Vetoryl


Kimberly
 

My DVM is requesting information on Vetoryl in laminitis cases that have trouble with Prascend.  Mouse, our horse has been successfully on Prascend since 2017 but we are currently fighting what is believed to be a hoof abcess.  He has been very lame on RF for over a week, DP medial side.  Using epson salt soaks, Ichtammol wrapped boot.  His hay is safe (we grow our own and test) and is on Stable 1, soaked beet pulp, flax.  magnesium.  We did blood work in 2017 and he was marginal IR.  Did blood work last week and are awaiting results.  Very concerned that if this abcess does not blow we will have laminitis develop.  Any help appreciated.  
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Kimberly joined 7.17.2018 Virginia


Sherry Morse
 

You'll be getting a full welcome shortly but what 'trouble' are you having with Prascend?  Is the current dose adequate to control PPID?  Having a full case history (you have received an email about this) and current hoof photos will be very helpful for us to help you.  Abscesses do not cause laminitis, elevated insulin levels do.  To control insulin you need to have diet dialed in and PPID well controlled. 




Bobbie Day
 

Welcome Kimberly,
Since this is your first post, I will be including your welcome message, I am sure your familiar with it but since you've not yet received one, we want you to have the information, it can be a lot to read but please take your time and let us know if you have any additional questions. The blue links will take you even deeper into the subject as well.
As you know the cornerstone of the ECIR'S philosophy is DDT/E which is Diagnosis, Diet, Trim and Exercise. The latter is safe only when your equine is ready to move about freely. Although it's the best insulin buster there is we don't want to comprise the already fragile feet.
I do not know anything about Vetoryl, I am hoping that Dr.Kellon might chime in about that but there are other avenues you can take if you think Mouse may have an abscess brewing. First off it would be really helpful to have a case history and photos of his feet and any x-rays you may have. It's really important that we have that information before offering too much advise. If his trim is in good shape, you can try J-herb (Jiaogulan). 
Do you know for sure your hay is under the 10% recommendations for sugar and starch? I would try soaking it for a few days and see if that makes a difference, if it does you will see improvement pretty quickly. Have you had it balanced? Are you rinsing his beet pulp? Is it molasses free?
If he happens to be on any NSAIDS that will keep the abscess from mobilizing as well, we do not recommend that.
If his insulin is high it can drive up hoof pain, or it can mean he needs an increase in his prascend. There are a lot of variables here that's why I mention a case history. You can also try Lamin-Ox from Uckele. If the insulin is the cause, you could try Metformin if your vet is on board. It's just really hard to offer sound advice without knowing more about Mouse. I may also add that lab "Normals" aren't normal, we want ACTH to be in the low twenties at the most. 
https://uckele.com/laminox-3lbs.html
https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin/Metformin%2008.08.20%20FINAL.pdf

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Hello 

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 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 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.

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. 

 


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
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


Eleanor Kellon, VMD
 

I wouldn't use Vetoryl. If ACTH is not controlled, increase the pergolide dose or go to cabergoline. Do you have a support wrap on his opposite leg?
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Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kimberly
 

thank you Dr. Kellon.  We hope to have bloodwork back today.   Can you tell me what numbers we should have to be safe for ACTH, Insulin and Glucose?  My vet just left and the abcess has not popped and we have pulses in both fronts.  She wanted me to ask if we should try Metformin?  I am hoping I can answer all of the questions from my original post in this one.  We grow our own hay and we test it so know the ESC is below 10% He was trimmed last Wednesday.  I started soaking hay this am as we know suspect laminitis and not an abcess.  He is on one Prascend and we hope to have blood work from Cornell today.  He gets soaked  molasses free beet pulp, Stable 1 feed, flax, vitamin E, and iodized salt and magnesium.  We should probably have hay balanced once we get this first cutting in.  We use Equi-Analytical in NY for our hay.  He is currently on one Equiox per day for pain, which is not an NSAID.  I received the paperwork yesterday to begin to load his history.  I have xrays from 2017 last week to upload.  Thank you so much and yes, I am a bit overwhelmed.  Kimberly 
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Kimberly joined 7.17.2018 Virginia


Kimberly
 

thanks Sherry, We are not having trouble with Prascend, just exploring options.  We are increasing his dose today by 1/2 pill.  He does fine on it.  We are thinking laminitis not abcess at this point.  
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Kimberly joined 7.17.2018 Virginia


Kimberly
 

thanks Bobbie, I think I answered all of your questions under Dr. Kellon's post.  I am new to this so please bear with me.  I am trying to get my files uploaded but am a bit overwhelmed.  I appreciate the response.  Kimberly
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Kimberly joined 7.17.2018 Virginia


Sherry Morse
 

Hi Kimberly,

You won't know if Metformin is indicated until you get your bloodwork results back.  We consider a horse with PPID well controlled when ACTH is in the lower 20s/upper teens at this time of year when ACTH is still at its lowest.  If your test results are higher than that or out of the reference range that's an indication that dosage of Prascend needs to be increased.  

For an IR horse we like to see insulin in the low teens with unfasted (hay only) testing.  Insulin over 80 is almost always associated with laminitis.  

Glucose usually will fall in the reference range unless a horse is diabetic which is very rare but does happen in some horses with out of control untreated IR. 

When you test your hay are you using Wet Chem or NIR testing?  Are you rinse/soak/rinsing your beet pulp?  How much should your horse weigh and how much does he weigh now?  How much is he eating?  I'm not sure who told you Equioxx isn't a NSAID but it most definitely is.  (From the BI site: EQUIOXX is a COXIB class non-steroidal anti-inflammatory for horses)

If you're administering it to help with pain relief it will not help with pain due to elevated insulin and if you are dealing with an abscess it will slow mobilization of the abscess so should be stopped ASAP. 

Getting your CH completed and current trim pictures will be very helpful for us to help you.




Kimberly
 

Hi Sherry, we are waiting on bloodwork so will not change anything until we have it. He did have hay before blood was pulled but not for four hours worth.  He had hay for about 1 1/2 before the vet arrived.   Will stop EQuioxx.  We use NIR testing I think.  We core drill dry samples and send to Equi-Analytical.  Yes, we rinse, soak, rinse beet pulp.  He should weigh around 900-950.  His hay is weighed and he gets 15-17 lbs a day.  He is a bit thin but has had fatty pockets over the last few years that seem to stay.  He weighs around 950 with a weight tape.  I spent the last several hours finishing my CH and when I went to upload it, it disappeared.  I cannot find it.  It only will open with a new form.  Do you know how I can recover it?  I still need to upload xrays from last week and can take pictures of the Hinds as we have both fronts padded and wrapped at the moment.  
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Kimberly joined 7.17.2018 Virginia


Sherry Morse
 

Hi Kimberly,

NIR testing can be off by up to 30% from Wet Chem so you definitely want to soak hay until you can run wet chem tests on the new hay.  Did you save the Case History form with a title like "Horse Name Case History"?  If so, you can do a search for the name and should be able to find where you saved it that way. Also check your trash file in case you accidentally deleted it.