New member! Need advice for Kitty and help with 1st post


MissKittyColorado
 

Hi! Kitty is a 14 year old AQHA mare and has struggled with excessive weight and problems with her feet at least 7 years, we purchased her at auction in 2015. We have had her in shoes since we bought her and shoes with  pads for a few years up until recently when we had them removed and we are transitioning her to barefoot. It’s been difficult but she is getting more comfortable. I didn’t know that there were ways to correct her feet and we are eager to help her and need guidance on trims, diet and exercise. Mark-ups for her trims would be greatly appreciated. She’s had some bloodwork recently as well as x-rays. Hay has been tested. We appreciate your time! I am doing my beat to navigate this format but I am struggling to attach her photo album and case history. I only have an iPhone and I am struggling to attach her case history to this message but I have uploaded it to files. 

https://ecir.groups.io/g/CaseHistory/album?id=278248
Nicole E from CO 2022


Lavinia Fiscaletti
 

Hi Nicole,

Welcome to the group!

Attachments aren't allowed but you can add the links to Kitty's photo album and case history to your auto signature here:

https://ecir.groups.io/g/main/member/11618375

I found her case history floating homeless in the Files - you need to create a folder first, then upload it into the folder. It would also be extremely helpful if you could convert it to a .pdf before uploading, as the pages version can only be viewed by people with Apple devices.

https://ecir.groups.io/g/CaseHistory/filessearch?p=name%2C%2Cnicole+and+kitty%2C20%2C1%2C0%2C0&q=kitty

If you need help with this, please let us know and we we can walk you thru the steps to accomplish that. It is more difficult to do on a phone but not impossible.

Thanks for adding photos, radiographs and her blood work results. She's negative for PPID but definitely positive EMS/IR, so a tight, mineral balanced diet is going to be crucial for her. Once you have created a folder, you can upload the hay test results there as well. As there is still too much of her to love, you'll need to weigh everything that passes thru her lips. More specifics are in the DIET section below.

Her trim definitely can be improved and you've made  good start on that. Her RF is the one needing the most help as there is both bony column rotation and capsular rotation that need to be corrected. Sole is thinner and the side bone much more advanced. Both toes need to be backed up considerably to shift the break over back closer to the tip of the frog, with the RF needing more. Both feet need to have only the heels lowered with RF a lot more than the LF. Time will tell how much that can be done as there are also a lot of arthritic changes present that are going to impact those corrections.

Below is our Official Welcome message. It contains a ton of info, with links to further reading, so storing it somewhere easy to find for future reference will help. Sit, grab a cup of your favorite beverage and have a read. It should answer many of your questions but may also lead to new ones. Just let us know how we can help.

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.

We appreciate you following the uploading instructions for your case history 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 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.

PPID is diagnosed using the Endogenous ACTH test, while EMS/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: 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. 

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 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.

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.


--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


MissKittyColorado
 

Thank you for the help! I believe I have created a folder correctly now and added a PDF case history. I was not successful in creating a hyperlink to her photo album on the PDF. 

I have included info on her current diet (hay analysis, feed labels ect. in photo album once again hyperlink challenged) and would appreciate and advice on balancing her diet to get on the right track and I will also do some reading on the diet library. 

Recent trim photos from 9-12-22 have been uploaded. She is back in her soft ride boots now size 1 because she lost the FR hoof cast 2 days after her 9-01-22 trim. My farrier and I are still looking for advice and mark ups on her photos for her trim but I think we are heading in the right direction.  
--
Nicole E from CO 2022


MissKittyColorado
 


Nancy C
 

Hi Nicole.

Good job. 

With protein of almost 16%, recommend testing nitrates for your hay.

Your major minerals (calcium, phos, magnesium) look okay as far as balancing. In the trace minerals, the iron is high and will take a good bit of copper and zinc.

You may have read that Lavinia is on vacation, so mark-ups will need to wait a bit. Regardless I would keep working on the trim, every two weeks.  The exterior of the foot needs to be trimmed to match what is inside the foot. Not completely sure because the angle of the camera is off, but break over may have actually moved forward.

As a reminder (for both of us) here is what Lavinia said  in your welcome message: Her trim definitely can be improved and you've made  good start on that. Her RF is the one needing the most help as there is both bony column rotation and capsular rotation that need to be corrected. Sole is thinner and the side bone much more advanced. Both toes need to be backed up considerably to shift the break over back closer to the tip of the frog, with the RF needing more. Both feet need to have only the heels lowered with RF a lot more than the LF. Time will tell how much that can be done as there are also a lot of arthritic changes present that are going to impact those corrections.

More reading: https://www.ecirhorse.org/DDT+E-trim.php
 and https://www.ecirhorse.org/realigning-trim.php

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Kirsten Rasmussen
 

Hi Nicole,

In addition to nitrates, the hay should be re-tested with the 644 Carb wet chemistry package.  I refuse to believe ESC is really that low because we've seen anomalously low carb results like that come back much higher upon retesting in the past with Equi-Analytical.

I looked at your feed labels and Case History.

We don't recommend feeding fish oil to horses, and the Omega-6 FA contents are too high in the fish oil supplement (the Omega 3:6 ratio should be 4:1, not 2:1).  Horses evolved to get their Omega-3 FAs from eating fresh forage.  On a hay diet, the correct amount of Omega-3 FAs is best provided by feeding 3-4 oz fresh (or stabilized, like the Triple Crown product) ground flaxseed a day.
https://drkhorsesense.wordpress.com/2021/03/08/omega-3-fatty-acids-in-equine-and-canine-nutrition/
Since you're already feeding enough ground flax, the fish oil product is only adding unnecessary fat and lowering the overall Omega 3:6 ratio in the diet. 

The 101 Balancer may or may not be appropriate for your hay.  I'm concerned by 2 things in it though.  The base is wheat middlings, which are not recommended for horses with EMS.  It might be a very small amount of wheat middlings, but I avoid inappropriate ingredients as much as possible.  And they don't report the iron content on their guaranteed analysis label.  Unless there is no added iron (unlikely--iron is added to most supplements and it is actually inherently higher in any processed feeds because of the equipment used) and unless you are feeding 2 scoops a day (you are not) I doubt the copper and zinc contents are high enough to counteract the iron in your hay.  To determine what you really need to balance your hay, you can contact one of our approved balancers here, who will go over your hay analysis with you to help you determine a mineral supplementation program that is safe for a horse with EMS.

The Standlee teff pellets do not have a guaranteed carb analysis, which means that sugar and starch contents can vary from bag to bag, and in theory could exceed our 10% ESC+starch cut-off.  Generally,  teff is a lower ESC hay, but this is not always true and you can't be sure without testing each bag (or batch run).  We do have 1 analysis in our files you can look at, and it had safe carb contents, but one analysis is not representative of the product: 
https://ecir.groups.io/g/main/files/9c%20Analyses%20of%20Various%20Feeds/Standlee%20Products
Please also note the high iron in that particular analysis.  Every time a pelleted feed is added to the diet, excess iron is added because of the processing equipment.  This should be taken into account with the mineral balancing as much as possible.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Kirsten Rasmussen
 

One more housekeeping detail. 

Can you use this link for your Case History document folder?
https://ecir.groups.io/g/CaseHistory/files/Nicole%20and%20Kitty
That one will take us to your folder, where we can then chose to open your pdf file.  And then we can also access any other pdf documents you might add to your folder in the future.

The link you currently have takes us directly to the pdf file.  This is a problem because if you upload an updated Case History file, your current link will not work anymore, nor will we see any other pdfs you may upload in the future.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


MissKittyColorado
 

Testing the links with my signature. Thank you for the info on the feed! 
--
Nicole E from CO 2022

https://ecir.groups.io/g/CaseHistory/files/Nicole%20and%20Kitty 
https://ecir.groups.io/g/CaseHistory/album?id=278248


MissKittyColorado
 

I received the test results from another hay option I have available for Kitty. It’s labeled 2022-09-20 Hay Test Orchard Brome in my photo album. I am wondering if it may be better to balance her diet with this hay vs the high protein teff. Thank you! 
-- 
Nicole E from CO 2022


https://ecir.groups.io/g/CaseHistory/album?id=278248


https://ecir.groups.io/g/CaseHistory/files/Nicole%20and%20Kitty


Sherry Morse
 

If that test is via Wet Chem (which I believe it is) that's a safer option for feeding an IR horse.  To truly get an answer on which one is better/easier to balance you should contact one of the balancers listed in the files: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf





Kirsten Rasmussen
 

I think the orchard-brome might be a better choice due to the safer protein level.  ESC+starch are nice and low, and it will be a bit easier to balance with the lower iron.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album