I have followed for some time - I am a grad of several of Dr Kellon's classes and manage a boarding facility geared toward horses with metabolic conditions. I currently have 4 PPID equines on my track system. The "newest" is one of the founding members and longest resident, my mare Salalah. I'm uploading her case history now and will link to my profile for future posts.
I have suspected Salalah to have PPID in the past. Last fall my vet prescribed Pracend when I explained she became a polar bear overnight - cresty neck, full winter coat. We managed her on .5mg through the fall and took her off in the spring when her strait ACTH was "low". It was a repeat this year, but with a terrible skin allergy, stocked up legs and lethargy that began around the 19th. I immediately scheduled my vet for blood work. He left Pracend with me, agreeing with my visual "diagnosis" while we waiting for blood work. I began .25mg the same day, 9/21. Blood work returned on the 24th with 285pg/mL where average lab range for September is <30. I bumped her up to .5mg today. She is still sluggish, but I feel this is more related to her front legs, which are still stocked up. I have her in a fly sheet, fly books and mask. I've scrubbed her gently with shampoo and covered her with hydrocortisone and bug repellent. I have cold hosed several times a day and took her for a few long walks, which help, but do not last.
My vet's assessment is that the stocking up is related to the skin allergy, which he feels in driven by insects. She has no prior skin issues in the 8 years I've had her. I do have her on the Spirulina and J-herb protocol with additional Chondroitin. She is on track with very little grass, tested hay and her diet is tightly balanced.
Has anyone experienced the stocking up with skin allergy? I can only describe it to say her skin is "hard" on her legs and belly. I am wondering if I am dealing with cellulitis and if an antibiotic is in order. I wanted to get a little feed back here prior to making that vet call.
Thank for all your time!
Molly Aggar and Salalah
If you think she has cellulitis take her temperature and call the vet. It's not something to be taken lightly. Having said that, if the walking is helping it's most likely not cellulitis, but that doesn't mean it can't become it if she has open sores on her skin.
Hello Molly and welcome!
Sounds like you know your way around, so this will probably be very familiar but since this is your first time posting I will be sending along your welcome message. You have a foot up being a Dr. K grad!
Please take the time to read it when you have a chance as it will provide you with answers to questions that usually come up.
I see Sherry has already answered you regarding your observations, that was my suggestion as well, to take her temp and consult your vet if you think it can be a possibility of cellulitis, but I can tell you that skin allergies have been discussed here many times.
If you do a search in the messages for that topic you will come up with tons of hits. But with that number of 285 I would think she needs more than .5mg. we all know that uncontrolled ACTH can cause many issues, but I will defer to Dr. Kellon and or the other mods with more experience with this topic.
We look forward to seeing a case history on your horse with more details.
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.
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.
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.
If you have any technical difficulties, please let us know so we can help you.
Bobbie and Maggie
Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
ECIR Group Primary Response
Thank you, Bobbie!
I bumped her up to .75mg on Sunday. I'm being conservative increasing, and thus far she hasn't gone off feed. She is about 13.2h 730lbs, if I didn't mention that. I consider her over weight, and I have always treated her as an IR horse with regard to feeding protocol. I will give her another 3-5 days, and plan to bump up to a 1mg does, at least through November, and we can pull blood work at that time and see where we are.
Molly & Salalah