Hay Analysis done and need help


joykagawa@...
 

I have just figured out how to upload my CH and Hay Analysis. Dr. Kellon, will you help me balance my hay please? Alabama is doing well, still dry lot, closed grazing muzzle when turned out, soaked orchard grass and transitioning to this year's tested orchard grass (total hay 19 lbs,/day), 9.4% ESC+Starch, so I won't have to soak, 2x4oz cold milled flax, 1 tsp Mag. Oxide powder, 4 Vit E human capsules (400IU each), Calif. Trace Plus 2x2 oz, 2x1 Tbsp noniodized salt. He seems to be urinating much more often, clear in color, I noticed in the last week but he could have been doing so before. I am wondering if Vit. E in Calif Trace plus is sufficient so I don't need the 4-5 capsules per emer. diet instructions. Also do I continue 1 tsp. Mag. Oxide? Is the iron and protein content in my hay a concern? I called my Vet and left message to make appt. for IR and PPID blood test, possible radiographs and when to do his dental work that is overdue.
--
Joy K in CA 2022
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Alabama
https://ecir.groups.io/g/CaseHistory/album?id=275576


 

Hi Joy,

Welcome to the ECIR group!  I’m sending you this welcome from the group as a response to your first post here.  There is a lot to read about our group and how it can help people care for their IR and/or PPID horses.  And there are many more worthwhile links to follow.

Thank you for uploading your case history and hay analysis.  Your hay protein is a little high, which might indicate high nitrates.  Is it irrigated?  Your hay is under 10% ESC+starch, which is good, but not all horses can tolerate even 10% so that’s something to be aware of should you have issues once you quit soaking and transition to the new hay.  Your iron looks fine.

After your hay is balanced, it may be determined that California Trace Plus isn’t the most suitable match for your hay, or it may be just perfect with the addition of a little of this and that, as guided by your balancer.  Vitamin E needs to be fed with oil to be absorbed properly so I would continue with the capsules, provided they contain oil.  Balancing will tell you whether to continue the Mg and/or how the dose needs to change.

When your vet arrives for blood draws, make sure your horse has had access to hay for at least the previous four hours and that any commotion is limited.  He should not be sedated before the blood draws, which should be done first thing, definitely before any dental work.

The increase in urine could be because he is getting more salt and drinking more.  PPID can cause an increase in water consumption and peeing but I’m not sure if either of those causes an increase in frequency.

If you haven’t already, I’m sure you will receive more advice from others.  What follows is our welcoming letter.

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


 
 


 

Hi, Joy. 
I glanced at your hay analysis. Your hay balancer will address this more specifically. In my experience, it's unusual for magnesium in hay to be more than twice calcium. Your sample is still at Equi-Analytical. I suggest you call tomorrow and ask the lab to confirm the calcium and magnesium results.  Odd things can happen to irrigated hay during drought, but it's worth double checking. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


joykagawa@...
 

Thank you, Martha for your comments. The feed store employees did not know where the hay came from. I know there is a fee involved with having someone balance my hay. I would like to take Dr. Kellon's course but after these 2 months of dealing with laminitis and all the things involved, I don't know if I have the time or energy. So I hope Dr. Kellon can advise re: fee, taking the course, or buying supplements from Uckele. Unfortunately, my horse does not like the vet and it is usually a minor rodeo in order to get a needle into his neck. I hope that does not cause false or skewed blood test results. I have given 2 x 1 Tbsp. salt since last year at least, so salt is not new in regards to a cause for increased clear urination. I appreciate all the info I have read from moderators, contributors, Dr. Kellon and all. Thank you for your efforts to help us. 
--
Joy K in CA 2022
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Alabama
https://ecir.groups.io/g/CaseHistory/album?id=275576


Eleanor Kellon, VMD
 

Hi Joy,

Please send all the feeding details and the link to the analysis to my kellon@....

As for the urination, I'll bet it corresponds to the new hay. It is very high in sodium. You don't need to add salt. This also probably means it is irrigated so definitely check nitrates.The high protein will also cause increased urination. Finally, the calcium is very low. Calcium is what normally makes horse urine cloudy.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


joykagawa@...
 

Hi Cass,
Just got off the phone with Equi-Analytical. They will retest or confirm the hay and results will be in next week.
Thank you for your help.
--
Joy K in CA 2022
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Alabama
https://ecir.groups.io/g/CaseHistory/album?id=275576


joykagawa@...
 

Thank you, Dr. Kellon. I will send you the requested info shortly. I just called Equi-Analytical back again and besides retesting or confirming the magnesium and calcium numbers, I requested a test for nitrates to be added. 
--
Joy K in CA 2022
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Alabama
https://ecir.groups.io/g/CaseHistory/album?id=275576


joykagawa@...
 

Hello Cass, Martha and Dr. Kellon,
I received the hay analysis retest on 2022-06-07 and they confirmed the original results from sample taken 2022-05-17 are still the same with Calcium .17 and Magnesium .38, Crude Protein 13.1 and Sodium .478. 
I added a Nitrate test: %Nitrate is <.01 and PPM Nitrate-Nitrogen <1. I have stopped soaking my last year's hay and transitioned to only this new, tested Orchard Grass on 2022-06-10.
I had my Vet out on 2022-06-06 and she drew blood after sedating my horse as he will not cooperate well. She said it would not skew the results. Non-fasting. Don't think she followed Cornell protocol after I emailed her the info. re: centrifuging, etc. I think she said she just lets it settle. She is mobile only and the only Equine Vet in our rural foothills. Rec'd my blood results today: Serum Insulin Baseline 74.67uIU/mL, reference interval 10-40, Serum Glucose 101 mg/dL, ref. 71-122  Plasma Edta ACTH Baseline 26.8 pg/mL, ref. 2-30. Alabama has lost weight from tape 1130# to 1070# and is moving much better. Has trotted and galloped with my other horse at moments! He had a sore RH last night but today he walking almost normal on it. Radiographs done on fronts only per Vet. She ended up doing a dental float before she left per my request and which was overdue and needed. My CH is updated, a photo and x-rays uploaded. I will email Dr. Kellon re: balancing my hay and diet. Thanks. 
--
Joy K in CA 2022
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Alabama
https://ecir.groups.io/g/CaseHistory/album?id=275576


Sherry Morse
 

Hi Joy,

Blood mishandling usually results in lower than normal results but not sure how the sedation will play into that as that can also skew results.  Hopefully Dr. Kellon can speak to that but in the meantime I would stick with the diet and great to hear that he's feeling better.




Eleanor Kellon, VMD
 

I answered Joy's private mail but as for sedation, many of the drugs in use today cause a suppression of insulin which  makes glucose spike. As they wear off, insulin spikes to compensate.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001