When to test for EMS

Jane&Ziggy

Jane&Ziggy

Jane&Sid these days!
Apr 30, 2010
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Surrey Hills
Ziggy had a busy day today. He had a groundwork lesson, saw Trevor Jones for a trim and had his jabs.

Trevor found a little hole behind his white line but showed me how to clean and pack it, said not to worry and opined that Zig's post-laminitis feet were very much improved after one trim and likely to be right as rain in two or three more trims. Ziggy adores Trevor and slept through the whole procedure.

The vet said he was lovely and looked very well, but looked at his fat distribution - pockets on his shoulders, which I notice pressing against the saddle now that he has lost most of his grass belly - and slight crestiness. She asked if I had had him tested for EMS. I said I hadn't and that I didn't really think I would unless he had a lami relapse this year. I pressed her to know what treatment for EMS might offer and she hedged a bit and said "Possibly it might be easier for him to lose weight".

Call me a cynic, but from what I have read EMS is a SYNDROME and that is medical shorthand for "a package of symptoms we don't know very much about and don't know how to fix". I watch Ziggy like a hawk for footiness - which is why he is barefoot and has learned that he can get out of any sort of unwanted activity by pretending to be lame - and he lives out on the poorest grazing I can rent nearby and a steep hill. He would be better off on the Mountains of Mourne without a doubt, but I don't have any moorland to hand alas...

Would it be sensible for me to have him tested for EMS? What benefits might EMS treatment offer him?

Yours sceptically, but as always willing to be persuaded....
 
EMS is a tricky one. Part of me says, its not a "condition" as such, but a problem generated by poor diet/being fat - much like us and developing diabetes. However I think in horses it is much more reversible than in humans.

Metformin is prescribed for horses that are insulin resistant, and it makes the body digest sugars more readily, so less is stored as fat.

I have to say though, my (very honest) opinion, is that if an owner wants the weight off, they will get the weight off. Silver is a nightmare to get weight off - and I was (in an odd way) lucky - she got really sick and lost the lot - and seeing her "underweight" was a revelation to me - I had a very skewed view of "correct weight" - and seeing her skinny made me determined to keep her that way. Its hard work, and it comes back very easily, but because she has very little grass its much easier to control for us. Two weeks ago her fat pockets behind her shoulders suddenly appeared - the hay was cut back and the exercise was increased in speed - she is now starting to lok lovely and toned and the fat pockets have come off.

It is hard, and sometimes circumstances make it even worse - lack of bare turnout, no stabling, lack of time for exercise etc etc
 
Not sure if they just prescribe Metformin if the horse/pony is able to be ridden.Also don't think I would be happy giving a drug if it was possible to manage without.My old boy had lami 7 yrs ago & had him tested for insulin but he was fine.I keep him in a lot during spring & autumn as we are in Cheshire on cow pasture,nothing else round her :sad:.
 
Jane&Ziggy I am having the same dilemma myself, whether to get Ginger tested. He is showing all the signs of IR and while how I manage him wouldn't change, he is getting increasingly difficult to manage at this time of year as he is so sensitive to the grass.

Popularfurball I can see where you are coming from but I don't agree that it is a condition caused solely by poor diet/being fat, although in many cases of overweight/lami horses that probably is the case!
Ginger was overweight the first couple of years I had him, then I got wise and did something about it. Then about 3 years after that he developed laminitis. He was not overweight or unfit, he just got it. Since then his weight has been managed almost obsessively (I have a serious case of PLOS ie Paranoid Laminitic Owners Syndrome). He still has fatty deposits on his crest, even though he is not overweight, and no amount of weight loss shifts them. He is actually a low 5 on a 1-9 condition scale, so slightly under what would be classed as perfect but the nutritionist said for him that's perfect.
His trimmer, who is very hot on this kind of thing, explained that it's not strictly fat that is deposited in the crest, rather the "toxins" in the grass that the horse is unable to metabolise, which are stored there. So it's possible for a laminitic/IR horse to still have a crest even though they are a good weight.
 
Gillydaydream said:
Jane&Ziggy I am having the same dilemma myself, whether to get Ginger tested. He is showing all the signs of IR and while how I manage him wouldn't change, he is getting increasingly difficult to manage at this time of year as he is so sensitive to the grass.

Popularfurball I can see where you are coming from but I don't agree that it is a condition caused solely by poor diet/being fat, although in many cases of overweight/lami horses that probably is the case!
Ginger was overweight the first couple of years I had him, then I got wise and did something about it. Then about 3 years after that he developed laminitis. He was not overweight or unfit, he just got it. Since then his weight has been managed almost obsessively (I have a serious case of PLOS ie Paranoid Laminitic Owners Syndrome). He still has fatty deposits on his crest, even though he is not overweight, and no amount of weight loss shifts them. He is actually a low 5 on a 1-9 condition scale, so slightly under what would be classed as perfect but the nutritionist said for him that's perfect.
His trimmer, who is very hot on this kind of thing, explained that it's not strictly fat that is deposited in the crest, rather the "toxins" in the grass that the horse is unable to metabolise, which are stored there. So it's possible for a laminitic/IR horse to still have a crest even though they are a good weight.
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Yes - Silver has ribs showing, yet fat pockets behind her shoulders and started looking cresty the other week. The fat pockets do go, but they are hard to keep away. I was surprised, I thought silver would be bordering on emaciated by the time the fat pockets went, but alas no, just the last thing to go - and the very first thing to come back.

Whilst there are some horses who will be insulin resistant from young (like Type I diabetes), the body becomes less sensitive to insulin the more it is overweight - the same as type II diabetes in humans. However, EMS in history, was rarely tested for without a case of laminitis - this is now changing - but the link is still there as the vet is rarely phoned "because he looks a bit fat" but always phoned because he can't move.

Exercise really is the way to go with it, in my humble opinion as it is the most powerful way of making the body more sensitive - losing weight helps, but not in the same way that exercise does. Metformin is used in laminitic horses where exercise is not possible - and has the same effect as exercise.

Dr Elenor Kellon has some interesting reasearch/information on it - as does the ECIR group - have a look at the ECIR calculator too as often the figure given by the vet is not "that" useful (depending on what the ratio calculation used is).
 
Interestingly my trimmer and i discussed this when cob had trim.

He felt that the tests and research was a little misleading as it had been done by the company who want to sell you their products.

Research shows 90% of lami cases have ems or cushings. That just changes the goal posts to me. You are not really any better off unless your horse is positive and then the drug is expensive? Your management would be The same wouldn't it?
If 90% of cases are the result of, does it depend on where you live, so type of grazing, whether it is fertilized etc.
The cushings horse i did know of was put down because she had other on going lameness issues.
Lami is not just about rich grass, being overweight, sugar. You can get lgl and lami from worming, trotting on hard surfaces, not turning out, steroids, operations, infections, change of grazing, diet, weather.

When would i test, if i had a recurring problem that did not resolve with the usual methods.
 
Just to throw something else into the pot -

Ellie and Harvey have both been tested for ems and for cushings. (I had a half price offer at the vets) I don't really think there was much point in getting it done though to be honest.
Both tested negative.
Ellie has all the signs of cushings and is especially cresty before she has a lami attack but fine the rest of the time, she is underweight most of the time (actually is a ok weight at the moment, at about a 3) about a 2 to 2.5 on a 1-5 scale according to the vet. She does store fat on her bum and above her eyes though.

Anyway i took her off her global herbs c-aid as didn't see the point if she didn't have cushings as it is for cushings really and I am going to go out tomorrow to get some more! She has been off it for about two weeks and is struggling again, her odd body shape with the fat deposits has come back too where as it had all but gone. Not entirely sure how it works on her though if it isn't to do with cushings! (her lami is not hugely grass related although it does play a part, stress/mechanical is more of a problem for her).

Laminitis is a funny thing though, I'm pretty dure it is what causes Harvey to be footy in one hind leg too, but it only affects ONE hind leg??!! (pulses raise in it too but not in any others). It goes though if treated like lgl and he's not really lame on it as such at any point.
 
Lf I've done some looking into the cushings testing - the sample has to be frozen etc to be as reliable as it can be and then you still get ACTH breakdown in the sample.

Madam has just started on prascend as I got her retested after a neg test. However prascend can be used as a diagnostic tool - have a trial and if no difference then stop it. Its cost me £7 for a prescription and £53 for 60 tabs. Madam is on one tablet per day though this may be able to go down to a half tab per day. 92p is the best I could find when I ordered it online.

There are some new suggestions that Agnus castus whilst it supports the body it doesn't affect the ACTH which is the causing factor of the symptoms.

As for Ems I'm neither here nor there on it. I do think some horses are prone, and I also think it is caused by bad management (pony being overweight) much like humans and diabetes. I'm also of the opinion that sufficient exercise and reduced calorie intake will manage it. Drug should only be used where lami is present/exercise is not possible IMHO
 
popularfurball said:
Lf I've done some looking into the cushings testing - the sample has to be frozen etc to be as reliable as it can be and then you still get ACTH breakdown in the sample.

Madam has just started on prascend as I got her retested after a neg test. However prascend can be used as a diagnostic tool - have a trial and if no difference then stop it. Its cost me £7 for a prescription and £53 for 60 tabs. Madam is on one tablet per day though this may be able to go down to a half tab per day. 92p is the best I could find when I ordered it online.

There are some new suggestions that Agnus castus whilst it supports the body it doesn't affect the ACTH which is the causing factor of the symptoms.

As for Ems I'm neither here nor there on it. I do think some horses are prone, and I also think it is caused by bad management (pony being overweight) much like humans and diabetes. I'm also of the opinion that sufficient exercise and reduced calorie intake will manage it. Drug should only be used where lami is present/exercise is not possible IMHO
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tbh, it's not really worth me re-testing. Just more money as as new forest says it doesn't really change anything with the results. It was frozen etc. I have got some pergolide but haven't used it as a trial yet as with Ellie it's not just her laminitis that is causing her problems so solving the laminitis won't make her all better anyhow.

what does Agnus Cactus actually do then? All i know is it seems to work. Changes the fat deposits and makes her brighter. It has always improved her footiness/lameness too.

Not so sure ems or diabetes is 'caused' by bad management though, exasparated by it perhaps but not caused. I think that you are either genetically predisposed to it or not.

Some of the problems with ponies such as Ellie i suppose is that she isn't overweight and has never been overweight when she has had a attack of laminitis, she's more often been underweight.

Insulin control and metabolic conditions arn't widely understood and even in human biology quite often there is not really any such thing as the 'norm' as all cases differ slightly which is why i suppose some laminitics can live out 24/7 and others can't even look at grass.
 
No I do genuinely believe that even the most metaboliccaly good pony, given a bad diet for long enough will become an EMS pony - though mostly, it is caused by a predisposition in breeding - coupled with us keeping them on much richer pastures than they are designed to survive on - I suspect you would find no ponies on welsh mountains displaying the symptoms that madam has for example - simply because they dont have access to the high calorie diet/low exercise regime.

I dont know what agnus castus does - I just know the new thing is that it doesnt bring down the ACTH levels which is what is believed to be the lami trigger - just manages the symptoms? Im all for the "if it aint broke dont fix it" model though :D:D thats the only system that works with madam. within 12hours of prascend tabelt she was itchy, open sores on face and footy... couldnt believe it. she has stabilised after a week now, but she is still more itchy etc than she was before the tablets.
 
popularfurball said:
No I do genuinely believe that even the most metaboliccaly good pony, given a bad diet for long enough will become an EMS pony - though mostly, it is caused by a predisposition in breeding - coupled with us keeping them on much richer pastures than they are designed to survive on - I suspect you would find no ponies on welsh mountains displaying the symptoms that madam has for example - simply because they dont have access to the high calorie diet/low exercise regime.

I dont know what agnus castus does - I just know the new thing is that it doesnt bring down the ACTH levels which is what is believed to be the lami trigger - just manages the symptoms? Im all for the "if it aint broke dont fix it" model though :D:D thats the only system that works with madam. within 12hours of prascend tabelt she was itchy, open sores on face and footy... couldnt believe it. she has stabilised after a week now, but she is still more itchy etc than she was before the tablets.
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Not so sure about your welsh theory :wink: think the reason you don't see many is because genetically speaking they probably wouldn't survive as long and therefore not breed for as long, be for lost in the gene pool. Although, incidentally on dartmoor you do see some lame ponies at times but again they tend not to survive. I think there were even some studies done ages ago that showed that when laminitis was tried to be 'induced' by using a known laminitis causing sugar (which incidentally is also in some barefoot balancers such as metabalance) - inulin/Oligofructose horses had varying degrees of 'ok' about it. There are plenty of horses kept on indadequete diets and on high sugar grass that do not get laminitis. Same as there are plenty of horses who are especially prone even when they do not have access to grass/have a good diet.

A good example would be where i am as to how metabolically different horses can be. 4 ponies, two of approx 14hh (one 13.3hh welsh sec C x, one 14hh Haflinger) and two of 12hh and 12.2hh (dartmoor x that is 12hh and British spotted pony type of 12.2hh). split into two paddocks but grazing the same grass. the haflinger and dartmoor in one paddock and the other two in the other. The haflinger and dartmoor live out 24/7 and have no hard food at all, and about twice a week they have horse treats. they are in no to very little work. Both are overweight, about a 4 to 4.5 on a 1-5 scale. They also have no laminitis and have never shown any signs of laminitis. The BSP and the welsh however are out 24/7 when possible but come in during the day when the sugars are high in the grass. They have a small feed of speedibeet, minerals, vits, linseed, magnesium daily. They are not overweight, being a score of about 3 on the 1-5 scale. They are in light work. Both have shown signs of footiness and or laminitis (welsh in one back foot BSP has founder and rotation).

As for the agnus castus, yep i'll go along with if it works then use it lol. :biggrin: It certainly seems to make a difference to Ellie and Harvey has it instead of rigcalm anyway. The side effects of pergolide etc is one of the other reasons i have been holding off from it although i will try the ones i've got if it gets to try it or this is it sort of thing.
 
Human diabetes can be genetic. If you have parents who are you are more likely to develop it-if you do not follow a healthy lifestyle.
This goes back to my thinking that we are in fact breeding the problems, or keeping the problems alive.
In the wild a fair few horses would not survive and hence what is bred is good stock. The not so good, the lame get eaten, foot sore eaten, lami eaten. Sick horses are removed its nature.
When my cob was seriously ill the vet did not want anything in her system apart from what drugs she had to have to stay alive. Even through her recovery she had no supplements, her body had to be able to sort itself out. If it couldn't them i would have made decision.
Are the ems studies of wild or captive horses? It is hard to compare wild with captive because they live such different lives you cannot compare apart from digestive systems and perhaps ability to absorb nutrients.
 
I'm saying i think it can be both...

you can geT diabetes from bad diet - but without a genetic disposition - that's not to say all horses on a bad diet will get it - just like not all humans who have a poor will get diabetes

As for the Welshes, I dont think you would see the issues because of the diet/exercise - this doesn't mean they don't have the predisposition, just that they dont have the environment in which the predisposition becomes a problem.

I'm certain if I stuck madam on a moorland her sensitivity issues would vanish.
 
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