case history help


suzy zarek
 

I made a case history for a second pony. how do I had that to the signature? Do I just add it in the edit link popup? add a comma or what??
--
Suzy. Nebraska. 2019
Case history https://ecir.groups.io/g/CaseHistory/files/suzy%20and%20%20thor


Trisha DePietro
 

Hi Suzy. I can try and walk you through....the directions on how to upload are at the end of the case history on the last sheet. Once you have added the new file....open it and at the top you will see a link, highlight it and copy it. Then go to the signature box and copy it there. Leave your other horses case history attached to  your signature. The signature box process can be found here: https://ecir.groups.io/g/main/editsub                             
--Hope this helps. There's no need to add any commas or anything extra...just be sure to make a space after the link so that it turns the link blue and it will become live....and also, be sure to scroll down on the signature box page and hit SAVE
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


 
Edited

Hi Suzy,
Your case history link in your signature leads to your your case history folder, as it should.  You signature doesn’t specify a horse so you can add the second case history to your folder as well, making sure it’s well labeled.  

(eta:  well, actually it does specify Thor because that’s how your folder is named but rarely does anyone read the links in that detail.  If you want to do as I have done, you could write “Suzy and Thor and X” in your signature and attach your case history folder link to that.  I can show you how if you feel you’d like to do that.  You can also go here and edit the folder name to include your new horse.)

It would probably be best to create two folders inside the case history folder, one for each horse, labeled appropriately.  Because the signature link goes to the folder, rather than the file, you can make any changes you want inside the folder and the link will still take you there.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


erica busch
 

I am totally lost on uploading case history file where do I upload it to?

I am sorry I can’t figure this out.  Please know I am totally computer challenged.

 

 

Sent from Mail for Windows

 


--
EricaBusch PA 2022


Lavinia Fiscaletti
 

Hello Erica,

Welcome to the group! 

Hang in there, we'll help you get this figured out. You are not the only person who finds computers challenging but most do become more at ease as they get more familiar with the process. I checked and you have joined the case history sub-group, so that first hurdle is done. Now you need to create a folder there so you can upload Windy's case history form to it. WHile you're working on getting that uploaded, you can post a message here with some of your questions so we can start to help you out.

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 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 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.

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. 

 


--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Nancy C
 
Edited

Hi Erica

I think you are getting there. I found your folder and two documents you uploaded.  I moved them to your folder (they were running free elsewhere).

Here is the link to your folder than now contains your hay analysis and CH. https://ecir.groups.io/g/CaseHistory/files/Windy%20Case%20History

Go here and change your signature to reflect this link above vs the one you currently have in your signature.
https://ecir.groups.io/g/main/editsub
Scroll down to the signature window to edit your CH link. DON'T FORGET TO HIT SAVE!

Then come back here and give us your questions. Here is your welcome message from Lavinia. https://ecir.groups.io/g/main/message/282958


--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



erica busch
 

I am still have no idea what I am doing.

--
EricaBusch PA 2022
https://ecir.groups.io/g/CaseHistory/files/Windy%20Case%20History


Sherry Morse
 

Hi Erica,

Did you see your welcome message from Lavinia? https://ecir.groups.io/g/main/message/282958

Looks like your vet did the TRH stim test in August which is in the time frame when it is unreliable for diagnosing PPID.  Is there a reason you had that test done (excessive drinking, long hair coat, etc?) Is Windy currently on medication for PPID? 

Was your insulin testing done fasting or with just hay in front of her?  4 hours after a grain meal if not done fasting? 

Has she been tested for Lyme which is endemic in our area?  Being sensitive to touch and jumpy would have me testing for Lyme before anything else and acting girthy even when being brushed goes with Lyme as well although you can always treat for ulcers as well and see if that makes a difference with that.  

Did you have any other specific questions for us?




On Tuesday, September 13, 2022 at 10:42:10 PM EDT, erica busch <ebusch@...> wrote:


I am still have no idea what I am doing.

--
EricaBusch PA 2022
https://ecir.groups.io/g/CaseHistory/files/Windy%20Case%20History


erica busch
 


erica busch
 

 

I don’t remember why we did the test.

She is on 1 tablet of Prascend

 

I am wondering what the high manganese in the water does.  She eats dirt a lot!!!  I saw a post that high manganse is the same as high iron but can’t find it. 

 

She used to be extremely spooky.  I mean jspooking at everything and nothing. Spooking when a dog barks a mile away.   I killed off all the clover in my pasture and have reduced the extra potassium where possible. She has become way more calm. 

 

I want to balance her diet first.  Unfortunatly the hay I had tested seems to have a low RFV of 70 and she won’t eat it.  She usually eats anything. 

 

Aside.  When I want to post do I always post next to my signature?

              Do I add to my folder or my file?

              Do I post to group ?

            

It’s very hard for me to follow the stream of data.

 

Is it possible for someone to call me and walk me through it?  I am so busy with work I don’t have a lot of time to figure this out.  I have been trying for months. I will be running out of the sample of California Trace Plus and don’t want to order it if I don’t need it.

 

Sent from Mail for Windows

 


--
EricaBusch PA 2022
https://ecir.groups.io/g/CaseHistory/files/Windy%20Case%20History


Sherry Morse
 

Not sure what you mean by 'post next to my signature'.  You can send an email to the group using the 'main@ecir.groups.io' email address OR post online by going to main@ECIR.groups.io | Topics and clicking on "New Topic" on the menu on the left hand side.

If you have new information for your case history you add that to the version of the case history saved on your device and then you upload the new version to your case history folder and delete the old version.  

If you have PDF or Doc files you want to add (hay tests/bloodwork results/lab reports) those would go in your case history folder.

If you have hoof photos or x-rays you want to share or body condition pictures you would need to create a photo album in the Case History group and add those to that album once created.

If you read messages on line or change your subscription to individual emails you might find it easier to follow the messages rather than trying to read them in a digest.





Nancy C
 

Hi Erica

Here are a couple of links that may help you navigate.  Bookmark them so you can find them more easily. This is a very busy group so having a system that works for you to follow things is a good idea.

To change your ECIR subscription delivery go here: https://ecir.groups.io/g/main/editsub
You are currently on Digest which is perhaps harder to follow.  Consider Daily Summary. You can also go NO EMAIL and read only from the webpage (see next link).

To read messages in real time: https://ecir.groups.io/g/main/messages
Here you can chose to group the threads you are reading, as you are reading, so they make more sense.

When you want to post to the group go here: https://ecir.groups.io/g/main/post
Enter your post ABOVE your signature. When you hit send it will go to the group. We'd like you to keep messages on the group. If you have the questions, others do as well, and in this way we help each other.

RE: your hay.  The test in your folder indicated a high NDF which may be why she is not eating it. It otherwise would not be hard to balance but it does no good if she won't eat it.
https://equi-analytical.com/resources/glossary-of-nutrient-terms/
Neutral Detergent Fiber (NDF) – a measure of hemicellulose, cellulose and lignin representing the fibrous bulk of the forage. These three components are classified as cell wall or structural carbohydrates. They give the plant rigidity enabling it to support itself as it grows, much like the skeleton in animals. NDF can be negatively correlated with intake.

"negatively correlated with intake" is the clue here.
 
RE: Manganese. It is low in your hay. Manganese competes with iron for binding sites and can make iron overload on a tissue level worse. Your serum iron test does not reflect this.

RE: Potassium.  In some equine circles potassium is blamed for EMS.  There is no evidence of this being so.  Potassium is cleared from the body easily. https://ecir.groups.io/g/main/message/280898

Issues like eating dirt and spookiness often resolve with a balanced diet.

We are a volunteer internet group and keep communications here. I understand you are having difficulty, but hope you can refocus on DDT+E as your road map. You have a diagnosis: PPID.  You are now working on your diet.  You could continue with CA Trace or the Emergency Diet while you sort the rest out for a tighter balance. https://www.ecirhorse.org/DDT+E-diet.php

Above all, keep breathing.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



erica busch
 

Thank you Nancy. 

 

So I am looking for new hay.  What is a relatively good range for NDF?

All  the hay I’ve had in the past ranges from 51.1 to 56.2 and alot of the hay is always wasted as she picks through it and  only eats some of it.

 

My water has very high Manganese and I thought that Dr Kellon has posted that high Manganese is as problematic as high Iron because of the ferritins.    I jotted some notes which  read … Manganese can tie up ferritin and cause transferrin saturation and free Fe to rise.  I seem to remember a specific blood test is required for this diagnosis.

 

Sherry had questioned whether Windy actually has Cushings due to the time of year test was done. I don’t really remember why my vet tested her for Cushings.   I’m having blood drawn for Lyme.

 

Should I take Windy off Prascend  after the seasonal rise and retest her?  She has been tested while on Prascend and her numbers are good.

 

I am thinking that all this info is in the Forum?   

 

Sent from Mail for Windows

 


--
Erica Busch PA 2022
https://ecir.groups.io/g/CaseHistory/files/Windy%20Case%20History


Nancy C
 

Hi Erica

ADF and NDF are best under 40 and 60 respectively. Not always possible especially these days with changing growing conditions, but it's helpful to know these numbers.

If she' refusing some of the more stemmy stuff even with lower ADF and NDF, you may have other issues like teeth or even reduced chewing effectiveness due to age.

Your manganese/iron notes are fundamentally correct and the issue can be addressed through balancing the hay. Correct copper and zinc works to keep the iron and manganese absorption in check. Checking water is also advised if you suspect high Mn, which I had.  You won't know if you are iron overloaded on a tissue level, however without getting tests through KSU. They are the only ones who do what is needed. See the files for more on this. Search ferritin while in the FILES section and the info docs should come up.

I agree with Sherry about your August TMH results. Many folks who have questined their diagnosis have done as you stated -- take her off the pergolide, then retest. You need three weeks off the drug.

You can get a LOT of info off the forum by learning to use the search functions. Some instructions here: https://ecir.groups.io/g/main/wiki/1993

The little box with the magnifying glass in the upper right or top of your screen (depending on device) is a magic wand to getting info quickly.

Keep at it.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



erica busch
 

Thanks again Nancy,

 

My water has been tested and the Manganese is very high.  Iron is normal.

I filter my water for myself but there is not a filter on barn water.

 

When would be a good time to retest Cushings.  My vet says after November.

 

 

 

Sent from Mail for Windows

 


--
Erica Busch PA 2022
https://ecir.groups.io/g/CaseHistory/files/Windy%20Case%20History


Sherry Morse
 

Hi Erica,

You can stop the Prascend after the seasonal rise (November) and then you need to wait at least 3 weeks before pulling blood.




On Monday, September 19, 2022 at 09:47:06 AM EDT, erica busch <ebusch@...> wrote:


Thanks again Nancy,

 

My water has been tested and the Manganese is very high.  Iron is normal.

I filter my water for myself but there is not a filter on barn water.

 

When would be a good time to retest Cushings.  My vet says after November.

 

 

 

Sent from Mail for Windows

 


--
Erica Busch PA 2022
https://ecir.groups.io/g/CaseHistory/files/Windy%20Case%20History


 

I agree with the others, for the same reasons.  Also, the ACTH seems remarkably low for a PPID horse, even on pergolide.  My horses were all close to 20 in August and I was thrilled.  Some horses need pergolide in the fall but not otherwise.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


erica busch
 

Hi Martha,

Thank you for the reply. I will recheck in November?

Were there other replies from others besides Nancy and Sherry?

How do I see them?

Thanks Erica

 

 

Sent from Mail for Windows

 


--
Erica Busch PA 2022
https://ecir.groups.io/g/CaseHistory/files/Windy%20Case%20History


Sherry Morse
 

Hi Erica,

To see replies you can go to the website and select the thread you started (in this case that would be: https://ecir.groups.io/g/main/topic/93585631#283425).  You may find it easier to read emails if they are delivered individually or if you read them online rather than as a digest.  

You may also find it easier to figure out which replies are to you and which are to other people who have asked questions on this thread by starting a new topic.  To do that you can either send an email to 'main@...' from your email or go to the website (https://ecir.groups.io/g/main/topics) and click 'new topic' from the menu on the left hand side. 

If you want to change how you receive emails from the group you can do that by going to https://ecir.groups.io/g/main/editsub and updating your email preferences.



 

Nope.  Just the three of us, Erica.  I just wanted to add my bit about the ACTH being lower than we usually see it.  Not a big issue, just another indicator that the pergolide may not be needed.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo