Update p122: good news/bad news. Is this founder? Xrays included

[Horsepoetry]

It seems I have dominated this post for an entire day so I’ll let other people have their say, but I did want to just list some interesting facts about what we know about insulin and EMS. Hopefully these will make you think a bit:

-EMS can occur in horses as young as 5 years old
-TB’s are not the classic breed but they can develop it so you cannot rule out a 6yo TB.
-Adiposity is no longer considered a core trait of EMS but an accompanying complication that can make matters worse. You do not have to be fat to be EMS.
-Other potential causes for EMS other than genetics and fat have had some research confirmation such as Lack of diversity of the gut biome and Endocrine-disruptive compounds i(EDC’s) in the envirronment (including plastics and pesticides).
-Horses that live on farms within 30 miles of an EDC disposal dump have a higher incidence of laminitis.
-The liver clears 70% of insulin from the blood stream. Some more naturopathic-oriented vets prescribe milk thistle because of its benefits to liver function hoping to encourage the liver to pull more insulin out of the blood stream.
-There is a “lean-type” EMS and these non-obese horses may be insulin dysregulated rather than insulin resistant. They may even be horses who struggle to keep weight on.
-Insulin dysregulated horses may not have consistently elevated insulin but will show spikes in insulin after meals. These might only be identified in a test such as the oral sugar test which tests after food intake.
-Histological studies have found cellular changes in lamina after only 6 hours of elevated blood insulin.
-Horses experimentally maintained at an insulin level of 200 for only 48 hours already showed pathology in the lamina. In my experience many “normal” behaving horses test at this level, especially ponies and likely have had high insulin for months or years before showing foot problems.

So could a lean 6yo TB who suddely became sore-footed have lamina pathology despite not seeming to be insulin resistant on a baseline blood test? Yes.

I’m not saying it is common, but you can see why it’s still worth ruling out.

[NaturallyHappy]

@Horsepoetry, I sent you a pm.

[IPEsq]

@NaturallyHappy

@IPEsq

We may have to resume the meds when the seasonal spike in insulin occurs in the winter, but in the meantime we are monitoring him.

Can someone talk more about this? Is it related to the ACTH seasonal rise? I’ve not been able to locate research on this. Thank you!

It’s not related to ACTH. Insulin can increase in horses from December to February. The lab notes on my insulin tests say “Evidence is mounting that insulin concentrations are affected by season with higher concentrations detected in December, January, and February in the Northern hemisphere, suggesting a winter-associated exacerbation of ID.”

We monitored my horse’s bloodwork while he was on Canagliflozin. He had no noticeable change to glucose, which for him is typically in the 90s mg/dL. At the lowest insulin baseline reading, glucose was still 99. And one of his highest baseline insulin readings since losing the weight and off medication (36, though he was on pasture some that day), his glucose reading was one of the lowest for him at 93.

In fact, just after starting Canagliflozin we did a full panel to recheck triglycerides and his liver and kidney values, and glucose at this time was the highest at 115. There is a risk of bladder infections due to secreting more glucose in the urine, but lowering blood glucose seemed to not be a thing in horses. Of course, it’s a good idea to do a full panel pre-test and to monitor the horse while using anything like this that is still somewhat experimental.

The studies show that the drugs do lower insulin in horses. They also seem to have a direct impact on foot comfort (with the studies reporting improvement in ability to exercise for horses with hyperinsulinemia laminitis), although my horse doesn’t have any apparent foot issues so I can’t provide any personal observations on that. He lucked out with having the strongest feet of any horse I’ve had except maybe my Connemara pony.

Compared to other options like Thyro-L and Metformin, I found Canagliflozin to be super effective for weight loss, easy to administer, and other than the urine output did not have other notable side effects…no change in appetite or excitability. It is pricy, though. The other gliflozins have some more affordable options for long term use. Although we don’t know yet if there are big problems associated with long term use.

[NaturallyHappy]

@IPEsq

It’s not related to ACTH. Insulin can increase in horses from December to February. The lab notes on my insulin tests say “Evidence is mounting that insulin concentrations are affected by season with higher concentrations detected in December, January, and February in the Northern hemisphere, suggesting a winter-associated exacerbation of ID.”

This is very interesting to me. My lab work comes from Cornell and does not say that.

In September of 23, his insulin was 44. I asked my local veterinarian about testing in December, and was told no- there was no reason to.

In February he appeared footsore occasionally. The weather was up and down, and shamefully, I chocked it up to frozen ground coming and going. His feet weren’t hot and he had no bounding pulse. In March I had the university vets out to care for him. Sure enough, he was laminitic. He did not need to lose weight, but they suggested we put him on ertugliflozin. He’s thin now, so we are weaning him off of it.
His glucose is usually around 90, and has stayed in that range. His insulin has ranged from 19 to 34.
And he’s sound. I have a very good farrier, fortunately. I wish I’d called someone else to test his insulin in December. I feel we dodged a very large bullet and I’m so thankful. The plan is to continue to monitor his insulin going forward. He may go back on ertugliflozin in the fall.
He is wearing a muzzle now, is on InsulinWise, and I ordered MilkThistle for him today.

[IPEsq]

You may want to test insulin after he’s been totally off the meds for at least a week. That’s what my vet recommended, and I’ve also been periodically monitoring it the past few months.

[NaturallyHappy]

Oh…believe me…I do, but thank you for the suggestion in case I didn’t😀. As my own n=1, I actually had it checked one morning, and then the following day after turn out. Are you using any supplements?

[IPEsq]

I had him on different chromium based supplements for a long time, but after I cut his feed even further to what ought to have been a weight loss ration for his goal weight, I dropped some of the supplements just because I didn’t have enough food to mix them with, and they obviously weren’t doing much if he kept ballooning into obesity.

[sascha]

Thank you for joining the forums and giving us all some great food for thought!

[alteredcarbon]

Replying to you but also speaking to the general:

Let’s say she’s high insulin. I’m a bit lost about it - there’s so much information to absorb and a lot of it is “put them on a diet and get rid of fat and exercise them”. My mare really does not have any extra fat, is too footsore to exercise (until I figure out how to keep shoes on her, she’s sore in her boots and pads for anything but turnout), and I have her on TCS Gold (11?% NSC), Kalm n easy (14% NSC), orchard hay (not tested, I have limited storage and get loads from multiple places throughout the year), and basically no pasture. I had her on a ration balancer and alfalfa at one point but I just couldn’t get enough calories into her.

I did put her on Ultium when she was really thin, and maybe a month after that she got trimmed and came up sore. I immediately switched to Senior Gold. I could put her exclusively on the Gold and drop the kalm, but it’s rather expensive.

If she tests as IR, I just don’t know what else reasonably I could do to manage her.

[NaturallyHappy]

I’ll share I’m now using Buckeye Low N Steady- it’s 8.5 NSC. He likes it! I had trouble finding it locally. Chewy had it. Mine is not heavy at all.

[quietann]

Thank you for all this info! My retired mare is IR by Karo test as of March; her insulin value got a little high a few years ago but this was the first time a Karo test showed IR.

This is the first year she hasn’t had at least an hour of turnout on grass; she gets minimal hand grazing with me.

She had “possible old laminitis” in the RF 12 years ago but has never (knock wood) gone full blown laminitic. Keeps good sole depth as long as she’s shod with pads. We had a barefoot + boots for turnout period when I retired her, but BO is unwilling to deal with the hassle of boots and she’s out 24/7 now on a dry lot with a shed. Outside 24/7 is essential for her health now.

She has very upright pasterns so her coffin bone angle is very steep but it matches her pasterns and hooves so we aren’t doing much with her hooves. For whatever reason, when shod she does a bit better in shoes that are a little tight, and higher heels… but again this matches her Xrays.

She’s a retired, easy keeping Morgan with anhydrosis, lots of arthritis, and mild heaves, plus she’s ulcer prone, so managing everything is a balancing act. She gets first cut low sugar hay, and two feedings of 1/2 pound ration balancer and a cup of Outlast. Her hay is in a small hole 1 inch net, but it does NOT slow her down much. She attacks nets like she’s greatly offended by them! A hay ball is better but not great for outside use if it’s at all muddy.

Keeping her weight down and exercise up isn’t easy. I take her walking on the trails a few times a week, weather allowing. Treat with Thryo-L if her weight gets too high… Most recent change, which for whatever reason is working, is adding Metaboleeze supplement. Our vet isn’t normally big on supplements, but she’s seen good results with it. I wish I had a current photo because she looks so good right now.

I wish she could be shod with something a bit more hoof-friendly, but that’s all I’d change right now.

Photo from 2 months ago…

[NaturallyHappy]

Interesting about Metaboleeze. That’s one I haven’t tried. I went through my horse’s history… In 2019, his insulin was 17.6 on 6 scoops of Metabarol. I’d still be doing that (and robbing banks to pay for it) but he now won’t eat it and I can’t syringe the powder down his throat, either.

[Horsepoetry]

Yes these are the hard ones, seemingly no fat to lose and too sore to exercise. I’ll reiterate that not all insulin problems are IR. A horse can be lean and not have elevated baseline insulin yet insulin spikes anytime starch and sugar are consumed. That is what we call insulin dysregulated. In my opinion these daily spikes are enough to cause sore feet. 11% NSC is too high, 14% is way too high, and unknown orchard grass could be anywhere. I just saw some in Oregon test at 18%! Grazing, even for an hour, in my book can be too much.

I like the rule that nothing in the diet should be high enough in NSC to spike insulin. Every meal needs to be below that 10% including the pasture.

Not that you have to do this forever, but it would be an interesting trial to go 4 days with nothing in any meal above 10%, which means no high NSC supplements, no grazing and soaking all the hay at least an hour in warm water.

Yeah, I know, it’s a hassle and your horse hates soaked hay and isn’t happy staring at grass over the fence… What I am saying is that if you do this for 4 days and your horse is better, then you are on the right track as far as a need to further tweak the diet.

I’ve had good look with coconut meal (Cool Stance) as a good calorie supplement that is low in starch and sugar yet high in calories and very pallatible to most horses. Mix that with alfalfa pellets and add warm water to form a mash. Yummy. (Do not feed it dry as it soaks up a lot of water quickly.) And as will all diet additions and changes, make the transition gradually.

Also, sore feet and over 10 years old-test for PPID because this often gets overlook because the vet is not seeing the overt signs of later stage Cushings (the hair coat, lethargy, top line loss).

A study showed that giving Prascend even when the horses did not test positive for PPID did help with insulin regulation. The researchers I believe question if the Prascend really helps with IR or perhaps the horses were so early in the PPID that tests were not detecting it. That is wht the TRH stimulation test is the way to test for PPID.

[Horsepoetry]

Hi, older horse, some possibility of IR or ID, annhydrosis, heaves. That all points to PPID. Have you tested? Do you test every year?

Further the heaves is airway inflammation which makes your job harder as inflammation will always drive up insulin making it hard to get things under control. And treating the repiratory issues with steroids again exacerbates your insulin problem, and if you have lamina issues, is really contraindicated.

Studies suggest that for exercise to be helpful in directly reducing IR, it really needs to be high intensity with heart rates at 130-170 and for 30 minutes. That is not to say that hand walking and hikes is not helpful. Anytime the muscles are working you are both burning calories and also using up insulin that is floating around in the blood.

On another note about the feet. From a distance she appears to have at least a RF club foot. Club feet come in vatious grades, and some are even within the normal angle range. What makes a club foot? A short DDFT. Can a horse within normal angles have a short tight DDFT? Yes.

You are right to not try to make her feet look less upright. When you chops heels off, you actually cause the DDFT to be even more tense, create chronic soreness and lack of sole depth in the toe. Meanwhile the heels just grow faster. The problem is not high heels, it’s a right DDFT.

So please look at this photo closely. The mare’s LF foot is all the way back but the heel has not come off the ground. She’s starting to break at the carpus (“knee”) instead, before her heel comes up. Tis could be a result of what I discussed above. While she appears to have pretty short toes, with a club foot scenario, they often need even more breakover reduction than what many farriers feels comfortable with. There are lots of ways to do with with metal or composites. A Softrider Arena or a Visani Full Roll in composite, or a Mustad Equilibrium or Morrison Roller might be possible metal options.

Also note that the right front is landing with the carpus broken forward as well. That suggests DDFT tension as well. You are on the right track with not trying to lower her heels to achieve a less upright look. You have to work with what they have. I’ll reiterate that club feet are a DDFT (deep digital flexor tendon) issue, not a high heel issue. The high heels are a response to the tight DDFT unweighting the heels. The more you lower the heels the worse you make DDFT tension and the worse the problem becomes. Thin soles, soreness and eventually pedal osteitis and eventually euthanasia because no one was willing to try a different approach or actually understand the problem completely.

[quietann]

Thanks for the feedback!

She has been tested for PPID every year, sometimes twice a year, for at least 10 years now. ACTH always, with thyroid stim test if ACTH is close to the high threshold (usually normal, never been over, tested at different times of the year, etc.) She’s never come up positive for it. Odd thing is, she has always - since I bought her in 2008 - had fat pads over her eyes - even now, though they are smaller - and drank a ton of water and peed a lot. I bought her when she was 9 and she’s now 26. She was actually a hard keeper when I got her but that changed as her workload eased.

She hasn’t been treated with steroids in many years because of her whole constellation of conditions. She does have allergies, worse in warmer weather and when there’s a lot of pollen. Does well on Zyrtec and Apoquel from April through October (we are in Massachusetts.)

Her front legs are a mess - you are right about the (mild) club foot and DDFT issues, and she is over at the knees and has pretty significant knee arthritis. All of this, plus the development of anhydrosis, contributed to my choice to retire her 2 years ago. We’d done some dressage and a lot of trail riding but had eased up on both quite a bit in 2021. Walking on trails is what we can do. I add a little jogging in areas with softer footing. But keep her exercise to cooler and less humid times of the day.

She’s been on Equioxx for a long time but just switched to meloxicam and I have seen good improvement in her range of motion and general health. If it seems like I’m patching her together with duct tape, I kind of am! But she’s pretty active in her dry lot and acts younger than she is.

Her trim has been changed since the photo was taken. More emphasis on keeping her heels up, longer foot in general, different breakover. Her shoes actually look a lot like the Mustad rollers with clips, and in fact may be exactly those shoes. (I rarely make it to farrier appointments so I have not asked.) She has leather pads with DIM right now. Tried pour in pads a couple of times and she hated them. The farrier has worked with a lot of Morgans, and they are prone to club feet.

Photo from beginning of April, when she was fatter and on Thryo-L.

[quietann]

Metaboleeze has more chromium than some of the other supplements for metabolic horses. On a different thread, people were talking about just giving pure chromium.

[Jackie_amp_Starlette]

@quietann

Metaboleeze

From what I understand, you don’t want any added iron and this does have added iron, which can block copper/zinc absorption.

Iron in the Equine Diet – Sources, Requirements, Deficiency & Overload | Mad Barn

Plus the copper/zinc radio should be 1:3 and this is not.

3:1 Zinc Copper | Mad Barn

[quietann]

You have to look at this in the context of the whole diet.

Not that I’m saying the Metaboleeze has a good mineral profile, but the amount of various minerals in one scoop of Metaboleeze is much less than what she’s getting in her hay and feed. I can’t say why they add iron to Mataboleeze. Her ration balancer alone provides 380 mg of zinc and 135 mg copper per day and has no added iron. (All numbers based on the Mad Barn nutritional analysis page, and yes I’m making a lot of assumptions WRT hay especially.) And she gets Coco Hoof though I’ll probably drop it when the bag runs out, which is another 300 mg zinc and 100 mg copper.

So I think I’m ok, but this would be another reason to consider pure chromium instead of the supplement. I know Platinum carries it.

OTOH being in New England, land of acidic soils, with most of her hay being cut within a mile of where she lives, she’s probably getting severe iron overload to the point where 100 more mg of iron makes no significant difference - but I don’t have any control over where her hay comes from, and I doubt hay from New York or eastern Canada, the other 2 common places where hay here comes from, would be that much lower.

[pn]

Thank you!!!