Hi there,
I am hoping to get some help with my mini. He is a rescue that has been with me for about 4 years. He came to me with a blind horse and he took care of her. I don't know much about him prior to getting him but while he was at the rescue they were feeding him sweet feed and hay. I'm sure with all of the volunteers he was probably getting lots of treats as well. These were my first ever horses and when they were dropped off I was given minimal instructions. I think he is about 7 years old.
Originally they were out on a pasture of about 1.5 acres with grass that was struggling. He only got fescue hay and triple crown balance rationer (approx. 1/3 lb per day). He had a bout of laminitis and I had the vet out to do testing and was told he had cushing's. I was given prascend and told to give him half a pill per day. I also created a dry lot for him so he has not been on grass since. It has been a couple years. He did really well for a while and very slowly lost a bit of weight.
He had had a couple flare ups but I was always able to get them under control within a few days. They usually happened because he escaped and got into some grass.
He had a flare up at the end of October and I realized there was grass sprouting up in his lot so I gave him bute and removed all of the grass. He seemed to get better. I had the vet out and they had me giving him bute and did x-rays. His feet looked good in the X-rays. There was no progression of rotation.
In November I had to put his companion down and I'm not sure if that kicked him into an episode but he was struggling again. We also had several really, really cold snaps in December. Basically it has been a stressful winter. I haven't been able to get him back to completely normal. He seems fine and then has a flare up. I had the vet out again Jan. 3 and they did bloodwork and had me up his Prascend to 1 full pill a day. I also changed him to Timothy hay. At this point he doesn't want his balance rationer anymore and hasn't eaten it since I upped his Prascend. He basically seems to be ok one day and then the next he is uncomfortable. 

Here is the most recent bloodwork. Jan. 4th Fasting
Glucose 97 mg/dL
Lipemia  7
Hemolysis 18
Icterus  1
Plasma Post TRH 10 min 1143 pg/mL
insulin Baseline 194.00 ulU/mL
Leptin Baseline 16.60 ng/mL
Serum
T4 (Thyroxine) Immulite 1.13 ug/dL

Thanks so much for your time!



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Shanda Anderson

Hello Shanda, welcome.
We're sorry to hear that your guy is struggling but glad you found us. Your first post here signals a welcome message which I will include below.  The ECIR'S philosophy is based upon the DDT/E protocol which stands for Diagnosis, Diet, Trim, and Exercise. The last is only if the equine is ready and willing to move about, forced movement will cause additional damage to the already compromised feet.
Have you had your hay analyzed and balanced? Please pay special attention to the diet section included.
His ACTH and insulin levels are very high. Some members have their horses on Metformin, for uncontrolled insulin but diet and exercise (if able) are always suggested first.
Nutritional Needs for Insulin Resistant.pdf (groups.io)
We see a lot of equines in trouble during the seasonal rise, which is the fall months, but I would not hesitate to increase his dose. Often you will need to bring APF on board to help with increases of Prascend.
Adaptogens.pdf (groups.io)
There is also cold-induced laminitis. I would get him some boots, socks, and leg warmers to keep his feet warm. We see many members of equines suffer cold-induced pain during winter. Some horses are sensitive to temperatures below fifty degrees. So that would be my first recommendation.
You can try Jiaogulan for increased blood flow if his trim is in a good place. 
Lastly, it would help us if you could get a case history done on him as soon as possible so we can better advise you. All bloodwork, x-rays, etc.
You will see in the message below that it includes many links that you can click on for more in-depth information. If you could read through it and let us know if you have any questions keep it handy as it will help guide you. 

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 
Horsekeeping Moderator

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

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Shanda Anderson 2023 GA

Hi Shanda,

I have a similar size mini and he eats about 1 heaping cup (after soaking) of beet pulp.  That's enough for his supplements.  Pergolide affects appetite but your guy should start eating his balancer again after he adjusts, although possibly with less enthusiasm than before.

Soaked hay, more pergolide and Metformin should help.  If you can redo his bloodwork after these changes, it would be a nice to know what his insulin and ACTH are at now.   Please ask for baseline (pre-TRH) ACTH, although you can get post TRH ACTH, too, as long as you get both.

Here's a helpful info sheet on Metformin:
https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin/Metformin%2008.08.20%20FINAL.pdf

Equioxx is an NSAID and should not be given long term.  Since metabolic laminitis is not inflammatory, an NSAID will not help with hoof pain.  It may make sore joints and muscles feel better, but you can give Devil's Claw for that, minus the damage NSAIDS can cause.

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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