Snort Case History
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Pat H
Hi,
Thank you for your response. You will find Snort's case History and photos below. https://ecir.groups.io/g/ https://ecir.groups.io/g/ Pat H Oregon January 16th |
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Trisha DePietro
Hi Pat. Welcome to the group. I see you are a cracker jack at getting your casehistory uploaded! That's great. I reviewed your case history...I still have a couple of questions for you...How tall is your mini and how much do you think his ideal weight should be?
How much magnesium is he getting? The Equioxx is probably not helping, nor would bute or any other NSAID. Its really the diet that needs to be tightened up here. This is the fastest way to reduce insulin, which is contributing to the hoof pain. Once the insulin is down, he should be much more comfortable. Our emergency diet works very well in these situations. You do need to get a weight tape and get his height too so we can see how much he should be eating. Does he eat any hay at all? Did he suddenly become lame when the weather got consistently colder? ie less than 50 degrees? I'm sure Lavinia will be along to take a look at his hoof films. And she can give more guidance on the trim piece. 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:
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. -- Trisha DePietro Aug 2018 NH Primary Responder Dolly and Hope's Case Histories Dolly's Photos Hope's Photos HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993 |
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Hi Pat,
Great job on being so organized, thank you! Could you please rename your rads as described here: https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions Go to each image, click the "Edit" button below it, and change the name to YYYY-MO-DD_[hoof + view] The Triple Crown Low Starch product is not safe for horses with EMS. One member tested it and starch was way above our 4% max: https://ecir.groups.io/g/main/message/286964 That product is likely going to keep Snort in acute laminitis. Instead, I would strongly recommend switching Snort to Triple Crown Naturals Timothy Balance cubes, which are guaranteed to be batch tested and safe for EMS horses. They are also already mineral balanced so you only need to add salt, vitamin E, and ground flaxseed. Once you've changed his diet, it would be good to have insulin, glucose and ACTH redone to see where he's at. If that's not enough, you can add Metformin: https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin/Metformin%2008.08.20%20FINAL.pdf A longer term goal would be to get his weight down. We have found that equines with EMS do best with a BCS of 4.5-5. It probably helps with insulin sensitivity, but it also reduces the weight they carry on their hooves. When you feed the Triple Crown Naturals Timothy Balance cubes, because they are higher in calories, we feed 25% less by weight than we would feed for hay only. So 5lbs becomes 3.75 lbs. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Pat H
Hi Kirsten,
I will switch him to the cubes.The vet recommened this feed. I tried to edit the photos but am having trouble finding them. Can you quide me in he right direction. I just had him trimmed and the shoer was able to take quite a bit off and get his angle better. He will do more on he next visit. Should I upload photos of the trim? I also had a message but can't find it that asked a couple questions. He is 11 hands and I am quessing aroun 450 lbs. I could find my tape so I will keep looking for you and get a more accurate weight. I am giving him magnesium Oxide at a 1/2 a scoop, 2.2 g, 1,175 mg. Thank you, Pat -- https://ecir.groups.io/g/ https://ecir.groups.io/g/ Pat H Oregon January 16th |
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Pat H
Hi Trisha,
I couldn't find this thread so I answered some of your questions in a response from Kirsten. He is 11 hands and I am quessing around 450 lbs. I could find my tape so I will keep looking for you and get a more accurate weight. I am giving him magnesium Oxide at a 1/2 a scoop, 2.2 g, 1,175 mg with flax oil. He as been consistantly lame for about a year or more. I don't see any difference if the weather changes. -- https://ecir.groups.io/g/ https://ecir.groups.io/g/ Pat H Oregon January 16th |
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Hi, Pat. The links to your case history and your photo album are conveniently located in your automatic signature. You can always find your automatic signature on your subscription page:
-- Cass, Sonoma Co., CA 2012 ECIR Group Moderator Cayuse and Diamond Case History Folder Cayuse Photos Diamond Photos |
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Hi Pat,
Are you looking for this message? Subject: Feed recmmendations Hi, I have a 17 yr old mini that I had blood work done. His Acth was 36 and his insulin was greater than 200. The vet had me put him on insulin wise and Triple Crown Safe Starch Forage. He has been on this for about a month. He seems a little better sometimes. He also gets Equioxx daily. Do you have any other suggestions? Thank you! -- Pat HYou can't find it because it never got posted. It was sent back to you with a request to complete your signature, then repost it. It's possible that request ended up in your junk mail. As for suggestions, the only dietary changes I think need to be made is changing the bagged feed. It might not be enough to get his insulin down though, so I would strongly suggest trying Metformin. One day when he's recovered, incorporating exercise will help keep his insulin down, too. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Sherry Morse
Hi Pat, Would you be able to post a picture of Snort so we can evaluate his BCS? 7 is NOT a normal weight for any horse - a 7 indicates he could be up to 100lbs overweight and your estimate of him being 450lbs backs that up. His ideal weight is probably closer to 350lbs which means he should be eating no more than 7lbs a day TOTAL. That is 2% of his ideal weight. Are you weighing how much you are feeding at this moment? Is there a reason he's getting 1lb of beet pulp? As an IR horse we recommend feeding a minimum amount of carrier to get minerals in. If you switch to the Triple Crown Naturals Timothy Balance Cubes you only need to add Vitamin E, Flax and salt to the cubes and you won't need to feed anything else for a carrier. The Timothy Balance cubes are fed at a 3:4 ratio to hay so if he would eat 7lbs of hay a day that would translate to 5.25lbs of cubes a day and NOTHING else.
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 https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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The dose for Metformin is 30 mg/kg of body weight, 2x a day.
You do need a reasonably accurate estimate of weight. Try measuring and calculating it with the second option presented here: https://www.horsehealthproducts.com/horsemans-report/equine-health/how-to-weigh-your-horse -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Pat H
Hi Kirsten,
I updated Snort's case history but i am unable to locate my files to delete the old one and upload the new one. Can you help me?
I also found my weight tape and more accurate height is 10.2 hands and 450 lbs. I changed his body score to a 5 -6. He was a little fatter but since I changed his feed he has lost some. I did upload some pictures of Snort.
Thank you,
Pat
-- https://ecir.groups.io/g/ https://ecir.groups.io/g/ Pat H Oregon January 16th |
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Sherry Morse
Hi Pat, If you click on the folder link in your signature that will take you to your files. Since you have uploaded a new file for Snort you seem to have gotten that sorted out. At 10.2 and 450lbs Snort is extremely overweight and the pictures you've shared (thank you!) confirm this. Were he mine I'd start with diet to get his insulin down and start him on Prascend/pergolide as well as the elevated ACTH may be contributing to the elevated insulin (although that does not negate him needing a diet). You can add Metformin if you don't see his insulin coming down on just the new diet - the dose is 30mg/kg 2x a day. It's probably already been mentioned but Insulinwise offers a money back guarantee and almost never actually lowers insulin so you probably want to take advantage of that sooner rather than later.
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 https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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He's adorable!!
Does he have a crease down his back and over his hindquarters? And can you feel the space in between his ribs, or are they filled with far? 450 lbs does sound like a bit much for a 42" pony, but weight tapes are not accurate with winter coats or little horses. Have you tried measuring and calculating weight using the second method given gere: https://www.horsehealthproducts.com/horsemans-report/equine-health/how-to-weigh-your-horse -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Hi Kirsten,
I measured Snort and he came back about 350 lbs using the second method. I would say that he doesn't have much of a crease down his back and can slightly feel his ribs. In my opinion I feel that he is close to a good weight. He has definitely lost some weight since he has been separated from my other horse.
I have started him on the cubes. How long do you think it will take to see a change in his lameness if changing him to the cubes help?
Thanks,
Pat |
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350lbs sounds much better. But if feeling his ribs is a challenge he's still carrying a bit too much. We really push getting weight down because horses with EMS do best when they have a healthy BCS, between 4.5-5. You should easily be able to feel his ribs and the space in between them.
If you want to keep him at 350 lbs he should eat no more than 2% of BW in hay, which would be 7 lbs. However, the Triple Crown Naturals Timothy Balance cubes are fed at a ratio of 3 lbs cubes for every 4 lbs hay, or at 75% the weight of hay, which would be 7lbs x 0.75 = 5.25 lbs in cubes. AND, being a mini his metabolism might be so efficient that you need to feed less, so watch his BCS and check his weight every 2 weeks because you dont want him to gain. I actually feed my full size horse 1.7-1.8% of body weight in hay (he's not on cubes) to keep his BCS at 4.5 and his weight at ~900 lbs; if I fed 2%, as I used to do, he would put on 200 lbs. I didn't realize he was fat because it was his "norm", until he lost those 200 lbs; it's amazing the difference! You should notice a chance in comfort within 72 hrs of changing diet, although it can take a couple weeks to see the full effect. After 1-2 weeks, we suggest retesting insulin so you can decide if you need to add a medication that lowers insulin, or not. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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