Since it now appears as if Buddy is not IR, but is PPID and really needs to gain weight, I have a couple questions about diet...

- What does that mean in terms of how strict the ESC and starch percentage needs to be still?

- How much Stabul 1 is safe to feed? (Something he finally likes!)

- Does this mean he can have alfalfa pellets?

He's lost all of the weight that he had been starting to gain again before I started soaking his hay. I got my hay results back and the 2nd cutting Orchard/Timothy/Clover mix that I have been giving him soaked is 10.6 ESC and 2.7 starch and then the 1st cutting that I wasn't feeding him is 5.7 ESC and 1.8 starch. So I started switching him over to the 1st cutting dry since he hates the hay being soaked and he started eating better, but it's more coarse and it's causing softer stools with squirts of liquid even though the manure is still formed in individual balls. Same thing happened back in October when I tried giving him the first cutting, too, so I'm pretty sure this is the cause.

He also started drinking a lot less while he was eating the soaked hay and has stayed that way even though he's getting more dry hay now over the last week.

What are his lab values? They're not in his case history.
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Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Oh, I'm sorry. I meant to go back and update it on the computer, I haven't been able to do it on my phone.

Glucose - 93 (wasn't given unit type?)
Insulin - 12.89 uIU/mL
ACTH - 364 pg/mL - Currently slowly increasing his pergolide from 1 mg to 1.5 mg

 OK. He's likely to need more than 1.5 pergolide but if that insulin wasn't fasted I'd try giving him the first hay unsoaked and a few pounds of Stabul 1. However, his weight loss  may be due to the uncontrolled PPID and won't reverse until that is fixed.

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Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

It wasn't fasted, he had hay available 24/7 before the test, but he ate a little and then took a break for a while several times in the hours before the blood draw. So not sure if that makes a difference.

He was gaining weight at the 1 mg dose before he had the abscess and bout of front hoof pain in December that prompted me to start the emergency diet. He had started to show some improvement in the day or two before I started soaking it, but I still did it to be better safe than sorry and cautious. So hard for me to say if that made a difference or not overall.

His weight loss seemed to really start with an abscessed tooth that he had in the late summer.

I just figured I would do baby steps with increasing his pergolide since he's finicky about eating anyway.


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Brittany in Ohio 2022

Buddy Case History - https://ecir.groups.io/g/CaseHistory/files/Brittany%20and%20Buddy

Buddy Photo Album - https://ecir.groups.io/g/CaseHistory/album?id=282333

They don't have to be eating constantly, just have it available. Pain alone can cause weight loss and tooth pain of course also affects eating. The infections are related to his uncontrolled PPID. Do you have him on APF?
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Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

No, he's not on APF. I know I saw that mentioned somewhere before, but didn't focus in on it since he luckily didn't seem to have an issue with the veil when he started pergolide with me just increasing it 1/4 of a pill at a time for several days.

So should alfalfa or some form of hay pellets still be avoided? I only ask because the only way I've ever gotten him to eat beet pulp was by flavoring it with Timothy pellets.


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Brittany in Ohio 2022

Buddy Case History - https://ecir.groups.io/g/CaseHistory/files/Brittany%20and%20Buddy

Buddy Photo Album - https://ecir.groups.io/g/CaseHistory/album?id=282333

Hi Brittany,

As Buddy has had alfalfa before without issues, I wouldn’t be concerned about adding them to his beet pulp.  I would focus on increasing pergolide.  With my horse, Logo, I could cater to any of his whims and never add much to cover his ribs until I remembered to increase his dose. 

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So there isn't an exact number or anything to follow for sugar & starch for a horse that just has PPID then? I'm working on the pergolide, hopefully it helps. He hasn't had alfalfa in a couple years, but he has been doing fine with clover in his hay. I hate that so many different things have been going on all at the same time which makes it really hard to pinpoint exactly what is causing what. But thankful for this group's help and that he's doing so much better!


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Brittany in Ohio 2022

Buddy Case History - https://ecir.groups.io/g/CaseHistory/files/Brittany%20and%20Buddy

Buddy Photo Album - https://ecir.groups.io/g/CaseHistory/album?id=282333

The guidelines for ESC + starch for an IR horse are just that - some can tolerate a bit higher and others need less than 10%.  If there’s no indication of IR, he could probably tolerate something higher but it’s best not to find out he can’t when his feet start to hurt.  When Logo was first diagnosed with PPID, I wasn’t aware of this group or any connection between PPID and IR.  The vet tested for both and
continued to do that until at some point he dropped the insulin testing as there was no indication it was rising.  Joining ECIR, I became aware of the recommended diet and dropped all the extra oil (he had been diagnosed with shivers) and alfalfa (for weight gain) I was feeding and tightened up his diet.  I did continue his turn out as it apparently wasn’t causing him any harm and my hay tested safe for my IR ponies.  He was never lame.  As you said, if you make too many changes at once, you’ll never know what’s going on.  The fact that Buddy had some sort of laminitic event diagnosed would have me proceed with caution.  Alfalfa won’t cause laminitis but it can cause some horses to be footsore so I would think that would be a good first change to make.  I did a lot of testing at first, which you’ll want to do to get his PPID under control before the next rise.  I would include insulin/glucose until you’re fairly confident your management changes aren’t affecting his insulin levels, definitely through another fall rise.
I’ve never been to Clermont County, Ohio but some of my ancestors spent a few generations there.  Whenever I see the name come up, I jump to attention, thinking it might be new Ancestry information.  It must have been a good stopping off point for settlers making their way West.
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It would be worth trying the APF to see if his appetite picks up. Adding hay pellets is fine. The dietary precautions with PPID are only necessary if high insulin develops. That could still happen and you should check it yearly with ACTH, or any time you see fat deposits developing.  In the meantime, that hay that you were soaking or alfalfa should not be a problem for him.
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Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Thank you again for all of your help! I'm sure Buddy is going to be thrilled to have a little more wiggle room in his diet lol.

Martha, that's really interesting about your family connections. What are the odds? And yes, I could see where that might be the case for Clermont County since it's just to the East of Cincinnati and would probably have had a lot of people coming through to get there and further West. My maternal side of the family has been in the area for over 6 generations now. If you have any questions, let me know!