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feed question post laminitis


Cherie Bandrowski
 

My quarterhorse mare was diagnosed in May with laminitis despite being on a dry lot (I think she ate another horse's grain but the owner denies it).  Her blood test showed she was not IR.  Currently she is being fed year old hay, alfalfa pellets and renew gold plus daily isoxuprene hydrochloride (20mg which the vet ways she needs to be on forever) and KIS trace pellets.. I have been warned that pelleted feed is inflammatory, but I want her to have enough calories especially with winter coming. I'm not crazy about her being on medication "forever" but certainly don't want her to move back into acute laminitis. Any recommendations for feed?
 
The vet also said x-rays should mild rotation in one hoof and very thin soles in both front hooves. I had glue on shoes put on 8 weeks ago and after her trim at 6 weeks had her wearing front flex hoof boots because without them she was cautious and "gimpy". Just removed the shoes yesterday when I discovered the top fasteners had been undone and as a result her heel bulbs were rubbed raw (we have been checking her feet daily.)   Packed her hooves with magic cushion and vet wrap and watching to see how she does.Thank you.
--
Cherie Bandrowski in SE Michigan 2020


Eleanor Kellon, VMD
 

Cherie,

Lab reference ranges are NOT the same thing as normals. Normal depends on the exact conditions under which the blood was sampled - e.g. normal for fasting isn't the same as normal after a grain meal, which makes perfect sense if you think about it because insulin is released in response to glucose level.

If she truly is not IR, she doesn't need a restricted diet and may  not have actually had laminitis - at least not endocrine related laminitis. Can you post the radiographs and lab work?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Cindy Q
 

Hello Cherie

Welcome to the group! I see Dr Kellon has commented on the diagnosis of your horse. That is the first part of the Diagnosis, Diet, Trim + Exercise (when ready) philosophy which is set out in greater detail in our welcome letter below.

A few comments to add on:
- "year old hay" - actually doesn't tell you what the ESC and starch are for the hay or what the mineral profile is. Many of us have found our non-IR horses to also benefit by growing more sole and have tighter hoof growth feeding along with the ECIR guidelines. 
- alfalfa pellets - some horses seem to get footy on alfalfa, even if it has low sugar and starch. Some horses do fine on it. You may want to play around with this factor.
- I have found horses with thin soles seem to love cloud pads (from Easycare) with or without the Cloud boots. Duct tape strips overlapping made into a duct tape square sheet to tape on the pads will be one way to try these without investing in the boots yet. They provide cushy comfort and these pads last rather long even for big horses.
- you can see information on safe carriers and feed to use in the meantime/to replace your alfalfa below under the DIET section (follow the link for the Emergency Diet) eg. unmolassed rinsed/soaked/rinsed beet pulp is quite conditioning and safe. Flaxseed meal can be added up to 1lb for a 1000lb horse. Many people just start with 3oz for a 1000lb horse.

Without further ado, here is the official letter:

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. 

--
Cindy and Glow - Sep 2017, Singapore
ECIR Primary Response





Eleanor Kellon, VMD
 


 

I bought a variety of pads from the HappyHoofPads company. Because they have a variety of pad density and thickness available you can inexpensively replace the pads that come inside of therapy boots and riding boots. They also sell "Equine Slippers" that you can put pads into.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Cherie Bandrowski
 

Thank you, Dr. Kellon. Here are pictures I took with my cell phone of the radiographs.  The vet is coming out Thursday for updated blood tests.  I will see if I can also get copies of the labs taken in June rather than just a verbal, "she doesn't have IR". I went to the link on "Diagnosis of PPID and IR" so I would "be on the same page regarding testing and protocols" and got confused.  The title refers to PPID and IR but the content refers to PPID and EMS.  I read under treatment in the summary that IR is not a disease.  So I'm not sure what I should ask the vet for regarding testing.


--
Cherie Bandrowski in SE Michigan 2020


Eleanor Kellon, VMD
 

Cherie,

Photos won't attach here. You have to make an album for them in the  case history group.

IR is a component of EMS.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 
Edited

Hi Cherie,
 
Please refer to your welcome message (https://ecir.groups.io/g/main/message/255127) and the email you received about joining the Case History subgroup.  That's where all pictures and PDFs related to your horse will go.  You can read more in the Wiki as well: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help.

As far as bloodwork, to cover all the bases you need ACTH, glucose and insulin.
 
If you have any questions on that just let us know.
 

 

 

 

 

 


Cherie Bandrowski
 

This is awfully complicated...
I filled out the case history, saved it and made a pdf.  Now it says, "Now that you have a pdf copy of your case history, go to your case history folder and upload it."  But I can't find anywhere that tells me where my case history folder is (if I have one) or how to make one (if I don't).

Also, I was going to upload the pictures of the radiographs but when I try I feel like I'm going in circles so I just gave up.

Help.


--
Cherie Bandrowski in SE Michigan 2020


Maxine McArthur
 

Hi Cherie
Sherry mentions this in her message below, but the links in your welcome message give you the details on how to do these things. 

To create a folder and upload your pdf (yay for getting the case history done! that's the hard part finished), you need to visit and join the Case History sub-group here: 
https://ecir.groups.io/g/CaseHistory
Scroll down and click 'join'. (or you can click 'Subgroups' in the left-hand menu on this page)

Go to the Files section in the Case History sub-group (look in the left-hand menu).
There's a blue button 'New' with a little arrow pointing down. If you click this, you'll be given a drop-down menu with some options. Choose 'new folder'.
In the window, write your name and the horse's name to identify your folder. "Cherie and nameofhorse". Click 'Add'. The folder will disappear--don't panic! 
In the search bar on the right-hand side of the page, type your name and search. Your folder will appear. Click on the name to open it.
Click the blue 'New' button, this time choose 'upload file'. In the window, click 'browse', then choose your case history pdf wherever it is in your computer. Click 'Add'.

Once you've done that, your case history will be in the folder. Deep breath of relief!
Then, so that we all can click on the link and find it easily every time you post a message, please copy the URL of your case history and paste it into your signature in the 'Subscription' tab in the main group -- where we are now (not the Case History sub-group) , hit 'Enter', then scroll down and click 'Save'. 

You can follow a similar process to create a folder in the Photos section of the Case History sub-group, then upload photos from your computer to your folder. 
All these instructions are in the 'Wiki'--at the bottom of the left-hand menu on this page. 

Let us know how you go.

--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Cherie Bandrowski
 

Thanks, Maxine, I think I actually did it!  It may not be pretty or exactly right but hopefully you can see Lexi's history and pics.

--
Cherie Bandrowski in SE Michigan 2020
https://ecir.groups.io/g/CaseHistory/files/Cherie%20and%20Lexi


Sherry Morse
 

Hi Lexi,

The link to your photo album is here: https://ecir.groups.io/g/CaseHistory/album?id=254084 - when you have a moment if you could add that link to your signature too, that will help us keep track of all your information.

The x-rays themselves are pretty terrible but she appears to have very long toes.  I don't think you were asked this, but why did the vet put her on isox and say she needs to be on it 'forever'?  Is the thought that she has "navicular" as well as having had laminitis?

Until her trim is addressed adding boots can help but putting shoes on a poorly trimmed hoof isn't addressing the underlying issue of the trim needing to be fixed. 

Having the actual labwork can help us address if she actually is IR or PPID, but in the meantime if you could post pictures of her feet (directions on the wiki of what we need) and her body we can at least offer some advice on the trim and her body condition. 



Cherie Bandrowski
 

The vet did an ADTH test it came out 39. She had a trim on Tuesday and I was going to take pictures to post but didn't have time before I had to be at work.  I am hoping to be there tomorrow and take pictures to post.
Cherie Bandrowski in SE Michigan 2020
https://ecir.groups.io/g/CaseHistory/files/Cherie%20and%20Lexi
https://ecir.groups.io/g/CaseHistory/album?id=254084


Sherry Morse
 

Hi Cherie,

Did she run insulin and glucose as well as ACTH? From your description it's more likely that Lexi is IR and for that having her diet as tight as possible is going to be key as well as getting her trim in order.




Cherie Bandrowski
 

On Thu, Oct 1, 2020 at 03:15 PM, Cherie Bandrowski wrote:
https://ecir.groups.io/g/CaseHistory/album?id=254084
I finally had a chance to add photos, some are from 9/24, some from today (1 week past trim).
 
--
Cherie Bandrowski in SE Michigan 2020
https://ecir.groups.io/g/CaseHistory/files/Cherie%20and%20Lexi
https://ecir.groups.io/g/CaseHistory/album?id=254084


Kirsten Rasmussen
 

Cherie, when I look at everything you've posted I'm thinking this is more of a trim and minerals issue rather than EMS, especially as her ACTH was not elevated.  A few more details though would be helpful: was ACTH done fasted (hopefully not, but even if it was it still looks normal for this time of year), and did you get insulin and glucose done, too?  If not, I don't think it's necessary right now, but if you did please add the results including your ACTH to your Case History.

I personally would get an analysis of the hay you are planning to feed this winter (the 603 package from Equi-analytical is ideal), and then have a mineral supplement balanced to that hay (one of our balancers can do that for you for a 1-time fee).  This should help with tightening up her hoof growth and growing unflared walls over the winter (from the photos you provided, I can see her hoof walls are flared quite high up her hoof capsule , so you can expect this to take 6-9 months minimum).  The trim is also critically important, too, but I'll leave that for someone more experienced to comment further on.

I think her body condition looks quite good for going in to winter, not fat and no ribs obviously visible.

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


Cherie Bandrowski
 

Thanks Kristin that’s very helpful. I should be getting the glucose in a few weeks (long story...). The ACTH was not fasting.


--
Cherie Bandrowski in SE Michigan 2020
https://ecir.groups.io/g/CaseHistory/files/Cherie%20and%20Lexi
https://ecir.groups.io/g/CaseHistory/album?id=254084


Cherie Bandrowski
 

Regarding getting an analysis of the hay Lexi will be getting this winter, the hay she gets (she is boarded) is from 12 different fields and the hay from each is different.  
--
Cherie Bandrowski in SE Michigan 2020
https://ecir.groups.io/g/CaseHistory/files/Cherie%20and%20Lexi
https://ecir.groups.io/g/CaseHistory/album?id=254084


 

Cherie,
I am replying late to your Oct 10 post. I just did a search for any new ECIR members living in Michigan and found your posts. I like to check for any new Michigan members in case I can offer assistance of any kind. I live in West Central Michigan and I do have a hay probe. Yes we are not exactly close.

I also have to board my horse at a farm that gets hay from 2-3 different farms. If you have a horse who needs low sugar/starch hay you can cut $ corners by sending hay samples to Dairy One or Equi-Analytical and just have ESC (sugars) and Starch tested. There will be another small fee for handling but testing just ESC and Starch is significantly cheaper than having a more complete test package done, like the 603 at EQ.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album