Good morning from sunny Africa. My 12yo boerperd gelding presented lame earlier in January this year.  He assumed typical lamintic stance. Few issues before this which we thought was a thrush issue. We don't have up to date remedial farriers in Zim but called our trusty farrier out. On inspection he was a bit concerned. Had to wait for the vet to come out which he did only a couple of days ago :-( and took xrays and confirmed my worst fear. Rotation in both front hooves. Thanks to this website I had already put him on the emergency diet filled his stable with riversand and have had him on box rest. I take him out three times daily for a stroll to the bigger water bath and have made makeshift pads for him out of old riser pads and duct tape. Trying to order some boots from south Africa still investigating to see what we can find. If anyone has some advice on this it would be much appreciated until I can get some may take awhile if I have to get from overseas so need something in the meantime. Have found barefoot boots the Cavallo make which I hope to get inserts either soft rubber or gel?
The first vet had recommended icing which we duly did but have since stopped due to info read here. 
I have replaced this with infra red light treatment. 
He is still on low dose of Bute 1mg per day, still on emergency diet giving nexium 40mg for his tum. Using speedi beet as a carrier magnesium will arrive on Friday. Waiting for a laminitis herbal mixture to arrive and wanting advice on the herbs if possible to make sure I'm not giving him something he shouldn't have. I've been trying to use the least amount possible of Bute to keep him comfortable and would like to ditch the Bute asap for reasons learned here. 
The ingredients are flax seed, rosehip, nettle, hawthorn berry, milk thistle, chaste tree berries, devils claw, meadows weet. Does anyone have ideas at all on these.  My vet is very supportive of any other treatments which may aid in healing process.  Not an awful lot is  known here in this country and mostly outdated. No disrespect meant. Vet recommended heart bar shoes but I'm against that for reasons also learned on fb and here... My heartfelt thanks to you all.... A very lonely path I'm walking with my beautiful boy, thanks so much for the lifeline. 

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Charmaine Fletcher
Zimbabwe Africa
2023

Hi Charmaine,

Welcome to the ECIR group!  Your first post here triggers our formal welcome message with a great deal of reading material relative to your being the partner of an IR and/or PPID horse.  Some of it will be very familiar to you and other ideas might be new to you.  Don’t forget to explore the links as well.

I’m not familiar with Boerperds but a quick search makes me think they might be quite hardy and small, something which would genetically predispose them to insulin resistance.  If this isn’t the case, please let us know.

We’d love to see the X-rays, which you can post in the photo album Cass is instructing you to set up.  Rotation can be either bony or capsular which would affect our guidance.  Does he go on his walks willingly?  If not, I would not force it because walking on laminitic feet can often increase the damage.  You mention a larger ‘water bath’.  I would not recommend soaking his feet at this point.  Without proper boots, we sometimes use insulation board cut to fit and taped on with duct tape.  Use 1” rather than 2” and change frequently as it will get smashed down.  I’ve noticed that 2” might be disorienting to them.

If he has metabolic laminitis, it’s unlikely the bute is helping at all.  You could switch to devil’s claw for muscle strain pain relief which might accompany the laminitis.  Nexium seems to be an omeprazole which is contraindicated with NSAIDs as the combination is more likely to cause unwanted changes in the hind gut.  Omeprazole is fine but the combination is not.

I can’t really speak to the herbal mix except that chaste tree berry is used to alleviate some PPID symptoms, flax we recommend as a part of the emergency diet and I spoke to the devil’s claw earlier.

You should no longer feel like you’re walking a lonely path.  There are many of us here to help you and many of those are here because our vets also are not well educated on the topic.  Educating is something we  ‘specialize’ in.

I was excited to see you are from Zimbabwe!  My husband received his first Rhodesian Ridgeback pup when he was a child - about 75 years ago.  Since we’ve been married, we’ve had quite a number of them.  In the interest of education, I now tell people when they ask about their breed not that they are Rhodesian Ridgebacks but, instead, Zimbabwean Zippers.  I hope that’s okay to share!

Now for all the details I promised.  Keep this information handy as it will continue to be useful.

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.

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.

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.

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. 

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Hi Charmaine,

Can you tell us the name of the herbal mixture you asked about?

Rest assured your path just got a lot less lonely,with almost 10,000 members here, mostly all for the same reason.
Important is to keep breathing. In AND out !

--
Lorna in Eastern Ontario
2002

--
Charmaine Fletcher
Zimbabwe Africa
2023

--
Charmaine Fletcher
Zimbabwe Africa
2023

You can make hoof boots from men's sandals https://www.naturalhorsetrim.com/Lindas_sandals.jpg by adding a strap around the heels/pastern. Description on this page https://www.naturalhorsetrim.com/Section_18.htm . Do you have a link to that herbal mixture?
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Thanks Charmaine.
Is this it?
https://www.ahfs.co.za/product/laminitis-mix/

--
Lorna in Eastern Ontario
2002

That's a pretty good mix but Jiaogulan is more effective than Hawthorn and Chastetree berry contraindicated with PPID and pergolide.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Indeed. I've had a bit of a setback. Medallion managed to get out of the stables and munched on green grass for about 30mins..... Is there anything I can do😢
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Charmaine Fletcher
Zimbabwe Africa
2023

Many thanks!!! 
--
Charmaine Fletcher
Zimbabwe Africa
2023

Charmaine, for a grass breakout, read this:  https://ecir.groups.io/g/main/files/Emergency%20Protocols

This is one time we do recommend icing. 

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

Snickers' Case History
Snickers' Photo Album

Thank you!!! 
-
Charmaine Fletcher
Zimbabwe Africa
2023

--it is yes
Charmaine Fletcher
Zimbabwe Africa
2023