Topics

New Diagnosis - 13yr old Gelding with PPID


Laura Lanza
 

Hello,

I'm new here and still reeling from the realization of this recent diagnosis.  I am a vet tech and I work with IR and PPID horses on a regular basis.  I never thought I'd be having to manage it with my own horse at the tender age of 13.  I'm writing in to see if there may be some hope to turn this around without jumping on the pergolide wagon - Chaste Tree Berry (I have read mixed reviews), Ashwaganda, Cinnamon for controlling insulin and getting the ACTH down to a more manageable level?  What have you tried? 
With him being so young, I am saddened and hoping I may be able to uncover a reversible causative factor....? 

It may sound like I'm living in la la land or following a pipe dream, but the holistic seeker in me has to investigate all the things. 

So, any thoughts, experience, suggestions, etc on the topic would be greatly appreciated.     Here is what I know: 


Signalment:
2007
Quarter Horse
Gelding
Foundation bred - (from Pitzer Ranch Two Eyed Jack line)

Current Body Condition:
Pot belly appearance 
Low tolerance for exercise
Long, curly hair coat
PU/PD
Laminitis last summer
Slow wound healing - had a significant laceration last July that took months to heal
Puffy above eye socket
Current BCS 5+/9  
His current photos: http://bit.ly/BartLanza

Cornell University Metabolic Panel results:
Ugh, Horrible numbers....
Glucose 138  (Range 71-122)
ACTH 91.6 (Range 9-35)
Insulin 131.12 (Range 10-40) 
Leptin 17.37 
T4 1.44 (Range 1-3)

Environmental: The horse has a low stress life.  We trail ride.  No crazy show schedule, excessive trailering, etc.  He is with three other Quarter Horses and a pony.  They are on a grass pasture that I limit to 12 hours.  I am careful to keep the penned up when the sugars are the highest in the early spring.  Last summer, I implemented muzzles to reduce their consumption even more.  He has a history of being overweight and infrequently worked...hate to admit that, but it's the truth.  

Diet: 
Grass hay 24/7 restricted by an extreme slow feed hay net. Filtered water.  No grain product.  

My case history has been submitted. 

Thank you in advance for your assistance.  I have heard from many people the value of this group and how passionate everyone is to lend a hand. 
_._,_._,_
--
Laura 
Rock City, Illinois 
2020


Eleanor Kellon, VMD
 

Hi Laura,

I'll look forward to reading your history when you have a link to post but just as a short note right now - we've tried EVERYTHING! - some of our members have.  There are no magic bullets, no supplements that substitute for pergolide and a controlled, mineral balanced diet. I know you already know this but the numbers don't lie. The good news is that with a comprehensive, WHOListic approach (our DDT-E), success rate is extremely high.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lorna Cane
 

Hi Laura,

You will receive a very fullsome messgae shortly.
But I just wanted to say to take heart. You are in the right place.

Passionate we are. There are lots of things you can do to help your boy,and keep him healthy and happy.


--

Lorna  in Eastern  Ontario
2002


 


Lorna Cane
 

P.S Laura......

 You said, "My case history has been submitted. "

Great. If you copy the link to your Case History, go back  to your signature box , in Subscription, and paste it to your signature, we can go directly to it, and get the details all in one place.You'll like having it for your records,too.

Remember to hit SAVE !
--

Lorna  in Eastern  Ontario
2002


 


 

Hi Laura,
Welcome to the ECIR group.  It sounds like you have a good background for this endeavor and you will find it a smooth transition.  Thirteen is young but, although I did not test and confirm my horse’s PPID until was 16, he was symptomatic when I got him at 14.  With experience, I became more sensitized to what his symptoms were.  You are already receiving good feedback so please let us know when more questions arise.

This should be a link to your Case History folder, for you to add to your signature.

https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Bart

What follows is our group welcome with some information about the ECIR group and its philosophies.

Hello 

Welcome to the group! 

The ECIR 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, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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. 

 



--

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


 
 


 

Laura, here is the link to Bart's CH folder:
https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Bart

When you have a second (and we know you're busy right now!), go to your auto signature and add that link to your signature. You'll find your auto signature here: 
https://ecir.groups.io/g/main/editsub

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse Case History Folder                Cayuse Photos
Diamond Case History Folder              Diamond Photos 


Sherry Morse
 

Hi Laura,

As Dr. Kellon has already said if your horse has tested positive for PPID as well as IR and has as many physical symptoms as he has your only safe option for his long term comfort is to get him on Prascend (or Pergolide) ASAP.  There are no magic bullets, there is nothing to reverse for either condition but what you can do is treat him so he can lead a long and productive life.

Were he mine, I'd order APF (more on this in your welcome letter) and get him started on that and then start titrating him up to a 1mg dose of Prascend to start.  You can retest 3 weeks after starting to see if it's making a difference in his ACTH levels or if he needs a dosage adjustment.  Getting his ACTH down may help with his insulin levels but even more critical to getting those numbers under control are getting his diet tightened up.

Looking at your Case history Bart is about 150lbs overweight and with his leptin level so high he has no 'stop eating' switch so free choice hay, even in a slow feed net is not a good option for him.  Ideally he needs to be eating no more than 22lbs a day (2% of his ideal weight). He also shouldn't be on pasture at all, unless his muzzle is completely blocked, as any grass is most likely an issue for him.  If it's possible you may want to dry lot him by himself so you can better manage his diet, at least until you can get him back to his ideal weight.




Frances C.
 

Just a quick response. I have used CEYLON cinnamon - very pungent and not apparently satisfying(1 teaspoon). No idea if it did any good. But I did notice a difference with ASHWAGANDHA in that the mare had a more perky attitude within a day or so of getting this- 1 teaspoon a day about 2000 mg.
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382


Maxine McArthur
 

Hi Laura
Just wanted to add to everyone's excellent comments, that my mare was symptomatic and diagnosed when she was 12. She has been on pergolide since then, and I am hoping that by catching and treating it early, we can slow the progress of the disease (she's now 16).  She did not have as high a test result as your gelding nor were her symptoms as severe, but I had no hesitation upon starting her treatment. Please, please don't waste his precious time chasing magic bullets that don't work. Pergolide is the only thing that will control his ACTH output, and diet and exercise are the only things that will control his IR. All that you need to do is change some of your management practices (yeah, I know, sometimes that is not as easy as it sounds!). We've all been where you are now, and we have your back in this. 

And a big thank you for getting your case history done--that is super helpful.



--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Laura Lanza
 

Thank you all for responding so quickly. I can't thank you enough. 

You have confirmed that the little voice in my head is telling the truth about starting him on Pergolide.  **Cries**

I did order a supplement prior to joining this group.  I will provide a link for your consideration: https://www.depaoloequineconcepts.com/products/harmony

Next on my agenda....pergolide and confinement.  Very much looking forward to Dr. Kellon's thoughts on the case history. 

Whatever. It. Takes. 

Laura Lanza
Rock City, Illinois 
2020
https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Bart


Tanna
 

Hello Laura

Nothing to add here, in terms of magic bullets, but from your descriptions and the numbers you've provided I'm wondering if his general symptoms (which read very much PPID) prompted you test him or a "laminitic episode" of sorts?

For you I would hope that perhaps his ACTH could have been a little elevated for other reasons (unlikely) but barring that it hope he has a good response to pergolide. It'll be comforting for you to see his numbers decline. 


--
Tanna 

April 2019, (Yahoo Group member 2008)
Langley, BC, Canada

Tula's Case History