I don’t have access to Triple Crown products, so that was never something I looked into. I should have qualified my response with the specific bagged hay products I do have access to - Standlee and DuMor. Thank you pointing out my oversight.
Standlee has always told me the NSC of their alfalfa is 9 (5-year average is what they go by). So it varies by feed company. I’ll feed their pellets but not their forage (it’s just way too dusty!). I have no idea about DuMor other than that it’s a lower quality feed hence why I stay with Triple Crown (Senior and Grass Forage).
An ACTH of 39.7, while out of range, is not wildly out of range. For comparison, I’ve had ACTH results come back at 200+. Good for you that you’re catching the Cushing’s early. I’ve had good success tapering onto Prascend/pergolide by 0.5mg/week, but do whatever your vet recommends. Not all horses experience the veil, and almost all of them come out the backside if you can stick it out.
If that 43.13 insulin is measured in uIU/mL, the RISQI calculator considers that poorly compensated IR. RISQI is a proxy measure of insulin resistance that can be calculated without a glucose value. (I’m running this calculation on the ECIR website, so you can do this any time – I just know it’s overwhelming at first!) Now, you have two different things happening here. IR is a metabolic type, not a disease in itself. Just like some people tolerate carbs better than others, certain breeds of horse – “easy keeping” types like TWHs – tend to get in trouble when too many carbs are available. They may never be able to tolerate unlimited grazing or high carb feeds, but most do fine with the right management.
IR can also be a symptom/result of Cushing’s disease, even in horses that did not previously have that metabolic type. I have a TB mare at my farm whose first symptom of Cushing’s was foundering. She isn’t the IR “type,” but the disease process made her IR. Right now you don’t know how much of the IR is being driven by Rocky’s Cushing’s, and how much is his baseline metabolic type. Once you get him on the pergolide and his ACTH is well-controlled, you’ll be able to re-test insulin and see how well he responded to that part of the plan. IIWM, I wouldn’t be giving him any access to grass without a muzzle until I had that data.
TLDR – Don’t be terrified. This is doable!
@Scribbler , @4LeafCloverFarm , @ryansgirl , @findthedistance , @frisky , @walkinthewalk – I really cannot thank you enough for sticking with me and helping me. It seems like the more questions I have and the more answers I get, the more confused I am.
This is the first really complicated thing I have ever had to deal with. Rocky has had soft tissue situations (right front) and a stifle injury (back left), but those were a piece of cake compared to this.
Thank you to @findthedistance for your thoughts on Rocky’s test results. I also thought that maybe the ACTH was perhaps not too awful considering it was just out of normal range. And I had read on two different sites that sometimes the insulin test is a bit high because of the Cushings or even because of the laminitis episode not being over yet. My vet just sent a text saying ACTH was positive for Cushings and Insulin was also high, with no numbers and no explanation. I had to ask (by text) several times to get the numbers and then he just sent the results without letting me know the normal range. I asked for that and finally, 3 days later, I had both the results and the normal range. THEN I asked him how Rocky’s test results should be interpreted – really awful, maybe not so bad, early stages??? I never got an answer to that, just that he should start on Pergolide. So I asked when and how is it administered and he just said “pill”. It has been one week and I do not have the medication yet. I know my vet is very busy as he is getting ready to be out of town for 10 days, but I really, really, really need more communication.
I am leery about starting the Pergolide while he is out of town, but at least my riding instructor will be back and not scrambling around getting 4 students prepped and ready for AECs. She will be a fantastic resource.
I am hoping maybe just Cushings and not IR because having both seems to make things even more complicated.
@ryansgirl - if I don’t get more blood tests for Rocky, how do I know if the Pergolide is working? And Rocky presented with the laminitis on August 2nd, so we had to test in August. Do I really wait until after January to test again? I read all of that on the EICR site and felt very defeated about how I was to know if he was better or not if testing is not advised during that time.
@4LeafCloverFarm , I buy Standlee Timothy in the compressed bales. Tractor Supply has these bales in the dark green plastic covers with handles and my feed store has the compressed bales uncovered (also by Standlee). I have been buying Rocky’s Timothy hay at TSC during this time frame because I am also buying the TSC brand pelleted bedding that expands when wet. I open every bale of Timothy in the store and sniff at it and make sure it is not dusty. Since most of the bale covers already have a little opening (just from handling, I guess), I don’t feel too bad about doing this. Since this is all Rocky has been eating, I have to be sure the hay is good before I take it from the store.
Here is the info about the Standlee compressed bales of Timothy:
Premium Timothy Compressed Bales are formed by allowing Standlee Premium Western Forage® to grow to the proper stage of maturity, cutting the plants, allowing them to sun-cure (dry) to an acceptable moisture level and baling the forage at the optimal time. Standlee Premium Western Forage® creates compressed bales of forage from a large 4’x4’x8’ bale that is put through a press, sliced horizontally, pushed onto a scale, weighed, compressed and then banded. Timothy Grass forage is highly palatable, is low to moderate in protein and high in digestible fiber.
GUARANTEED ANALYSIS [TABLE]
[TR]
[TD=“class: type”]Crude Protein[/TD]
[TD=“class: quantity”]Min 8%[/TD]
[/TR]
[TR]
[TD=“class: type”]Crude Fat[/TD]
[TD=“class: quantity”]Min 1.5%[/TD]
[/TR]
[TR]
[TD=“class: type”]Crude Fiber[/TD]
[TD=“class: quantity”]Max 35%[/TD]
[/TR]
[/TABLE]
The Triple Crown product I have referred to is his Senior Feed which he has not had since August 1. It is a grain free, beet pulp based feed for senior horses. It does have molasses added, so probably Rocky won’t be having this again.
I read another site that discussed how to get horses to take their Pergolide and/or eat their ration balancers and it was mentioned to add 1/8 teaspoon of peppermint extract to the portion. Rocky is not food motivated, but he would just about walk through fire for a peppermint. So even though I think I will be giving him the Pergolide in a syringe to be absolutely sure he gets it all, I am keeping this peppermint extract tip “on file” if I need to use it.
@4LeafCloverFarm - what is your general area? I am in upstate South Carolina. If the veterinarian gives the okay, I may try to find a local farmer who does Coastal Bermuda squares vs. Round Bales. I do remember that hay being very fine and the Timothy is much “thicker” for lack of a better description. Rocky seems to eat the Timothy very well – I would see the chunks if he spit it out, but maybe the CB would be better for him? If I wind up having to keep him on Timothy, I must find a way to get more than 4 bales at a time from TSC. Not only $$$ but buying hay every week is getting very old.
@findthedistance, you said “Once you get him on the pergolide and his ACTH is well-controlled, you’ll be able to re-test insulin and see how well he responded to that part of the plan. IIWM, I wouldn’t be giving him any access to grass without a muzzle until I had that data.”
Thank you for your advice about the muzzle if he is turned out on the grass. Now I just need to know WHEN I can do this. The Extension Agent said only to turn out in the morning because of the sugars. My instructor keeps her previously foundered horse inside during the sunny daytime and turns out only after dusk. Or if it is a cloudy, overcast day, the horse can go out in the daytime. My veterinarian does not really answer me … so I am stuck.
Not that I am planning to put Rocky’s muzzle on and turn him out for hours and hours … I would like to give him maybe 15 minutes, working up to 30 minutes so he can walk around. I am just so confused about when to do this since I have conflicting information (and no guidance from the vet. I am going to ask him again).
And, getting back to blood testing Rocky - “… and his ACTH is well-controlled” … how do I find this out if it is not advised to test between August and January because of seasonal rise? Do I seriously wait until February?
SCM1959
I’m in Middle Tennessee - so not terribly far from you. I use the Standlee chopped Alfalfa in the 40lb “bale” bag. I used to get the compressed Alfalfa, but after getting bales that contained so much thick-stemmed stuff my senior horse wouldn’t eat - it became a massive waste of $$$. So I switched to the chopped alfalfa and it is very consistent, in both size/thickness of stems and in quality. I also get mine from TSC. Sadly, my local feed store doesn’t carry bagged bales of chopped or compressed hay, so I’m limited to what TSC carries. But I have to say I never considered opening the bags prior to purchase! :lol:
Please don’t be too hard on yourself. I can certainly understand how difficult this is and doing research can leave you with more questions than answers. Our dog Bailey was diagnosed with Epilepsy when she was about a year old. I was devastated. I’ve had pets all my life - but nothing prepared me for a dog having grand maul seizures. I think I drove the vet crazy at first - and myself too. But that was almost 9 years ago. Bailey’s epilepsy is fairly well controlled with medication. And I’m a champ now at being able to give her the rectal Valium dose with a syringe. :o Though it is still upsetting to see her go through it.
@4LeafCloverFarm - you said: “But I have to say I never considered opening the bags prior to purchase! :lol:”
You would do this if you had to keep lugging those 50 pound bales out of your hay storage, BACK into the van, and then BACK into the store, over and over and over.
I do not feel one bit bad checking the quality before I buy.
TSC did recently get new pushcart style buggies, so that makes it easier than their old kind that had such wonky wheels the buggies would not go forward (had to push them diagonally), but still! Way too much work!
SCM1959
Are you saying he can’t have TC Senior because it has molasses in it?? You are forgetting that the NSC is 11.7 which is a good thing. Most feeds are higher than that. My mare gets enough so her supplements stick to it. She doesn’t get the recommended amount because she doesn’t need the calories. So instead she gets Horsetechs High Point Grass supplement which is a vitamin/mineral that covers basically what she needs. You can also try Triple Crown Lite or their 30% Ration Balancer - both cover a horses daily needs if fed at the recommended amount (which is a lot less than the TC Senior pound wise) and both are less than 10 for NSCs. I tried both but my mare didn’t think they were tasty enough so she wouldn’t eat either.
Some horses will eat the Prascend right with their feed and some won’t. I find it easiest to put it in a 10ml syringe with tiny bit of water and give it to her that way. I know she gets all of it with this method (and shes perfect about it every time). I’d be curious to see what amount your vet says to start with - normal is 1/4 or 1/2 tab (we did 1/2 tab to start my mare). We bumped it to 3/4 tab when her number came back a little higher than we wanted during one spring test. We typically test in May and sometimes early January. You just have to assume the Prascend is working. Read up on symptoms of Cushings - if he seems worse then you might bump up the dosage amount. I go by test results.
I mentioned the molasses because it is used in some bagged hays to reduce dust and that does raise the NSC of that particular product. If two products are available - one with molasses and one with oil to control dust, I would select the one with the oil, because my little pony doesn’t need the added sugar/energy - even if it is small amount. My main point was, when you see a bag/bale that say “chopped” or “compressed” or “forage” don’t assume the only ingredient is the type of hay it is! 
Especially if it is your primary forage for the horse.
So, @SCM1959, if your feed has molasses, but the total NSC of the product is under 11% or 12% I would not worry about it. It will be fine.
Sorry, didn’t mean to cause a disturbance over molasses. :o Sometimes I abbreviate my posts for brevity (being the old wind bag that I am), when I shouldn’t.
Regarding testing, and I know this is tricky when you’re vet’s not very responsive, but it’s worth getting his ideas. There are established norms for seasonal rise, and you can test ACTH now. https://www.ecirhorse.org/seasonal-rise.php My vet is still not a fan of testing during seasonal rise, so I follow her lead. I manage a group of older horses and we have a long track record of success managing PPID & IR together. Depending on your vet’s philosophy, you might test again after Rocky has been on the pergolide for a bit, or, yes, you might wait until February.
There’s good information about grazing at http://safergrass.org/articles.html. I would think you should be able to do 15-30 minutes of muzzled turnout at whatever time of day works for your life. If early morning is an option, that would be a good starting point. To grossly oversimplify, grass photosynthesizes during daylight hours, so sugar stores increase through the day. Then the grass uses those sugar stores overnight, meaning that (all else being equal) grass should have its lowest sugar content just before dawn.
Here are the tests done for Cushings and the Reference Values per New Bolton Center. [TABLE=“border: 1, cellpadding: 0, cellspacing: 0”]
[TR]
[TD]Test Name[/TD]
[TD]Reference Values[/TD]
[TD]Units[/TD]
[/TR]
[TR]
[TD]ACTH[/TD]
[TD]9-35[/TD]
[TD]pg/mL[/TD]
[/TR]
[TR]
[TD]Insulin[/TD]
[TD]10-40[/TD]
[TD]ulU/mL[/TD]
[/TR]
[TR]
[TD]Cortisol[/TD]
[TD]2.00-6.00[/TD]
[TD]ug/dL[/TD]
[/TR]
[TR]
[TD]T3[/TD]
[TD]30.0-80.0[/TD]
[TD]ng/dL[/TD]
[/TR]
[TR]
[TD]T4[/TD]
[TD]1.000-3.000[/TD]
[TD]ug/dL[/TD]
[/TR]
[/TABLE]
If your ACTH results are a little high, that can be accounted for by the natural seasonality where ACTH increases in the fall. For example, an ACTH number in the 35-40 range might be ok when taken in the fall.
I keep a medical record for my horses so I don’t have just one number in a vacuum.
Depending on your numbers your vet should tell you what dosage to start your horse at. We started at 1 pill per day. I have tested mid-summer and fall to see how things are tracking.
@SCM1959 , here’s the Triple Crown link that shows NSC value of all their products.
https://www.triplecrownfeed.com/wp-content/uploads/2019/02/NSC-page_web020819.pdf
A good friend had a horse that was both cushings and IR. He did pretty good on the Timothy Balancer cubes which are only 10% NSC; she soaked the cubes for her horse.
This product is not a complete vit/min product however. You might consider a condensed complete vit/min supplement in addition to the Balancer cubes. You would have to be mindful of the selenium, if you live in a high selenium area:)
i use HorseTech’s HighPoint for grass fed horses. It is a complete vit/min supplement that is soy-free and does not have added iron. It costs about 86 cents per feeding. They will also custom mix a supplement.
I have empathy for you, regarding your vet. When my other metabolic horse was diagnosed back in 2007, all the farm vet could tell me was to watch his diet but could not tell me what that should be and I also did not get the results from the blood tests.
I spent that summer in tears, researching till my fingers were numb on the keyboard and my eyeballs looked like road maps. It was caring members on this forum who got me pointed in the right direction to help my horse. I am eternally grateful and make it my mission to try and pay that forward with what I have learned and works for me:)
Thank you for this information. I have asked my vet if he has any other numbers besides the ACTH and the insulin and have not had an answer back.
I want to keep a record of Rocky’s test results so I can compare them when he is next tested. My veterinarian is a good diagnostician, but he is disorganized. He needs a secretary and/or a vet tech who could do some follow-up calls or visits to help clients like me.
He is leaving this coming Saturday to take his daughter to college. He has told me he will have the Pergolide for me before then.
I am going to my instructor’s farm tomorrow to drop off her tax return items (I do all of her sorting for her) and hope to have a few minutes to chat with her. She is so knowledgeable and she understands how I understand, so her explanations to me are always spot on.
I also hope my farrier can come tomorrow.
Rocky seems pretty good today, no better, no worse as far as I can tell.
SCM1959
@walkinthewalk No wonder you are so patient with me. I hate it that you have had an experience like mine. It is scary dealing with all of this and not getting feedback from the vet. I am a rule follower and I need regular communication to let me know I am doing things correctly.
I had that chart from TSC but could not get it to copy/paste to my post. I intend to show it to my veterinarian to find out what, if anything, I should get.
Rocky really does not like wet hay or hay cubes (soaked). It is so hot here that it is hard to keep wet forage fresh. In the winter, he enjoys his Senior soaked with beet pulp, but he does not like wet hay products.
I have found your supplements online so have printed off that information as well. I will check to see if my feed store has it, and will also show it to the vet to see if Rocky should start having it each day.
Today was the big day to let Rocky have some “grazing time” wearing his muzzle. I was all set and felt good and confident about doing this … and instead I found an emaciated stray dog in my garage. She is obviously part pit bull, but she is so very sweet and so submissive I fear that she has been beaten in the past. We fed her a little bit and gave her some water, but I was afraid to give her too much food because she is so starved. Her backbone and her ribs show and she is all sucked in on each side. It looks like she has recently had puppies as her nipples are very noticeable.
There was no way to lead Rocky to his smaller paddock without being around this stray dog and Rocky was very ALERT about a different dog being on our property. I have no idea how this dog would act around the horses, and I was certainly not going to test her behavior with Rocky today. The animal shelter was closed so I will have to take her tomorrow when they open at noon. This means that it will be Wednesday before I can let Rocky have some wandering/grazing time. Ugh.
Luckily my big pasture (where Rocky’s pen is) is entirely fenced with no-climb wire fencing, 5 feet high, so Rocky is safe in his pen and the dog is safe from our pony, who would probably feel that the dog must be stomped.
It’s always something!
SCM1959
Okay, here I am again. Stray dog was picked up by Animal Control and she has a chip (although as emaciated as she is, I wonder if she should go back to owner or not).
I got ready yesterday to do Rocky’s hand walking and brought the muzzle with me to try it on him. He seemed to hate it. This is a horse who does not usually have much of a reaction to anything, so it was notable that this muzzle seemed to alarm him.
Taking him to his small paddock for “grazing” was out anyway … he was not walking well yesterday at all.
The farrier came and watched him walk in the Soft Ride Boots and thought he looked a bit better than before (farrier was here 8/12). He used hoof testers carefully and I thought Rocky would fall over. Obviously still very sore. The farrier did a quick trim and at one point I was sure Rocky would fall down. This was very frightening to see and he was much worse than he was on August 12th when the farrier came the first time.
I went out this morning to clean the pen, re-do the waters and leave hay and he is not moving well at all. He even rocked a bit and I have not seen that since August 8th. Moving around even in his small pen was very difficult for him. So obviously no hand-walking.
Now I am wondering if I should have given him bute yesterday after the farrier was here.
I am trying not to panic.
I sent my vet a note about giving him bute and have had no response. The pergolide is here and I had a text from the vet this morning saying to pick it up in his dropbox (which means no talking with him – just go get the meds).
I have had no guidance whatsoever re giving Rocky a mineral supplement. I sent a text asking about the specific minerals recommended here but no answer.
In the meantime, since my vet is leaving for 10 days tomorrow, I contacted another veterinary practice because I am very nervous about being totally on my own, particularly with starting Pergolide. I think maybe I will ask them to come out tomorrow to look at Rocky. That way, if I need to call them during the 10 days, they will have something to go on.
I am feeling very worried right now.
Edited to add that I just called the other veterinary practice to see about an appointment for tomorrow. They have vet techs who answer the phone which was such a relief. It looks like their veterinarian will come out today to take a look at Rocky since she will be on a farm call less than 5 minutes from me and has to pass my farm on her way back to her office.
I am going to go get the Pergolide so I will have it on hand when this new veterinarian comes.
SCM1959
Sorry to hear that Rocky’s laminitis has flared up again. I would give 1g of bute AM and 1g PM. This will make him more comfortable.
I understand being worried with your vet going out of town. You are doing a great job caring for him. Having a second vet look at him while yours is unavailable sounds like a great plan.
Just wanted to say thank you so much for this post. My mini was diagnosed with laminitis last week and I’ve been working my butt off to make him comfortable. I plan to make my own thread to try to get my questions answered.
This new vet really sounds like they are really on the ball. If it were me, this new vet would my vet going forward for Rocky.
Very sorry to hear about Rocky though. Hope he is feeling better in a day or two. How is your husband coming along on building you that shed for Rocky?
Do make sure the hay supplier of the fescue bales has tests available to show you the NSC of his/her hay, as you wouldn’t want the NSC of the hay to go up from the Timothy you are feeding. I was always taught (probably incorrectly) that fescue grass and fescue hay was not advised for lamanitic/foundered horses. But that may well be outdated info from way back in the dark ages (1970) when I started riding as a child.
@4LeafCloverFarm - Ditto that, I think I would stick with this second vet.
BUT — what did she suggest regarding Rocky’s hooves? IMHO some changes might need to be made regarding how they are being managed but that rotation is so severe, I’m not comfortable making suggestions.
I will say he can de-rotate, to some degree, with the help of an experienced therapeutic farrier. No matter how good your farrier is and how willing that person is to bend over backward, trust me when I say, if he/she does not have therapeutic training or access to a farrier who does, you really need to get a therapeutic farrier involved — which probably won’t be cheap:(
I am afraid that, even on Rocky’s good days, you are not going to be able to relax too much. I reached a point where I started taking pictures of my horse (including good hoof pics) every few days because I got to where what I THOUGHT I was seeing wasn’t what I was seeing at all:).
Start a folder on whatever device has the most storage and be sure to date each hoof picture and be sure to include good sole shots. The farrier will also appreciate those dates pictures.
This link shows hooves, along with written instruction. http://www.all-natural-horse-care.co…of-photos.html. I used to step Joker’s front end onto a small piece of plywood, if you don’t have a cement barn aisle or garage apron. Rocky needs to be on a level surface.
It is important, to NOT wash the hooves - wet hooves do not tell a good story. If Rocky’s hooves are not clean, use a stiff bristled brush to clean them:).
Be prepared to minister to those hooves for the long haul and to get less sleep to fit everything in that is already a part of your life:). It can be overwhelming but my best advice for that is to stay organized and keep finding ways to kick efficiency up another notch:)
Oh and I forgot - if you haven’t already, get those new rads to your farrier. He may have some suggestions of different inserts for those boots you are using.
-
I can see enough of the rotation on your thumbnails – I can’t handle enlarging them – he is worse than Joker was and Joker was pretty bad.
-
Regarding therapeutic shoes and pads:
2.1. Ask the new vet how she feels about VetTec’s EquiPak CS. “CS” means copper sulfate, which helps guard against anaerobic issues. It is a pour-in that hardens up in less than five minutes.
https://www.vettec.com/equi-pakcs-160cc-pour-pad
2.1.1. I tried leather pads one time only and had the farrier come back out a week early to get those awful things off Joker. He lives on dry ground and nothing but grass. He is stalled at night. Even at that, he was developing hoof health issues brought on by the moisture under the leather.
2.2. Joker is in a model of a steel Natural Balance shoe called “PLR Flat”. I doubt that model will initially work for Rocky but my point is I really like the Natural Balance shoe. They are NOT a slick shoe, therefore offer some grip for the horse on wet grass.
We took him out of aluminum due to his preponderance for WLD, plus she can heat the steel shoes to cauterize his hooves without worry of cracking them.
She also uses copper nails for the same reason:)
https://www.anvilbrand.com/shop-cate…aturalbalance/
There are other brands of therapeutic shoes such as Nanric and Kerckhaert. Joker wore a wedge style Kerckhaert early on, then “graduated” to the Natural Balance with pour in pads. He has reached a point where he no longer needs the pour-ins but I have a tube in the closet just in case:)
Hope you really did get some pool and reading time:)
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