Mare diagnosed with EMS/IR


Lisa
 

April 12, 2022 my mare was diagnosed EMS/IR after a series of events and sudden onset of laminitis. 

since then I have been struggling to get her stable. I’ve learnt a lot and learning more but really need help. 

I’ve not done a case history yet but will give a brief rundown of what I’ve done/doing with hopes of getting some help. 

Jamie 22 yr old mare. Owned since birth, first 10 yrs was spent showing western pleasure then started breeding her. Easy breeder, foaling, never had to force cycling always caught first AI. 6 foal and her last was 2020. 

Attempted one more breeding here in March 2022 cycled normal, follicle presented, AI’d checked next day for ovulation and was going to AI again but she retained fluid so vet flushed her put her out in pasture turnout for a couple hours after administering oxytocin to flush remaining fluids 
after three days vet wanted her on regumate for 13 days to help in egg retention. Towards the end of the 13 days she started displaying right front lameness. Thought it was an abscess starting so soaked foot poultice wrapped for a few days. Had farrier out to check and found nothing. No reaction to pressure test. 
Two days later she was worse but this time both front feet so had farrier out again pressure test positive, placed lily pads on and had vet come pull blood to test for PPID, EMS OR ? CBC was done and blood sent to Cornell results came back with elevated levels (insulin 98.40 ulU/mL, lepton 24.21 ng/mL) thyroid was low 0.892 ug/dL, ACTH was wnl 22.1pg/mL. Started researching EMS/IR, changed her feed program to just soaked grass hay, started her on banemine 500 lb dose 7 am, bute 7 pm, icing feet 3-6 hours per day. Continued this until I could get a vet out to do X-rays mild rotation on right foot only, vet suggested prevocix instead of banemine and bute so made that change, had her feet done rolled back the toes  I got 3-4 good days with her then she’d started sliding back. Then got a full week was good. Started taking her out and hand walking in arena, then she’d go down hill again. Got new grass hay in, nothing I have has been tested or was tested prior to me purchasing it…never had a reason.  I have continued to soak hay, hay net small amounts through out the day totaling 15 lbs of hay per day ( she was 1057 lb 15.2) 
She has declined these past few days when I started her on the new hay (orchard) soaking it even longer, rinsing it.  I had tapered her off meds because she had been doing good  
Ive been trying to source tested teff grass hay, Timothy or triple crown balance Timothy cubes but have not been successful. So I am having to continue with the hay I have until I know what else I can do  I do know that until the insulin level is not lowered she is going to be laminitic
Vet suggested starting her on pergolide of which she had her first 1 mg dose yesterday am and then this morning dose,  she had not finished her hay, was not interested in eating and has only nibbled a small amount through the day 
This all started March 30 and I have been so diligent to trying to figure this out  but with our hay situation these past couple years, availability etc is making this hard for me  
I know there is so much more I’m missing and this was not very brief intro but I am hoping to get some direction. A friend sent me your link a couple days ago and I have read and learned so much but not enough to get my girl stable  
I look forward to any and all feed back  

Lisa M Lavoie
Anderson CA
May 2022


Sherry Morse
 




Lisa
 

Thank you Sherry for your prompt response. So appreciated. 

In answer to your questions: yes her diet is of soaked orchard hay at 15 lbs divided up throughout the day and fed in hay nets. She gets 1/4 lb triple crown lite ( I saw where it is not a recommended product but was the only thing I could find) as carrier for her DAC E & Se supplement, equinity (amino acids) and previcox 1/4 tab nightly. I have order Stabil 1 to replace TC lite. I have sourced Teff grass hay as well as Triple Crown Balance Timothy cubes. 

Trim was done April 22, day after X-rays so farrier had them to view. We had to skip Jamie’s March scheduled 6 wk trim due to the severity of the laminitis. She is scheduled for May 20 th for next trim. Otherwise she has been on a 6 wk schedule all her life, 6 month dental care, worming every 6 weeks ( at trim dates) seasonal vaccinations, chiropractic care. 

I am glad to hear I can discontinue prascend. She’s only had two doses at 1 mg per dose. 

Yes I discontinued NSAID and started the previcox per Dr recommendation. I also started her on Devils Claw two days ago.
Today she was off her feed and so tight in the flank I did give 500# dose banemine to prevent colic episode. She did start eating later in the day. 

when I did my CH I could did copy my URL https://ecir.groups.io/g/CaseHistory/album?id=27505
Just do not know where I am to paste? I have done my CH as of tonight with foot photos (could only get lateral and dorsal photos of rt front due to her discomfort of picking up foot and weight baring on hind, X-rays, body composition, Dr notes, lab work and hay tests for hay I have access to if meets the WSC and Starch. 

As far as exercise I had only walked her two alternating days because she was at her best to see if I could put her in her turn out of which I did. We then had a relapse so she has been stall bound again.  

I hope I covered enough to get my girl out of pain and on the right track. Lord knows I have been trying. And I am so thankful to have been introduced to this site. Wish i had a month ago. We’d be much further along. 
--
Lisa M Lavoie
Anderson CA
May 2022
https://ecir.groups.io/g/CaseHistory/album?id=275057


celestinefarm
 

On Fri, May 13, 2022 at 10:27 PM, Lisa wrote:
Yes I discontinued NSAID and started the previcox per Dr recommendation. I also started her on Devils Claw two days ago.
Today she was off her feed and so tight in the flank I did give 500# dose banemine to prevent colic episode. She did start eating later in the day.
Lisa, one of the mods or Dr. Kellon will explain this further, but Previcox is an NSAID. It is a different type than Bute or Banamine but it is in the same class. It is designed for dogs, there is an equine paste  and tablet version called Equioxx. I would not add any additional NSAIDs including bute, banamine,  and I wouldn't start Devil's Claw right now until your horse has had a chance to clear the Previcox if you decide to discontinue. Use of multiple NSAIDs ( Devils' Claw is not , but can be irritating in some horse's gastro system) can lead to right dorsal colitis and severe stomach ulcers. 
From the Previcox website:
As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, kidney or liver side effects. These are usually mild, but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including PREVICOX. Use with other NSAIDs, corticosteroids or nephrotoxic medication should be avoided. Refer to the prescribing information for complete details.
From the Equioxx website:

EQUIOXX is a COXIB class non-steroidal anti-inflammatory for horses that helps to manage the roller-coaster effect of pain and pain relief that can occur with other products which might require multiple daily dosing.

 

EQUIOXX is available in two formulations: paste and tablet. EQUIOXX tablets are small and palatable enough to be hand-fed with or without feed. EQUIOXX paste provides more accurate dosing by weight for smaller horses or competition horses subject to testing.

 

As with any prescription medication, prior to use, a veterinarian should perform a physical examination and review the horse’s medical history. A veterinarian should advise horse owners to observe for signs of potential drug toxicity. Use with other NSAIDs, corticosteroids or nephrotoxic medication should be avoided.



 
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Sherry Morse
 

Hi Lisa,

Previcoxx is a NSAID and should be discontinued.  Dawn's already outlined that and there is information in our files on switching from NSAIDs to Devil's claw. You do not want to administer them together.
--

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response

PA 2014

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

 


Lisa
 

OMG. 
THANK YOU. 

This is all so helpful as well as confusing, conflicting and frustrating. 

Doing what is recommended by my vet and still not appropriate for my girls situation. 

I have discontinued any and all NSAIDS Pergolide devils claw and have just sourced Triple Crown Balance Timothy Cubes to start her on until I can test my hay or source tested hay. 

my question now is introducing her to the cubes. I need to transition from my soaked hay to them? I do not need anything else to tip her over further. 

And with these cubes do I need to add iodized salt, Vit E Magnesium and flax seed? 

I do have Stabil 1 being delivered today as carrier 

I so appreciate all the help. I am feeling im
in an emergency status with her as the past two days she lays down early and poops laying down through the night. 

slow to get up but does have an appetite. 

She’s just so uncomfortable 💔
--
Lisa M Lavoie
Anderson CA
May 2022


Sherry Morse
 

Hi Lisa,

You can use Devil's Claw without an issue.  Please read these 2 articles about weaning off NSAIDs and changing to Devil's Claw:

If you could complete/post a case history that would be helpful as would be pictures taken post trim. Please see https://ecir.groups.io/g/main/wiki/1482#Photos-and-Hoof-Evaluation-Help for information on taking and labeling pictures.  

If you're using the Balance Cubes please remember they're fed at a 3:4 ratio to hay.  You do need to add salt, Vitamin E and flax but no magnesium as they are mineral balanced to themselves.  




Lisa
 

Sherry

thank you. Yes she has been off NSAIDS for a while and was going to start devils claw but am just going to try and get her S/s levels regulated now that I’ve gotten proper feed. 


I did do a CH last week but not sure if I’ve done something wrong that is not allowing anyone access to it?? 
--
Lisa M Lavoie
Anderson CA
May 2022 CaseHistory/album?id=275057
https://ecir.groups.io/g/CaseHistory/album?id=275057


Sherry Morse
 

Hi Lisa,

There is no case history file nor folder for you and Jamie.  You need to create a folder in the file section of the case history site (https://ecir.groups.io/g/CaseHistory/files) and then add the file to it and update your signature so we can access it.




Lisa
 

Sherry, 

Thank you for you assistance, I have completed the steps, regarding the Case History file. 
You should be able to review in my folder. 

Thanks, 
--
Lisa M Lavoie
May 2022, Anderson CA

Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Jamie
Jamie's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275057


Sherry Morse
 

Thanks Lisa!

So a couple of things jump out at me.  Assuming the pictures you posted of Jamie are current she's not thin.  I would say she's at a good weight now and you would not want to see her put much - if any - weight back on.  So if she's taping at 1025 that's a better weight to aim for than 1060.  You can have a look at the BCS score file for more info on how we judge that but for an IR/PPID horse we prefer to see them about a 4.5 to 5 in condition and she's firmly a 5 to me based on those pictures. (https://ecir.groups.io/g/main/files/Case%20History%20Tools/Tools%20and%20How-To%20Help/Body%20Condition%20Scoring%20Guide.pdf)

With that being said you should hopefully see an improvement with her comfort level as she's on the Timothy Balance cubes.  You do want to make sure she doesn't gain weight on them as they are more calorie dense than hay so you may need to adjust the amount fed down (or up) depending on how she does with them.  I would suggest planning on retesting her insulin within 3 weeks of the diet change and have a TRH stim test done at that time for her ACTH as she may well be early PPID and that could be contributing to her elevated insulin.  If that comes back with a positive result she would need to be on Prascend but you can put her on APF (that's covered in the welcome letter) before starting it and titrate her up to the full dose as you already know she'll have a veil effect if given a full dose right away.  

IF she's not showing improved comfort with the diet change she'd be a candidate for metformin but I'd want to check her ACTH first as she's a QH and when they present with IR it's usually due to PPID.

Oh, one last thing - if you want assistance on her trim please post a note for Lavinia with a title of "Lavinia, markups needed" and make sure you have all the photos and views requested here: https://ecir.groups.io/g/main/wiki/1482#Photos-and-Hoof-Evaluation-Help in her photo album.




Lisa
 

Thank you Sherry

Yes I agree on her current weight and body condition. I will monitor her weight as we go along on the cubes. 

I will request blood work in the recommended time frame. My concern at this point it’s getting to the 3week point. What is your experience as to how long before seeing improvements once on approved diet? 

She is so unstable on her hind quarters at this time and I am not certain my farrier is even going to be able to get her trimmed on Friday. And I know how crucial this is for healing. 

Also, I have not yet put her on devils claw because I’m so afraid of any change that will exacerbate her condition. 
--
Lisa M Lavoie
May 2022, Anderson CA

Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Jamie
Jamie's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275057


Sherry Morse
 

Unless I missed something you just started switching her to the cubes 3 days ago, isn't that right?  I wouldn't hesitate to get her started on the DC to help with her comfort level.  As far as trimming you can trim without picking her feet up if you can put her feet up on a block of wood or put her in soft ground that will allow some give as she's trimmed from above (which most likely is all that should be happening now).  Doing nerve blocks will also allow trimming to take place if needed but I would try the less invasive versions first.

Evidence of pain right now could be insulin, trim, diet or abscess - it's hard to say and makes things very difficult for us as the humans.




Lisa
 

Sherry

correct on the the feed time. 

thanks for the info on way to get her trimmed. 

we will try that approach. 

and I will start DC. 

thank you
--
Lisa M Lavoie
May 2022, Anderson CA

Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Jamie
Jamie's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=275057