Soaking hay dilemma
One of my last posts, quite a while ago, was about whether or not to soak my low ESC+starch hay. Well, I decided to try it and unfortunately it made no difference. Apollo’s lab values (done through Cornell) 01/03/23, on soaked Groeschl orchard grass hay (ESC 2.5+starch 0.9 done by E-A Lab): insulin 68.35, glucose 99, and ACTH 17.3. Previous blood work 10-27-22 on unsoaked Groeschl hay (ESC 4.9+starch 1.2 by E-A Lab / 3.88+1.92 by Holmes Lab): insulin 68.35, glucose 83, ACTH 16.7. Labs were drawn at same time of day (11 AM) and with same feeding schedule (started feeding hay at 5:30 AM). Nothing else was different except for air temperature and season of year. Does colder air temperature and/or different season (winter vs fall) affect insulin and/or glucose levels?
Kathleen Gustafson did mineral balancing using a soaked hay analysis done by Equi-Analytical. She also had balanced dry/unsoaked Groeschl hay using grower's (Groeschl) analysis done by Holmes Lab. Soaked hay analysis showed iron level more than 2x higher than dry hay Holmes Lab analysis. Our barn water shouldn’t be a factor as pH tests at 7.5 with no detectable iron. I had previously rechecked ESC+starch level on our load of Groeschl hay, and results were only slightly higher than Holmes Lab. Both my soaked hay and ESC+starch retest hay samples were from core samples of 20 random bales in our barn. When Kathleen did my mineral balancing, she said she had another client who purchased Groeschl hay. This person did their own hay analysis through Equi-Analytical and results were very different (especially ESC+starch) from those of Holmes Lab. Also found out Holmes Lab is not a certified forage lab.
These issues with Holmes Lab are concerning. My soaked hay protein level is 13.9% protein which seems high for all-grass hay and I know nitrates can be a factor in elevated nitrate hay levels. I didn't test nitrates in soaked hay because Holmes Lab analysis showed nitrate as "negative" in their dry hay sample. No nitrates in hay grown on fertilized farm land seems odd to me. In 40+ years we've lived on our rural property, our well water nitrate level has never been less than 8 because of contamination from neighboring farms. Last fall our water nitrate test came back unusually low at 0.4 so I had it retested. Retested nitrate level was 6.6, so a third test was done which confirmed the results; testing was done by certified forage lab. If I’m still soaking hay do I need to be concerned about nitrates?
Also wondering if amount of protein in Apollo's diet may be an issue. Since soaked hay protein level was more than adequate, Kathleen felt additional lysine was optional but also advised I could add it if I noticed a loss of topline muscle. I do think he’s lost some top line but I’m not sure so I decided to give 1/2 serving of lysine along with methionine and threonine (using 3 amino acid supplement). Can excess protein increase insulin and/or glucose?
When Apollo’s last labs were done, I had been leaving soaked hay to drain for 15+ minutes inside laundry tub. Now, soaked hay is drained for 30 minutes in a hay net hung from ceiling of our garage. I figured this might help remove more sugar given how much water this very leafy hay absorbs (6 lbs dry becomes 18 lbs after soaking and draining). My laundry tub holds about 22 gallons of water. I soak 6 lbs of hay at a time (keeping it submerged) in luke warm (softened) water for 60 minutes. Anything else I could improve on with soaking hay?
Actually, I'm wondering if I'm gaining anything by continuing to feed soaked hay.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album: https://ecir.groups.io/g/CaseHistory/album?id=275817
That makes no sense to me. Especially since the numbers are not just close but identical. Could there have been a transcription error somewhere?
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ECIR Group Primary Response
Martha and Logo
Hi, Karen.
I’m sure you’re disappointed that you aren’t seeing reduced insulin values for all your hard work soaking hay. Your hay soaking method is fine and obviously working well: your soaked hay has very very low ESC. Unfortunately I don’t have any pat answers, other than to point out that insulin can increase when temperatures are low. So it’s possible the 35 degrees at your most recent blood draw — vs 50 degrees at the previous draw — increased the insulin result.
As for the potential of increased insulin from hay with higher protein, I have to leave that effect for others to explain.
My opinion is that you don’t need to worry about nitrates in this soaked hay. My experience is that nitrates, even really high levels of nitrates, rinse down to safe levels with soaking in warm, soft water. Obviously we’re working without critical facts because you don't have analyzed nitrates for either the dry hay or the soaked hay. I want to point out that crude protein in both the dry and soaked hay analyses is virtually identical. You can see that by looking at dry matter which eliminates the effect of different moisture levels. My point is that I wouldn't assume that nitrates are high in your soaked hay because the CP level is 13.9%. I doubt you are seeing a real increase in crude protein after soaking.
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Diamond's CH at ch.ECIRHorse.org
Cayuse and Diamond Old Case Histories pre-2023Cayuse Photos Diamond Photos
I wouldn't bother to soak that hay. In the absence of exercise, diet is often not enough to get into normal insulin numbers. The jury is still out on protein effects. More work needs to be done.
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Eleanor in PA
www.drkellon.com
EC Owner 2001
The first step to wisdom is "I don't know."
How is he looking physically? Any gauntness to his thigh or stifle area? Any other signs of PPID? His Sept photos showing ribbiness and muscle loss in the hinds suggest to me that his PPID might not be fully controlled on 2mg pergolide a day. I know his baseline ACTH was excellent, but given that his insulin remains high on a very low carb diet you can try increasing pergolide and see if that has an effect on insulin and body condition. His ACTH may not be showing us the whole PPID story.
Another option, especially if exercise is not possible, is to consider an SGLT-2 inhibitor to lower insulin. Not sure if his insulin is high enough that you'd want to go that route just yet, but it is still an option for him in the future.
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Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
Snickers' Case History
Snickers' Photo Album
The results are very close and almost but not quite identical: 68.25 and 68.35. I have no reason to believe the results are incorrect. Prior to trying metformin his insulin was 62.60. All management interventions have been kept consistent: labs were drawn at same time of day by same vet after same morning feeding. No change in turnout time/exercise. Everything Apollo eats is weighed and he gets fed on very consistent schedule. My thinking is that consistency helps improve accuracy of test results. Only factors different between two tests were air temperature and time of year.
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Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album: https://ecir.groups.io/g/CaseHistory/album?id=275817
Regarding protein: in human medicine, older adults are encouraged to increase both amount and quality of their protein intake. Are there similar recommendations for older horses? Apollo is a 21 y/o Percheron/paint cross. If he was a full blooded Percheron, 21 years would be considered quite old for a draft horse but not necessarily for a lighter breed horse.
As for exercise, that's still a work in progress for several reasons which I will go into in a different post.
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Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album: https://ecir.groups.io/g/CaseHistory/album?id=275817
You asked:
Won't I be risking his insulin going even higher if I go back to feeding unsoaked hay? Or is the ESC level of dry hay so low soaking it won't have much of an effect on insulin so it's not worth it?
Dr Kellon explained:
I wouldn't bother to soak that hay. In the absence of exercise, diet [alone] is often not enough to get into normal insulin numbers.
IOW, by itself, soaking hay to the point of reducing ESC to ultra low levels - less than 4 or 5% - doesn't guarantee normal insulin in an EMS equine that isn't exercised.
Is there a specific reason you are asking about additional protein? Does it have to do with Apollo's hooves or lack of muscling or something else? Your hay supplies a more than adequate quantity. We don't know about the quality and about Apollo's utilization of what's in the hay. Aging can have an impact on digestion in general and on the digestion of proteins specifically - from different chewing mechanisms to less stomach acid to fewer microflora and fauna within the digestive tract. More detail is outside the scope of this forum - Dr Kellon offers an entire short course on the care of older horses that can help sift the noise from the research.
If you can get Apollo to eat supplemental essential amino acids, that would be a start to see if you observe any differences. It doesn't take a lot. You can try something like Uckele TriAmino or MyBestHorse Top 3 or Top 4 Aminos. As usual, you need to give supplementation several months to observe differences.
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse's CH at ch.ECIRHorse.org
Diamond's CH at ch.ECIRHorse.org
Cayuse and Diamond Old Case Histories pre-2023Cayuse Photos Diamond Photos
You bring up a good point about how well controlled his PPID is. It's crossed my mind it may not be because of the subtle increase in ACTH over the last year. His ACTH was 12.1 in April 2022 and 11.2 in June 2022 while on 1 mg Prascend. After increasing his Prascend to 2.0 mg in anticipation of seasonal rise, it was 10.3 in August 2022. His ACTH went up to 20.1 during seasonal rise in September 2022 and came back down to 16.7 in October 2022 but in January 2023 it was 17.3 so I'm concerned there's a trend in the wrong direction. If I increase his Prascend, how much would you recommend 0.5 mg or 1.0 mg? I know I'd have to retest but then I'd have to increase it again in anticipation of seasonal rise wouldn't I? The cost of more Prascend and $300+ test to check it's effectiveness are definitely concerns.
Physically, Apollo's the thinnest he's ever been. I'd rate his current BCS as 5. He's always been ribby (? skinny fat horse) except when he was severely overweight. I haven't noticed any muscle loss other than his top line around withers. I don't see the muscle loss you describe seeing in his September photos. In fact, I was told he wasn't thin enough back then. Isn't some muscle loss normal when losing weight without exercise? And isn't some muscle loss (sarcopenia) associated with aging also normal, especially without exercise?
His neck crest is the softest and smallest it's ever been and his tail head fat pads are softer but still present. There's been no increase in water intake or urine output (still much less than it had been prior to starting Prascend). Occasionally some eye goopiness but nothing consistent. No ligament issues. Definitely not lethargic as he notices everything in his environment and often is so distracted by activity at neighbors he doesn't eat his hay right away. We've tried hand walking him but he gets so excited, it's hard to safely handle him. He doesn't want to walk (sometimes his forehand or all 4 feet come off ground) so we end up having to turn him in tight circles to keep him from taking off. His Cloud boots don't fit well, rather loose and sloppy (only 6 months old and worn just for daily paddock turn out) which doesn't help with his foot placement. He makes heel first contact (more on right front) or foot flat contact (more on left front). He needs new boots designed for exercise but given his hoof trim is still a work in progress, I'm not sure it's the right time to invest in them. Yes, I know that his insulin level is high enough to be affecting his hooves but I'm concerned his hooves are not mechanically sound for safe exercise (seems like a viscous cycle).
I have had some concerns about decreased temperature regulation. Apollo's always preferred standing out in rain and snow rather than under the lean-to roof but he never seemed to get chilled. However, in March on a cold, rainy and windy day, I found him shivering in his paddock and he hadn't eaten all of his hay. Our other horse was fine. I brought him inside the barn, toweled him off and put a blanket on to warm him up and he finished all his hay. So I bought him a light weight turnout blanket and put it on whenever it rains or snows and he's been fine since. However, it's been my experience in 50+ years of owning horses, they aren't as cold tolerate as they were when they were young. On the flip side, we recently had some unusually warm weather, 4-5 days in a row with temps in high 70's-80 degrees (broke the record one day). The first couple of days, I noticed Apollo sweating a bit but then he seemed to adjust. He is shedding out well but I did notice his sheath was unusually hairy this winter (don't know if that's significant).
I'm open to any other suggestions you may have and appreciate your help.
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Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album: https://ecir.groups.io/g/CaseHistory/album?id=275817
Saying I'm disappointed that soaking Apollo's hay didn't help would be an understatement. I'm very frustrated that despite spending thousands of dollars and countless hours caring for him (basically having my life revolve around him), not much as improved in past year. Although he isn't doing poorly, he isn't doing great either and some days I'm ready to just give up! I'm sure people are going to judge me for saying that but I don't know how much longer I can keep trying. The financial and emotional strain are enormous.
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Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album: https://ecir.groups.io/g/CaseHistory/album?id=275817
Yes, I understand that diet alone isn't sufficient in the controlling insulin level of a severely IR horse like Apollo. If soaking his hay isn't helpful and feeding unsoaked hay won't risk increasing his insulin then I see no point in continuing feeding soaked hay, do you? That's what I was trying to ask.
I asked about the protein because of his hoof growth, his age and issue of muscle loss (due to his age and lack of exercise and weight loss diet). Weight loss in humans without exercise (particularly strength training) is not recommended by most personal trainers because a significant amount of that weight loss will also be muscle loss. My understanding is that carbohydrates also have a protein sparing effect and since he is on a low carb diet for his IR, I thought protein may be more important. Apollo has been getting 1 tablespoon of MyBestHorse Top 3 Aminos since November. If or how much it has helped, I can't say. The 1 tablespoon is actually a half dose and I'm giving only a half dose because his grass hay's protein level.
If I stop soaking his hay, I probably should have Equi-Analytical do a full analysis of dry hay sample (Groeschl orchard grass hay) including nitrate testing, to make sure it's properly balanced. I still have some concerns about the accuracy of dry hay analysis grower did using Holmes Lab. Iron content of soaked hay was more than double that of dry hay sample, which doesn't make sense given we have no detectable iron in our water and pH is 7.5
Dr. Kellon's course on care of the older horse sounds interesting. Thanks for the suggestion.
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Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album: https://ecir.groups.io/g/CaseHistory/album?id=275817
It sounds like you have a close eye on the usual PPID signs and are not seeing anything too alarming. When I look at this photo, it seems to me that he's a bit gaunt in the ribs and hindquarters. But, it could be the extreme angle as the other 2 photos look fine. You could try increasing by 0.5 mg now, then just do the early July retest and decide how much more to increase it for the rise.
His insulin was 68 on the unsoaked hay previously, so I don't think it will climb much if you stop soaking. It will save you some work, too. You may feel more comfortable if you keep soaking until the end of June, stop soaking 1-2 weeks before his blood pull in early July, and then you'll get a sense of his insulin on unsoaked hay. Or just stop now and watch for signs of hoof soreness, crest hardening, fat pads increasing, etc.
I know it's hard and frustrating and expensive, we've all been there. Hang in there for Apollo but don't forget to give yourself a break, you don't have to do everything perfectly 100% of the time. The fact that he wants to levitate when you take him out tells me he's feeling pretty darn good!
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Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
Snickers' Case History
Snickers' Photo Album
Hi Karen,
I must not have noticed the .25 vs .35. Thanks for pointing that out! I agree that consistency is key to good results. Unfortunately, we don’t have control over everything which affects insulin - temperature and time of year are two that do. Which is not to suggest that there’s anything wrong with your results, now that I understand there wasn’t a transcription error.
Going back over the posts since I started this last night, I agree with Kirsten that your ACTH testing might not be telling the entire story. I’ve run across several situations where that was the case in members of my own herd. Increasing the pergolide should not present a problem and I think it would be worth doing to see if it brings about further improvements. Is there a reason you’re still using Prascend as the dose increases? It would be much less of a financial struggle if you were able to switch to pergolide.
His feet in the most recent photos (which are most likely a few trims back) still look like they’re too far out in front of him. I lost track of whether or not the crack is still an issue. Has Kathleen balanced the hay you are using now? I trust if she has that you’ve made any changes she suggests.
Has Apollo ever been ridden? I know you bought him as a driving horse. Can you long line him? I think you have an exercise story to share and I’m looking forward to reading it.
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ECIR Group Primary Response
Martha and Logo
Yes, I need to post new hoof photos and body shots. I will be doing so soon. I definitely need some input on his current hoof issues and his readiness for formal exercise.
I now compounded pergolide is less expensive but I've kept using Prascend because it's easy to get from my vet, there's no issues with stability and I don't have to worry about problems with shipping. I've seen the list of compounding pharmacies on this site but I honestly don't know which compounding pharmacy to choose! I do wish there were reviews of each pharmacy from our members to help me decide. I also don't know how my vet feels about prescribing compounded pergolide. Getting him to prescribe Metformin took some doing. He doesn't have any issues with running lab tests, if fact, he usually asks me what I want. However, he also doesn't go over any results with me either but that's probably because he knows I'm a member of this group and get the help I need here.
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Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album: https://ecir.groups.io/g/CaseHistory/album?id=275817