Topics

severe founder

mega20607@...
 

Hello, I am new to this, so I apologize if I do something not according to the rules.
I need some advice, even though I am aware that due to not having any lab work available, that might not be possible. My 22 year old mare Aine (PPID and IR) came up lame on 9-24-2019, took her off pasture, hay and forage feed only. Radiographs on 10-9 showed 4 and 6 degrees rotation of coffin bone. Some improvement, walked nicely with boots on by November. Walked her around the field on 11-14, no problems, moving eagerly. Next day, significant change, which I noticed mainly, when I walked her around the field again. By Sunday, 11-17, she is dead lame, staggering, difficulties to walk. Radiographs of 11-22 show now 16 and 18 degrees rotation. On Bute since 11-22 (initially I was convinced the lameness must have a different reason, thought it is something neurological, since she still picked up her feet easily, also not the typical 'Laminitis stance'), glue on shoes since 11-28. The shoes and the Bute help, she is walking around slowly. I don't know what are the next steps to do to get some improvement. Pointed out this group to the vet, he said he read through the proceedings from the conferences, which I had forwarded to him. He wants to continue the way it is now, but I think I need to do something more, because things are not improving.
--
Mega
Maryland
November 2019

https://ecir.groups.io/g/CaseHistory/files/Mega%20and%20Aine

 

Hello Mega,
Thank you for getting your signature created and your horse's case history posted.  I have attached our "new member" post below. Please read thru it as you can. I realize it is a lot of info. It sounds like you have already been digging into our web site. I wanted to get my own thoughts posted to right now.  

This may be the single most important thing you can do right now for your horse.  No grains of any type, soak her hay to reduce the sugars until you can test the hay being fed.  Here is a link to the "Diet" section on our web site. Follow this protocol to the letter.

Here is another file about the Emergency Diet: Read the info about the Emergency diet, https://ecir.groups.io/g/main/files/1%20Start%20Here/2.%20Emergency%20Diet.pdf

You will be getting more advice from our experienced moderators soon. If you have xrays (in document form) you can create a folder for the xrays/photos. Go to the Case History group and look for the "Photos" section in the left side column. You will create a folder for your horse, using the same naming protocol that you used for your case history folder. You need to add a link for the folder into your "Main Group" Signature. 

Use our Main Group "Wiki" for all the how to info. The Wiki will give you step-by-step help.
 

Welcome to the ECIR group! 

The ECIR 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. 

--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album

Sherry Morse
 

Hi Mega,

Bonnie already provided you with the rather long and involved welcome letter but I wanted to point out a couple of other things for your girl.  If she's having an laminitic event that's driven by a metabolic issue the Bute isn't going to help her feel better and can in fact interfere with healing. (This is addressed under the Exercise portion of the welcome letter)   We also do not recommend forcing a horse with laminitis to move any more than they are willing to do on their own so don't feel that you need to force her to exercise no matter what else you've been told.  Let her dictate how much moving she is willing to do.  There's no way to say for sure at this point if she overdid it on the walks you did with her so please don't beat yourself up for not knowing what she could or couldn't do, just don't ask her to do anything else until she's comfortable again.

At this point a good start would be running blood work so you know what her ACTH, Glucose, Insulin and Leptin levels are and if the 1g of Prascend is keeping her ACTH under control.  The fact that she became laminitic in September points to it not being enough of a dose and/or her IR is not well controlled.  Those results can help point you towards what needs to be tightened up in her diet.  

If you can start a photo album in the case history group and post copies of the x-rays as well as current hoof pictures we'll also be able to tell you if she needs adjustments in her current trim to help her feel better.  Even with a tight diet and ACTH under control if the trim isn't as optimized as can be the horse may still not improving to the extent we'd like to see.


mega20607@...
 

Thank you very much for your responses. To Bonnie: hay is tested and is ok (ESC + starch is 7.5, and 8.1 for the 2 different hay batches I have). Aine gets no grain, unless you consider the ration balancer to be grain. Also no treats etc.
I will try to upload the hay testing results, the x-rays etc. Since she has glue on shoes since 11-28, there will be no pictures of her hoofs. I am not making Aine walk, on 11-15, when I walked her around the field, I had noticed the change during the walk, but she refused to turn around, but would easily walk forwards. Since then any movement she does is voluntarily, except me getting her in the barn for the glue on shoes. We even did the radiographs on 11-22 outside in the paddock area.
I had mentioned the blood work to the vet, he stated the insulin and glucose are somewhat difficult to test, but I will talk to him again. ACTH needs to be tested I guess. I had neglected that, since Aine's full brother, Razz (4 years older), was tested on 5-25-2017 and had a value of 379 pg/ml. Razz does not tolerate the Prascend that well, was on 1.5 g at the time, was kind of thin. He clearly has PPID (hirsutims, some muscle loss, increased urination and drinking; had Laminitis previously). I had reduced the Prascend, at one point discontinued for several months, and he was doing better. Coat improved, and I used Chaste Tree Berry, which made him shed out for the first time in a few years. Currently I again discontinued the Prascend (advice of holistic vet, he had been on 1 g for the past year), since about 2 months, he is fine, lively, gained weight, running around, not a bit lame. He is almost 100% on feed (15-16 pounds Legends Senior Carb Care, appr 4 pounds Timothy/Alfalfa hay cubes soaked, appr. 4 pounds beet pulp soaked), since he has not enough teeth to eat hay or grass (he chews it and spits it out).
The high value of Razz's ACTH test at the time made the vet (and me) concluded that there might be some insensitivity towards ACTH that has developed over time, a theory I did find some confirmation online. This was, why I did not think it makes so much sense to keep on checking Aine, since she did not exhibit pronounced symptoms, except a fairly long coat in the winter, which however usually sheds out. She also has fat deposits and bulging supra orbital cavities (more an IR symptom I guess).
Sorry for the long post, there are just so many somewhat conflicting things I observe, and I guess I would like for other people to take all the information into account. 
I will however ask the vet for the blood test. Again, no trim right now, until glue on shoes come off.
--
Mega
Maryland
November 2019
https://ecir.groups.io/g/CaseHistory/files/Mega%20and%20Aine 

 

There are a few items in the Legends Balance that could aggrevate her laminitis. The alfalfa meal can be a trigger for many IR horses, my 1/2Arab cannot tolerate any alfalfa now. Soybean meal is often high in ESC, Rice bran is a high starch item, and it has molasses in it also.

Really, at this point the best advice is eliminate everything that is not on the emergency diet. What is listed in the Emergency diet is known to be safe. And the beet pulp if used does need to be Rinsed/Soaked/Rinsed.

By the way, I lived in Charles County, MD for about 20 years and my commuting route took me thru Accokeek. 


--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album

Lorna Cane
 

Hi Mega,

Just want to add to Bonnie's suggestions about the Emergency Diet, that soy hull pellets can be used instead of the beet pulp. The advantage is that soy hull pellets just need to be moistened, a little or a lot depending on your horse's preferences. Some horses prefer a mush.
Beet pulp needs to be rinsed/soaked/rinsed and drained.

Thanks for making your CH link clickable.

--
--

Lorna Cane
Ontario, Canada
2002


 

 

Thanks Lorna for adding a note about soyhull pellets! I began feeding them to my IR horse when I lived in Maryland. I didn't want to have to deal with beet pulp and I had never had any luck getting my gelding to eat beet pulp. I called around to the larger feed mills that make/mix feeds on site. I found the soyhull pellets in Culpepper VA at the farmers co-op. The pellets are amazingly inexpensive and they store well for a long time. I am still feeding the pellets here in Michigan. The price just went up to $7.00 for 50 lbs. Another reason to like soyhull pellets.They need very little water to break into crumbles.
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album

mega20607@...
 

Ok, thanks for the suggestions. She eats the soaked beet pulp fine, kind of likes it. I will cut out the ration balancer, but will probably continue to add some Timothy hay cubes, just to give some volume (I am mixing the Bute powder in with the feed, also the Prascend). I'd like to also continue with the Spirulina, Jiaogulan, Chaste tree berry and vitamin C. I added the Vitamin E already, will add Iodized salt instead of the regular one and need to pick up the flax seed tomorrow.
Do you think that increasing the Prascend, in case her ACTH levels are high, would help with the Laminitis? My understanding was that the PPID eventually causes some type of IR, so increasing the Prascend is more of a 'preventative', but not a cure at this point. Is that wrong? Would it make sense to just increase the Prascend, even before the ACTH test is done?
(Bonnie, my office is in Charles County, so I probably go opposite of what you did for 20 years)
--
Mega
Maryland
November 2019
https://ecir.groups.io/g/CaseHistory/files/Mega%20and%20Aine 

mega20607@...
 

Just read in your files that Vitamin C might increase iron uptake. So no more Vitamin C right now.
--
Mega
Maryland
November 2019
https://ecir.groups.io/g/CaseHistory/files/Mega%20and%20Aine 

Jane Fletcher
 

Just in case no one notices but I see you are putting the prascend in with the feed. Are you sure she gets it? I watch mine like a hawk as he’s a star at spitting out tablets put in his feed.


--
Jane, South East Western Australia
Nov 2016
Garnet and Bill

Sherry Morse
 

Hi Mega,

Is the beet pulp you're feeding rinsed, soaked and rinsed again?  If not it will need to be.  As Jane already pointed out giving Prascend in a feed may mean she's not getting it all so we recommend feeding it by itself in some sort of treat that the horse finds palatable to make sure it's being consumed.

You need the bloodwork to tell your what her current ACTH level is, but if that is high (or her IR is out of control) that can cause laminitis.  PPID does not always cause IR although uncontrolled ACTH can drive insulin levels up.  If her insulin and glucose are out of control that can also cause laminitis.   There is no 'cure' for PPID as such, there is just control of the disease.

Since the other horse is a full sibling with a known history of PPID you may want to get him checked now as well and don't be surprised if his results are still off the charts for ACTH (and I would get Insulin, Glucose and Leptin pulled on him as well were he mine so you have a full set of results).  Chaste tree Berry will help with shedding, but does nothing else to control PPID so he may need to be on Prascend as well.  If he doesn't tolerate it well you'll want to read the section of your welcome letter on "Treatment" and consider giving him APF to see if that helps with him. We often find with PPID horses that do not have their ACTH under control that they will be thin as this is one of the characteristics of the disease.  Frankly, I'd be scared to feed a known PPID horse who's had laminitis that type of that grain (it's 20% sugar + starch and 7% fat which is well over our recommended limits) at that amount - too much of a risk of a major train wreck for my taste.


Eleanor Kellon, VMD
 

Hi Mega,

Prascend is dosed in mg, not grams (g).

If you haven't found it already I think you would benefit from reading through the ecirhorse.org web site to see the difference between IR/EMS and PPID.

PPID symptoms vary throughout the year, being worst in the fall and best late spring. It's never a good idea to stop pergolide because that lets the abnormal tissue enlarge without any control. It's fine to reduce dose during the good months in some cases but you should always confirm that the ACTH is remaining controlled.

It's not unusual to need to increase pergolide dose over time. Resistance to the drug is one possibility but it may also be that the pituitary mass is increasing in size or the controlling dopaminergic neurons continue to be lost. Regardless of the cause, it means you need to use more, not less, or switch to cabergoline. Not treating will always lead to more serious problems with control down the road.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

mega20607@...
 

Thanks for your responses.
Prascend in the feed: I used to put a half hand full of low sugar/low starch feed in the middle and put the Prascend on top. She always went for that first, ate it right up. Now I just put the Prascend in the middle and she eats it right up as well.
Beet pulp: yes, I rinse/soak/rinse the beet pulp
Regarding Razz, the brother with PPID: I will get him tested as well. He is doing fine, actually has been doing well for a while. Only major problem I had with him is his inability to sweat, which for years I managed fairly well with the Equiwinner patches, but this year they did not do a thing. I guess I could have bumped up his Prascend, but did not even think about it and vet did not suggest it either. Tried One AC and other stuff, nothing helped. Then (and here it gets scary) I contacted a holistic vet. And guys, I am not kidding: she put him on some homeopathic meds (Sulphur 1M, for those who are interested), some adrenal and pituitary support pills, and my horse started sweating again. He had a reaction, which the vet stated is a detox reaction, where he would not eat for 2 days with a dark violent diarrhea, then recovered from it and started sweating. I noticed it first when we had a few warm days, and then specifically on 11-14, when I walked Aine around the field and he was upset, running around like crazy. He was wet afterwards (and this was NOT due to pain), not everywhere, just  chest, belly, flanks, but there was not a drop of sweat all summer and it was a lot of work to keep him comfortable. So I am very torn about how to continue with him, because I can see that with him homeopathy worked great. I will get him tested however.
I am also concerned about the diet, thinking that eventually this might be a problem. So I will try to put a diet together based on Soy hulls, beet pulp and some hay cubes. It was just difficult to keep the weight on him, but what can I say, he has gained weight, since he is off Prascend and had the homeopathic meds. I think right now he is about his ideal weight, however, top line is not perfect.
All that stuff is what I meant with 'conflicting observations'. Things are not so clear cut for me, except for right now I will follow the strict emergency diet and testing for Aine.
Thanks again for all the input.
--
Mega
Maryland
November 2019
https://ecir.groups.io/g/CaseHistory/files/Mega%20and%20Aine 

mega20607@...
 
Edited

By the way, here is a link to the article, that had sparked my interest in homeopathy in the first place.

https://www.researchgate.net/publication/12119443_Cushing's_Disease_a_new_approach_to_therapy_in_equine_and_canine_patients
--
Mega
Maryland
November 2019
https://ecir.groups.io/g/CaseHistory/files/Mega%20and%20Aine 

 

Hi Mega,
I just wanted to add that if you replace the hay cubes with Ontario Dehydrated Timothy Balance Cubes, also sold by Triple Crown as Timothy Balance Cubes, you won’t need to worry about how many you feed.  They were developed with Dr. Kellon’s help, guaranteed to be low s/s and are formulated with the minerals needed to balance them as well as some beet pulp to hold them together.
You’ve  got a lot going on there and the hay cubes you mention might well be these already, just overlooked by me.
--
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


 
 

Eleanor Kellon, VMD
 
Edited

Yes, that's come up before.

Of the 23 horses included, only 2 were actually confirmed by blood work to even have PPID - one by dexamethasone suppression, one by TRH stimulation. Of those two, one was only followed for 2 months and the other for 3 months but both considered to be "cured". No blood work results were given for any horse at any time before or after starting the remedy.

If you are going to try something completely unproven like this you owe it to your horse to at least carefully follow  blood work to prove it's working.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

mega20607@...
 

Thanks for all your input. And yes, the Timothy hay cubes are the ones you mentioned, just picked up another bag today. I am glad to hear that they are ok. That is a relief.
About the homeopathy: Dr. Kellon, thank you for your input on the article. I did not know these details. I would not try this on my own anyway, could not even get the ACTH medication that was mentioned. However, I found it very interesting. I am not sure how I will proceed with Razz, since he had responded so well to the homeopathic treatment of the holistic vet (different of course than what was described in the article). I actually would like to get him off these huge amounts of Senior feed, since it is very high in starch (15%) and sugar (5%). I will look up the information regarding feed that is posted on the ECIR website.
Thank you again.

--
Mega
Maryland
November 2019
https://ecir.groups.io/g/CaseHistory/files/Mega%20and%20Aine