Hello,

I am thankful to have found this resource for my gelding. Hopefully, I have uploaded his case history properly. I purchased an 11 year-old Hanoverian dressage gelding in February 2021.  His previous owner said that he was an extremely easy keeper and had him on Thyro-L to maintain his weight. Out of an abundance of caution, I decided to test his glucose to make sure nothing was going on.  Unfortunately, he did test positive for Cushings in January 2022.  Thankfully, he seems to be doing very well on 1 prascend tablet per day.  I noticed he became calmer and less spooky after being on the medication for a month or two. I have never owned a horse with a metabolic disease before, so I do have many questions.

1.  Upon diagnosis, I attempted to provide him with an appropriate diet less than 10% NSC with the aid of FeedXL  He is currently eating Triple Crown 30% Balancer, which does not appear to be appropriate per your website, although FeedXL and another source says it is.  He is in moderate to heavy work, receiving 4-5 training rides and lessons per week.  When I switched him to the TC balancer, he lost weight.  None of the balancers you listed as appropriate appear to provide much protein, and I know that most cushings horses are older and not in heavy work.  I am concerned about him not having enough calories and protein to sustain his work level if I switch him again to one of your approved balancers. How should a younger cushings horse in moderate to heavy work be fed?  I also noted that the main ingredient in the TC balancer is dehulled soybean meal, so I assume this means it contains soy, which. you say to feed cautiously.

2.  He is on Cosequin ASU joint supplement, which contains MSM.  Which blood test looks at selenium and copper levels?  Are there any other minerals I should be looking at?

3. I found a website that lists the selenium and manganese mean concentrations for our county.  The Selenium mean is .393 with a minimum of .119 and maximum of .956. The Manganese mean is 827.115 with a minimum of 423.59 and maximum of 1620.01. However, your website doesn't indicate what concentration of these minerals is considered low or high.  Could you please provide some guidelines?

4. I read elsewhere that horses with Cushings are prone to infections and parasites.  My barn does not do fecal counts or worm the horses very often.  Is there a recommended worming protocol for a cushings horse?

5.  I board at a dressage training barn.  Both the trainer/owner and barn manager (and even my vet) have discouraged me from testing the hay.  They say that their hay comes from multiple fields and cuttings and testing it would be pointless as it changes so often.  What is your response to their arguments?  Do you still think I should test it?  I will have no way of knowing which bales come from different loads, and it will put me at odds with the barn manager.  They are also unwilling to soak the hay and tell me that if I am that worried about the hay, then he shouldn't be in the pasture at all (see #6).

6.  He currently goes out on pasture with a green guard muzzle for 2 hours from 6:30 am - 8:30 am.  The pasture is mowed regularly, and I plan to stop turning him out on the grass at the first frost. My trainer thinks that he should not go out on grass at all due to the cushings.  This short time frame with a muzzle seems fairly conservative to me and greatly benefits him mentally.  Am I putting him at risk?

7.  Does his younger age put him at any additional risk of which I should be aware?

Thank you so much for your help.

--
Jo Ann S
September 2022
Salem, WI
Case History: https://ecir.groups.io/g/CaseHistory/files/Jo%20Ann%20and%20Owen
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=278267 

 

To answer number 5, I can see where they’re coming from about not being much point to testing the hay. But I also think if you want to get it tested they shouldn’t discourage you. I live in an area where hay right now is very inconsistent and hard to find good quality but typically boarding barns buy a good bunch at once from a single supplier. Even if they used a different supplier the next time it still wouldn’t hurt to test each batch.

I think it’s extremely disrespectful of them to refuse to test or soak the hay. Going out for a few hours in the morning with a grazing muzzle is far different from eating on unsoaked and untested hay all day. Flat out refusing to soak the hay on the basis that he goes out for two hours a day is wrong, especially if they know that your horse needs special diet. I hope this answers your question. 
--
Jenna
Texas
Member since Aug. 2022
https://ecir.groups.io/g/CaseHistory/files/Pepper%20&%20Jenna 
https://ecir.groups.io/g/CaseHistory/album?id=278305

Hello Jo Ann and welcome to the group!  Thank you for getting your case history completed, it helps us to help you.
Since you are a new member, and this is your first time posting I will be including your welcome message below. 
Please take time to read through it as it will clear up questions you may have. The cornerstone of the ECIR group is based on the philosophy of DDT/E which stands for Diagnosis, Diet, Trim and Exercise.
I will do my best to clear up some of your questions, but our other mods will offer their advice as well. 

1- His previous owner said that he was an extremely easy keeper and had him on Thyro-L to maintain his weight. Out of an abundance of caution, I decided to test his glucose to make sure nothing was going on.  Unfortunately, he did test positive for Cushings in January 2022.  
PPID and IR are two different things, Cushing's is diagnosed by testing ACTH, it's an age-related disease which involves the pituitary gland, it's mostly seen in our older horses. Although it's rare for a younger horse to have PPID it can happen, but I would be interested in the conditions when the blood was drawn, was he stressed? Fasted? For weight control we suggest feeding according to weight, 1.5% of his current weight or 2% of what he should weigh. 
http://www.xcodesign.com/aaep/displayArticles.cfm?ID=268 (groups.io)
We don't recommend giving thyroid meds as it will not help with controlling anything, just aid in weight loss and if he is still receiving it you will need to taper him off so his thyroid can begin to do its job.
2-He is on Cosequin ASU joint supplement, which contains MSM.  Which blood test looks at selenium and copper levels?  Are there any other minerals I should be looking at?
It's impossible to give you advise on what supplements are needed without a hay analysis. Blood work for mineral deficiencies can be unreliable. The only way to see if he is lacking or getting too much of a mineral is to test the hay.
Re: Blood work for testing (groups.io)
3-I found a website that lists the selenium and manganese mean concentrations for our county.  The Selenium mean is .393 with a minimum of .119 and maximum of .956. The Manganese mean is 827.115 with a minimum of 423.59 and maximum of 1620.01. However, your website doesn't indicate what concentration of these minerals is considered low or high.  Could you please provide some guidelines?
Again, you need a hay test to see what is needed to supplement. We know it's difficult when you board, many of our members do. You could possibly go to your local ag department and see if they have any testing from hays in your area and go from there. Or ask the growers of the hay to see if they have had any testing done, many do. We don't know what you need or don't need until we have those results. You could also take Dr.Kellons nutrition classes to learn more about minerals and balancing.
4- I read elsewhere that horses with Cushings are prone to infections and parasites.  My barn does not do fecal counts or worm the horses very often.  Is there a recommended worming protocol for a cushings horse?
Yes, uncontrolled PPID can be a cause of many problems, we recommend blood work and re-testing at least twice a year, especially before the rise. For worming suggestions, you should really get your vet involved.
5-I board at a dressage training barn.  Both the trainer/owner and barn manager (and even my vet) have discouraged me from testing the hay.  They say that their hay comes from multiple fields and cuttings and testing it would be pointless as it changes so often.  What is your response to their arguments?  Do you still think I should test it?  I will have no way of knowing which bales come from different loads, and it will put me at odds with the barn manager.  They are also unwilling to soak the hay and tell me that if I am that worried about the hay, then he shouldn't be in the pasture at all (see #6).
We recommend no grass at all for IR horses but is Owen having any signs of IR? you don't mention any of the typical signs we look for, fat pads, is his sockets above his eyes filled in? foot sore, etc.? Given his breed I would be very careful with his diet.
6.  He currently goes out on pasture with a green guard muzzle for 2 hours from 6:30 am - 8:30 am.  The pasture is mowed regularly, and I plan to stop turning him out on the grass at the first frost. My trainer thinks that he should not go out on grass at all due to the cushings.  This short time frame with a muzzle seems fairly conservative to me and greatly benefits him mentally.  Am I putting him at risk?
7- If a horse is IR there is no good time for him to be on grass. We always suggest a completely sealed muzzle for IR horses. 
7.  Does his younger age put him at any additional risk of which I should be aware?
Again, if he is showing any signs of IR/EMS I would not be putting him on grass, exercise is the best insulin buster there is if he is able. Getting his hay analyzed and balanced will go a long way. Please let us know if you have any additional questions and again welcome.

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
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

 Hi Jo Ann,

We need to see the actual numbers/results of your blood tests to give you specific answers but let me cover some high points.

Carbohydrates are not a concern with PPID (Cushing's) unless the horse has abnormal insulin - which many do and over time most will. NSC is not the issue. It's ESC + starch https://wp.me/p2WBdh-1cc . NSC contains fructans, which do not increase insulin. Whether he needs more protein, calories, etc. depends entirely on what he is taking in and you need hay analysis for that.

Blood tests won't tell you how much copper, selenium or any other mineral to feed. You need diet analysis to know that.

Similarly, soil levels don't tell you what's in the hay.

They are right that if you are worried about the hay he shouldn't be on pasture, but without an insulin you don't know if you should be worried about either one. He can still go out on pasture with a sealed muzzle even if insulin is high. There are ways around the multiple loads/sources problem - such a paying the barn owner to keep a  known safe supply marked off for your horse, or getting a small storage shed and doing that yourself.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Hi Jo Ann,
Welcome to the ECIR group!  My horse, Logo, was a 17.2h Holsteiner I purchased when he was 14 as a dressage schoolmaster for me.  He was diagnosed PPID positive at about 16 but, knowing the symptoms he exhibited when he needed more pergolide, I’m fairly certain he would have tested positive when I purchased him.  I had not been acquainted with this group at that time so I was dependent on my veterinarian to guide me and he seemed to know at least as much as many I’ve run across since then.  Logo’s first test was for ACTH as well as insulin, something I would not have thought to ask for.  Logo’s insulin was always normal so eventually the vet quit including an insulin test.  As I was clueless, Logo’s diet wasn’t changed.  After I was introduced to this site, I realized I also had some IR ponies, which needed more diet control so Logo benefitted from having his hay tested and balanced.  On the rare loads of grass hay I needed to soak for the ponies, I did not soak for Logo.  I did make some diet changes based on what I learned here but those all resulted in simplifications.

So, my point here is that Warmbloods are not often IR at baseline but they can have elevated insulin due to uncontrolled ACTH.  If you manage Owen’s ACTH carefully with pergolide and test the insulin when you test ACTH and it remains low, you may not need to fret about whether or not the barn will soak his hay.  It’s the elevated insulin which makes a metabolic horse susceptible to laminitis.  However, testing the hay so the minerals can be balanced is wise for any horse - PPID, IR or not.  Having adequate minerals is not the same as have their ratios balanced.  That was, in fact, important for Logo as I had some trouble with his hoof quality.  I lost Logo to a colic at age 31, so it would be hard to say that PPID and/or my management interfered with his longevity.

I would encourage you to test frequently at first.  Right now would be good to see how well he is handling the fall rise, which peaks in late September.

--

Hi Bobbie,

Thank you for your responses.

Owen has not been on the Thyro-L for at least a year and a half.  My vet told me to take him off of it.

His blood was drawn in the morning, at home.  He wasn't stressed or fasted.  He had access to hay and water beforehand, but not grain.  His ACTH has been tested 3 times (please see case history file).  I do think the cushings diagnosis is correct as he started to get the long curly hair for the first time in March.

I was asking about the MSM and blood tests for selenium and copper because your file about things to avoid says "Check your horse’s blood levels for these minerals regularly." Has your group's position changed on this?

--
Jo Ann S
September 2022
Salem, WI
Case History: https://ecir.groups.io/g/CaseHistory/files/Jo%20Ann%20and%20Owen
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=278267 

 

Hi Eleanor,

Thank you for your response.  My horse's blood test results are included in his case history.  If you could please review and then address the insulin and carbohydrates I would very much appreciate it.  His insulin and glucose have tested in normal ranges 3 times, but when I plugged them into your calculator to get the ratio, it appears questionable.

As I responded to Bobbie, I was trying to follow the instructions in your files regarding the selenium and manganese in the soil and testing his blood for copper and selenium if he consumes MSM.  You have both confused me regarding the MSM.  I understood your file to say MSM can cause a spike in these minerals and this should be monitored with a blood test.  This sounded like a separate issue from diet to me.  Is this mineral uptake a concern only for PPID/IR horses or all horses?

I will attempt to get the hay analyzed.  If the analysis combines multiple sources though, is it still worthwhile?  I'm just not sure I will be able to get any help identifying the individual loads in the hay barn.  And to do this properly, I would need to test every load they buy, separately, correct?  

Thank you.

--
Jo Ann S
September 2022
Salem, WI
Case History: https://ecir.groups.io/g/CaseHistory/files/Jo%20Ann%20and%20Owen
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=278267 

 

Hi Jo Ann,

You're not wrong that statements in the files that seem contradictory.  In some cases it has to do with when various documents were written/updated and our loss of an archivist a few years back.  

The MSM section of the "Items to avoid" document says: METHYLSULFONYLMETHANE (MSM), also known as methyl sulfone or dimethylsulfone, in some cases can be an effective anti-inflammatory but be aware it can influence mineral uptake, particularly selenium and copper. Check your horse’s blood levels for these minerals regularly.

Perhaps that should be revised to add the information from the blood testing document which notes: Blood levels are a “snapshot in time”, giving you information only about the circulating levels at the exact moment the blood sample was drawn....As with hair mineral analysis, blood levels of minerals are most likely to be informative for the trace minerals such as selenium, zinc, copper and manganese. ...A further drawback to blood testing for mineral levels is that tissue levels, where it really counts, will drop significantly long before this is reflected in the blood levels. Bottom line is that a low blood level of a trace mineral indicates a deficiency, but a normal one does not mean there is no deficiency at the tissue level and doesn't tell you anything about the diet.

As far as the selenium/magnesium question - Average concentrations of elements in Kenosha County, Wisconsin (usgs.gov)
If you can test the hay you'll know if you need to supplement for Se or take an abundance of Se into account when balancing the diet. 

This is why we focus on analysis of the diet going into the horse and balancing the minerals needed (or approximating that when possible by using data for the general area) to that. 

Horses that are characterized as 'easy keepers' and been on Thyro-L to help control weight are usually IR. If Owen is not IR that's great as PPID is usually easier to deal with IME.  However, speaking of PPID - his bloodwork shows that he was not controlled on 1mg of Prascend earlier this year.  Has that amount been increased to account for the elevated ACTH reading last March?  If not you may want to bump him up to at least 2mg now (although it's too late to help with the rise for this year) and plan on retesting him by January to see if that's enough to bring him into the upper teens/low 20s where we like to see PPID horses year round.  

At that time we'd suggest getting his insulin checked again to make sure he is maintaining his non-IR status.
--

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/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

Hi Jo Ann, sorry to have confused you, I think I am as well!
The reason why I replied as I did is because you the advice you had been given from the barn regarding soaking hay, not letting him in the pasture led me to assume that he was being treated (treated maybe not diagnosed as IR) As Dr.K said in her comments being PPID doesn't mean a carb restriction is warranted like we see in IR horses.
And I asked about the testing because he is so young and there was a big drop in his ACTH, we're happy to see it go down! Some horses can have PPID/IR or both, so just being proactive is always recommended.
As far as the selenium and copper, I will attempt to clarify but I hope Dr.K or other mods will correct me if I am wrong. As per the NRC plus course.
Whole blood selenium is the preferred test, since it measures both se and plasma and se inside red blood cells. For maximum antioxidant protection, the target level is 200 to 250 ug/L, this target should be used for active horses and 160 to 180 ug/L may be adequate for inactive horses, serum or plasma levels will be around 25% lower than whole blood. 
This may help as well. 
Selenium and Iodine for Just About All | Dr. K's Horse Sense (wordpress.com
I am not aware of a blood test for copper, but I will defer to Dr.K on that one. Again, I apologize for the confusion.

--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
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

Hi Sherry,

Thank you for clarifying the MSM issue for me.

I was told by my vet that his ACTH in March was within normal range.  The range on the lab report says "<110 pg/ml is considered negative for PPID" and it was 58.  Is their range not correct?

--
Jo Ann S
September 2022
Salem, WI
Case History: https://ecir.groups.io/g/CaseHistory/files/Jo%20Ann%20and%20Owen
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=278267 

 

A good explanation, we aim for low twenties or high teens. 

Laboratory Reference Ranges are NOT the Same as Normal | Dr. K's Horse Sense (wordpress.com)

--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
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

Okay, that is very good to know. Thanks so much for pointing that out.
--
Jo Ann S
September 2022
Salem, WI
Case History: https://ecir.groups.io/g/CaseHistory/files/Jo%20Ann%20and%20Owen
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=278267 

 

Hi Sherry - I added photos of all of his test results to my photo album.  Hopefully, that is okay.  I didn't see another way to attach a file.
--
Jo Ann S
September 2022
Salem, WI
Case History: https://ecir.groups.io/g/CaseHistory/files/Jo%20Ann%20and%20Owen
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=278267 

 

Also, please let me know if I need to pull him from the pasture for the time being.  I assume he is at higher risk for laminitis if he isn't on enough prascend, especially since it is fall?
--
Jo Ann S
September 2022
Salem, WI
Case History: https://ecir.groups.io/g/CaseHistory/files/Jo%20Ann%20and%20Owen
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=278267 

 

Thanks, Sherry.  He was tested with access to hay and water, but not grain. Would you mind please explaining what changed your mind?  I'm pretty confused and already emailed my vet about raising his dose.
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Jo Ann S
September 2022
Salem, WI
Case History: https://ecir.groups.io/g/CaseHistory/files/Jo%20Ann%20and%20Owen
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=278267 

 

Okay, that is good news; I was very concerned.  Thank you for clarifying.  I see that now on the lab report.  Do I need to somehow indicate this in his casework file?  All I see is ACTH.

Could you also please clarify whether or not I should be concerned with his diet since he is only PPID and not IR? I am kind of lost in all of the various responses, with some of the moderators responding as though he also had IR.  Dr. Kellon said above that carbohydrates are not of concern for a PPID horse unless the horse has abnormal insulin, which I don't think he has. Since sugar and starch are both carbohydrates, it is difficult for me to decipher which diet instructions in your files apply to a PPID only horse.  The DDDTE sheet says EMS is managed with diet and PPID is managed with peroglide.  So which dietary instructions, if any, apply to a PPID only horse? Do I still need to get his hay analyzed?

Thank you.
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Jo Ann S
September 2022
Salem, WI
Case History: https://ecir.groups.io/g/CaseHistory/files/Jo%20Ann%20and%20Owen
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=278267 

 

Hi Jo Ann,
I was one who suggested you not worry about soaking.  I think, from some of the replies I read, that not everyone saw that Owen’s insulin was normal.  It is a bit all over the place, depending on which lab is doing the test.  We generally recommend Cornell, if possible.

For Owen, testing the hay would be good so you can arrange the perfect diet for him.  Most horses would benefit from a balanced diet but, for metabolically challenged ones, it’s even more important.  You don’t need to soak the hay.  Most of our recommendations apply to all horses, and particularly metabolically challenged ones.  The ones regarding sugar and starch are not applicable to a PPID horse, unless his insulin begins to climb.
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