Cushings


Melissa Starks
 


I have a 22 yr old mustang recently diagnosed with cushings. I was being proactive and had him tested because of age he had no signs and he came up positive on both spectrums what ever that means.  His test on his organs came back fine. He is not IR but has high chances eventually because the size of his neck. He's a big guy standing at 16.1 and a half draft roughly close to 1300 lbs and a easy keeper.  I have him eating 20lbs of hay a day mostly Timothy occasionally mix but very little. He gets 11lbs at night 9lbs in the morning both times in a slow feed net. He gets peroglide in the morning at night he gets 3/4 qtrs of a lb of stable mix to mix with his platinum performance, salt, vit e, msm,  silver Lining immune support. My vet wants me to add more protein and since he gets the platinum she said it would be fine to add alfalfa to his hay. She said 6lbs if alfalfa and subtract 6lbs of grass. Should I be soaking the alfalfa  or does that deplet the protein in it? He's still very active in the arena and trails. I want to keep him as healthy as possible.  Any info and suggestions appreciated.  Thanks
Melissa in NV 2022


Eleanor Kellon, VMD
 

Soaking alfalfa won't help with laminitis aggravation because it's not the sugar level doing it. He may or may  not need more protein  - only a hay analysis will tell. We also need all your actual lab results in a case history to be much help. I have no idea why she thinks getting PP means you can add alfalfa.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Hi Melissa,
I’m sending you our formal group welcome which will introduce you to lots of information you might find useful for caring for a PPID horse.  Plenty here on insulin resistance as well as the two often go hand in hand.  Before the welcome, I will try to answer some of your concerns.  Those I don’t get to, I’m sure someone else will.

We focus on the acronym DDT/E, which stands for diagnosis, diet, trim and exercise.  Could you please post your bloodwork results with your case history?  Not everyone has the same idea of what ‘normal’ is but we can help sort that out.  It’s possible the vet did a TRH stim test which measures ACTH both before and after stimulation by the hormone TRH.  The two results might be ‘both counts’.  Insulin resistance is quite common in thriftier breeds but his size might be protecting him there.  We would like to see those results also as it’s quite common that they aren’t interpreted accurately.

There’s a lot to ‘digest’ in your diet but I’ll make some comments.  We advise getting your hay tested, both to be sure it’s appropriately low in sugar (ESC) and starch and also so that you can accurately mineral balance it.  This requires a wet chemistry test.  My own PPID horse showed no signs of being IR but balancing his hay made a huge difference in the quality of his hooves and most likely other areas as well.  Metabolically challenged horses need much more attention to their diet than those who aren’t, although they would all benefit from the same plan.  IR horses can become footsore on alfalfa but, if you haven’t noticed that, it probably isn’t an issue, just something to keep in mind.  No need to soak alfalfa as it’s already fairly low in s/s.  We don’t know the reason it causes footsoreness.  There are a few diet items we don’t generally recommend but probably aren’t causing him issues.  We can get deeper into that once we see his bloodwork.  The salt and vitamin E are important as well as flax, which I don’t see.  The PP would eventually be replaced with a mineral mix suitable for his hay.

What follows is our formal welcome!

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 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. 

--
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


 
 


Melissa Starks
 

I don't believe the suggestion of alfalfa had anything to do with him having cushings. I believe she just wanted him  to have little more just because he's older and still very active  It's more of my concern what's best for him . He isn't IR and I want to keep it that way and he's never had laminitis also. He's been pretty healthy.. I'm working on hay analysis hopefully get it tomorrow.  Also forgot to add he's on Collegan which is 18grams of protein daily.
Melissa in NV 2022


 

Hi Melissa,
I wanted to clarify that insulin resistance is genetically determined and not something one can prevent.  Whether or not it becomes problematic for the horse is something we do have a lot of control over.  
--
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


 
 


Melissa Starks
 


Hay report pics have been posted to case history.  Please let me know what you think.
Melissa in NV 2022


Sherry Morse
 

Please update your signature with your photo album link: https://ecir.groups.io/g/CaseHistory/album?id=271546 which is where you posted your hay test.  Do you know if this test was done NIR or wet chem?




 

Melissa's hay analysis is in her photo album, here:
https://ecir.groups.io/g/CaseHistory/album?id=271546 

Melissa, 
Having a sound estimate of Nevada's actual weight is important to determine optimal nutrition for his age and level of work. When you say Nevada is very active in the arena and on trails, could you explain a bit? How many days a week is he in work? How long does he work each day he's in work? How many miles on the trails?  How did you determine his weight? Do you have access to a scale? Some of us have found that weight tapes aren't very accurate. Taking detailed measurements using height, heart girth, and length as described in the weight calculator may be more accurate than a single heart girth measurement.

Here's the link to the weight calculator. https://ecir.groups.io/g/main/wiki/Home#Case-History-Help You can find the calculator under Case History Tools
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Melissa Starks
 

I do not know.
--
Melissa in NV 2022


Melissa Starks
 


--updated case history
Melissa in NV 2022


Melissa Starks
 

Updated case bio
--
Melissa in NV 2022


Sherry Morse
 

Hi Melissa,

Please add the link to your photo album to your signature.  To do that:

1) Go to this link to amend your auto-signature: https://ecir.groups.io/g/main/editsub

2) Look at the bottom of that page for the window where you typed your name and location in.

3) Add the link to your photo album on the line below your location (https://ecir.groups.io/g/CaseHistory/album?id=271546 is the link)

4)make sure you make the link "live". Adding a space after it or hitting enter on your keyboard will turn it blue.

5) IMPORTANT: Scroll to the bottom and hit SAVE!

You'll do the same thing with your case history folder once you have created that.




Melissa Starks
 

Already did.
--
Melissa in NV 2022


 

Hi Melissa,
I’m guessing there’s some confusion because I don’t see a link in your signature to your case history files/photos.  If you give us a link to them, we can help you get them into your signature.  And with that information in hand, we can review them and comment.

Thanks!
--

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


 
 


Melissa Starks
 

https://ecir.groups.io/g/CaseHistory/album?id=271546
Dos this work? If not I have no clue how.

Melissa in NV 2022


 

Yes, Melissa, that’s the correct link to your photo album but you need to add it to your signature, as Sherry described a few posts back, so that it appears to everyone reading your posts. 

You’ve replied to several requests for information that you’ve already updated your case history (which is not the same as your photo album) but we can’t find any evidence of a case history you’ve posted.  I would suggest you go back and reread the welcome I sent you on 1-6-22 to see if you’ve overlooked anything.  We are a relatively small group of volunteers attending to the needs of many people looking for advice.  If you are in need of our input, please post a case history, add a link to you signature and let us know your concerns.  To date, you have posted a photo of Nevada and two photos of a hay report but you have not answered our question about what type of testing was done on the hay.  

We are quite different from the average FB group in that you will be receiving replies from trained volunteers, supervised by a scientifically oriented veterinarian, who is very invested in studying IR/PPID, rather than a group of friendly participants who may or may not have the latest advice.  When you join with a question, we jump into action, in an effort to help your horse.  Your horse obviously can’t speak to the issues so you will need to clue us in.

--

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


 
 


Sherry Morse
 

Please see https://ecir.groups.io/g/main/message/272519 for specific directions on how to add that link to your signature.  If you have any issues please let us know.




Melissa Starks
 

I believe it worked.
--
Melissa in NV 2022

https://ecir.groups.io/g/CaseHistory/album?id=271546


Melissa Starks
 


--
Melissa in NV 2022

https://ecir.groups.io/g/CaseHistory/album?id=271546


Sherry Morse
 

Perfect (and I checked on the website and the link is live so not sure why it's not in the message).