My 3 horses are all kept in a partially covered corral together. They are all from the same ranch in the west and related. I lost one from this same ranch due to possible complications from IR and laminitis about 6 years ago.
My 8 yr-old Tennessee Walking Horse mare, Prize, his half sister, was diagnosed as being IR in early February. I've been trying to follow my veterinarian's advice and combining it with what I have learned from this group.
All of them are having their Bermuda hay soaked and fed in slow feeder nets. I still have a lot of alfalfa, so am feeding about 10 lbs. per day to the three of them along with the 40 lbs. of Bermuda. I sent the hay samples to the Equi-Analysis today. Prize seems to be improving. Next blood test is mid-April.
I have been giving all 3 horses vitamin E in the powdered form for equines because one of them had been diagnosed with a 50% chance of EPM and his blood test showed zero Vitamin E in his system. He has recovered from the EPM and is sound. I've been adding a little corn oil to their daily supplements to help with the E absorption. My veterinarian advised giving no oil to Prize. Am I wasting my money feeding the Vitamin E in powdered form? Is it ok to add a couple of teaspoons to their supplements to mix with the E?
--
Sara Goodnick Arizona, 2016 chttps://ch.ecirhorse.org/case-history.php?id=49

Hello Sara and welcome! We're very sorry to hear about your horse.  And a huge thank you for getting your case history started, it really helps. Could you pass on what Prize's test results were? And the reference ranges would be very helpful.
I do have a few things I would like to mention that I saw regarding her diet. 

I know you weren’t asking about feed, but I want to point out that Nutrena Special care is not on our approved safe feeds list. Most feed other than what’s on our list is too high in starch and sugar and (usually) too much fat for a metabolic horse, I would discontinue that right away. One of our members analyzed this product and at that time it tested over 18% sugar and starch alone! Most feed manufacturers don’t test each batch so it could be way more or less every time you feed it.  I will include the safe feeds list link below, but it’s also included in your message.

Safe Bagged Feeds.pdf (groups.io)

Also, it would make better sense on your pocketbook to have your hay analyzed and balance to that accordingly, PP is a very expensive supplement that usually doesn’t have enough of any one mineral to do any good. You would save a lot of money by supplementing what your hay is lacking and feeding what you actually need. I would for sure put your horses on the emergency diet until you can have it balanced. If you haven't already be sure to get the 603 Trainer from EA, we need to have wet chemistry. 

HAY BALANCING (groups.io
As mentioned above I didn't see any of the test results in your case history for Prize, (she’s beautiful by the way), exercise is the best insulin buster we can recommend but only if she’s willing and able to move about. Sometimes we can recommend medication if diet management alone doesn’t bring the insulin down, but we advocate a tight, balanced diet first.

You are smart to phase out the alfalfa, a lot of horses get foot sore on it, and it can be hard to balance as well, having high protein and calcium.

We also have NOT found that insulin wise actually works, I think it comes with a money-back guarantee if it doesn’t work for you, as a group we have not had much success with it.

Review of InsulinWise Study.pdf (groups.io)

Now on to your question regarding vitamin e.

Vitamin E in oil (500 IU per 250 lb of body weight) to replace ingredients lost when the grass is cured into hay.

Many of us use  Coca-soya from Uckele to activate the powder but you can also buy the liquid form, sometimes you need to shop around to get most bang for your buck. You can get human caps from your local store or order online. Coca-soya is safe in small amounts. You also need to feed flax and salt. More details are in the diet section.

Dr. Kellon does not recommend feeding corn oil, you can read this here.

https://ecir.groups.io/g/main/message/275327
Please let us know if you have any additional questions, and a *Hint* the search button with the magnifying glass in the upper right hand of the messages page can be your best friend!

Below is your personal introduction to DDT+E, the ECIR Group protocol found to immediately address the comfort and welfare of the metabolic equine. Bookmark this message so that during your journey you may return when you need to review more information. Blue font links in each section will lead to further evidence-based and sourced information. We include a folder specifically for vets and other pros. Links previously opened will display in grey when you return to this message.

IMPORTANT STEPS DURING ACTIVE LAMINITIS
PAIN RELIEF

• NSAIDs do not work on metabolic laminitis
  • Long-term NSAID use interferes with healing. We recommend tapering off NSAIDs after the initial days of use.
  • Icing does not work in most stages of laminitis and may make things worse.
  • If your equine's comfort level has not increased, then the cause of the laminitis has not been removed. The underlying cause needs to be addressed and the trim corrected.
  • Movement while using NSAIDs can cause further damage as pain is masked.
• For pain relief also see the use of jiaogulan and why it works.
• If the equine wants to lie down, do not encourage him/her to get up. Place feed and water where it can be reached easily without having to move more than necessary.

START YOUR CASE HISTORY. Request membership in the ECIR Group Case History site. Completing a case history is critical for in-depth, individual help. Bookmark this link. Our new Case History site is designed so that once you are registered and approved, and you have enrolled your equine, you can come in and select which section you wish to work on, returning as you need to add or update information. Please add copies of all your bloodwork results to support the details of your history. Further guidance to get you started is available in the Wiki.

In-depth step-by-step information is available from Dr. Kellon’s 2017  NO Laminitis! Conference lectures, including references to science explaining why DDT+E works. Download Acute Care for Endocrinopathic Laminitis and Tiered Management Approach to EMS and PPID on ecirhorse.org.

INFORMATION FOR YOUR VETERINARIAN.  After two decades, the ECIR Group knows recommendations in DDT+ E are often different from the equine veterinary community. We offer documentation of protocols, with deep background, evidence, and the science behind recommendations in the Veterinary Information folder. Please review and share this valuable supportive info with the team working on the ground with you.
 
INTRODUCTION to Diagnosis, Diet, Trim and Exercise (DDT+E)

DIAGNOSIS: Effective treatment requires correctly identifying the problem. There are two metabolic conditions causing laminitis that share symptoms. Equines can have one, the other, or both.   

• Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR) - can appear at any age and may have a genetic component.
  • EMS/IR is diagnosed by non-fasting testing of insulin and glucose.
• Cushing's (PPID) - increasing age is the greatest risk factor for developing PPID.
  • PPID is diagnosed using the Endogenous ACTH test or TRH Stim Test.
• BEFORE CALLING YOUR VET TO DRAW BLOOD FOR DIAGNOSIS, READ THESE DETAILS. All ecirhorse.org sections can be printed or links can be emailed. Sharing them with your vet will help ensure correct testing protocols. Request email of digital or hard copies of the test results to add to your case history.

 

• TREATMENT:
  • EMS/IR is not a disease but a metabolic type. High insulin is responsible for laminitis 
and is controlled through diet as described below, with exercise as able.
    • ECIR Group has monitored use of specific medications that can be effective to lower insulin These do not replace a correct diet which must be in place first.
  • PPID not controlled through medication can raise insulin, leading to laminitis. High insulin causes laminitis, even at a sub-clinical level.
    • PPID is a progressive disease, treated by medication.
    • When first starting pergolide some equines may experience the "pergolide veil", a temporary loss of appetite, lethargy and/or depression. Wean onto the drug slowly and use the product APF to avoid this. Jiaogulan is also used in countries where APF is not available.
    • The best long-term results are seen when in diagnosed equines the ACTH is maintained in the middle of the lab reference range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time.
  • Neither EMS/IR nor PPID is ever cured, only properly controlled for the remainder of the equine's life. If your partner is both PPID and EMS/IR then both medication and diet management will be needed.

DIET: Crucial for an EMS/IR horse to lower insulin, the correct diet also supports the PPID equine’s delicate immune system.

In active laminitis, your first step is:

• Remove/reduce the most likely trigger — high insulin — by using the emergency diet.
• The emergency diet is untested hay, soaked for an hour in cold water or 30 minutes in hot water, which removes an average of 30% of the simple sugar content. Soaking does not remove starch.
• Make sure you dump the soaking water where the equine(s) can't get to it.
• Add ground flax seed (2 ounces by weight), and Vitamin E in oil (500 IU per 250 lb of body weight) to replace ingredients lost when grass is cured into hay. Magnesium, usually deficient, is added at 1.5 grams/day per 500 lbs body weight; (1/2 teaspoon feed-grade magnesium oxide) Iodized table salt is fed, 1-2 ounces for a 1000-pound horse.
• This diet is not intended for long-term use.
  
  DO NOT FEED:
  • Grass
  • Grain
    • Bagged feeds with a combined ESC and starch of over 10%
    • Bagged feeds with starch over 4%
    • Bagged feeds with fat over 4%.
  • Sugary treats, including apples and carrots
  • Brown/red salt blocks that contain iron which interferes with mineral balancing
  • Products containing molasses
  • Alfalfa hay
    • Protein and calcium are often high, which can contribute to sore footedness and make mineral balancing difficult.  

Your ultimate goal is:

• Grass hay, tested to be under 10% ESC + starch by wet chemistry analysis. While sugar converts 50% to glucose, starch converts 100%, driving a higher insulin spike. Starch should not exceed 4%.
• Excess and deficient minerals balanced. 
• Safe feeds used only in an amount needed to carry minerals and supplements, under 10% ESC and starch, with starch under 4%, and fat under 4% or less.
  
  • Almost all commercial feeds are not suitable for EMS/IR individuals.
  • It is important to know the actual analysis.
  • Please see the Country Specific info for some safe suggestions.
• To use a "stop-gap" product until you get your hay balanced, here is a list of "acceptable" ration balancers. This is a far second best from actual balancing.

TRIM: Addressing high insulin through diet and the realigning trim are the fastest ways to relieve pain. The proper trim for any equine is one that closely hugs and supports the internal structures of the foot for improved function. This type of trim is essential for EMS/IR/PPID equines, who are at increased risk for laminitis.

• In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment. We recommend the use of padded boots rather than fixed appliances (shoes, clogs).
• You are encouraged to obtain radiographs, hoof photos, and video to include in your Case History and help guide trimming needs for your horse. Example of good images are described in the Case History site and in the main group Wiki.

EXERCISE: The equine must be non-laminitic, off NSAIDs and comfortable.

• Do not force a laminitic individual to move, or allow its other companions to do so.
• Once the equine is moving around comfortably at liberty, hand-walking can begin in long straight lines with no tight turns. When finished walking, he/she should be as or more comfortable than when the walk began.
• Before serious exercise can begin, a previously laminitis individual needs 6-9 months of correct realigning trims without relapse.

ADDITIONAL RESOURCES

For a one-on-one, visual explanation of DDT+E, see ECIR Group Films.

For members outside North America, there are country-specific folders in the files and international lists in the Wiki to help you find local resources.

ecirhorse.org will provide more in-depth information. The FAQ section answers questions many new members have.

ECIR Group Facebook page.

ECIR Group Resources, printable for quick-scan access to more information when needed, such as in your barn.

ECIR discussion group Wiki provides information on the use of the Groups.io site including how to access the Case History site, information in the start here folder, message etiquette,  and many how-to pages.

Bookmark these pages, as well as this message, for easier access when you need more info.

--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
ECIR Group Primary Response 
Horsekeeping Moderator

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821

Hi Sara,

1-2 tsp/horse of any type of oil to mix with vit E powder is ok.  You really don't need much.  I avoid olive oil because of the strong taste.  I mix it into the powder before adding to the dish so that the powder is suspended in, and coated with, the oil.  If you have a horse that tested at zero vitamin E, you might want to increase their dose dramatically.  I'm not sure by how much, but perhaps Cass or Dr Kellon can jump in.  Cass had a similar experience where one of her horses was quite low in vitamin E despite regular supplementation. 

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

Snickers' Case History
Snickers' Photo Album

Hi, Sara. 

I’m interested in seeing copies of your lab work showing zero Vitamin E. I have given Vitamin E powder mixed directly into a few teaspoons of oil for more than 10 years. Powdered Vitamin E is NOT a waste of money unless you’re not mixing it with oil before adding it to supplements, as Kirsten explained. My horses have no objection to olive oil. 

One of my mares with suspected neurological issues didn’t respond to increased Vitamin E supplementation the way my other horse did. I switched her to micellized Vitamin E, specifically Emcelle Vitamin E. https://www.qcsupply.com/emcelle-tocopherol-vitamine-liquid-1liter.html

After a few month of 2 teaspoons Emcelle/day, her Vitamin E levels reached well into the mid- to high reference range. That had the unexpected effect of greatly reducing one of her neurological issues, head-shaking. I should point out we have no evidence increased powdered Vitamin E wouldn’t do the same but might take longer. I was impatient and saw an unexpected benefit, so I’ve continued to use Emcelle with that horse while the other continues with powdered Vitamin E in oil. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator

Diamond's CH at ch.ECIRHorse.org

Cayuse and Diamond Old Case Histories pre-2023               
Cayuse Photos                Diamond Photos