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Help for IR mini please - new to group


lamarleau@...
 

Hi

I uploaded Magic’s case history, test results and pictures as requested, I hope...  So much details. I have been reading for 2 months here and loosing it.

He is IR and his ACTH is under control, but not his insulin and glucose. I started soaking his hay a month ago. Laminitis since the summer.  Living in his boots.

Since October 10, he gets 1.5% of timothy hay divided in 4 meals.  I soaked 2 of his meals for 1 hr in cold water, but since yesterday soaking them all.  My hay's ESC+starch is 10.31 so I thought we were good, guess not.

2 days ago, I stopped giving him Blue Seal Carb Guard and Purina Optimal after reading some posts. Again, thought that was safe, guess not.  Today I started Madbarn AminoTrace and he won't eat it. 😣  He gets Timothy balance cubes as a carrier. He also had Madbarn IR Supplement, but he no longer wants it.

I’m discouraged and we are not getting through this.  We had Xrays done, realignment trim was done and then trim again…. Still in pain. My trimmer is a fan or Dr. Kellon so I trust her 100%. She is coming again this week so will post hoof pictures after. He has his own little dry lot (30 x 40 ft) so he is not pushed by the others.  He goes out about 3 hrs a day but not moving much and back in his stall so he can lie down as he wishes. Thank God for COVID, I get to work from home and take care of him. 


What else can I do?  What am I doing wrong?  Poor little guy wants to live so much that I can’t let him down. He was born here and is 17 now. I see winter coming with his history of winter laminitis and now the soaked hay in freezing temperature and I am about to quite.

Help! Thank you

https://ecir.groups.io/g/CaseHistory/filessearch?q=francine+and+magic

https://ecir.groups.io/g/CaseHistory/photosearch?q=francine+and+magic

--
Francine & Magic in Quebec Nov 2020
Was a member 10 yrs ago with Shamy


Sherry Morse
 

Hi Francine,

You'll get a full welcome message shortly but a couple of things jump out - the ESC+starch on your hay is just a titch above our recommended 10% cut-off but many horses can't handle that level and your guy sounds like he might be one of them.  Soaking all hay fed to him is a good place to start.

As you've discovered the Blue Seal Carb Guard is one of the better commercial feeds for ESC+starch but it's higher in fat that we recommend and the Purina level is 9% (+/- 2%) so also in the danger zone for an IR horse.

Looking at your xrays from last month there is a lot of extra toe that needs to be removed to get Magic's trim in a better place which will help him feel better. Those results can be fairly dramatic while it may take time to see the diet changes take effect.

You're on the right track with the changes you've just started so keep looking forward.  One thing to keep in mind is that to maintain weight we recommend 2% of current body weight including ALL things fed - both hay and concentrates.  To lose weight we recommend 1.5% of current weight or 2% of ideal weight - whichever is more.  It's hard to tell from the picture you posted do you want to get weight off of Magic or maintain him where he is?

Just a quick bit of housekeeping - could you please update your links for your folders




Trisha DePietro
 

Hello Francine. I am so sorry to read about Magics story. You are in the right place.

What follows is our welcome letter that has links under each category to help bridge you to areas of more in depth information. Its a lot of information to take in. But I would focus on the diet and trim section.  There are also sections with suggestions on how to transitions horses to the newer foods. Some horses take to it quickly and others take longer.  After you read through this, we will be here to answer any other questions that come up. 

Hello 

Welcome to the group! 

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. 

 

 
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


lamarleau@...
 

Thank you!  Yes I am soaking his hay now and I weight everything.  He only gets about 5 cubes of timoty balance that I chop with his Amino Trace, camelina oil (omega & vit E) and salt.  He finally ate it during the night little bugger. He is sooo hungry!  My vet and I find him in a good shape, but my trimmer said that he could loose a bit so we have him on 1.5% of his weight.

I have another type of hay, but the ESC is higher and I think he got in bad shape because of it.  Should I try soaking this one instead of the timothy hay?  It's a mix of grass, brome and timothy.  I just uploaded the analysis: https://ecir.groups.io/g/CaseHistory/files/Francine%20and%20Magic/2nd%20mix%20hay%20analysis.pdf  

He already had a few trims since, so his hoofs are better than on the Xrays.  She had to see where we were at before giving a good trim.  Will post more pictures again this week after next trim. Usually the trim made him feel better, but the last one did not.

My vet ordered Metformin so we will start as soon as he gets it.

He hasn't been going out in 3 days.  Usually he wants to, but with the cold and the frozen ground, he doesn't ask for the door. ; ((  He walks around in the barn only.


--
Francine & Magic in Quebec Nov 2020
Was a member 10 yrs ago with Shamy


 

Francine,
Most of us have found it difficult to get our horses to eat their minerals with out using grain. Try just adding a bare pinch of your mix per meal and stick with that for weeks. The make it a slightly bigger PINCH. There are a few things that you can add as flavorings. I used to make a sugar-free peppermint "syrup". Then I found that Brewers Yeast is safe and tasty to most horses. I use the Animed brand but since you live in Canada you would probably need to hunt around for an alternative brand. It is a common additive in many equine supplements but you should be able to find a source for straight brewers yeast.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


Lorna Cane
 

Hi Francine,

Here's Animed Brewer's Yeast, if you're looking for it......

https://www.amazon.ca/Animed-Brewers-Yeast-2-Lb/dp/B000HHLRGW

Lorna
Ontario


Sherry Morse
 

Hi Francine,

As the 2nd hay you posted the analysis of is higher in ESC+ starch than the one you've been feeding I would not use that one at all. 

Thanks for getting your links fixed!




lamarleau@...
 

Update... 4 days off carb guard and optimal and he is walking and he is so happy. What a change. Also soaking all portions.  I hope it continues. Next is metformin.
So glad I read the posts on this.
Thank you 

Francine & Magic in Quebec Nov 2020
Was a member 10 yrs ago with Shamy


Eleanor Kellon, VMD
 

Great news, Francine. Many horses have trim issues that get in the way of seeing this but you are a perfect example of how quickly the correct diet can help.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001