PeggyJ and Solo: Attempts to share case history and photo album


 

Hi Peggy,

Through some great stroke of good fortune, we had two Peggy’s join at about the same time but you were sent the wrong welcome letter.  They’re actually identical welcomes but we try to preface each one with pertinent information.  In your case, as this is late, you’ve already received lots of feedback.

I agree with the others about not riding him.  It doesn’t sound safe for either one of you.  I will be very interested in seeing his radiographs.  Has his farrier seen them?

Vets have differing opinions of when you should test for PPID.  All horses have elevated ACTH levels in the fall but PPID horses have dramatically elevated values.  The importance of checking his ACTH, even at his age, is that uncontrolled PPID can drive insulin levels higher.

Your focus should be on tightening his diet to see whether you can decrease his insulin significantly.  Let us know if you have questions or need help and thanks for posting both your case history folder and your album.

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 etiquettewhat 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.

EXERCISEThe 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. 

--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


Sherry Morse
 

Hi Peggy,

It would be very helpful if you could post pictures of all of Solos feet following the guidelines here: https://ecir.groups.io/g/main/wiki/1482#Photos-and-Hoof-Evaluation-Help.  Solo's front feet both look like the toes are long and there is moderate flaring on both feet.  With pads and shoes on it's impossible to evaluate what his sole looks like but the x-rays would also be helpful when you can get them up. 

As far as your current diet for Solo - Nutrena does not make ANY products that are actually safe for an IR horse and that includes their Safe Choice line. It's good that you've stopped that and put him on the Emergency Diet.  Please note that as per the weight loss recommendations of 1.5% of current weight or 2% of ideal weight - whichever is greater - he should be eating no more than 17.5lbs per day.  Is the current diet being weighed?  Please note that we do not recommend underfeeding as this can create other issues although you may need to play with the exact amount that he receives to find the sweet spot where he will lose weight.  Note that the Timothy Balance Cubes are more calorie dense than hay so 1lb of cubes is equivalent to about 1.35lbs of hay.

Insulin Wise has been found to not be effective by the majority of our members who have tried it.  Fortunately it comes with a money back guarantee I believe. 

As far as exercise - please read the Exercise section of your welcome message.  Until he has had a chance to grow out most of a well connected hoof we do not recommend forced exercise and if he's buckling at the knees I would certainly not be riding him as this isn't safe for either of you.




Peggy Jones
 

Thank you for your response Dr. Kellon.

When did he start gaining weight and buckling when ridden?

Solo as been slowly gaining weight for the last couple years. I think the bulk of his gain was in the last year. The reason I say this is based on comments from friends when we were camping (March 2022). I'm afraid I thought he looked great. One friend said "Hey, Solo is looking like a stallion. He is getting kind of cresty". If I knew then what I now know, I would have been alarmed and moved to action. In November of 2021, again while camping, Solo bucked me off. This was very unusual behavior. After a vet check and other investigations, we determined the extra Alfalfa was to blame. Our vet concluded it was just too much high octane fuel!  I have since eliminated Alfalfa from his diet. As for what I was feeding him up until recently, Solo was given 18 lbs of Teff hay and 1.5 lbs of Nutrena Balance Topline / day with 1/4 cup of Flax Oil. He was also given carrots. (Alas, no longer). I found that he likes celery so we have treats again. He was being ridden at least 3 - 4 times per week on trail for 1 to 1 1/2 hours each time.

As for the buckling, Solo has, on rare occasions, stepped and buckled, but we started noticing it after I moved him to a new ranch in July and Solo was in a Bermuda grass pasture. He was grazing so much that he wore the hair on his nose down to feel like a three day old beard! Another clue that I missed. I think this was the trigger that caused his spike in insulin and inflammation. "Mild laminitis" was the farrier's determination. I probably used the wrong term on the laminae - stretching? thinning? something like that and there were some little specks of red (bruising). Wish I had photographed it. In regards to the photo you commented on there was one photo of his sole in our album that had a shadow. I think that is what you saw thinking the pad / shoe is falling off. I just haven't had a chance to reshoot and replace it.

Solo has not yet been tested for PPID. I have seen that there are conflicting attitudes about testing ATCH during the Fall when numbers are naturally elevated. Dr. Libby suggested waiting until December to test and at that point probably we will need to begin Pergeloid / Prescend medication. Blood panels and test T3 and T4 at that time. If I hadn't seen such an obvious improvement in the last couple of weeks, I might have insisted on an ATCH test now. I feel like I want to give Dr. Libby a chance and follow her plan. 

Thank you for your thoughts on his Thyroid benign tumor. I also got a chance to ask Dr. Libby today about it and she didn't believe it was causing problems.

I saw the radiographs of Solo's front hooves today. I will upload them ASAP. Dr. Libby was happy with them. I think they support my feeling that Solo's feet are not as sensitive as they were just a 3 weeks ago when we moved him to a dry lot, and changed his diet. When hand walking, he has not been buckling at all and he only did it once during the last two times I rode him, at a walk.

I really appreciate your time, expertise and the depth of information I have found on this site.  I am learning more all the time.

--
  Peggy J
  September, 2022
  Vista, California
  Case History of Peggy and Solo
  Solo's Photos

--
Peggy J
September, 2022
Vista, California
Case History: https://ecir.groups.io/g/CaseHistory/files/PeggyJ%20and%20Solo
Photos: https://ecir.groups.io/g/CaseHistory/album?id=278595


Eleanor Kellon, VMD
 

 Hi Peggy,

When did he start gaining weight and buckling when ridden?

I'm not sure what you mean by the lamina thinning. Could he have meant stretching? We will know a lot more after you get the radiographs but personally I would not be riding him, or even forcing him to walk at this stage. Turnout in a grass free area or with a muzzle is fine as long as he is not on any pain medication.

Was ACTH tested? I didn't see it in your history.

Thyro-L may help with weight loss but does nothing to lower insulin. None of our members have found Insulin Wise to be of use but the dietary changes you have begun should make a big difference.

Thyroid adenoma is very common and may even go away when you get your diet properly mineral balanced. In any case, it definitely won't cause low thyroid hormone although that benign growth may be related to low iodine and selenium intake, which will cause hypothyroidism. That is an extremely common finding when PPID and/or EMS is not controlled and typically improves all by itself when the body is in better metabolic and mineral balance. There are also malignant tumors of the thyroid, much less common, but they cause hyperthyroidism, not hypo.

Just as an aside, in the photos you posted the frog insert on the RF has shifted out of place and looks like there may be a tack missing. This needs to be fixed ASAP.
--
Eleanor in PA

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


Peggy Jones
 

Hello Kirsten and all,
I am so happy to have finally succeeded in posting a message. Whew! Today we have the radiographs done of Solo's front hooves. This should provide more information about his laminitic condition. I will upload them to our photo album as soon as possible.
My friend Alisa who is a member of ECIR and encouraged me to join / participate, has been instrumental in helping me to understand and care for my equine partner.
Cheers!
--
Peggy J
September, 2022
Vista, California
Case History: https://ecir.groups.io/g/CaseHistory/files/PeggyJ%20and%20Solo
Photos: https://ecir.groups.io/g/CaseHistory/album?id=278595


Kirsten Rasmussen
 
Edited

Hi Peggy, 

Welcome to the group and thank you for getting your Case History and photo album in place!  [Edited to remove reference to another Peggy.]

Your questions will be answered shortly. 

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


Peggy Jones
 

Hello,

I have been receiving messages via email but have not had success uploading this narrative below.  I just want to know that my group message has been received. I have included the link in my signature (subscription) for Solo Case Study and his photo album.

Solo is a 14 year old Rocky Mountain gelding that was identified on 9/2/22 as most likely having PPID and is showing IR symptoms of high blood insulin levels.

Trim: During riding, knee-buckling led to the farrier first. We enlisted Kasey Kincaid  (well known in our area for his skill and knowledge).  As he trimmed Solo's front hooves he found the lamina was thinning at the front and there were some small, red spots Kasey identified as bruising. Shoes with pads were recommended as you can see in the photos. I will take photos of the bare soles of his hooves next time to include in our photo album.  With the diagnosis of Laminitis, we  then called the vet for baseline blood work which revealed low T4 ( 0.564 ug/dL) and high insulin (101.50 ulU/mL). Prior to August 30, Solo was barefoot for the previous 6 years. Our former farrier never mentioned seeing the lamina thinning or any bruising.

Diet: Solo was moved to a dry lot pasture immediately. We replaced daily supplement Nutrena Topline Balance with Nutrena Safe Choice Special Care on 8/31.  After the blood work results, we changed to the ECIR Emergency Diet on 9/5. Dr. Libby also prescribed one scoop Insulin Wise (started 9/5) and 2 scoops Thyro-L (started 9/12) for two weeks, then to be reduced to 1 scoop/day after. No carrot treats.  I am soaking his Teff dinner hay net Teff (8 lbs), and when possible, his lunch Bermuda net (3 lbs). Breakfast is also Bermuda (3 lbs). Solo is also getting about 1 lb of Triple Crown Timothy Naturals / day divided up and added to the Emergency diet (plus 1 scoop Thyro-L) in the morning, and with the rest of his medications / sups prescribed by Dr. Libby in the afternoon.
Dr. Libby described Solo as chunky and cresty. Using a tape, I estimated his current weight to be 930 lbs.

Exercise: Dr. Libby recommended tack walking for 20 minutes, 5 x/week which we have been doing. The farrier had only said to go ahead and keep riding him. I try to keep track of how many times he buckles and the knee during our rides, which has been averaging  2-3 times / ride. On off days, I hand walk Solo for 45 minutes and he has not appeared to buckle at all.

Hindsight: I am wondering about Solo’s Hypothyroidism. Could this be caused by a benign tumor on his Thyroid that was diagnosed about in 2017?  We chose not to remove the tumor at that time. I don’t think it has gotten significantly larger but you can see the thickening of his throat latch in the side view of his photo album. I have the blood report and will upload it to our case history folder.

Future: Radiographs of front hooves scheduled for tomorrow, 9/27.

I know this is long-winded and appreciate that you read it : ).

Peggy Jones

Peggy J
September, 2022
Vista, California
Case History: https://ecir.groups.io/g/CaseHistory/files/PeggyJ%20and%20Solo
Photos: https://ecir.groups.io/g/CaseHistory/album?id=278595



--
Peggy J
September, 2022
Vista, California
Case History: https://ecir.groups.io/g/CaseHistory/files/PeggyJ%20and%20Solo
Photos: https://ecir.groups.io/g/CaseHistory/album?id=278595