Understanding Equine Metabolic Disorders Webinar


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  • Understanding Equine Metabolic Disorders Webinar

    1. 1. Understanding Equine Metabolic Disorders Lydia F. Gray, DVM, MA Medical Director/Staff Veterinarian Jessica Normand Director of Supplement Marketing June 8, 2011
    2. 2. <ul><li>Agenda </li></ul><ul><li>What are the problems? </li></ul><ul><li>A Review of Cushing’s Disease </li></ul><ul><li>A Review of Equine Metabolic Syndrome (EMS) </li></ul><ul><li>Questions </li></ul>
    3. 3. <ul><li>What are the problems? </li></ul><ul><li>1. Obesity </li></ul><ul><li>A 1998 USDA study estimated less than 5% of the US horse population to be overweight or obese while a paper published in 2008 by Virginia Tech showed this value to be closer to 51%. </li></ul><ul><li>2. Laminitis </li></ul><ul><li>“ Studies have shown that about half the adult horses that founder for no apparent reason have evidence of Cushing’s Disease.” </li></ul><ul><li>Dr. Dianne McFarlane, Asst. Professor, Oklahoma State University </li></ul>
    4. 4. <ul><li>Equine Cushing’s Disease </li></ul><ul><li>What is it? </li></ul><ul><li>A collection of clinical signs caused by chronic elevation of cortisol in the blood. </li></ul><ul><li>*Pituitary Pars Intermedia Dysfunction (PPID) </li></ul>
    5. 5. <ul><li>Equine Cushing’s Disease </li></ul><ul><li>What types of horses commonly get it? </li></ul><ul><li>Between 18 - 23 years of age </li></ul><ul><li>Any breed </li></ul><ul><li>(Though common in ponies and Morgans) </li></ul>
    6. 6. <ul><li>Equine Cushing’s Disease </li></ul><ul><li>What does it look like? </li></ul><ul><li>Hirsutism and excessive sweating </li></ul><ul><li>Weight loss and muscle wasting OR </li></ul><ul><li>Weight gain and abnormal fat deposits </li></ul><ul><li>Lethargy and poor performance </li></ul><ul><li>Increased appetite </li></ul><ul><li>Increased drinking (and urination) </li></ul><ul><li>Delayed wound healing and increased infections </li></ul><ul><li>Chronic laminitis </li></ul>
    7. 7. <ul><li>Equine Cushing’s Disease </li></ul>
    8. 8. <ul><li>Equine Cushing’s Disease </li></ul>What causes it? A enlarged and overactive pituitary gland normally kept in check by inhibitory dopamine from the hypothalamus.
    9. 9. <ul><li>Equine Cushing’s Disease </li></ul><ul><li>How is it diagnosed? </li></ul><ul><li>Physical appearance of the patient </li></ul><ul><li>Results of routine blood tests </li></ul><ul><li>Elimination of causes of similar findings </li></ul><ul><li>Low-dose dexamethasone suppression test </li></ul><ul><li>ACTH (stimulation) test </li></ul><ul><li>Combined dexamethasone suppression/thyrotropin-releasing hormone stimulation test </li></ul><ul><li>(Domperidone) “C orrelation of pituitary histomorphometry with adrenocorticotrophic hormone response to domperidone administration in the </li></ul><ul><li>diagnosis of equine pituitary pars intermedia dysfunction.” </li></ul>
    10. 10. <ul><li>Equine Cushing’s Disease </li></ul><ul><li>How is it treated? </li></ul><ul><li>Good general health care </li></ul><ul><li>Body clipping </li></ul><ul><li>Improved nutrition </li></ul>
    11. 11. <ul><li>Equine Cushing’s Disease </li></ul><ul><li>How is it treated? </li></ul><ul><li>4. Medication </li></ul><ul><ul><li>Pergolide </li></ul></ul><ul><ul><li>Cyproheptadine </li></ul></ul><ul><ul><li>(Trilostane) </li></ul></ul>Efficacy of trilostane for the treatment of equine Cushing’s syndrome. McGowan CM, Neiger R. Equine Vet J. 2003 June; 35(4):414-8.
    12. 12. <ul><li>Equine Cushing’s Disease </li></ul><ul><li>Consider Supplements </li></ul><ul><li>Antioxidants: Vitamins E and C, Se, GSE </li></ul><ul><li>Immune Support: Adaptogens/other herbs </li></ul><ul><li>Weight Gain (if needed) </li></ul>
    13. 13. <ul><li>Equine Metabolic Syndrome </li></ul><ul><li>What is it? </li></ul><ul><li>A syndrome of obesity*, insulin resistance and laminitis in middle-aged horses. </li></ul>*or regional adiposity
    14. 14. <ul><li>Insulin: a hormone secreted by the pancreas that stimulates the uptake of glucose by tissues when sugar is abundant (after feeding) </li></ul><ul><li>Insulin Resistance: failure of tissues to respond appropriately to insulin </li></ul>Equine Metabolic Syndrome Definitions
    15. 15. <ul><li> – a system for estimating fat cover over six different body areas to develop a single score for overall condition; ranges from 0 to 9 </li></ul>Body Condition Score (BCS):
    16. 16. <ul><li>Cresty Neck Score (CNS) – a system for assessing fat accumulation in the crest, a particularly “risky” place for fat that may be associated with an increased risk of laminitis, ranges from 0 to 5 </li></ul>
    17. 17. <ul><li>Equine Metabolic Syndrome </li></ul><ul><li>What types of horses commonly get it? </li></ul><ul><li>Obese or with regional adiposity </li></ul><ul><li>Between 8 – 18 years of age </li></ul><ul><li>Specific breeds or types: </li></ul><ul><ul><li>Domesticated Spanish Mustangs </li></ul></ul><ul><ul><li>Pony breeds </li></ul></ul><ul><ul><li>Peruvian Pasos </li></ul></ul><ul><ul><li>Paso Finos </li></ul></ul><ul><ul><li>Tennessee Walking Horses </li></ul></ul><ul><ul><li>Rocky Mountain Horses </li></ul></ul><ul><ul><li>Saddlebreds </li></ul></ul><ul><ul><li>Morgans </li></ul></ul><ul><ul><li>Warmbloods </li></ul></ul>
    18. 18. <ul><li>Equine Metabolic Syndrome </li></ul><ul><li>What does it look like? </li></ul><ul><li>Obesity (7 – 9 body condition score) </li></ul><ul><li>Abnormal deposits of fat in the crest of the neck, behind the shoulders, over the tailhead, above the eyes and in the sheaths of male horses </li></ul><ul><li>Insidious onset of laminitis </li></ul><ul><li>(also, abnormally cycling or difficult to breed mares) </li></ul>
    19. 19. <ul><li>Equine Metabolic Syndrome </li></ul><ul><li>What causes it? </li></ul><ul><li>Although there is a strong genetic influence, obesity is the primary problem that sets off the cascade of metabolic abnormalities </li></ul>
    20. 20. <ul><li>Equine Metabolic Syndrome </li></ul><ul><li>How is it diagnosed? </li></ul><ul><li>Physical appearance of the patient </li></ul><ul><li>Results of routine blood tests </li></ul><ul><li>Elimination of causes of similar findings </li></ul><ul><li>Fasting hyperinsulinemia </li></ul><ul><li>Glucose tolerance tests (CGIT, FSGIT) </li></ul>
    21. 21. <ul><li>Equine Metabolic Syndrome </li></ul><ul><li>How is it treated? </li></ul><ul><li>Reverse the obesity! </li></ul><ul><li>Increase exercise </li></ul><ul><li>Provide strict diet </li></ul><ul><li>Consider supplements </li></ul><ul><li>Appropriate use of Thyro-L </li></ul>
    22. 22. <ul><li>1 . Increase Exercise </li></ul><ul><li>Guidelines: </li></ul><ul><li>Under veterinary supervision </li></ul><ul><li> if laminitic </li></ul><ul><li>Start slowly </li></ul><ul><li>Turnout ≠ Exercise </li></ul><ul><li>Effect of short-term exercise training on insulin sensitivity in obese and lean mares. Powell DM, Reedy DR, Fitzgerald BP. Eq Vet J. 2002 Sept;34(S34):81-4. </li></ul><ul><li>Effects of exercise training on adiposity, insulin sensitivity, and plasma hormone and lipid concentrations in overweight or obese, insulin-resistant horses. Carter RA, McCutcheon LJ, et al. Am J Vet Res. 2010 Mar;71(3):314-21. </li></ul>
    23. 23. <ul><li>2. Provide Strict Diet </li></ul><ul><li>Guidelines: </li></ul><ul><li>Hay should be the basis </li></ul><ul><li>Feed 2.0% then 1.5% of current body weight daily </li></ul><ul><li>(Then feed 2.0% then 1.5% of ideal body weight daily) </li></ul><ul><li>Make sure NSC < 10% </li></ul><ul><li>Soak hay in warm water 30 minutes (cold 60 minutes) </li></ul><ul><li>Limit grass </li></ul>
    24. 24. <ul><li>2. Provide Strict Diet </li></ul><ul><li>Products that can help: </li></ul>Grazing Muzzle Small Hole Hay Net Freedom Feeder Withers & Withers IR Horse Treats Hilton Herballs (treats)
    25. 25. <ul><li>2. Provide Strict Diet, cont. </li></ul><ul><li>Guidelines: </li></ul><ul><li>Do not feed grains, molasses, or other sources of sugar </li></ul><ul><li>Use vitamin/mineral supplement (“multi-vitamin”) or ration balancer </li></ul><ul><li>Give sugar-free treats </li></ul><ul><li>Prevent scavenging! </li></ul>
    26. 26. <ul><li>3. Consider Supplements </li></ul><ul><li>Antioxidants: Vitamins E and C, Se, GSE </li></ul><ul><li>Minerals: Chromium, Magnesium </li></ul><ul><li>Vitamins: Biotin </li></ul><ul><li>Amino Acids: Taurine </li></ul><ul><li>Herbs: Cinnamon, Fenugreek, Banaba </li></ul><ul><li>Dietary supplementation with scFOS improves insulin sensitivity in obese horses </li></ul><ul><li>Psyllium lowers blood glucose and insulin concentration in horses. </li></ul>
    27. 27. <ul><li>4. Appropriate use of Thyro-L </li></ul><ul><li>“ Administration of L-T4 decreases blood lipid concentrations, improves insulin sensitivity and increases insulin disposal in horses.” </li></ul><ul><li>(it is not used as a treatment for hypothyroidism) </li></ul><ul><li>New drugs: Metformin, Pioglitazone </li></ul><ul><li>Effects of the insulin-sensitizing drug pioglitazone and lipopolysaccharide administration on insulin sensitivity in horses. </li></ul><ul><li>Suagee JK, Corl BA, et al. J Vet Intern Med. 2011 Mar;25(2):356-64. </li></ul>
    28. 28. <ul><li>Summary </li></ul>EMS Cushing’s Who? Middle-aged Seniors What? Obesity, IR, Laminitis Pituitary dysfunction leads to increased cortisol; also immunosuppression (laminitis, IR) Diagnosis “ Drive-by” diagnosis (obesity or regional adiposity), bloodwork “ Drive-by” diagnosis (hirsutism), LDDST, ACTH Medication No (Thyro-L short-term) Pergolide, cyproheptadine Diet/Exercise Low sugar/starch Low sugar/starch Supplements Antioxidants, IR Support Antioxidants/Immune, Weight Support (if needed)
    29. 29. <ul><li>Questions? </li></ul>
    30. 30. <ul><li>Questions? </li></ul><ul><li>Is it okay to give glucosamine to a horse with IR or Cushing’s? Can I give my IR horse a joint supplement? </li></ul><ul><li>2. My horse is really sensitive to any grass and sugars it makes her feet really sore. How does this happen? </li></ul><ul><li>3. My horse has small feet & stands 15.3. I worry about his weight since he seems to go from Lean & Mean to Fat & Ouchy overnight. I've taken him off alfalfa & put him on grass hay. His blood work is normal. What kind of diet should my performance horse be on? </li></ul><ul><li>4. I have a 15-year old Mustang that has foundered. She was severely overweight also. She has lost over 100 pounds, but is still crested. Can you suggest tests or supplements to her diet? </li></ul><ul><li>5. How can I help my geriatric pony reduce her excess fatty tissue build-up on her neck and buttocks area? She is slender otherwise and on a very restricted diet. I am afraid she starting to lose too much main body weight. </li></ul><ul><li>6. Did I cause my 9-yr old TWH to develop founder/insulin resistance by giving him too many SmartPak supplements i.e. 4 at one time? Are they sugar based for more palatability? </li></ul>
    31. 31. <ul><li>Questions? </li></ul>7. My TWH gelding is hungry all the time. How do I keep his weight down and still satisfy him? Is soaked, molasses-free beet pulp something I can feed him safely? 8. Pergolide made my horse lose too much weight and still did not shed out. I started him on Chaste tree berry and he shed out in one week. How can I safely put weight back on him and can he get turned out on pasture now? He foundered 4 times and is still being ridden. 9. My horses receive Thyro-L to assist with equine metabolic issues. Can this be managed just as effectively with a product like SmartControl IR? 10. My horse has Cushing's but has no signs of insulin resistance. Is it still important to limit the amount of sugars in his diet? 11. I am interested in mineral balancing to address imbalances in our hay. 12. I have two Welsh Ponies who get sore feet if they are allowed on grass in the spring/early summer. I have hesitated having them checked for metabolic disorder because my vet insists on doing a “dex” suppression test which I've read can be dangerous. 13. Side effects, if any, to worry about from long-term use of Pergolide. So far my pony has been on Pergolide for about 3 years & is doing great.
    32. 32. <ul><li>Questions? </li></ul>14. I understand that omega fatty acids are important for Cushing's horses but they all seem to be high in carbs. Can you address? 15. Can metabolic disorders cause a mare who is barren for over 5 years to lactate? 16. My horse Bandit takes thyroid medication through my vet. He is a very aggressive eater, like he is starved to death. What can I do so he can enjoy some grass? 17. Can a horse have Cushing’s and Insulin resistance at the same time? How do you go about treating both at the same time? My mini is on Pergolide and a low starch diet. I exercise her everyday and she is beginning to lose a little weight. 18. If you have performed blood tests to confirm insulin resistance and they are normal but horse is showing some clinical signs, should you try treating with medication/supplements anyway?
    33. 33. Thank you for attending our Webinar! Please visit us at SmartPak.com Or call us at 800-461-8898 if we can answer any further questions. ~ Your Friends at SmartPak