How can I best help Bristol?
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Rebecca and Bristol
I am in need of this group's expertise. I'm an "old" member with a new horse. I adopted Bristol four months ago when his owners were going to dump him at the animal shelter. He is 25 years old and is PPID/IR. I had a PPID/IR Welsh pony named Princess who lived to the age of 37 because of all that I learned from this group, so I thought I might be able to help this horse. I knew nothing about Bristol but my vet has been treating him for the past three years so I do have some background info and tests/x-rays.
He is currently free-fed Timothy hay and Mountain Sunrise Bermuda pellets. He's a TB and his BCS is about 4.5; he's lean and the vet says he's at a perfect weight. (I've just cored the latest load of hay to have it tested.) After many trials of various carrier feeds (including the Stabul 1 line), I've settled on TC Lite--but even that is hit or miss; he gets approx. 0.4 lbs. per day at most, if he eats it at all. My biggest challenge is getting him to take his Prascend consistently. I currently put it in vegan capsules and put it in his feed (I have tried almost everything). Syringing anything is not an option. I am beyond frustrated--if only he'd meet me halfway! He's in Softride boots 24/7 in a dry lot with his buddies. I'm able to separate him but if his BFF is not close by he gets frantic. He's very lame on his right front (head bobbing lame and painful to watch--a 4/5?). At the last visit with the vet on 10/5, she recommended euthanasia since he's been dealing with this for over 2.5 years. He moves around a lot even though he is so lame. I have a great barefoot trimmer but she recommended an out-of-state farrier that specializes in tough cases like Bristol and he really tailors the "footwear" to the horse and x-rays. He's pricy but I can afford it if I can get on his schedule. Here's my dilemma. If we can get him more comfortable with trims and whatever the farrier can do, and offer him a properly balanced diet--which he may or may not eat, will it all be in vain if he won't take his Prascend consistently? Will I be throwing good money after bad? Is it cruel to keep Bristol going with his current level of lameness? Should I confine him so he doesn't move as much? I have uploaded x-rays and filled out the case history with as much info as possible. Any guidance would be much appreciated. Thanks in advance! Rebecca and Bristol (PPID/IR) Feb. 2009, Southern California Bristol Case History:https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Bristol Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=280743 |
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Hi Rebecca,
Welcome back and thank you for taking this guy on in hopes of improving his comfort. I’m sure you’ll get feedback from others on this. TBs are not generally IR at baseline but many have elevated insulin when the PPID is not well controlled. His ACTH jumps around a bit but I don’t know if that’s due to changes in his pergolide dose or not actually ingesting the drug. We don’t generally recommend pergolide in solution because of its decreased stability, however you can purchase a flavored pergolide in oil from compounding pharmacies, which I have used on occasion and others here have as well. You might try offering him several different flavorings in TC Lite to see if he likes one more than the other. Uckele sells flavored syrups but I’d be inclined to ask the pharmacy if there’s a way to trial their flavorings in oil. If he lights up at a particular flavoring, then try adding some of the pergolide compounded flavored oil to his meal. I general just poke the capsule into the mouth with my fingers but it sounds like Bristol might not go for that either. His trim is in desperate need of new guidance. He has a lot of bony changes In his feet that are not going to be reversible but the fact that he’s moving around now is in his favor. I’m going to attach a copy of our Group Welcome, even though you’re not actually new. We change things occasionally and you may have forgotten a few things.
Welcome to the group! 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 etiquette, what 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:
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. EXERCISE: The 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 |
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Hi Rebecca,
You could also consider Cabergoline injections instead of Prascend. They are given every 10 days I believe. Search our messages for "Cabergoline" to learn more. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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Hi Rebecca
Bless you for taking on this boy. You may find that if you can get him more comfortable in his feet, he will start the journey to meeting you half-way. If he were here, I would not put him in any appliances other than boots. He will need frequent trims, even more often then every two weeks to start. IME from my own gelding with coffin bone remodeling such as Bristol's he can be made much more comfortable. -- Nancy C in NH ECIR Moderator 2003 ECIR Group Inc. President 2021-2022 HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993 |
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Hi Rebecca,
His PPID needs to be treated or you will be facing bouts of acute laminitis and ongoing hoof damage. As already mentioned, cabergoline injection is one option to consider. I would also try treating him for three days with GastroGard to see if that makes a difference in his appetite for bucket meals. If so, there are less expensive ways to address gastric ulcers. In the meantime, have you tried hiding the capsules inside a large grape or a prune? Assuming you can get past the eating issues, which I'm pretty sure you can, the hooves need major attention. His toes are WAY too far in front of the bones. These are the type of feet I would be tempted to take a hatchet to in order to get rid of all that excess toe. In addition, the LF has arthritic changes at the coffin joint and the RF is currently focusing weightbearing directly over the tip of the rotated coffin bone. When you pick up that foot you can probably see an obvious outward bulge to the sole. That's where the tip of the rotated coffin bone is located. These coffin bones are not in good shape but I've see much worse and wouldn't give up on him until you have a realigning trim in place with appropriate padding and boots. Appliances (shoes, etc) are another option but unless expertly applied and maintained they are not going to work. The major issue with correcting the trim on horses like this, beyond the trimmer knowing what they are doing, is having frequent enough corrections. Your trimmer can probably do what is needed with the correct guidance. First thing you need to do is ask your vet to repeat lateral radiographs with a marker at the tip of the frog. Thumb tack works well. -- Eleanor in PA www.drkellon.com |
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Rebecca and Bristol
Hi Martha,
Thank you for the information and your thoughts on Bristol. I have been reading the site for a couple months now before posting and am still finding more and more information. I've tried different flavors of the Stabul 1 feeds (pina colada, peppermint fenugreek--whatever Chewy had at the time) and a neighbor gave me some Uckele flavoring. I'm keeping a log of how much and when he eats his Prascend; today he ate one of the capsules in a handful of his regular Bermuda pellets--go figure. I take it day by day and try lots of different things. I swear he thinks I'm trying to poison him. My trimmer does have lots of experience with laminitic horses. I just uploaded the photos she took. This last trim she hacked off the toes according to the latest x-rays. He doesn't grow a lot of hoof and has thin soles. What he does grow goes straight out front to his toes. His left hoof went to a negative angle before I got him and the vet said it's starting to go that way again. How often should his feet be trimmed? I realize it varies by horse but he's currently on a 6-week schedule with my mini horses and I know that's not often enough. I'm not sure how often my trimmer can get here. -- -Rebecca and Bristol (PPID) Feb. 2009, Southern California Bristol Case History: https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Bristol Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=280743 |
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Rebecca and Bristol
Thank you Kirsten. I'm now considering the injections and am researching the boards. I think it would be a great option for Bristol because I know getting the pergolide in him is critical to his recovery. I'll ask my vet about it. It looks like it's IM, so I'd be able to give the injection myself, right?
-- -Rebecca and Bristol (PPID) Feb. 2009, Southern California Bristol Case History: https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Bristol Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=280743 |
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Rebecca and Bristol
Thank you Nancy. That's an excellent point about more frequent trims and validates my concerns with having an out-of-state farrier whose schedule varies.
I want to do everything I can for Bristol. He's a sweet horse who has not had a consistent person. He was a "therapy" horse by default at his last two places which are high-end mental health rehab centers in Malibu (he wasn't ridden). He was not happy there and would hide behind the trees when a patient attempted to interact with him. I was also told that he witnessed another animal at the ranch get killed by a mountain lion (not sure if a goat or what). After that encounter the place burned down in a wildfire and he was evacuated and stayed at their other facility in Malibu Canyon. At the second place he had to be evacuated for the 2018 Woolsey fire and was constantly on watch for mountain lions. He's had a lot of emotional trauma and has started coming out of his shell at my place, so I tread lightly with him. We don't get mountain lions in my area but he is still always watching his surroundings. I feel so bad for him. -- -Rebecca and Bristol (PPID) Feb. 2009, Southern California Bristol Case History: https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Bristol Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=280743 |
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My heart is bursting with gratitude for your compassion for Bristol,and willingness to go the distance to make his life so much better than he has known.
You've got this, Rebecca. -- Lorna in Eastern Ontario 2002 |
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Rebecca, I think you should plan to desensitize Bristol to syringing. He tolerates injections and you don’t seem concerned about giving him injections so you’re comfortable around him. I’m not going to offer specific suggestions because it’s best if you work it out between the two of you. There will be lots of times when needing to syringe comes up and it would be so much easier for both of you to have that option.
-- 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 |
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Rebecca and Bristol
Hi Dr. Kellon,
Thank you for your quick reply. You've confirmed what I thought about the pergolide. I considered giving him GastroGard (which I do have from another horse) but he's extremely difficult to get anything in his mouth. I've tried to build his trust in me. The first time might go okay but after that he will likely fight me. Any tricks on getting the GG in him so I don't get injured? I posted photos today of his hooves including after his trim on 10/10. My current barefoot trimmer was trained by Miranda Ferrer in Santa Barbara who I used to have trim my horses. The vet will be here on 11/5 and I can have her do the x-rays with the marker at the frog. How often do you recommend he be trimmed at this stage? Are the Softride boots enough or is there another that would be better? He has the aqua/purple pads--what frequency do you think the pads should be replaced, and should the frog part of the pad be left in place? I know some people shave that off. What about movement--is it okay for him to move about with his buddies? -- -Rebecca and Bristol (PPID) Feb. 2009, Southern California Bristol Case History: https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Bristol Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=280743 |
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Rebecca and Bristol
Yes, Martha, that is a great suggestion. In the past when I've desensitized my horses, I used yummy sugary things but what would be some good options for Bristol, seeing as I must limit sugars? TIA.
-- -Rebecca and Bristol (PPID) Feb. 2009, Southern California Bristol Case History: https://ecir.groups.io/g/CaseHistory/files/Rebecca%20and%20Bristol Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=280743 |
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Hi Rebecca,
I use a tiny (tiny) amount of this Uckele Equi Sweet Molasses flavoring in the syringe before I add the compounded pergolide to the syringe for my horse. It is safe for Cushings/IR horses. It took a few tries until I figured out how much to use, but now my horse looks forward to his medicine. He gets a tiny piece of safe cookie (stabul 1 nuggets) after his medicine. There are some good, safe treats and flavorings available for our horses. The Uckele website has a section just for ECIR horses: Uckele ECIR Management Supplements This group is amazing. My horse is alive because of this group and the amazing barefoot trimmer who directed me here (hi Pamela!). I'm so glad you're here! Joy -- Joy and Willie (EC/IR) Nevada County, CA - 2019 Case history: Willie's Case History Willie's photo album: Willie's Photos |
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Hi Rebecca, All sorts of possibilities to explore and play with but, as you know, the pergolide is very important for his welfare. 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 |
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Hi Martha
Thanks for lots of great suggestions. Safe Treats here: https://www.ecirhorse.org/assets/documents/ECIR-Safe-Treats.pdf -- Nancy C in NH ECIR Moderator 2003 ECIR Group Inc. President 2021-2022 HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993 |
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Jennifer Boydstun
For about a year i used the Beet-E-Bite soft pill pocket and he ate no problem. Then i loaded one with the medication and let it sit overnight and he would not eat; assuming the flavor of the pergolide could be tasted through out the cookie. So i moved to plan B. I used Uckele treats (apple pie and peppermint seem to be a fan favorite) along with Beet-E-bite soft pellet to hide the pergolide. I feed a few of the uckele treats first then offer the beet-E-bite loaded cookie along with a couple more uckele treats. and if needed to keep him chewing and interested a couple more uckele treats. This worked very well. -- Jennifer Boydstun Folsom, Ca. For T-Birds Windrunner- Tennessee Walker 8-5-18 https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20T-Birds%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=89742 |
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