Hi Becky-
Fellow Paso owner here - there are several of us on this group.
Agree with putting Sali on the emergency diet for now. 
Paso's are insanely easy keepers.  My gelding had la aminitic episode last fall that we're still battling.
I get one step forward and then we go back two.
Vet is out tomorrow morning for a blood draw.  Sigh.
Just saying hello to a fellow Paso person.
Hang in there and use the advice from this group.

Tracy

--
Tracy and Salsa (1999 model year Paso Fino)
Middle TN USA, September 2019
Case History  https://ecir.groups.io/g/CaseHistory/files/Tracy%20and%20Salsa
Photos https://ecir.groups.io/g/CaseHistory/album?id=95827

Hi Becky,

I'd encourage you to add a current st of hoof photos to Sali's album. That way, we can see if the trim did what was needed based on the rads.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Hi Everyone,
 Thank you for the responses! Yes, she did have a trim shortly after the most recent x-rays were taken. She is currently in shoes and full pads.

I will definitely look into the milk of magnesia, Sali can be a difficult one, and is not the best at taking anything via syringe, but I will try the milk of magnesia and will check out the Metformin group.

Our 1st crop hay is from the same field as the hay analysis that is in our case history. I do also have a water filter on the hose for the barn, and am reaching out to a plumber to see if we can get that water line tied into our house's existing iron filter.
--
Becky R in WI 2022

Sali Case History: https://ecir.groups.io/g/CaseHistory/files/Sali%20and%20Lucky/Sali
Sali Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=277118

Hi Becky,

Thanks for posting your Case History and xrays for Sali!  I have a special place in my heart for all our Paso Fino members as my boy is one, too!

She should be on the ER diet as outlined in Bobbie's welcome letter, and that includes stopping the Buckeye, Manna Pro, and apple/carrot treats, and adding vit E, salt (most horses cannot get their daily minimum of salt from a block so we add it to their feed) and ground flax.  Any grass, even dead grass, is risky.  You will need to invest in making her a dry lot with no vegetation if you plan to keep her at home.  Sali is a horse that should never be on pasture again, unless you can get her onto an endurance-type exercise program.  In the meantime, a sealed muzzle on grass so she can't eat (but can still drink), and meals in the barn every 4-6 hours are recommended.  Also critical will be getting her on minerals balanced her hay...just reiterating what Bobbie has already told you.

I really recommend taking a full round of hoof photos, as described here, and posting a message to request trim markups.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Hello Becky,
Welcome to the group and thank you so much for getting things in order for us, it helps us to have everything in place to better advise you.
Your first post signals me to send you your welcome message on behalf of the group. It can be a bit overwhelming, but please read it over as it will help you immensely through this journey in helping Sali. You will see blue hyperlinks in the message, which will take you even further into that particular subject.
We're sorry Sali isn't feeling her best but we're all here for you. Our members are the best at offering their support and experiences as well.
I will leave the x-rays to Dr.Kellon and our hoof experts but her blood work is certainly indictive of IR/EMS, for her height i would say she is definitely overweight, we suggest soaking her hay until you know for sure it's safe.  Be sure you're not overfeeding her. I would get her on the emergency diet asap and follow these guidelines. 
Grass hay – preferably a mature cutting of grass hay, e.g., a second- or third-cutting. Avoid ryegrass/grain hays. Avoid alfalfa unless the horse is known to have tolerated it. Ideal body weight minimum (i.e., 15-20 lbs/day for a 1000 pound horse). If your horse is overweight, feed at a rate of 1.5% of his current weight, or 2% of his ideal weight – whichever is larger. Do NOT underfeed/ starve the horse. 
Can you manage to syringe the metformin in her? Just be sure you're doing it with some milk of magnesia as detailed here. I'm sure other members will have some useful information on ways to get that done. 
Metformin 08.08.20 FINAL (groups.io)
Your iron level in your hay isn't bad, are you able to get a filter for your water? Getting your hay balanced will help with that, I will include a list of balancers that you can contact if you wish, it's very important for these horses to have a balanced diet. The tests in your file doesn't seem to be too high in sugar and starch, (we suggest under 10%) this hay looks pretty good, did it come from the same field?  It actually tests very similar to mine and its quite easy to balance. But I would also ask that it be tested for nitrates.
HAY BALANCING (groups.io)
I would cut out everything she is getting besides what's listed on the emergency diet and soak her hay until you get your new results back. We know that exercise is the best thing you can do for a horse with high insulin but only if she's able.
I am including your welcome message below, please let us know if you have any additional questions.

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:

• low carb (less than 10% sugar+starch)
• low fat (4% or less) 
• mineral balanced  

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

Hello Everyone,

This is my first post. I have a 2015 Paso Fino mare who I've been struggling with for the past few years, but particularly the last 5 months. Our case history and x-ray links are below. She has had 2 minor flare-ups and 1 significant laminitic episode since we moved her home in March of 2022. I am concerned about possible high iron levels since I know we have high iron in our well water. Our vet did prescribe metformin, but I've not been able to get her to eat the pills yet (I grind them to a powder in a coffee grinder-- problem is I only have her on a small amount of balancer right now, so it's not enough to mask the taste). I'm not exactly sure where to start in this group, but any advice if greatly appreciated! Sali had her significant laminitic episode in July, there were no apparent triggers for this one, as nothing in her environment had changed, which is so frustrating to me. I really need to figure out her triggers to prevent this from happening again. 

(A side note, the hay analysis in our case history is from our 2nd/3rd cutting hay, we are non on 1st cutting hay from the same field, but I haven't gotten the analysis back yet)

--
Becky R in WI 2022

Sali Case History: https://ecir.groups.io/g/CaseHistory/files/Sali%20and%20Lucky/Sali
Sali Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=277118