Help reading and understanding labs


ambermpreston@...
 

Hello and thank you for being there!!
I sure hope I’ve dotted my T’s and crossed my I’s in signing up to this group! There is much navigating and info to sort through and I sure hope I have covered all my bases…definitely not very computer savvy:)

I am here for Gus.
Please see his case history which hopefully I have linked correctly.

He has not quite been himself since last fall. Mid winter he developed a sticky coat and mane. In winters past his coat may have felt a little sticky but his mane has never been like this. I consulted with my trimmer and she recommended I test him for PPID. (She has often stated that he likely has EMS)  I have shared the lab results and need help understanding them.  

Any and all guidance is so very much appreciated! 

And please advise on how I go about getting my hay tested and then reading and understanding the results.

Thank you so much for your help!!!




--

Amber in WA 2023
https://ch.ecirhorse.org/case-history.php?id=92


Cindy Q
 

Hello Amber

Welcome and thank you for getting your case history up.

1) Sorry, I was not able to locate your test results. I will alert the volunteers group on this.

2) Haystack Special Blend has alfalfa which is not recommended here unless you are sure your horse is not sensitive to it. Further, it has higher ESC and Starch than we recommend. Safe carriers would be Triple Crown Timothy Balance Cubes, unmolassed beet pulp (rinsed soaked and rinsed so the water runs clear), Stabul 1 (most horses are ok especially in small amounts).

3) For hay testing, we recommend Equi-Analytical Labs with the 603 Trainer test. This uses the wet chemical method vs NIR (less accurate). It will give you ESC and starch figures, as well as major and trace minerals for balancing.

Looking at hay tests, I often refer back to: https://ecir.groups.io/g/main/message/217649 with the main part extracted for you below.

"I look first for the ESC and starch, because I really hate soaking hay. Next, I check the ADF and NDF - if they are higher than 40% (reduces digestibilty) and 60% (reduces palatability) I might think twice. (or I might not, depending on the hay season and whatever else is available)   Protein should be 8% to 11%; if it is 6% to 7.9%, I can deal with that with protein supplements, but any lower than 6% is out. (because the hay is likely no more than "grass skeletons", as Dr. Gustafson says). Season of cutting has a big effect on protein, as more mature hays generally have lower protein.  Whether first cut or second cut, more depends on the weather conditions and the maturity of the hay than whether first cut or second cut. (ie - poor weather conditions often make for later than optimal cutting, and more mature hay)   Proper soil analysis and fertilizing the hay fields can make a big difference in major minerals and trace minerals. I know Nancy achieved much better results from her hay grower when she tested hay, soil and got fertilizing recommendations .    https://ecir.groups.io/g/main/message/193387  

High iron and high manganese can be balanced for with reasonably palatable supplements."

There is a mineral balancing folder linked below in the DIET section, linked here as well: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing
It includes more information as well as a list of people who can help you balance once you get your hay test sorted, for a fee. The price and scope varies.

As you probably saw, alfalfa is not recommended as quite a number of horses get footy on it. Best to avoid unless you are sure your horse is not sensitive to it. You also mentioned you suspect it might be linked to the diarrhea that your horse has.

4) For IR horses, Dr Kellon often recommends psyllium husk fibre as safe thing to try. You can use the search function, I provide a link to results for diarrhea and psyllium here: https://ecir.groups.io/g/main/search?p=Created%2C%2Cdiarrhea+psyllium%2C100%2C2%2C0%2C0&q=diarrhea+psyllium 



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.   

 

  • 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.

--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response

--
Cindy and Glow (over the rainbow bridge) - Sep 2017, Singapore
ECIR Primary Response





ambermpreston@...
 

Wow Cindy thank you so so much for taking the time to share with me that wealth of information!! I will dig in!

At this point I feel my first step is to sort out what his labs are saying before I delve too deep. I am hopeful that I am just mis- reading his mild symptoms. My vet says I should not necessarily be focusing on the possibility of PPID or insulin resistance (although she did suggest follow up testing  in 6months to a year, and for this she recommends the TRH stimulation test not ACTH) For now she said to “avoid getting excessive with sugars, long trotting on straight lines, ground poles and low cavaletti, foot protection/shoes, maybe joint supplements such as Platinum Performance wellness or equithrive, or Adequan injections once in the spring”

These recommendations don’t exactly jive
with recommendations from ECIR so I’m just trying to decipher what direction I need to go!

You mentioned that you could not see the labs…is there another way I can share them outside of the case history site?

I would so appreciate a second opinion on what those labs are saying!

Again thank you so much!!

--


Nancy C
 

HI Amber

I'm not seeing the labs either. Please enter the info into the LABS section as you have with your other sections. We also ask for documentation back up, but we can start with the text info in the LABS section and then guide you with doc uploading.  Remove any personal info such as name, location, etc., for you or your vet. If you are seeing labs already loaded, please send a link to where you are.

Cindy has laid out important points to consider but please allow me to add a few more. Growing evidence is showing that EMS/IR is highly driven by breed. Mustangs are one of them. This means that higher insulin can be driving subclinical laminitis and flat soles as a result. It is often misdiagnosed as arthritis. Please understand "lab normal" or within "lab reference range" is often not normal. Gus is of an age where PPID may be a factor.

Here are a couple of articles that may help on Subclinical Laminitis and Lab reference ranges.:

https://drkhorsesense.wordpress.com/2019/03/17/all-ir-ems-horses-have-laminitis/
https://www.ecirhorse.org/FastingInsulin-LabRefRanges.php

The good news is that, based on what you have uploaded so far to your history,  you may be able to work proactively, vs the very hard work of navigating a rehab. Now is the time.

Hope this helps.
--

Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President 2023-2024

Skip and Sonny New Site CH links:
Skip:  https://ch.ecirhorse.org/case-history.php?id=1
Sonny:  https://ch.ecirhorse.org/case-history.php?id=4

Beau groups.io CH links:
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Beau

ECIR Group NEW Case History site is now open Bookmark and save this link somewhere on your device(s). https://ch.ecirhorse.org/ 
HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993