomfortable with them. Is there a recommended sole hardener I could use? I have front boots for her, but they are not the kind I can add pads to or leave on in the paddock-is there somewhere I can get advice on the best boots to use for her? In regard to the developing side bone, is there anything I can do to stop this progressing? and could this be caused by chronic foot pain? or is it more that the side bone is causing the foot pain? I suppose it is hard to know. Her right front has always seemed to be the most problematic for her and she will always choose to load with her left front, I wonder if this is why she has some arthritic changes on the left pastern? I have started a new message for her trim photos to be assessed-I hope it's in the right spot. Thank you so much for all your help so far, I am feeling so great full for this support. Eli and Alaska -- Eli South Australia 2022 https://ecir.groups.io/g/CaseHistory/files/Eli%20and%20Alaska https://ecir.groups.io/g/CaseHistory/album?id=277144 |
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Those numbers are normal. If the testing was done when she was sore, it's not laminitis. If it wasn't, repeat baseline insulin and ACTH if she is sore again. Yes, her thin soles and developing sidebone could cause pain. Your vet is correct about early PPID being worse fall/winter but if there is laminitis there would be high insulin.
For the side bone, her medial to lateral imbalance needs to be corrected. -- Eleanor in PA www.drkellon.com |
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Hi Eli, you can get boot advice in our Horsekeeping sub-group. It sounds like the wet winters softening her soles is part of the problem. I have used Hoof Armour on soles. It's supposed to make them tougher and reduce the amount of moisture they absorb. You also want to make sure she is getting minerals balanced to her pasture and/or hay so she has a better chance to grow healthy hooves and hopefully thicker soles. And make sure your trimmer never removes any sole unless you have xrays showing excess sole. There are lots of horses with thin soles that live in boots though.
-- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Thankyou Dr Kellon,
-- Eli South Australia 2022 https://ecir.groups.io/g/CaseHistory/files/Eli%20and%20Alaska https://ecir.groups.io/g/CaseHistory/album?id=277144 |
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Sherry Morse
Testing should be at least 4 hours AFTER the first feed of the day. She can have hay right up until the blood is drawn.
-- Thanks, PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Hi Eli,
Lavinia has your hoof photos and you are in her line-up for markups. I think there might be 1 ahead of you in the group, unless Lavinia has private requests to deal with as well. If there's a specific date you need them by, please notify her in the hoof markup message thread you started. -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Amazing! thank you so much for the update:)
I have also found some different hay and am thinking of organising a trailer and traveling a couple hours to get it. I have added the feed test to my photo album, I think it looks good but a little unsure as it has 2 values for ESC over both pages. -- Eli South Australia 2022 https://ecir.groups.io/g/CaseHistory/files/Eli%20and%20Alaska https://ecir.groups.io/g/CaseHistory/album?id=277144 |
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Sherry Morse
That hay was tested via NIR and at those levels would not be safe for an IR horse without soaking.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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