All PPID Horse Owners and Lovers... I Need your Help with Feed Suggestions for an OTTB

[PonyPilot]

My horse was diagnosed as being in the early stage of PPID. This is a bit shocking as he will be 10 in a month. He had a couple signs, and my vet’s suspicions were confirmed after the blood test (take blood, inject hormone, wait 10 minutes, take blood again. Pre and Post were both elevated). I just found out today and am now working on figuring out how management will look going forward. One piece I’m a little stuck on is the feeding. I know keeping his NSC’s low will be critical. I’m just not sure what percentage would be considered “low”. Would that be anything under 12%, 14%? I’m thinking anything 16% and up is too high. He is an OTTB and does need a decent amount of calories while in work to maintain his weight. So far his PPID symptoms have been mostly immune related and not laminitis related (knock on wood).

He’s currently on Triple Crown Senior, Alfalfa Pellets and Purina Amplify. The Amplify is being stopped as it’s 23% NSC and the Senior is within a threshold of 11.7% - 16.5%. I was looking at replacing the Triple Crown Senior with Sentinel Performance LS which provides comparable Protein/Fat/Fiber to the Senior with a maximum of 14% NSC. Is that still too much NSC? I’m sure that the amount of NSC a horse can tolerate is different for each individual, but I’m also thinking there is a general percentage that is typically “safe”.

I want to try to keep him on a complete feed that is low in NSC that also gives him enough calories to maintain weight while in work. He is being trained as an eventer, so currently starting out with mostly hacking and jump lessons at least twice a month, jumping no higher than the BN level. I had added the Amplify to his diet toward the end of summer as he needed to gain a bit more weight and the Senior alone wasn’t doing the job. Amplify did the trick, but now we can’t be on that with our latest diagnosis. I am working closely with my vet and will be discussing these feeding changes with her before pulling the trigger, but I wanted to kick-start my research into this to help make this feel a bit more manageable. I have looked at some older posts, but most of them were for elderly horses or easy keepers that did not need a larger caloric intake.

[MorganMaresVT]

Before you knock yourself out on diet-did you also test him for insulin resistance at the time you tested ACTH? If so, what were his insulin/glucose/leptin results?

Generally-very generally-speaking, an IR horse probably wants NSC of hay and hard feeds 10% or below. But your PPID horse without IR may have more flexibility.

[luvmyhackney]

What MorganMaresVT said.

Also depending on the amount of Amplify and if its working, I’d be hesitant to change as meds for this can make them picky. If its a 1-2 lbs I wouldn’t worry about feeding it as his overall diet might be low enough NSC to balance it.

Hay is the big driver that I look at since it is the primary source of food. Some do ok on alfalfa, some don’t. Some have issues with soy, some don’t. Its a ton of trial and error and keeping up with blood tests to figure out what works and what doesn’t.

[NaturallyHappy]

I recently learned of Triple Crown Senior Active ( only available at Tractor Supply). Mt very picky horse loves it and looks fabulous on it. The NSC is 12.5 I think. He won’t eat any other TC feed.

[JB]

@PonyPilot

take blood, inject hormone, wait 10 minutes, take blood again. Pre and Post were both elevated

Dex suppression test? If so, your vet really needs to come up to speed, and quickly, on what’s not new info for testing. The DST has been out of favor for years because of the relatively high risk of causing laminitis

What were the pre- and post- injection results, and what date? i’m assuming you’re in the northern hemisphere?

@PonyPilot

One piece I’m a little stuck on is the feeding. I know keeping his NSC’s low will be critical. I’m just not sure what percentage would be considered “low”. Would that be anything under 12%, 14%? I’m thinking anything 16% and up is too high.

Generally, feed more like he’s IR/EMS than not, but if ht’s not EMS, it’s not nearly as much of an issue. < 15% is where I’d stay, and this includes his hay. A LOT of PPID horses happily eat grass for years and years, mine included, since PPID doesn’t mean they’re also IR.

The ECIR group will be adamant that a PPID horse’s diet stay below 12% NSC, total diet. Small meals of higher NSC are usually ok - like 1-2lb of a ration balancer that’s 15%

You DO need to test for that too, even though TBs are generally not predisposed to being/becoming IR, it can tag along with PPID

@PonyPilot

He’s currently on Triple Crown Senior, Alfalfa Pellets and Purina Amplify. The Amplify is being stopped as it’s 23% NSC and the Senior is within a threshold of 11.7% - 16.5%. I was looking at replacing the Triple Crown Senior with Sentinel Performance LS which provides comparable Protein/Fat/Fiber to the Senior with a maximum of 14% NSC. Is that still too much NSC? I’m sure that the amount of NSC a horse can tolerate is different for each individual, but I’m also thinking there is a general percentage that is typically “safe”.

that’s probably totally fine. If you can get TC Sr Gold, that’s more calories, and lower NSC than regular Sr, and that might mean you can do without the Amplify (which is probably not a problem to start)

Sentinel is extruded, so it’s more volume per pound, if your horse has a volume limit for his eating, just something to be aware of

@PonyPilot

I want to try to keep him on a complete feed that is low in NSC that also gives him enough calories to maintain weight while in work.

He needs a fortified feed, it doesn’t have to be a complete feed Complete just means it’s got enough fiber if can be the sole or most of the horse’s food. That doesn’t mean complete feeds aren’t suitable, TC Sr is a complete feed and he’s doing well. TC Sr Gold is complete

TC Sr Active is definitely an option, just know it’s also extruded (though looks like a regular pellet), and my biggest beef with it (besides the fact that it smells like stale cardboard lol) is it’ sa 40lb bag for the same $32-ish the other 50lb TC bags are. My old guy wouldn’t even take a nibble, BUT, other horses do like it.

[MorganMaresVT]

@JB

Dex suppression test? If so, your vet really needs to come up to speed, and quickly, on what’s not new info for testing. The DST has been out of favor for years because of the relatively high risk of causing laminitis

I was assuming TRH stim test based on the description, but yes, curious to hear from OP.

TRH Stimulation Test Timing Critical for PPID Diagnosis

[PonyPilot]

He was diagnosed PPID without IR. I wasn’t sure how much flexibility PPID has on it’s own, so that’s good to be aware of.

[Simkie]

I’m not sure why anyone would assume a dex suppression test was done rather than a TRH stim based on this description.

Fwiw, @PonyPilot, Sentinal LS made two of my horses absolutely BONKERS. They aren’t prone to that sort of thing, and it was quite the surprise. I also found it hard to deal with because it’s so light. It takes a LOT of volume to hit the pounds. Maybe great for a horse that feels cheated with not much in the bucket, but really tough for a horse that needs calories and maxes out volume wise when eating.

You could swap out oil for the Amplify. Sticking with the TCS, at least for now, especially if he’s eating it well and you’re happy with his condition, is not at all unreasonable.

[JB]

@MorganMaresVT

I was assuming TRH stim test based on the description, but yes, curious to hear from OP.

Yes, duh, not sure why I jumped to dex. TRH would be ideal this time of year. Still curious about the result.

[PonyPilot]

Thank you for going through each piece and adding comments. It’s very helpful. The test was the TRH response test and the results were sent to Cornell for review. I just got the report from my vet this morning. I wanted to look at it a bit more closely. She mentioned that his pre and post were elevated and said that they were still with in the normal range - the pre and post are above the reference interval (what seems to be normal range) with the post being within the intermediate interval of 110 - 200. Basically a gray area that, I guess, based on clinical signs would determine if it could be PPID or not -, but I think the amount of the increase is what makes her tentatively say he’s in the early stages of PPID. I need to talk with her again. It was a lot of information to take in on a subject I don’t know much about (I spent the whole day researching more about it). I wanted to try to learn as much as I can before talking with her again so I can understand everything better. I also have this bit of doubt in my mind about it. I can’t say why, but I almost don’t know if I believe he has it. Which is another reason I’m trying to research to figure out if it’s just my ignorance to PPID or what. - really thinking it’s my ignorance of PPID at this point as I’m finding out more

I did see an article published by Kentucky Equine Research that said a horse on a starch rich diet could be incorrectly diagnosed with PPID. Could my Amplify’s 23% NSC be skewing the data? This article was published in 2017, so not sure how far testing has come since then.

Edited to add: the bold text after I could make more sense of the report.

[PonyPilot]

He does well on the senior and I definitely do not need to make him bonkers! He’s already goofy enough. I had thought about using oil before going on Amplify, but I don’t have a setup that would allow the oil to keep without spoiling. He’s currently on 1lb of the Amplify per day.

[Simkie]

@PonyPilot

but I don’t have a setup that would allow the oil to keep without spoiling

Unless you’re looking to do something fancy like flax, tons of oil is shelf stable. Solidifying in winter is about the toughest part on management. Canola has the best O3:O6 ratio of the “regular” oils. You’re looking at about 2/3rd cup oil to cover the calories in your Amplify.

But tbh I wouldn’t even worry about a pound of 20ish NSC. It’s just not impactful in the diet as a whole.

More important to test the hay and target reduction efforts (if needed) there.

[jherold]

If he’s doing well on what you currently feed, you don’t need to change anything since he’s not insulin resistant. I actually had to add grain to my previously easy keeper once started on 1/2 prascend. It’s been at at least 13 years since he was diagnosed. While his pergolide has increased over the years, he is still on a normal diet including full pasture because he is not insulin resistant.

[PonyPilot]

That’s really helpful to hear. I was thinking all PPID needed to have their diet changed to lower NSC. He is doing well on his current feed. I can keep a change in mind if anything changes, but for now it sounds like it might be best to leave his feed alone as he’s not IR and is doing well on it.

[jherold]

I definitely wouldn’t change his feed at the same time you add prascend. Some horse do go aff their feed and you don’t want to add another variable. My vet starts with 1/2 tablet and my horse did great for a number of years on just a 1/2.

[PonyPilot]

I will be starting him on Prascend soon (I’m waiting for my order to come in). We are starting on 1/2 a pill and I was going to ask her about keeping him on a 1/2 pill, since he’s numbers aren’t crazy out of control. Maybe a 1/2 will be enough for him. I’ll see what she thinks. She wanted to do a 6 month dosage and then check him in 6 months to see where we’re at. She did mention that it can make them go off their feed, so it’s probably best to keep that the same when starting Prascend. Especially since it sounds like his diet isn’t too much of an issue at the moment at least.

[jherold]

Check the manufacturers website. They often have a rebate.

[JB]

I think it’s worth re-doing the TRH test in a couple of months, since he’s in the equivocal range, but he’ll have to be off pergolide to do that. That said, given the equivocal PLUS his issues, I do think it’s worth starting, and yes, 1/2mg

The “pergolide veil” is real, causing inappetence. Hopefully starting at 1/2mg won’t cause it, and I, personally, would do 1/2mg for 2 weeks just to hedge your bets

Be sure to not touch the pill with your bare hands, and be sure to wrap the remaining 1/2 tightly back in foil

You also have the option of doing the ACTH test around the peak of the seasonal rise which is mid-Sept to mid-Oct, and I, personally, would probably rather do that than test again in July with the rise really just starting

[PonyPilot]

I’m happy to stay on 1/2 mg for as long as possible! Thanks for the extra info too, I’m loving all these extra tidbits as I’m so new to this lol I have disposable gloves that I can use when handling the pill and I will definitely look into ACTH testing around the peak of the seasonal rise.

[JB]

Have you been here yet?
https://equineendocrinologygroup.org/

The EEG is at the forefront of PPID research, testing, medication, etc

This Equine PPID group is excellent, and while they still do go by the guidelines of the ECIR group, they also allow for wiggle room - the ECIR group can be pretty rabidly strict.

And, you can join the www.ecirhorse.org site as well