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Senior Gelding Diagnosed with cushings and having bladder issues

Jess
 

Hi all,

My name is Jess and I am new to the group. A friend recommended this group to me when my horse was diagnosed with Cushings this February 2020. My horse Danny is in his mid 20s and I retired him where he could have fresh air and grass turnout because he had suffered from heaves. He's 16.2/3 German WB/TB. I have had him tested for cushings before in 2019 but he was always negative. Then from end of this November until February he lost a ton of weight, fuzzy but shedding, had an eye ulcer and the following week his bladder was leaking. Back in 2018 he had discolored urine so he was lavaged but then fine we never had any issues up until a few months ago. 

He's had 3 lavages from February until this past Friday and I took him to the clinic for his bladder to be scoped and have a neurological examination. He was diagnosed with Sabulous Cystitis but he still continues to leak, hurting his hind legs. My local vet has put him on 1 pill of Pergalide once a day but he is also on Equisul and Thyro-L for 10 days. Also sent home with banamine and some anti immflamatory meds to help calm down his bladder.

The reason for my message though is that the vet at the clinic has advised we feed him more grain and less hay because of the calcium/sediment build up for his bladder. He currently eats Purina Senior grain which they are recommending he goes from 1/2 a scoop am and pm to increasing to a full for one feed. He currently gets 1/4 cup of corn oil in his grain too. We feed him 1/2 scoop of beet pulp and he loves it so we could increase that. He is also starting Vita Flex Pure C and I was recommended Vitamin E as well. SmartPak makes a Pituatary senior supplement so that should be here May 1st. 

 

He's put a bit more weight on but I am still worried on what to feed if he needs to cut back in hay. He has always been a pacer when turnout out so being being out now all day is amazing for us. Our vet had recommended all day turnout and for the summer to sleep out at night but his current stall isn't connected to the paddock so we may look into getting a form of shelter for the paddock that way he can have more grass and be able to walk more for his bladder. 

Any advice for feeding based on his bladder support as well is greatly received!

Jess
New Jersey
Joined 04/2020.

Eleanor Kellon, VMD
 

Purina Senior has 2.5 to 5 times more calcium than the requirement and much more than most grass hays.  Beet pulp is almost as high as alfalfa!  Forget about pituitary supplements (there really is no such thing).  If his ACTH is controlled on that dose of pergolide and his insulin is normal, you could give him some plain oats (low calcium) and use Uckele Equi VM (calcium free) until you get a hay analysis https://uckele.com/equi-vm-7lbs.html .  Corn oil is a proinflammatory fat. Better to feed him 4 oz of stabilized flax. Very important is at least 1.5 ounces of salt a day to make him drink well and keep the bladder flushed out. Try coating those scalded areas on his legs with a thick layer of Vaseline or Desitin.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Cindy Q
 

Hello Jess

Welcome to the group! I see Dr Kellon has already given you specific advice on the diet. On the flax, you may be able to get it very cheaply in bulk (many members use Triple Crown brand for example). On the Uckele Equi VM, if you use ECIR as a code on Uckele website, you will get a 5% discount (for all EMS/IR related products). 

For hay testing - ECIR recommends getting the #603 (trainer package) hay test from Equi-Analytical, the equine branch of Dairy One. This is the "full" analysis using wet chemistry method and includes accurate measure of ESC and starch, protein etc. Either this test or the basic (601) test will give you the major minerals such as calcium (by wet chemistry method) but if you are testing, it would be most beneficial to get the 603 analysis then knowing that it is all accurate. Here's the link to getting a free forage testing kit from them that includes postage paid envelope, form, sample bag: http://equi-analytical.com/supplies/


Below is our official welcome letter which has a lot of information on Cushings, recommended testing protocol, diet and more. There is a section called Treatment below and you can see what Dr Kellon referred to - for PPID/cushings, 
ACTH should be maintained in the middle of the normal range at all times. Have a read through and you may wish to save this so you can continue to refer back to it.

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, 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




Jess
 

Hi Cindy and Dr. Kellon,

Thank you so much for your responses. He is in need of grain as we speak, is there a certain brand I should get with low calcium? I see you mentioned Triple Crown which he used to be on Triple crown senior.  I will fill in the history report that has all of the tests we have run. I will look into getting the hay tested because I only know that it is a second cut Timothy/Orchard mix. 

We used to wet his hay due to his heaves and he didn't really like it. He used to dunk his hay a lot but not so much anymore. 

--
Jess in New Jersey 2020

Eleanor Kellon, VMD
 

Do you mean he needs to gain weight?  Many PPID/Cushing's horses have insulin resistance which makes grain dangerous. You need to check insulin before feeding grain. All commercial grain mixes and balancers have way too much calcium for him. So does beet pulp. Get the hay and insulin tested, send to me at kellon "at" uckele.com and I'll figure out a diet for you.  In the meantime, get him some TC Naturals Golden Ground Flax and you can feed up to 1 lb/day.  See if you can locate some grass hay pellets.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Sherry Morse
 

Hi Jess,

Until you get his hay tested you may want to consider using Timothy Balance Cubes which are distributed by Triple Crown in the US as Naturals Timothy Balance Cubes (https://www.triplecrownfeed.com/products/timothy-balance-cubes/).  These have a guaranteed analysis and can be used in place of hay.  It's difficult to answer your other questions without having the case history information so I look forward to seeing that once you get it completed.



Eleanor Kellon, VMD
 

The Balance Cubes are high calcium too.

The problem is most species regulate calcium absorption. Horses do not, absorbing as much as they can then excreting in the excess in urine which creates the "sludge" in the bladder.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Cindy Q
 

Hi Jess

The link I gave you for forage sample kit has been changed. This should be the new one: https://dairyone.com/shop/equi-analytical-mailer-kit/

Also, to add a bit of background Dr Kellon gave you a Uckele email address to - she does free hay balancing for ECIR members who are using Uckele products.

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




Jess
 

Hi Dr Kellon,

Thank you! I emailed you but I just got a quick phone call today he did test positive for lepto too. I didn’t catch the name so I’ll confirm that tomorrow.
--
Jess in New Jersey 2020

Jess
 

Hello! 

I have the kit but I am really not sure which box to tick in terms of what I should have the hay analyzed for. My vet said it would be good to know the fiber break down and of course calcium, anything that could help with the mineral sludge. 

I have the hay ready to go.


--
Jess in New Jersey 2020

gypsylassie
 

Is the kit from Equi Analytical?  If so, you want the 603 Trainer analysis.  It give us everything we need and uses the wet chem process for accurate results.  When you get the results, you'll see columns for as sampled/as fed and dry matter.  We use the as sampled/as fed column.  
Laura K Chappie & Beau over the bridge
2011 N IL

Jess
 

Yes it is. Thank you so much! 
--
Jess in New Jersey 2020