Topics

New to ECIR

Jen Stern
 

Hi!
I finally finished my case history and uploaded photos...now what?  ;)
So happy I found this group, hope to help my Deva!
--
Jen S. NY 2019

Lorna in Ontario
 

Hi Jen,

Here is the link to your case history

https://ecir.groups.io/g/CaseHistory/filessearch?q=Jen+and+Deva

Go to Subscription and add it to your automatic signature box. Remember to hit Save.
That way it will attach to every message automatically , and volunteers can go right to your case history.

Welcome! You'll receive a message soon from our  Primary Response Team shortly ,chock full of details for you to help Deva.

--

Lorna  in Eastern  Ontario
2002


 

Lavinia Fiscaletti
 

Hi Jen,

Thanks for creating a photo album for Deva - what a beautiful girl.
Here is the link to Deva's photo album:

https://ecir.groups.io/g/CaseHistory/album?id=243352

Would you please add that to your signature as it will help us find it quickly when needed.

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

Jen Stern
 

Here are my case history and photo links.  Hopefully I did that correctly!
--
Jen S. NY 2019

https://ecir.groups.io/g/CaseHistory/files/Jen%20and%20Deva

 

https://ecir.groups.io/g/CaseHistory/album?id=243352

Cindy Q
 

Hi Jen

Thank you for getting all that done.

I saw your question seems to be in your case history at the end, which I reproduce here:
"Despite being in work (heavier work in Spring/Summer/Fall), weight loss is impossible. Vet recommended bumping up her Thyro-L to 2 scoops per day, which causes some weight loss, and that has plateaued.Vet now suggesting giving Metformin, 7 tablets twice a day. Ive see conflicting data on its effectiveness".

It looks like Deva was uncompensated IR in 2008 although your case history does not mention any laminitis. Since then you haven't retaken glucose and you do not have leptin. We have an IR calculator here: https://www.ecirhorse.org/ir-calculator-leptin.php that is useful if you wish to check yourself. However, blood tests need to be taken non-fasting, no grain and allowing hay in front of the horse up to testing. You can read all the details in the Diagnosis section of our Welcome letter below where it says "reading these details".

Your case history does not state how much hay Deva gets. ECIR recommendation for overweight horses is to feed the higher of 1.5% of current body weight and 2% of ideal body weight. Also your hay is not tested so you can try soaking it in the meantime as that can reduce the sugar significantly and also the calories (as outlined in our emergency diet linked below). It would be good to get your hay tested so you know what you are feeding as that is the bulk of the diet. I've experienced fat ponies that don't seem to lose weight even though we increase exercise. What helped in the end was to add minerals to balance the hay better, stop grass and soak the hay to reduce calories. You can see a discussion by one of our members who was also on Thyro-L but found that tightening the diet helped more https://ecir.groups.io/g/main/topic/71894477#247758 .

I will leave Dr Kellon and others to comment more on your metformin question and Thyro-L.

None of the Purina feeds fit within the guidelines of ECIR diet that is safe for IR horses (see Diet section below in Welcome letter).

Right, without further ado, I shall set out the welcome letter. Although you are not in crisis there is a lot of information here that can help you tighten up the diagnosis, diet, management etc so do go through it carefully when you can and bookmark it so you can refer back in future:

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.

Thank you for starting your case history. This link is still useful in case you want to do updates in future: 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.




--
Cindy and Glow - Sep 2017, Singapore
ECIR Primary Response




 

Jen,
Is your horse still going out on pasture?

Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album

Jen Stern
 

Hi Bonnie,

No, she is not out on pasture at this time; only turnout in an indoor arena.

--
Jen S. NY 2019

https://ecir.groups.io/g/CaseHistory/files/Jen%20and%20Deva

 

https://ecir.groups.io/g/CaseHistory/album?id=243352

Jen Stern
 

Hi Cindy,
"Despite being in work (heavier work in Spring/Summer/Fall), weight loss is impossible. Vet recommended bumping up her Thyro-L to 2 scoops per day, which causes some weight loss, and that has plateaued.Vet now suggesting giving Metformin, 7 tablets twice a day. Ive see conflicting data on its effectiveness".

Yes, that is my most current question.  I will look over all the info you posted, and if Dr. Kellon could comment on the Thyro-L and Metformin that would be greatly appreciated.  Thank you!
--
Jen S. NY 2019

https://ecir.groups.io/g/CaseHistory/files/Jen%20and%20Deva

 

https://ecir.groups.io/g/CaseHistory/album?id=243352

Eleanor Kellon, VMD
 

 Please list exactly how much work plus what she eats and how much, by weight. Hay analysis?

In people, metformin can help achieve modest weight losses.

In horses, thyroid supplementation only works at doses high enough to cause hyperthyroidism. IMO, that's not a good idea.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Jen Stern
 

Hi Dr. Kellon,

She currently gets 18-20 lbs of day per day - splint into 3 feedings per day, 2 flakes AM, 2flakes LUNCH, and 4 flakes DINNER/OVERNIGHT.  Each flake weighs approx. 2.25 - 2.5 lbs each.  ALL hay is put into her Porta-Grazer to slow down her speed of intake.

She is currently on 1/2 cup of Purnina Enrich (Balancer feed) twice a day.  1/2 Cup of Platinum Performance Digest twice a day.

Supplements: Thryo-L - 1 scoop twice a day.   Platinum Performance Metabolic Support (Magnesium/Chromium) - 1 scoop twice a day.

She is currently in work 5 times per week, 30 - 45 min of walk and trot, as she is coming back from a slight tendon strain, so no cantering at this time.  She is on INDOOR turnout only at this point.

I have NOT started her on the Metformin yet, though it was suggested by my vet according to her last bloodwork ( see case history).  Is that something you would recommend? 

I am checking with my feed store to see if they carry the Timothy Balance Cubes that the group recommends, and will switch her over to that.  I do not currently soak her hay, but will start that as well.  (I have done that in the past, but it did not seem to make a difference as to her weight, neither did having her on dry lot).

I have NOT had the hay analyzed yet.

Thanks so much for your feedback! :)
Jen S. NY 2019

https://ecir.groups.io/g/CaseHistory/files/Jen%20and%20Deva

 

https://ecir.groups.io/g/CaseHistory/album?id=243352

Eleanor Kellon, VMD
 

I personally wouldn't recommend metformin - preferring to reserve it for more serious situations i.e. laminitis because it doesn't always work and doesn't always continue to work long term.

I would reduce her hay to 15 pounds/day and be sure to weigh it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001