Topics

Case histories uploaded, photo folders uploaded, questions?

Kate Triplett
 

I have uploaded my initial case histories for both mares. This morning I took the (considerable) time to collect and (hopefully properly) rename photos and xray images for Lacey into her xrays and hoof photos  folders.

How may I tell if these have been accepted? Is there something else I need to do?

NOT seeing anything for the new case history uploads in the case history subgroup messaging..... (and I need to find the signature thing again and update to reflect BOTH mares)
--
Kate and Bunny (Irish Draught broodmare PPID) and Lacey (Irish Draught Sporthorse broodmare IR)
Homesick Angels Farm, WA USA
Joined August 2019
https://ecir.groups.io/g/CaseHistory/files/Kate%20and%20Bunny

Kate Triplett
 

Updated signature, hopefully this will do it!
--
Kate and Bunny (Irish Draught broodmare PPID) and Lacey (Irish Draught Sporthorse broodmare IR laminitis
Homesick Angels Farm, WA USA
Joined August 2019
https://ecir.groups.io/g/CaseHistory/files/Kate%20and%20Bunny
https://ecir.groups.io/g/CaseHistory/files/Kate%20and%20Lacey/Lacey%20Case%20History%20Form.pdf
Lacey feet https://ecir.groups.io/g/CaseHistory/album?id=95212

Eleanor Kellon, VMD
 

Hi Kate,

Good job!

First, that ACTH is normal for a pregnant mare. No need for the Prascend and she would need to come off it later anyway. Unfortunately, insulin resistance is also normal for pregnancy, and will get worse later on. It can be an issue for any mare but if the breed is already predisposed, as yours is, laminitis risk is higher.

Pregnancy is not the time for weight loss but it will be important going forward not to overfeed them for what their target nonpregnant weight should be. Also very, very important to get the entire diet's protein and mineral levels carefully evaluated and balanced to support normal development of the foals.

The first step is get rid of the alfalfa. Although sugar levels are low, it often aggravates laminitis. The mineral profile is also almost impossible to balance.  Look for a nice grass hay with a  protein level of 11 to 12% and sugar (ESC) plus starch no higher than 10%. Once you find one, have the minerals tested for balancing.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

 

Hello Kate,
Yes I found the case history folders for both of your horses and took a quick look at the case history documents you uploaded into each folder . GOOD JOB!

Now I have to tell you that there is one minor hiccup with your signature. It isn't hard to fix and you will have to fix it yourself. You did a nice job with your signature except that you used direct links to each horse's case history document. What you want to put into your signature is a link to each horse's FOLDER.  This folder is a holder for all type of documents you may want to store inside of it, hay tests, lab test results, and of course the case history. So you want the links in your signature to be for each folder. To fix this open just one horse's folder (do not open the file inside) and copy the location of the folder from your browser. Then move back to the main group, click on Subscription, then select edit subscription. You can delete the "file" link and insert the "folder" link. Go to the bottom of the page and "SAVE".

If my directions aren't clear enough then ask for help with your signature, but ultimately YOU have to be the editor for your files, folders and signature. If anyone else edits them for you then you will not be able to do your own edits.

Back to your case history files: I do not see any mention of blood tests for Insulin, Leptin, or Glucose. Were any of these additional tests done on your two horses? Since the Lacey in currently experiencing laminitis she should have additional blood tests done. Her laminitis may be caused by "Insulin Resistance" which means that her diet may be causal in the laminitis. Please go to our website, 
https://www.ecirhorse.org/
and read the info under DDT&E. I cannot emphasis enough how important this information is for you to read.

Welcome to the ECIR Group
The ECIR 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, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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. 

 

--
Bonnie Snodgrass 07-2016

ECIR Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album

Kate Triplett
 

Dr. Kellon and Bonnie,

Thank you!

First things first - I am awaiting delivery of hay probe and sampling materials. One I have that I will be having testing done on our hay - yes it's alfalfa and yes we have a BARNFULL, two full loads, lovely stuff all of the horses have done well with since it arrived in late April. Grass in this country is lousy from a nutritional standpoint, and usually high in sugars to boot - timothy is out as I'm violently allergic to it. Once I have test results back, (doing both dry and soaked, rinsed samples) I will do a best case balancing for minerals etc and we will proceed. wit eight others to feed and care for, the hay we have is the hay we feed - I have built TWO hay soaking rigs....

Bunny has ACTH levels of 64.2 (a full third higher than high normal) and Lacey had 30.0.

Lacey's laminitis "could be" a bounce off the grass as we had a serious growth spurt due to weather changes, in addition to pregnancy. She also had a bad subsolar abscess, so non-weigh bearing on LF for a couple weeks - definitely could have been a factor in her laminitis. Rotation did not show that awful on the rads, but we are dealing with getting her back. Lacey is responding beautifully to the Emergency Diet, has lost the blubber she put on at the time of maternal recognition, and is doing well.

Bunny - well, Bunny is hog fat. When maternal recognition hit her, she exhaled and gained a hundred pounds seemingly overnight. Fat pads on ribs, and a cresty neck that was alarming enough to me that I requested the blood draw at the 90 day ultrasound - boom, high ACTH. Her doctor wanted her on 0.5mg Prascend for three weeks, then retest and see what we have. I am hoping with HER emergency diet and the medication, metabolic supplement etc, and light exercise that we can get her back down to a reasonable number. Her feet are not showing ANY signs of issues, and I will keep those toes pulled back as a safety measure. I don't know what the ACTH bodes for her going forward, but for this winter we will make the best that we can of it.

FWIW I have pored over the ECIS website for a couple weeks now - and introduced Lacey's new vet (he's the sports medicine guy, not her repro vet) to the site as well. He is duly impressed.

Both mares are officially dry lotted for the duration this winter, and we pull all of them off pasture over the winter in any case. Too much rain here.

I hope that I have finally gotten the case history files in better shape. Still fumbling with signature but I think I may have it too!
--
Kate and Bunny (Irish Draught broodmare PPID) and Lacey (Irish Draught Sporthorse broodmare IR laminitis)
Homesick Angels Farm, WA USA
Joined August 2019
https://ecir.groups.io/g/CaseHistory/files/Kate%20and%20Bunny
https://ecir.groups.io/g/CaseHistory/files/Kate%20and%20Lacey
Lacey feet image files https://ecir.groups.io/g/CaseHistory/album?id=95210



Eleanor Kellon, VMD
 

I'm not sure if you missed this but Bunny's ACTH is within normal for a pregnant mare. I can send your vet the research if you like.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Kate Triplett
 

Dr. Kellon, how may I send you the vet's info privately? I have not found a private messaging function here as yet.
--
Kate and Bunny (Irish Draught broodmare PPID) and Lacey (Irish Draught Sporthorse broodmare IR laminitis)
Homesick Angels Farm, WA USA
Joined August 2019
https://ecir.groups.io/g/CaseHistory/files/Kate%20and%20Bunny
https://ecir.groups.io/g/CaseHistory/files/Kate%20and%20Lacey
Lacey feet image files https://ecir.groups.io/g/CaseHistory/album?id=95210



Eleanor Kellon, VMD
 

My gmail address is drkellon "at".
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Lorna
 

Hi Kate,

For sending  private message - hit Reply .
Under the message page it will say, left to right, Reply to Group, Discard,...and over in RH corner Private.

--

Lorna  in Kingston, Ontario, Canada
ECIR Moderator
2002
https://ecir.gro
ups.io/g/main/files/PPID%20and%20IR%20Success%20Stories/Success%20Story%20%233%20-%20Lorna%20and%20Ollies%20Story.pdf


 

Kate Triplett
 

FIrst, thanks to Dr. Kellon for sending over the research paper for my repro vet, it is much appreciated. She (my vet) said to me last night that she had consulted with a theriogenologist before starting the mare on Prascend; he had advised  that there is "a normal rise associated with pregnancy, but (that it is) later in gestation". She's taking it into her next meeting to add to the discussion.

As an aside - I did a search on the io group for Irish Draught - and lo and behold, friends started popping up from the waybacks (the Irish Draught world is a very small place). Of particular interest to me is this purebred ID mare, whose symptoms are identical to our Bunny's.
Link to Dr. Kellon's conversation with mare owner is https://ecir.groups.io/g/main/topic/1002245#31076 You noted that this mare was likely not insulin resistant, but insulin SENSITIVE, which could point to a whole raft of other issues like EPSSM.

Can you expound on what bloodwork you would have us order to get a little closer to the truth for Bunny? We will continue the trial of Prascend and see what the next blood pull gives us for ACTH, in another week. I can order any other recommended tests at that time, if I know what to ask for!

For now, Bunny's on the emergency diet and very restricted at that - I weigh her hay dry and then soak and drain, then rinse and  drain again. Minimal soaked-rinsed-drained beet shreds as carrier for her metabolic supplement, salt and Vitamin E. In just over a week of diet management (read that she thinks she's starving) my husband can already see her losing blubber. The redmond salt has been removed, as it evidently (per searches here) has iron out of bounds, too bad as the other minerals are what they crave.Once I have my hay sampling kit I can get that tested (both dry and soaked) and will be able to find out where we are on mineral balance.
 
I know your initial concern was that the Prascend may be totally un-necessary (Please God???) but I'd like to make our horse whole if possible - she's only ten, one of the best mares in the breed, and her first filly is pretty spectacular. Bred back for a full sibling, on the last dose of frozen in North America for that deceased stallion.
 
Thank you so much for your caring attention - may many blessings flow your way!


--
Kate and Bunny (Irish Draught broodmare PPID) and Lacey (Irish Draught Sporthorse broodmare IR laminitis)
Homesick Angels Farm, WA USA
Joined August 2019
https://ecir.groups.io/g/CaseHistory/files/Kate%20and%20Bunny
https://ecir.groups.io/g/CaseHistory/files/Kate%20and%20Lacey
Lacey feet image files https://ecir.groups.io/g/CaseHistory/album?id=95212
Bunny image files https://ecir.groups.io/g/CaseHistory/album?id=95239