I think I have created & uploaded Dot’s case history correctly, and also added photos and blood work.  There is so much valuable information in so many places that I want to double check some steps I have taken.  Dot is at a boarding facility where the staff changes frequently and most do not speak English, which is why I am not confident he gets his meds as prescribed.

ADDED TO HIS FEED:
devils claw via a product called SU-PER suBstitUTE because I could not find just devils claw locally.  This product has other ingredients - PER 2 OUNCES: MSM - 10,000 mg, Yucca - 6,000 mg, Devil’s Claw - 5,000 mg, Bromelain/Grape Seed Extract/Omega 3 Fatty Acids/Salix Alba - 500 mg each, Curcumin - 275 mg, Omega 6 Fatty Acids/Omega 9 Fatty Acids - 167 mg each, Ginger Root/Black Cohosh - 100 mg each, Vitamin B12 - 500 mcg - I am feeding the 2 oz once per day.

Added jiagulan from Uckele, estimating 5000g twice per day.
Uckele E 5000 powder, 1 tsp twice per day
Table salt, gradually increasing to 2-4 Tlbs

He has been a very picky eater the last few months and I don’t think he has gotten much of his prescribed 3 tsp of Thyro-L, basically he self weaned.  He has been getting 1 tsp since 2012, increased to 3 tsp 2021/12.  I have not added it back to his diet yet.  He has not eaten his Prascend pill regularly either, but seems to have weathered that.  It has not been higher than 24 for the last calendar year.

I test his insulin frequently and it constantly goes up and down.  A year ago it was 55, but this year with him fighting a liver infection it has stayed over 100.  My vet has never checked glucose at the same time, and I was not aware that he should have been.

He loves the new TC Timothy Balance Cubes we switched to this week, so great news because he is eating all including supplements.  Do I need to add any other minerals or flax to this (magnesium?)?  We do not currently soak his hay.  There is little to no chance that the barn staff can correctly R/S/R beet pulp, and I can’t be there twice a day to handle it myself.  He is in a dry lot and gets no grass.

We were walking under saddle for about 2 months with Cloud boots on and he was very happy and comfortable.  It gave him more exercise which we hoped would bring the insulin level down.  This was under the vet’s guidance (with no sharp turns).  His weight is the best it has been since 2010 when I bought him.

He was getting metformin for 5 months (confirmed 95% of the time).  Initially it seemed to help but never significantly so we discontinued.  Vet is now suggesting Steglatro.

He got his flu/rhino vaccine on 2022/09/29 along with Equimax wormer.  The next week he was lame, but he had also spooked and ran in between events.

When should I retest insulin and glucose?

Thank you all SOOOO much!!  Yes, the information is overwhelming and the platform cumbersome, but very much worth the effort.  I’ve researched this for 6 years and thought I was knowledgeable.  Preparing the CH made me realize there have been so many signs I was missing or unaware of, especially during periods when he seemed to be doing well.
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Nancy O, Colorado, 2022

Hi Nancy,

Thanks for creating the case history and the photo album.  Here are the links to those:

Case History:  https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Dot

Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=280596

Unfortunately, the SU-PER suBstitUTE is not appropriate for an IR horse. The yucca can cause insulin to rise; MSM needs to be used with caution unless the diet is already tightly mineral balanced as it interferes with copper and selenium absorption; the omega 6 and 9s are already overloaded in the diet - you need to add omega 3s.

You can get plain devil's claw here: https://www.theequinewarehouse.com/item/Wendals-Herbs/Wendals-Liquid-Devils-Claw-1-L/QBC

Unless he needs to lose a lot of weight, we don't recommend using Thyro-L, so if he's already weaned himself, then don't restart him.

Great that he likes the TC Balanced cubes. Unless they make up his entire diet, you will need to balance his minerals to his hay analysis. Good on the vit E and salt, just need to add ground flax for the omega 3's.

Steglatro is not a drug to be started lightly, as it requires a lot of regular blood work to monitor and the diet needs to be specific as well or the horse will crash. Best to get the diet dialed in tightly first, then exercise and trim in place before considering it.

Based on the rads, his trim definitely needs some adjusting to get it optimal for him. He has thin soles and sinking and his toes need to be backed up.

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

Thank you for the feedback.  The rads were last taken in July.  My farrier has been trimming the toes every 3 weeks.  She shared photos of the trim but they are not identified as to which foot so I have not yet uploaded them.  She has been making good progress with that.

I would prefer a dry version of devils claw and see that Dr Kellon has recommended Uckele’s Phyto-Quench.  Is that appropriate for Dot at this time?  I also now see that she recommends 3 days of devils claw THEN add jiagulan.  I see others post that they also use the Phyto-Quench, but need to be sure it is OK to give both at the same time.

For the flax, is the TC Golden Ground appropriate?  Can I use Bob’s Red Mill from the grocery store in the meantime?
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Nancy O, Colorado, 2022

https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Dot

https://ecir.groups.io/g/CaseHistory/album?id=280596

Are electrolytes recommended, especially with severe weather changes?
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Nancy O, Colorado, 2022

https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Dot

https://ecir.groups.io/g/CaseHistory/album?id=280596

Hi Nancy,

I just want to add that your grass hay analysis was done by NIR methods, which can underestimate the carbs substantially.  Given Dot's extremely high insulin since July, I would be soaking his hay.  After 7-10 days of soaking and having cut out the Crypto product, you could have his bloodwork redone.  You want to see his insulin come down, but it is a good idea to monitor glucose and, because he has PPID, everyone you check insulin you should also check ACTH (and vice versa).  Your September ACTH was quite good, but slightly higher than we like to see it (no higher than mid-20s), so I would increase his Prascend by another 0.5 mg.

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

Snickers' Case History
Snickers' Photo Album

Well that is frustrating news.  This was my first hay analysis and I did have someone with experience help me.  More $$$ down the drain.  Is the entire report useless, or are the mineral numbers likely to be accurate?  I am now soaking his hay and he is loving the TC Balance Timothy.  I am able to add salt, flax, jiaogulan and Uckele E-5000 powder and it all disappears.  This is a huge improvement.  

We have unfiltered well water at the barn.  When we rinse the hay there is a lot of red water.  The hay report appears to have a safe iron content so the iron must be coming from the water.  This is what he is drinking also.  Could that be a problem?  Should I have his iron tested?

What is the correct link to choose when responding to a moderator’s post?  Reply Online, Reply to Group, or Reply to Sender?
--
Nancy O, Colorado, 2022

https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Dot

https://ecir.groups.io/g/CaseHistory/album?id=280596

Hi Nancy

Yes. It can be frustrating, but hugely good news about him eating the TCBC.

If you are feeding from these hays as tested -- IOW, not subsequently being soaked and fed -- you can rely on the minerals. When to rinsing for iron or soaking for carbs long term, you'd want to retest and balance to those results. You may have already heard this.

My water was similar to yours. Once tested we found it was actually high manganese  causing the discoloration, which can be a problem along with high iron. As it supplied both house and barn, we installed a filter system. Significant difference in water quality. Many members have used RV filter systems for barn water. Lots of info here and on Horsekeeping.

RE: your reply questions, I am guessing you are replying via Digest. I don't get those any more but like many members go directly online to read and reply. https://ecir.groups.io/g/main/messages I believe from Digest you could reply via Reply Online or Reply to Group. Reply to sender would send your response  privately to the poster. We try to keep things all in the group and not privately.  If you have the question, so do hundreds of others. It is amazing how far reaching and helpful the info can be for so many.


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Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President 2021-2022

HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993

Hi Nancy O,

All the minerals are done by wet chemistry so they are fine.  Your carbs, protein DE, etc might be a bit off though.  If Equi-Analytical still has your hay sample, you could ask them to upgrade it to the 603 Trainer test.  They will only charge you the difference between the 2 tests.

Rather than testing Dot's iron, have your well water tested first.

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

Snickers' Case History
Snickers' Photo Album

The hay analysis was done in June so no chance Equi-Analytical still has it.  I see posts about sampling soaked hay.  Since I am now soaking it seems to make sense to have the soaked hay analyzed rather than sampling a full 12-20 bales of dry.  I am guessing I would send in a dried sample of the soaked hay.  If that is accurate, exactly what tests should I ask be done?  FYI - I just spent 2 hours calling and searching for a hay probe to rent or borrow to no avail.  The last one we used and the only one I can find at an extension office are 2 hours north of here, and they want them back ASAP.  $250 to purchase one from Penn State is beyond my budget, especially since I am the only one at my barn currently concerned with this - although I did consider buying it and renting my services out!

Since this is a boarding facility I can’t see the point in testing the water.  I am powerless to amend it.  Wouldn’t it make more sense to test his iron load when I do the glucose/insulin/ACTH test?
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Nancy O, Colorado, 2022

https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Dot

https://ecir.groups.io/g/CaseHistory/album?id=280596

Boarding complicates the issue for sure.

You can test serum iron, but it will not tell you what you need to do to fix it if high. If I suspected high iron in the water, and I wanted to soak, I'd want a lot more info, including water pH.

Taking all dietary intake data into consideration and balancing to that, is what will help keep everyone at your barn healthier. You may not have iron overload on a tissue level, Only high in the diet, but continued high unbalanced iron and manganese in the diet is not good for any horse.

High iron in water is ten times more available than in food.

Here's a couple of links for more info.
https://ecir.groups.io/g/main/topic/68553884#248319
A member on her results when rinsing for iron
https://ecir.groups.io/g/main/message/242207
A thread on water
https://ecir.groups.io/g/main/topic/1058060#179099

When I had to soak (not rinse) all winter, I took a new sample of 15 bales. Soaked it. Dried it. Sent in sample. I did the full test and balanced to that. Others may have different input.

I know this isn't what you want to hear. Take it a step at a time.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President 2021-2022

HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993

Hi, Nancy O. 

I think you can sample a good number of bales as the other Nancy described without a probe. It will take a good hay hook and real strength. With a hook, you can jam the hook into the long side of the bales that show the cut edge with no strings. Do it in the middle of the bale and try to hook a good handful of hay. Put 20 or more handsful into a hay net and soak as you expect to soak - same water temperature, same length of time. When done, dry thoroughly in the shade. I try to dry away from barn areas with a lot of dust. Feel the hay periodically to see if it feels dry. It takes good airflow and can dry in a day or two.  Then draw as random a selection into a gallon baggie. Mail to Equi—Analytical and order 603 Trainer analysis. This will give you all the information you need to balance soaked hay, to know how much to feed and to confirm the ESC is reduced.

You should get a good idea how soaking affects the hay. FYI all soak water is a reddish brown color. That isn’t necessarily iron. My hay isn’t much different than your hay in terms of iron and my water has ZERO iron. The soak water has the look of diluted molasses- dark reddish brown. 
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Kirsten, can you tell me how you can tell my hay test was NIR?  I see nothing on the actual report that indicates that, and the amount I paid does not reflect that ($164 for 2 hay analysis's).   I am getting ready to submit new samples and don’t want to make the same mistake.  The last one was a first for me and I had someone with experience help me.  She filled out the form, which I neglected to make a copy of.


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Nancy O, Colorado, 2022

https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Dot

https://ecir.groups.io/g/CaseHistory/album?id=280596

Hi, Nancy O.
The reason your tests were so expensive is that you added Selenium, which is an expensive test. IME once you have a general idea that your local hays don't have sufficient selenium to meet your equine's needs, you don't need to repeat that testing.

We can usually tell that a test was done by NIR instead of wet chemistry by the inclusion of Ash in the results. There is a very thorough test, the 604 or Equine Complete, that includes Ash but it also reports Cobalt, Sulfur and Chloride. Since those are missing from you results, we deduce that you ordered the 601Equi-Tech for $30 plus Selenium for $52 more. You can always contact Equi-Analytical, provide your Lab Sample Number and ask which test was run.

To be perfectly clear: you want the 603 Trainer analysis.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Thank you SOOOO much!  Now I can send the new samples in with confidence.


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Nancy O, Colorado, 2022

https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Dot

https://ecir.groups.io/g/CaseHistory/album?id=280596