Hi I’m Patricia Larsen, my mare is experiencing laminitis now- been diagnosed about a month ago.
still in somewhat acute stage
walking pain free no lameness detected
she has been in SoftRide boots with laminitis orthotics for the past month
on Laminox and emergency diet
one blood test so far showed very high insulin 
no other outward signs
we had new X-rays today
showed ‘serum pocket ‘ not picked up before(X-rays 2/4 weeks ago
my vet asked which specific tests we wanted / he contacted lab and got recommendations but wanted to know what Dr Kellon recommended 
I did receive response from msgs from group 
acth. Insulin and glucose 
thank you all for advice 

hi Pat. It looks as though you have been a member here for a long time....and some things have changed all for the good! We have a new Case history website that just opened up last week and we also have a new welcome letter, with up dated information for your review.  The new case history allows for testing, photographs, xray up loads, and other uploads so all of your horses information is in one spot. Very user friendly!!! So, I will start you off with our updated welcome letter and you can probably gleen from the new letter what items you need for testing. Yes- ACTH, insulin and Glucose. Keeping in mind the handling of the specimens is key for accurate results. It is very common for abscesses to form during and following laminitis...those pockets need to mobilize and drain- which can be painful. But once drainage occurs, there is relief. It would be really helpful if you could complete a Case history....start here: https://ecir.groups.io/g/main/wiki   And here is our welcome letter. --

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.   

• Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR) - can appear at any age and may have a genetic component.
  • EMS/IR is diagnosed by non-fasting testing of insulin and glucose.
• Cushing's (PPID) - increasing age is the greatest risk factor for developing PPID.
  • PPID is diagnosed using the Endogenous ACTH test or TRH Stim Test.
• BEFORE CALLING YOUR VET TO DRAW BLOOD FOR DIAGNOSIS, READ THESE DETAILS. All ecirhorse.org sections can be printed or links can be emailed. Sharing them with your vet will help ensure correct testing protocols. Request email of digital or hard copies of the test results to add to your case history.

 

• 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.Trisha DePietro
Aug 2018
NH
Primary Responder

New CH for Dolly  https://ch.ecirhorse.org/case-history.php?id=50  
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993