Frodo - Radiographs, Iron Panel Results - in Flare-Up


rebecca.ann.crowe@...
 

Hello,
It has been a while since I have updated or needed some support. Unfortunately, Frodo is in the midst of a laminitis flare-up and has been terribly lame for four weeks. The laminitic episode started after we began a new supplement. It may be coincidental, but I wanted to note it (supplement was immediately removed from his diet).

I have updated his case history and noted various changes since the last update, particularly in the comments. The most recent hay analysis documents are also uploaded.

The vet was also out recently, and we checked for Lyme disease and a KSU Iron Panel. I also wish we would have done a ACTH and Insulin to see how they compare to 2019. Radiographs of his front feet were taken. I will update hoof and body pictures in the next day or so.

I would love support with the following:
  1. KSU Iron Panel interpretation - noted in my case history, but I will upload actual document as well - my vet only looked at the individual tests, but in reading about Dr. Kellon's work on iron overload, it seems there is more to it. 
  2. X-ray mark-ups
  3. Other ideas welcomed!
As a side note, we have lost two of our horses (Thunder and Soozee) in the past year or so to non-hoof/IR/PPID causes. Do I need to update their files to note that?

Many thanks!
Becky

--
Becky Crowe
Luck, Wisconsin, USA
Joined July 2019
-------
Frodo
Frodo Case History
Frodo Photos: https://ecir.groups.io/g/CaseHistory/album?id=93268
-------
Thunder (2000-2021)

Thunder Case History
Thunder Photos: https://ecir.groups.io/g/CaseHistory/album?id=93211
-------
Soozee (1999-2020)
Soozee Case History
Soozee Photos: https://ecir.groups.io/g/CaseHistory/album?id=93212
-------
Hay Analysishttps://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee/Hay%20Analysis/2021_7_20_%20Crowe_Hay%20Analysis.pdf


Sherry Morse
 

Hi Becky,

So sorry you lost Thunder and Soozee.  For them if you want to leave their CH folders in place you can go to the main folder: https://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee and then click on the update button for each of their folders (it's the icon that's a square with a pen in it) and then in the description box that opens just add a note that they've passed and the approximate date.

Going to look at the Frodo updates now and will let you know if I have any insights after I've read everything over.




Sherry Morse
 

Hi Becky,

At a glance from the old hay to the new the first thing that jumps out at me is the change in ESC with the newer hay.  While it appears safe for an IR pony we have noted that some horses do better with a lower ESC and if this were my pony I would be soaking the hay to minimize the ESC effect.  I would also stop the alfalfa given his insulin numbers in the past. 

Why did you start him on the Purina Omega Match?  It's not only higher in fat than we recommend for an IR/PPID equine but also much higher than our 10% ESC+starch cutoff so would stop that immediately as well.

Since you have a current hay analysis you may want to check with one of our recommended balancers on a mix that will balance that hay rather than using a variety of supplements: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf

Posting current body photos will help us let you know if Frodo is need of a diet but you can also feel his crest and use that as a bit of a gauge of how he's doing as far as IR (along with other regional adiposity).




rebecca.ann.crowe@...
 

Thank you, Sherry! 

The soaking of hay is a bit of a conundrum. He is one of four horses in a dry lot in the summer and one of five horses and two donkeys in a winter paddock. We primarily feed netted round bales due to lack of storage space for small squares (and the added fun of winter hay soaking in Wisconsin). 

We incorporated the alfalfa on the recommendation of an equine nutritionist. With my previous research in 2019, I had all but eliminated it and honestly saw little difference in soundness when we reincorporated it. The reason for using it in the first place was to increase satiety and lessen their intake of the grass hay as the entire herd (minus my elder gelding) had become terribly obese despite following the dietary guidelines (minus soaking). I am open to the conversation about the alfalfa being a contributing factor but would like to account for the protein it adds because we have seen such a positive change in all of our animals body conditions since adding it in. I can post pics of the body condition changes that I've kept since. Are there IR/PPID-friendly sources of protein that are comparable?

I made a quick switch to the Purina Omega Match on the fly for two reasons: First, it was free of soy, added iron, wheat, and alfalfa and has flax, which I wanted to try adding in. Second, I was looking for a quick stop gap while searching for my next step. The bad news is, as you mentioned, it has some concerning traits with the higher ESC and fat. The good news is that they hate it, and Frodo will not touch it. Unfortunately, he will not eat beet pulp or flax either, so I'm back to square one in finding a carrier for my supplements. Ugh. As noted in the case history, we struggle with our entire herd with palatability of mineral and carriers. They typically with eat it for 3-4 weeks and then refuse it forevermore. Originally, I tried many of the recommendations on the provided list. I can circle back around and give it another go. 

I am open to having our ration re-balanced now that we have updated hay analyses completed. The only supplements he is currently receiving are the Horse Tech High Point Alfalfa, Uckele Poly Copper and Poly Zinc, and Immubiome Strength and Stamina.

What is the best way to get feedback on the KSU iron panel results?

I will get body pics today. Hoof pics will be delayed because he's all duct-tape-booted-up to address the abscesses and thrush.

Thanks again!
--
Becky Crowe
Luck, Wisconsin, USA
Joined July 2019
-------
Frodo
Frodo Case History
Frodo Photos: https://ecir.groups.io/g/CaseHistory/album?id=93268
-------
Thunder (2000-2021)

Thunder Case History
Thunder Photos: https://ecir.groups.io/g/CaseHistory/album?id=93211
-------
Soozee (1999-2020)
Soozee Case History
Soozee Photos: https://ecir.groups.io/g/CaseHistory/album?id=93212
-------
Hay Analysishttps://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee/Hay%20Analysis/2021_7_20_%20Crowe_Hay%20Analysis.pdf


Lorna Cane
 

Hi Becky,

Soy hull pellets make a good carrier, if you haven't tried them. They just need to be dampened, not R/S/R .

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


 

Hi Becky,
Your comments about food fussiness made me think of PPID.  You had him tested in summer of 2019 and his ACTH was quite high.  You started him on 0.5 mg of pergolide but don’t appear to have tested his ACTH since then so you don’t really know whether the pergolide you’re giving him was adequate two years ago.  PPID is a progressive disease and more pergolide is frequently needed, even with a controlling dose of pergolide to start so it’s highly likely he needs more.  A good discussion to have with your vet.
--
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


 
 


rebecca.ann.crowe@...
 

Thank you for the suggestion - any concerns about them being inflammatory?
--
Becky Crowe
Luck, Wisconsin, USA
Joined July 2019
-------
Frodo
Frodo Case History
Frodo Photos: https://ecir.groups.io/g/CaseHistory/album?id=93268
-------
Thunder (2000-2021)

Thunder Case History
Thunder Photos: https://ecir.groups.io/g/CaseHistory/album?id=93211
-------
Soozee (1999-2020)
Soozee Case History
Soozee Photos: https://ecir.groups.io/g/CaseHistory/album?id=93212
-------
Hay Analysishttps://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee/Hay%20Analysis/2021_7_20_%20Crowe_Hay%20Analysis.pdf


rebecca.ann.crowe@...
 

Thank you - yes, we have the vet out annually and as needed in between. We just chatted this week, and wondered why we hadn’t revisited those tests. It’s on the list for the next visit. He’s not well enough to trailer and because of our rural location, the cost of farm calls is prohibitive, so I have to be a bit strategic. 
--
Becky Crowe
Luck, Wisconsin, USA
Joined July 2019
-------
Frodo
Frodo Case History
Frodo Photos: https://ecir.groups.io/g/CaseHistory/album?id=93268
-------
Thunder (2000-2021)

Thunder Case History
Thunder Photos: https://ecir.groups.io/g/CaseHistory/album?id=93211
-------
Soozee (1999-2020)
Soozee Case History
Soozee Photos: https://ecir.groups.io/g/CaseHistory/album?id=93212
-------
Hay Analysishttps://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee/Hay%20Analysis/2021_7_20_%20Crowe_Hay%20Analysis.pdf


 

Becky, just a heads up that you don’t want to truck him to have his ACTH tested.  Your results will be elevated.  There are members who draw the blood themselves and deliver it to the vet or have a small animal vet draw it for you and hopefully submit it for you as well.  Your vet might be willing to increase his pergolide without testing if you agree to test the next time the vet is 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


 
 


Lorna Cane
 

Soy hull pellets?

No,we avoid inflammatory foods. They are close to the profile of beet pulp.
Note also ,they are soy hulls, made into pellets. Not soy beans.
Sometimes that can be misunderstood.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


rebecca.ann.crowe@...
 

Lorna,
Thank you! I want sure if the hulls would fall into the inflammatory category as well. Thanks for the clarification. I’ll see if I can round some up. 
--
Becky Crowe
Luck, Wisconsin, USA
Joined July 2019
-------
Frodo
Frodo Case History
Frodo Photos: https://ecir.groups.io/g/CaseHistory/album?id=93268
-------
Thunder (2000-2021)

Thunder Case History
Thunder Photos: https://ecir.groups.io/g/CaseHistory/album?id=93211
-------
Soozee (1999-2020)
Soozee Case History
Soozee Photos: https://ecir.groups.io/g/CaseHistory/album?id=93212
-------
Hay Analysishttps://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee/Hay%20Analysis/2021_7_20_%20Crowe_Hay%20Analysis.pdf


rebecca.ann.crowe@...
 

Thanks, Martha. At my request, we increased by a half dose this time last year and sustained it through spring but saw no improvement. I’ll chat with my vet and see what she thinks.
--
Becky Crowe
Luck, Wisconsin, USA
Joined July 2019
-------
Frodo
Frodo Case History
Frodo Photos: https://ecir.groups.io/g/CaseHistory/album?id=93268
-------
Thunder (2000-2021)

Thunder Case History
Thunder Photos: https://ecir.groups.io/g/CaseHistory/album?id=93211
-------
Soozee (1999-2020)
Soozee Case History
Soozee Photos: https://ecir.groups.io/g/CaseHistory/album?id=93212
-------
Hay Analysishttps://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee/Hay%20Analysis/2021_7_20_%20Crowe_Hay%20Analysis.pdf


Eleanor Kellon, VMD
 

The alfalfa causes problems in a large percentage of metabolic horses. I would definitely stop it.  If the supplement was the problem, he would have improved by now. Toes can come back more going by your films but it's not a major issue.  He is obviously a chronic case but something is triggering this.  He may need to be isolated and fed separately until you can get on top of this.

He is mildly iron overloaded. Should be easily managed with correct diet balancing. Another mineral issue you have is that your diet is very heavily calcium overloaded. I would start him on 10 grams/day of magnesium ASAP.

For a palatable and safe mineral carrier, try Stabul 1. You can order from Chewy.com.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


rebecca.ann.crowe@...
 

Thank you! 

Will you please remind me the proper calculation with the iron results?

We will omit the alfalfa. Is there a good protein substitute.

As a side note, I noticed that the Stabul 1 has alfalfa and soy meal. Is there an acceptable amount? I am overwhelmed with decision making and knowing what is okay, when. 

I appreciate it - thanks!  
--
Becky Crowe
Luck, Wisconsin, USA
Joined July 2019
-------
Frodo
Frodo Case History
Frodo Photos: https://ecir.groups.io/g/CaseHistory/album?id=93268
-------
Thunder (2000-2021)

Thunder Case History
Thunder Photos: https://ecir.groups.io/g/CaseHistory/album?id=93211
-------
Soozee (1999-2020)
Soozee Case History
Soozee Photos: https://ecir.groups.io/g/CaseHistory/album?id=93212
-------
Hay Analysishttps://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee/Hay%20Analysis/2021_7_20_%20Crowe_Hay%20Analysis.pdf


Kirsten Rasmussen
 

Hi Becky,

The only calc to do is Transferrin Index:
(Serum Fe ÷ TIBC) × 100

For information on iron overload, see this link:
https://ecir.groups.io/g/main/files/Iron,%20Iron%20Testing,%20Iron%20Overload/Iron%20-%20Dr.%20Kellon%20on%20Iron%20Overload.pdf

Specifically this message on normal ranges:
The tests in an iron screen are:
1. Serum iron - the amount of iron circulating in the blood. This primarily reflects the amount the horse is absorbing from his diet. Upper normal is between 150 and 190 for most labs.
2. TIBC - Total iron binding capacity. This is a measure of transferrin, a protein in the blood that binds and carries iron. Free iron is very damaging to the tissues. TIBC normally increases as serum iron increases. Like serum iron, it can't be used as a measure of body iron load. KSU has reported seeing them as high as 455, but I have several higher than that, in both the normal and the IR group. Think of it as a "reaction" to the presence of iron in theblood, like insulin going up is a "reaction" to blood glucose.
3. TSI - Transferrin saturation index. This is a calculation, iron divided by TIBC x 100, that shows how much of the transferrin protein is saturated with iron. TSI does correlate with body iron burden, and also with how much iron is being absorbed. Upper normal is somewhere in the low 40s.
4. Ferritin - This is the protein that binds iron in the tissues and has been proven in horses to correlate very well with body iron burden. It can also be elevated with inflammation, malignancy, severe trauma, etc. but in that case the serum iron and TIBC go down. Horses in the IR study that were actively laminitic and showed the pattern of high ferritin but low iron and TIBC were not included so that there would be no false elevation of ferritin values. Serum ferritin of normal horses in Dr. Smith's study showed a mean of 152 with a standard deviation of 54.6, which means 152 was the average and most (95%) of the horses fell within a range of 97.4 to 206.6. My normals were similar, 139 plus or minus 43.9.
If the supplement contributed to this laminitis, you might have to do more than just remove it.  To stabilize Frodo again,  try separating him and soaking his hay for a few weeks.  My experience has been that after a laminitic flare-up I have to do more than just remove the apparent trigger for my horse.  Perhaps this is because my horse's 7% hay was borderline for him when fed dry, so soaking it makes the biggest difference.

I would separate and soak anyways if Frodo is still in pain.  All it takes is an electrified string and some push-in posts (or wood posts in buckets of solidified concrete) between him and his buddies, or some round pen panels if you have them. 

Also, following up on the ACTH testing.  Generalization: most IR horses are ravenous and not picky eaters.  If he is being picky then maybe that's another sign of PPID having a role in this.  Interesting that the rest of the herd is picky, too!

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


Kirsten Rasmussen
 

Re: picky eaters.  They are more likely to eat their supplement if they are hungry...so 24/7 access to hay probably means stuffed full stomachs 24/7.   I'm not suggesting starving them for extended periods, but limiting hay intake for few hours (4?) before offering supplements might help with finishing their minerals before they go back to the "buffet".  Can you block them off from the round bale for a few hours once a day?

I do sympathize.  Dealing with picky eaters is frustrating.  :(

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


rebecca.ann.crowe@...
 

Kirsten,
Thank you for the suggestions and extra info on iron results. 

He is currently separated - day 3, and he’s getting very grumpy 😬. He’s still refusing any beet pulp and supps or meds despite not having the usual round bale buffet. He’s currently getting his hay in a small net and usually has at least a few hours before the next meal.  I’ll begin soaking his hay when I get home tonight and see if that helps us turn the corner. If not, we’re at square one with our mystery. We do have a herd full of metabolic and lameness issues and haven’t been able to sort it out over the last seven years. 

Thanks again,
Becky 
--
Becky Crowe
Luck, Wisconsin, USA
Joined July 2019
-------
Frodo
Frodo Case History
Frodo Photos: https://ecir.groups.io/g/CaseHistory/album?id=93268
-------
Thunder (2000-2021)

Thunder Case History
Thunder Photos: https://ecir.groups.io/g/CaseHistory/album?id=93211
-------
Soozee (1999-2020)
Soozee Case History
Soozee Photos: https://ecir.groups.io/g/CaseHistory/album?id=93212
-------
Hay Analysishttps://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee/Hay%20Analysis/2021_7_20_%20Crowe_Hay%20Analysis.pdf


Eleanor Kellon, VMD
 

On the weight issue at least there's really no mystery. Too many calories. You need hay analysis to see how calorie dense your hay is and a scale to accurately weigh what you are feeding. Exercise is the other part of the equation.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


rebecca.ann.crowe@...
 

Yep! Thank you.  While he is still has a bit of a crest, his weight is much better than it was last fall. We have had a few hay analysis reports done on what we are currently feeding.

When he was on alfalfa, that was weighed very carefully, and to the best of our estimates, they were going through the netted round bale at an appropriate pace — much more slowly after increasing protein with alfalfa. I’d like to find a good substitute for that reason.

While he’s separated, the grass hay is being weighed and netted as well.  
--
Becky Crowe
Luck, Wisconsin, USA
Joined July 2019
-------
Frodo
Frodo Case History
Frodo Photos: https://ecir.groups.io/g/CaseHistory/album?id=93268
-------
Thunder (2000-2021)

Thunder Case History
Thunder Photos: https://ecir.groups.io/g/CaseHistory/album?id=93211
-------
Soozee (1999-2020)
Soozee Case History
Soozee Photos: https://ecir.groups.io/g/CaseHistory/album?id=93212
-------
Hay Analysishttps://ecir.groups.io/g/CaseHistory/files/Becky%20and%20Frodo%20-Thunder%20-%20Soozee/Hay%20Analysis/2021_7_20_%20Crowe_Hay%20Analysis.pdf