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New member in New Mexico ..... basic help/questions - thank you!


Sharon@...
 

Hi there from New Mexico! My 14 year old mare was diagnosed with laminitis & Cushings this past month. I’m thankful to have found this group;I have no experience with either issue. I am not sure if this is the right group for laminitis questions, but will include this information in my post. 
 
I started noticing this year that she was resistant to being ridden, which she has never previously been. I ride often rocky and sometimes steep trails. Even after getting Cavallo boots for riding (I pulled her shoes in the beginning of the year) and a new nicer fitting saddle she wasn’t happy about being ridden. And then in mid-September (about 1.5 mos ago), after going on a steep smooth downhill part of a trail she was very choppy/short strided in her front. As well, she still likes to avoid some rocks while riding. So I took her to the local vet and he took x-rays and did the cushings/insulin tests. Her diagnosis: low-grade, early stage laminitis and Cushings. Solution: good barefoot trims every 4-6 weeks, and Prascend 1 mg/day. 
 
Here are my Questions:
 
1) I am not sure this diagnosis of Cushings is correct. My nutritionist wanted me to investigate. It was done Nov 1. Should I get her bloodwork done again? Do I keep her on Prascend?
 
2) Can I still ride her - how do I know? I can use padded boots (or no padding - the Cavallo boot brand padding isn’t much)? Do the trails need to be soft footing (no rocks) and no inclines/declines? 
 
3) Her diet: 
 
~ She is 15 hands, bigger build quarter horse. She was very overweight (my nutritionist estimated via internet photos about 990 but I’d say she was more, although no fat pads, cresty neck, etc).  I am now using hay nets for my tested Bermuda hay and she doesn’t like the nets so I am afraid/concerned she is now not getting enough of her hay - maybe only 10lbs/day, versus the recommended 15-18. It is hard for me to tell but when I put out the 15-18lbs/day in two slow-feeder hay nets and the barrel there is some still left after 24 hours. And my younger horse seems to be eating more often. She prefers the hay slow-feeder (porta-grazer) barrels. They are in a large 10 acre wooded pasture (no grass basically a wooded dry lot), and it would be complicated to feed them differently. Younger horse  is also on a diet. They are on some nutritional supplements to balance out a mineral deficiency in their hay as per Clair and Summit-Equine Nutrition. 
 
 
Here is the link to images of foot, photo of mare and vet report:  https://imgur.com/a/XVCElqH 
 
 
Please let me know if you have any thoughts. My main wish is to keep her feeling well and be able to ride her. Thanks so much in advance - Sharon & Tailight
--
Sharon Bice, New Mexico,  2020


Sharon@...
 

Oh goodness, just realize I need a case history. I will do tonight or tomorrow first thing. I’m sorry! Will get photos of feet and perhaps better body photos. Thx again for this forum!
--
Sharon Bice, New Mexico,  2020


Eleanor Kellon, VMD
 

Sharon,

We'll look forward to your history but from the information so far the radiographs are more consistent with an overlying long toe and somewhat underrun hoof than with laminitis but can't rule it out. Nerve blocks would tell you more and photos would help us. Was she sound on all surfaces and inclines previously?

Antech's insulins tend to run much lower than other labs. I would consider repeating that and the TRH stimulation and sending to Cornell. The TRH stimulation shouldn't be done that early in November because we don't have seasonally adjusted normal but with a response that high it is probably a true positive.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Maxine McArthur
 

Hi Sharon
Welcome to the group! While you are getting your case history and photos folder organised, please have a read of this welcome message that we send all new members. It contains lots of information on how to navigate the group, where various resources are located, and the group’s philosophy.  You can click on the blue links in each section for further information. The Wiki is also a great resource for looking up anything you need to know about navigating the group. 

 

Hello 

Welcome to the group! 

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.

 

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. 

 


--
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

 


Sharon@...
 

Eleanor in PA - Thank you for your review and quick feedback. I have pulled her off Prascend, because I think it was affecting her appetite as she only appears to be eating about 10 lbs of hay/day and seems a bit frantically hungry or something. (Maybe this is a mistake, will talk w/ my normal vet, unless you have any thoughts on this.)I will also mainly feed out of her porta-grazer as she appears not to like the hay nets, despite the fact that I've been using them for several months and have recently transitioned to larger holes. I am working on new photos of feet and body and will upload to the group/her file tonight. I am in the process of uploading more information but am not techy so my husband will help me tonight as he is :) 
I will ask my normal regular vet (I went to more of a specialist, I thought...) to do a repeat test and send to Cornell.

Thanks so much again, you don't know how much I appreciate your help! I wish I could thank you with a pie or something!!! 
--
Sharon Bice & Tailight, New Mexico,  2020


 

Sharon, PPID horses frequently encounter the ‘pergolide veil’ when started on pergolide and occasionally when the dose is increased.  They may go off their feed and seem a bit spacey.  There are ways to avoid this, such as starting the pergolide more gradually or using an adaptogen such as APF for a few days before starting pergolide.
I understand you’ve stopped the pergolide, which is a good move if you can’t manage the veil, but should you start it up again after more testing, keep this in mind.  Don’t hesitate to ask for more information if you are ready to start pergolide again.
--
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