locked Urgent Advice Required (Part II)


Rebecca.speed@...
 

Hello again, 

Seeking urgent advice regarding recent bloods taken which result in an unusual Anti-mullarian hormone result. My previous topic here was ‘Urgent Adive Required’ where I outlined the extreme troubles Emme is experiencing with chronic laminitis. 

Any further suggestions in light of the iron results would also be much appreciated. All new blood work is in our file along with new photos and an up to date case history. Thank you x


Sherry Morse
 


Eleanor Kellon, VMD
 

The elevated iron is consistent with iron overload. You can address this over time with strict mineral balancing. Some have gone the route of venisection (blood removal) to quickly lower iron with good results.  The elevated anti-Mullerian hormone is consistent with granulosa theca cell tumor or PCOS.  They should be easy to tell apart with an ovarian ultrasound.  PCOS in mares with EMS responds well to estrogen.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Here is a list of articles linking PCOS and anti-Mullerian hormone https://pubmed.ncbi.nlm.nih.gov/?term=pcos+anti-mullerian&sort=date .  There may be a vet in your area with small enough hands and forearms to do the exam (e.g. I can do horses/ponies her size!)

We obviously cannot prescribe for her but some options would be to remove 2 liters of blood (this likely needs to be repeated) and start her on estradiol 3 mg daily.

Is she off the Danilon yet?

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Rebecca.speed@...
 

Dear Sherry, 

profuse apologies for only just replying to this. I did see your message. Thank you. I got distracted by completing her CH and getting photos uploaded etc. 
From her ATCH records, I too have also not been convinced she is PPID but it’s likely I’m wrong? Her or Prascend trial hasn’t made much difference to circumstances. Now that I have uploaded her ACTH records, would you consider her to be a PPID pony? 


More weight needs to shift. Absolutely and I’ve rationed her hay to the bare minimum and I’m soaking it for one hour. I uploaded the hay analysis to her files. 


Emme is currently on box rest on a very deep bed. She was out on the track in December with pads and boots but she struggled which is obvious due to the rotation and sinking. She has been stabled the last 4 weeks. Now between a rock and a hard place as light movement would help aid slightly more weight loss and circulation but she’s currently too uncomfortable. 

I’m just taking in Dr Kellons replies with regard to blood draining etc. 


Thank you for the suggestions and support. 
--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


Lavinia Fiscaletti
 

Hi Rebecca,

Thanks for adding the latest photos and case history.

Her trim has definitely improved improved but still needs to move the toes back at ground level even more. Also needs to stop trimming all the calloused frog material away as you don't want to expose the immature, waxy frog material. Getting the trim as tight as possible will also help her by eliminating any mechanical aspects that are contributing to her discomfort.

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


Rebecca.speed@...
 

Thank you Eleanor. I’ll digest the articles and pass this info onto my vet and hopefully pursue this route. 

I stopped the Danilon and I’m giving her 15g of Forage Plus devils claw and Jiaogulan. 
--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


Rebecca.speed@...
 

Thank you Lavinia, 

Her feet were looking so much better during summer ‘21. Pretty devastating we’ve regressed this way. 

My trimmer is due again in two weeks so I’ll pass this on and post new photos ASAP. 


thank you for taking the time to help.
--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


Eleanor Kellon, VMD
 

You'll probably also want to show your vet this article on iron overload and EMS https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971364/
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Rebecca.speed@...
 

Hello again, 

I was hoping to ask; looking at Emme’s ACTH/TRH results from her files - whether the labs are clear enough to determine if she does or does not have PPID. 

Thank you. 


--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


Sherry Morse
 

Based on those results she is IR, not PPID.




Rebecca.speed@...
 

Thank you Sherry. Over the various years of testing, I too thought she isn’t a PPID case but my vet wanted to trial Prascend. 

Now I have a greater picture from her most recent bloods, I agree with Dr Kellon that the high iron and possible PCOS is the driver here.

Many thanks all. X
--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


Rebecca.speed@...
 

Hello again, I add loose salt to Emme’s feeds but she’s quite picky about it. We get by with what I hope is the amount she requires without it ruining her feeds. Is Redmond rock safe for IR ponies? Himalayan salt is best avoided?


Many thanks x 

--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


Eleanor Kellon, VMD
 

Those are unpurified, or "dirty" salts.  There is no problem with IR directly but no reason to use them either. Sprinkle your salt onto wet hay if she doesn't like it in her feed.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Bobbie Day
 

Rebecca
I had this discussion on a FB horse group about feeding Redmond, in fact I just (barely) deleted the analysis but there was upwards of 500ppm of iron in a serving. They are actually in my home state but as Dr.K says it’s just dirty salt.
They were recommending it for PPID/IR horses and if anything we’ve learned here that iron overload is a real thing and shouldn’t be taken lightly. I admit I have used Himalayan salt before but now I just buy good old table salt.


--
Bobbie and Maggie
Desi (over the rainbow bridge 7/21)
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie/Maggie%20and%20Bobbie%202021.pdf
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi
https://ecir.groups.io/g/CaseHistory/album?id=78821


Rebecca.speed@...
 

Thank you. Good tip :) 

I hear different views on the benefits of offering apple cider vinegar. A yes/no for IR and EMS? 
--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


 
Edited

Hi, Rebecca.
As a general principle, you can't go wrong with this very simple one: there is no magic bullet for EMS. Diagnosis, Diet, Exercise and Trim, all four, are the answer. The aim is to find and remove all potential triggers for laminitis, put the equine on a safe, optimally nutritious diet, get a good trim in place, regrow a good solid hoof, and implement an exercise program once the feet are comfortable and functional.

Many of us can attest that getting a proper physiological trim, where the hoof capsule and internal structures inside the hoof are appropriately aligned, is the hardest to put in place. 

Emme has one additional potential factor in her reproductive tract. It is not common, but some mares can continue to experience high insulin even after the diet is fully controlled. Have you followed up on Dr Kellon's observations about elevated anti-Mullerian hormone? There's a brief article you can download for free from the No Laminitis Conference Proceedings, here: https://www.ecirhorse.com/proceedings-2013.php 

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Rebecca.speed@...
 

Thank you Cass, 

Yes, I fully appreciate and heed the advice above. I was only asking about salts and ACV because Emme is back out on her small rehab track (pads and boots) and I’m trying to make it as engaging and interesting for her as possible but making sure not to add any dietary triggers which could potentially set her back. Just wanted to add a few things on the track to encourage her to wander and browse. 

She is having another light trim this week so I will be able to get up-to-date photos to upload. 

Thank you for the article. I have passed all the articles posted here by yourself and Dr Kellon onto my vet who I hope to be hearing back from by tomorrow with the hope that an ultrasound can be done ASAP. 


I would like to make sure I have her vitamin and minerals balanced according to the current hay supplier I am using. Is that something I can post as a new topic here?

Thank you all for the advice and support x
--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


Sherry Morse
 

Hi Rebecca,

You can contact any of the people on this list: https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/HAY%20BALANCING-1.pdf for assistance with balancing your hay.




 

Hi, Rebecca. As long as Emme is browsing only safe hay and is comfortable moving in boots/pads, you’re doing the right thing. If she can be turned out with a favorite friend, that’s good too. I never underestimate the benefits of nothing more exciting than the comfort of the afternoon nap in the company of a trusted companion. 

Ad Sherry points out, getting the diet balanced is critical. I believe ForagePlius offers that service. 

We look forward to hoof photos. If you don’t want to trim them with clippers, those lovely feathers can be tamed for photos with pantyhose or knee-highs so the coronary band/cornet is clearly visible. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos