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IR Mare not healing with laminitis- need help!


Bendhorsetalk@...
 

I have a 9 year old mustang whose first laminitis episode was at 2 years. She is on her 4th episode and not improving (2 1/2 months now). She is not on grass, eats tested grass hay (.7 starch and 8.3 ESC), 2 scoops of thyro L, now on InsulinWise and Platinum Performance GI with 3 cups of hay pellets. We tried Easy Slippers and there was no improvement; she is usually barefoot and I know how to trim keeping her toes short. We had x-rays 2 weeks ago and those were shared with an excellent farrier who put backward shoes on with a leather pad to her fronts 4 days ago. She is still uncomfortable moving. She tests for IR and has for the past years with cresty neck and fat deposits, but she isn't fat. I believe her back feet are involved too. I'm not sure what else to try or why she isn't improving. I don't know if the new shoes and InsulinWise take time to help.      I also don't know the cause of the episode this time. She had a lower leg wound/swelling and GI upset from some prior hay both preceded the laminitis. She eats 3 x day and has free range to move around. She has the over the eye bulge too.  The PP GI has mostly stopped the fecal squirts she had for a few months.  I have soaked her hay some, but it's complicated by having 4 horses here and trying to keep her separate. Any suggestions? I am so worried about her.  She is also on Gabapentin and Equioxx which help some but not enough. She was on Bute for too long so the vet suggested these two.

--
Shera Felde, Central Oregon, 2020


Kirsten Rasmussen
 

Hello Shera,

Welcome to the group!  You asked about how to post hoof photos (and radiographs): scroll down to the section on "Trim" and take a read through, there is a link there that I have bolded for you that tells you how to take useful pictures and where to post them.  You've also been sent instructions on creating a Case History for your girl, so any information on the current and past laminitis episodes will be helpful, as willas all the details on her current diet, exercise and living situation.  We like everything to be in the Case History, including all the results of her bloodwork, so that the volunteers can quickly look up all the details on your horse before answering questions; details tend to get lost in these message chains and are very time consuming to find.

As mentioned earlier, definitely soaking her hay right now is a must.  In addition to 2.5 months of laminitis, her fat pads and over-eye bulges tell you that her insulin is too high.  The pain won't stop until her insulin comes down, and she won't be completely sound until her hooves have time to heal.  Definitely post your hoof photos and radiographs; if there is anything in her trim that could be improved to reduce pain you will get some feedback here.  I would also remove the Platinum Performance GI (it contains rice bran and molasses and although its not clear how much, it could be part of the problem right now) and hay pellets for now.  We recommend Triple Crown Naturals Timothy Balance cubes (aka Ontario Dehy Timothy Balance cubes) as a tested and guaranteed safe carrier for minerals, or rinsed-soaked-rinsed beet pulp.  The Thyro-L will help with weight loss, if that's what she needs, but it will not lower her insulin.  She will need to be weaned off of it if she has been on it for an extended period and no longer has weight to lose.  The Insulin Wise has provided mixed results with our members; it seems to work for some horses, and not for others.  While it likely doesn't worsen the situation, it is expensive so unless you have bloodwork showing its helping you may want to reconsider giving it.  The Equioxx is an NSAID and NSAIDs do not block pain signals from the distal limbs, plus they can slow healing and abscess mobilization in the hoof, so I would recommend tapering her off of it.  Not sure if the Gabapentin is helpful, but someone else will surely jump in and tell you whether or not to continue it.

Alright, what follows is our standard welcome letter, packed with links to additional information.  Let us know if you have any questions:

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. 



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


Helen Connor
 

Shera, I have a mustang too (Kiger) and struggled for several years to get her insulin lower. I think the thing that made the difference, finally, was soaking the hay. I now buy the lowest sugar hay I can find, and soak it at least half the time for Blessing. Using only low sugar hay did not get her insulin low enough.

Blessing is also PPID, so our experience may not match yours, but I think you'll find that soaking the hay makes a huge difference in your numbers and in your horse's comfort.
--
Helen Connor and Blessing (IR/PPID)
Scappoose, OR
Member since May 2017
Case History:  https://ecir.groups.io/g/CaseHistory/files/Helen%20and%20Blessing
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=6847


Ronelle
 

Shera-  I'm in your area and as you probably know, Triple Crown/Ontario cubes are not available in our area (at least I've not found them) so IMO the best we have is Haystack Low/Low.  It is on ECIR's approved list of feeds and plus it's not so expensive.  
--
Ronelle and Yoyo
2015 Bend, Or, US


 

Ronelle and Shera, I found two places in Bend that advertise Triple Crown feed, one of them being Ace Hardware, a not so obvious place to check.  With several of you interested, they may be willing to stock the balance cubes.  The cubes have become so popular here that my feed store has trouble keeping them in stock.  I order them by the pallet now.
--
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


 
 


Bendhorsetalk@...
 

Thank you everyone who has chimed in. Figuring out this site process is still in the works, but I am eager for all help. I have gone back to soaking 2 out of 3 feedings. Not sure what to do about her digestive upset if the PP GI is a bad idea (vet recommended). Thanks. I'll keep reading and trying anything that comes our way until she is better.
--
Shera Felde, Central Oregon, 2020
https://ecir.groups.io/g/CaseHistory/files/Story%20and%20Shera


Kirsten Rasmussen
 

Just a thought, Shera, I soak enough hay for 24 hrs all at once in individual hay nets. Then I have a soaked net to put out at each feeding.  I know it's different for you dealing with 4 horses (that's a lot of hay to soak if you can't separate Story!), but I just wanted to share that you can soak a big batch for one horse once a day, unless temps are very warm and humid or below freezing....then a big cooler on wheels is needed to store the extra hay in until feeding time.

I wonder if the soaked hay might help her digestive upset?  I'm also wondering if her laminitis was caused by the hay she was switched to after the Blue Grass caused GI upset?  Are you able to have her hay tested for ESC and starch?  If you are planning to feed it all winter I would send in a sample to Equi-Analytical and get the "603" package, which will give you accurate data and allow you to balance your minerals properly to the hay.

Like Helen mentioned above for her Mustang, Blessing, finding low sugar hay may not be enough for very sensitive horses, and soaking it can make a big difference.  I too have to soak my low sugar hay.  Given that Story had her first laminitis at 3, and again 3 more times in the next 6 years, I would think she is very sensitive.

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


Bendhorsetalk@...
 

Thank you, Kirsten. I figured out a barrier to feed her separately so can soak again (although I appreciate the suggestion that all 4 could eat soaked hay). She is very sensitive and I keep thinking that between her digestive upset, her immune issues (sarcoids), and her liver numbers, that something is going on I need to identify. Talking to the vet today about some more bloodwork.  The hay we have now is testing well but doesn't show micronutrients. We have a free choice mineral out but the PP GI supplement for her gut has added nutrients. One vet said not to worry about overlap, but I wonder if something is out of whack.
--
Shera Felde, Central Oregon, 2020
https://ecir.groups.io/g/CaseHistory/files/Story%20and%20Shera


Sherry Morse
 

Hi Shera,

Would just add that the free choice mineral may not be the best option for Story.  If you have had the hay tested you may want to contact one of the people on the ECIR balancer list (https://ecir.groups.io/g/main/files/6%20Diet%20Balancing and then open the "Hay Balancing.pdf" file) about getting a mineral balancing done for your hay.  All of the issues (liver, immune, digestive, IR) may be linked so getting her IR under control may be the first step to getting everything sorted out.




 

Hi Shera,

Can you share the hay test results with us, please?  I could not find them.

I didn’t see any recent bloodwork so I think getting more is a good idea.  Your CH mentions she is getting bute, equioxx and gabapentin.  She was getting thyro-l but I’m not sure if that is continuing.  I have been prescribed the same drugs for my horses in the past but here are some things I’ve learned in the meantime.  Thyro-l is an aid for weight loss but you score her body condition as normal.  Perhaps she doesn’t need that.  If you and your vet decide to stop it, it should be tapered down, not stopped abruptly.  Gabapentin is not well absorbed by the horse, is used for neuropathic pain in humans and my dog is getting it as a calming agent as he awaits surgery for a blown knee.  It seems to do a good job there but I’m not sure it is helpful for horses.  Bute and equioxx are both NSAIDs and giving them together is like doubling up on one or the other.  They are useful for inflammatory pain but laminitis is not an inflammatory process.  

It’s possible, although I’m not sure, that all the NSAIDs could be contributing to her stomach distress.  When I’ve had horses with squirts, I’ve usually had the best luck by changing hay or soaking it.  That’s a common enough problem that you can search the messages to learn from the experience of others.  Some posters have had great luck with their routines.

From the Xrays, I think she would be more comfortable with more attention to her trim.  Perhaps you have already begun this?  If you post photos of her feet according to our instructions, our hoof trimming gurus can offer more guidance for you there.  They will need to be posted to a photo album on the CH group site.

I would put her on the emergency diet for now, until you are ready to balance your hay with the minerals it needs.  That includes soaked and rinsed hay, a measured amount of granulated salt, vitamin E and ground flax.  It turns out that horses taking what they need from a free choice menu sounds better than it works out and actually feeding them what the hay does not provide can be a miracle worker of sorts.

--

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


 
 


Sherry Morse
 

Hi Shera,

When you get a chance could you please add the link to your photos (https://ecir.groups.io/g/CaseHistory/album?id=253720) to your signature?  The pictures of her feet that we need are outlined here: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help but just from the 2 pictures you posted to me it looks like she has room for improvement in her trim to help get her toes back and her heels where they belong.




Bendhorsetalk@...
 

Thank you Sherry. I will look for the place to upload the hay tests. I do think her issues may be linked somehow!
--
Shera Felde, Central Oregon, 2020
https://ecir.groups.io/g/CaseHistory/files/Story%20and%20Shera
https://ecir.groups.io/g/CaseHistory/album?id=253720


Bendhorsetalk@...
 

I just uploaded them, but who knows if I put it in the right place...Still getting the hang of how to navigate the site!
--
Shera Felde, Central Oregon, 2020
https://ecir.groups.io/g/CaseHistory/files/Story%20and%20Shera
https://ecir.groups.io/g/CaseHistory/album?id=253720


 

You did it perfectly, Shera!  Thanks.
--
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


 
 


Kirsten Rasmussen
 

I just took a quick peak at your hay results.  I'm not an expert, one of our trained balancers would be able to help you more.

At first glance, the first cutting hay should be soaked if she is laminitic on it and it is her only source of forage right now.  Even though the ESC+starch is under 10%, more sensitive horses need it lower and given her history and young age I suspect she is one of them.  I can tell you that on my 7.1% ESC+starch hay, my boy had a laminitic flareup this summer from sneakily getting a couple pounds of hay with 9.9% ESC+starch through the fence and I could not get the flare-up (pain) under control until I started soaking his 7.1% hay, 2 days later he was feeling better.  His soaked low sugar hay tests at about 4.5% ESC+starch and he is thriving on it...so he is one of those horses that needs his sugars as low as possible.  I suspect Story is as well and with this logic you may want to soak her second cutting hay, too, even though the ESC is lower.

Unfortunately there is no iron value for the first cutting analysis, but your second cutting comes back at moderately high iron at 219ppm (toxic limit is 500 ppm, we like to see <100 ppm).  Since iron overload and insulin resistance both worsen the other ( https://drkhorsesense.wordpress.com/2020/09/10/be-cautious-with-iron/ , or search our files for more info on iron and IR), minimizing iron in the diet for these horses is especially important.  Soaking and then rinsing the soaked hay should help bring down the iron number if it is due to dirt contamination.  You could try soaking and rinsing a hay sample, drying it in your oven, and sending it in for ESC, starch and iron if you want to see how much of an effect soaking has on these critical numbers.  If the iron is lower, then you will need to feed less minerals to make up for excessive iron, so it could save you money over the long run.  I would also ask for the remaining trace elements: Cu, Zn, and Mn at that time so you can include these in your mineral balancing program.  Cu and Zn are particularly important because they are deficient in pretty much all hay, yet so critical to the horse's health.  I know it might seem like overkill to balance the minerals properly but I can speak from personal experience that it made a huge difference in my horse's hooves, and many others will say the same.  It does work and its especially important for IR/PPID or otherwise unwell horses because proper minerals so strongly affect the immune system and overall body health.  https://drkhorsesense.wordpress.com/2020/08/26/put-a-strong-foundation-in-your-nutritional-program/

Otherwise the minerals that you do have look reasonably easy to balance for both analyses.  The last thing of note is your protein in the second cutting is a little high.  Not sure if it should also be tested for nitrates, but if you are already planning to soak this hay, too, then that should help remove some nitrate and that might be all you need to do for that.

Here's another good one to read:
https://drkhorsesense.wordpress.com/2020/07/16/safe-supplements-for-metabolic-horses/

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