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Aged Pregnant Mare help!!!!


Marcie
 

Hello all. I'm new to this group.

I have a 25 yr old mare -- I bottled raised her mother, and she has spent her entire life here, and is so precious to me.  We've been trying to get a foal from her to carry on her legacy, and finally this year we were successful. My vet had no issues with breeding her, as she looks like a 15 yr old mare, has a toned and "young" uterus (she has had 1 foal, for a friend, several years ago).  This past winter when she haired up A LOT, I didn't think a lot of it, because here in Houston we have had some cold winters, some mild, and I can always tell how cold a winter will be by how much the horses hair up -- and all of them haired up more than normal.

Joy has been getting a tablespoon of chasteberry powder at every feeding for years.

She started to get fussy about her feed about the time she got pregnant.  She lost the long winter hair but kept the shorter winter hair; again I wasn't too concerned as all the horses hung onto their hair longer (we had cold nights much later this year than usual).  However, when she came up "ouchy" a week or so before her 120 day ultrasound, I was concerned. I had spent a month with a shedding blade at every feeding, with the barn aisle looking like a snowstorm had hit every time.  When we went to the vet, he xrayed her feet and she indeed has some rotation (he didn't tell me how much).  I got a copy of the xrays for my farrier who was coming 7 days later.  In the meantime the vet had me giving her 1g of Bute a couple of times a day.

I called my farrier. The vet had recommended lily pads, which confused my farrier.  He bought some to show me, but we ended up with a plastic pressure pad under a normal shoe and he shortened her toe quite a bit.  She was immediately sound after the shoes.  However, 2 weeks ago she got sore again.  I've put an ice boot on her right front leg (the one with the least amount of rotation, but the intensely sore foot right now) which she hates and I don't see much improvement.

When the original rotation was discovered we immediately put her on Triumph Safe Choice Special Care by Nutrena (per my vet recommendation) and coastal hay (which she had always been on); switched from Nutrena Triump Senior and a 12% dry mix. 

I need help.  The mare is pregnant and my vet says he can't do the Cushings test until after she foals (but I'm betting that she's positive). She's getting 1/4c of Chasteberry powder daily in her feed, along with red raspberry leaves.  I tried a 25 day sample of Equinety but didn't see much difference so I didn't keep it up. I am giving her CortaFlx, 1 oz per feeding.

I would love some advice!  I'm hoping the issue with the soreness right now is that the plastic pad stretched, and once the farrier resets her next week she will be OK again.  Should she be put in a heart bar shoe instead?  Or something else?

This is my baby, and she's in foal with my next generation of her line.  I can't stand the thought of her being in pain, I hate seeing it in her eyes.  I need to do what's right for her but I'm hoping that someone can give me some hope that I can get her past this. She's never been lame a day in her life before this.
--
Marcie Fessler
Houston, Texas
September 2020


Sherry Morse
 

Hi Marcie,

You'll be getting a full welcome message shortly but in the meantime the most important thing for you to do right now is breathe.

Now a couple of questions that will help us help you - how pregnant is Joy now?  Is there a reason you've been feeding her chasteberry for years? 

It would be really helpful for us if you could add pictures of her feet (directions on how to take those images will be in your welcome letter) as well as the xrays to a photo album in the Case History sub-group.  Did the bute help at all when you gave it to her?  How long ago was this and is she off of it now?

How long between her trim and her becoming sore again?  We prefer that horses remain barefoot and have more frequent trims rather than using shoes because unless the shoes are being attached to a properly aligned hoof they may not be providing any actual help.

As far as her feed program - if she is laminitic due to PPID the feed you are using is above our recommended ESC+starch recommendation as well as above our fat recommendation.  The Cortaflx has an alfalfa base which is also questionable for a sensitive horse. 

I'm not aware of any reason the vet can't run ACTH, glucose and insulin numbers now - even though we are in the seasonal rise you can still interpret the ACTH numbers in light of that situation.  Dr. Kellon will hopefully chime in with more information on that for you.




Kirsten Rasmussen
 

Hi Marcie,

Welcome to the group! 

You have provided us with quite a bit of information, but it would really help out if you could take some time to fill in a Case History.  Sherry has covered the main questions for now, but I think your situation will get some feedback from Dr. Kellon here because of your girl's pregnancy.  I do know that pregnancy can increase insulin in horses, so it may be a combination of that with the possible onset of PPID that is causing these issues. 

A blood test for diagnosis is just a simple blood pull to get baseline ACTH, insulin and glucose (non-fasted).  Perhaps your vet is worried about doing a 
TRH stim test to diagnose PPID, in which TRH (a hormone) is actually given to the horse, but at this time of year the TRH stim test is not done because PPID horses will have notably elevated baseline ACTH compared to normal horses already and can be diagnosed on that alone.  If she is positive for PPID, getting medication started should go a long way towards helping her and it is important to get meds on board as soon as you can.  I would not delay having the bloodwork done; as you'll see below in our welcome letter an actual diagnosis is our first priority.  Until then though, its best to treat her as insulin resistant (which can be a separate condition, or can accompany uncontrolled PPID) by making the diet adjustments Sherry suggested to minimize her chances of serious laminitis while pregnant.

Take a deep breath and some time to read through the following welcome letter we send all our new members.  There are lots of links embedded in it for additional information that you can go back to after your first pass over it, and you will learn lots just by going through it all.


The ECIR Group provides the best, most up to date information on Cushing's (PPID) and 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 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: IR 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 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. 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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. 



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


Frances C.
 

Wow! a 25 year mommy mare! How far along is she? If she is carrying more weight then the pain factor may be reduced once she foals. If she is diagnosed with PPID you should take precautions as the hormone imbalance can disrupt the milk supply and also the labor process. PPID can cause a horse to be weak. To ensure the best outcome for the foal I would have a supply of colustrum in the freezer. The vet should be able to locate some. Really watch your mare for signs of labor, which can be false or disrupted and have a "heads up" with your vet for emergency delivery. The foal can be delivered, early, late, viable or not. My 23 year  old PPID mare did not make it but that was many years ago and things have improved. I did have a successful outcome with a DSLD mare who was in a great deal of pain. It stunted the baby's growth in utero. Wishing you all the best and a very happy outcome.
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382


Marcie
 

Thank you Sherry.

Joy is about 6 months (bred in mid/late March).

The reason she was on chasteberry is that when we were campaigning her, she would be an absolute witch to ride every time she was in season. Without actually having her examined, my coach (who was raised by an old-time horseman) suggested she was probably cystic. I did some research and found chasteberry. The change in her was almost immediate. We started giving a tablespoon on her feed every feeding, and she stopped the misbehaving while in season.

This spring is the first time she hasn't slipped her winter coat quickly.  I can try to attach the xrays, and take photos of her feet tomorrow in the daylight.

Would love feed recommendations for her.

Marcie Fessler

On Tue, Sep 8, 2020 at 07:42 AM, Sherry Morse wrote:
Hi Marcie,
 
You'll be getting a full welcome message shortly but in the meantime the most important thing for you to do right now is breathe.
 
Now a couple of questions that will help us help you - how pregnant is Joy now?  Is there a reason you've been feeding her chasteberry for years? 
 
It would be really helpful for us if you could add pictures of her feet (directions on how to take those images will be in your welcome letter) as well as the xrays to a photo album in the Case History sub-group.  Did the bute help at all when you gave it to her?  How long ago was this and is she off of it now?
 
How long between her trim and her becoming sore again?  We prefer that horses remain barefoot and have more frequent trims rather than using shoes because unless the shoes are being attached to a properly aligned hoof they may not be providing any actual help.
 
As far as her feed program - if she is laminitic due to PPID the feed you are using is above our recommended ESC+starch recommendation as well as above our fat recommendation.  The Cortaflx has an alfalfa base which is also questionable for a sensitive horse. 
 
I'm not aware of any reason the vet can't run ACTH, glucose and insulin numbers now - even though we are in the seasonal rise you can still interpret the ACTH numbers in light of that situation.  Dr. Kellon will hopefully chime in with more information on that for you.

 

 

 

 

 

 She was bred in mid-late March, so about 6 months along.

The reason she has been on chasteberry for years is that she had issues being ridden when she was in season, and we attributed
--
Marcie Fessler
Houston, Texas
September 2020


Eleanor Kellon, VMD
 
Edited

There is always some degree of insulin resistance associated with pregnancy, which is also why pregnancy is a high risk period for laminitis. Pregnancy also changes other hormones but the ACTH peak is in early pregnancy . https://www.sciencedirect.com/science/article/abs/pii/S0034528817300723

Her nutrition is critically important right now, both for her own health and the development of the baby. It's very different from nutrition for a nonnpregnant adult.

Looking ahead, I would suggest your vets consult the Rood and Riddle practice in Kentucky for advice on pergolide in pregnant mares. It would also be prudent to look into not only frozen colostrum but also a nurse mare.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kirsten Rasmussen
 

Hi Marcie,

Attachments are not supported her so we will ask you instead to create a Photo Album in the Case History sub-group,then upload your images there.  

See these links for Instructions, and click on the embedded links for more information:
https://ecir.groups.io/g/main/wiki/How-to-Make-a-Photo-Album
https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions
https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions
https://ecir.groups.io/g/main/wiki/Case-History-and-Photo-Instructions-for-Tablet-and-Smart-Phone-Users

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


Marcie
 

Dr. Kellon, thank you very much for the information. I would love to get your advice on her nutrition. She is right at 6 months gestation.
--
- Marcie
Houston, Texas
September 2020 
Case History:  https://ecir.groups.io/g/CaseHistory/files/Marcie%20and%20Joy
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=253525


Eleanor Kellon, VMD
 

Hi Marcie,

You'll need an analysis of your hay if you don't have one. Send it to me as soon as you get it. In the meantime, switch her off that grain and onto rinsed, soaked, rinsed beet pulp with some Stabul 1 (from Tractor Supply or Chewy.com) on top as a flavor enhancer .  In short, follow the emergency diet.

Phenylbutazone should not be used in pregnancy, and definitely not twice a day https://thehorse.com/126909/nsaids-and-pregnancy/ .  Need to focus on getting her diet tight, investigate pergolide, proper trim  (photos please) and try boots for comfort.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001