Hello and welcome back to part two of this Ask a Farrinarian special on metabolic diseases.
I'm Dr. Brian. In part one, we talked about the diseases themselves, so if you haven't,
I'd recommend watching that one first, as it'll make everything we're about to talk about make a
lot more sense. In part two, we're going to talk about the care and managing of metabolic horses,
including the testing, the medications, and most importantly, proper feeding. Quick note:
I'm going to use the term "metabolic" a lot in this video. For this video, "metabolic" refers
broadly to a horse with a metabolic disease. If I'm referring to a specific disease,
I'll use the term "EMS" or "PPID." So let's just start with some care and management. I
can't stress enough how important a proper diet is for a metabolic horse. Please make sure you talk
with your vet about your horse's individual needs. The proper diet is critical. Please don't skip by
this just because it can be challenging. And it is challenging. The great news: a well-managed
diet is one of the biggest ways we can improve these conditions in the horse. The bad news is
lack of dietary management almost certainly negates everything else we can do and all but
guarantees laminitis and founder. We can only do so much with medications. In the same vein,
exercise is critical, too. That is a big part of how they regulate that glucose-insulin balance
we talked about. Even 15 to 20 minutes, 3-4 times a week, can make a huge difference.
Please check with your vet about the best way to do this for your horse. I usually suggest
light riding and hand walking, walk/trot stuff. Straight lines are the easiest on their body but
I'll accept as big of a circle as possible. For those horses with severe limitations,
I even have clients who will just take their horse for a walk around the neighborhood. If our cat
Nellie can get walked for at least an hour a day, you and your horse can muster 15 to 20 minutes.
So moving on to testing. Metabolic testing is an evolving science. There are a lot of
testing options, and they can be tough to navigate. There usually
isn't a one-size-fits-all magic test. Testing mostly revolves around good, basic blood work,
so looking at organ function and overall health, but also measures more specific things like ACTH,
insulin, cortisol, and thyroid levels. So why test? Why not just wing it based on the
common presentations we talked about? Don't forget how we started part one - multiple
diseases can be present. Minimal testing only gives a minimal picture, and in most cases,
it's worth knowing more of what's going on. Metabolic diseases are usually permanent
conditions, so please don't skimp on the testing, especially in the early stages.
So moving on to medications, and this part's going to be brief, mostly because this is
such an evolving field. For EMS, there isn't a great medication at this time for the disease.
The cornerstones for managing this disease are, you guessed it: diet and exercise. There
are some meds out there we can use to give the horse's system a bump, like thyroid supplements,
and there are some newer drugs being evaluated for improving sensitivity to insulin. For PPID,
the drug of choice at this time is pergolide or "Prascend." This acts on the dopamine receptors
to decrease production of cortisol in the system. Again, remember back to the car
analogy of part one, and think of it as helping or replacing the brakes in the system. Again though,
we can only do so much with meds. Diet and exercise are key for these horses as well.
So going back to something I've mentioned from the beginning - the importance of diet
and proper nutrition in managing metabolic horses. The main focal point for managing a
diet in metabolic horses is carbohydrates, or more specifically, the sugar content.
So why is managing carb intake so important in these horses? An excess of carbohydrates
is one of the main factors driving weight gain, insulin-glucose imbalance, and everything else,
including laminitis and founder. So now, let's get into the nitty-gritty of diet. You might
find this information detailed and perhaps a bit boring, but it really is critical. If I lose you,
please just hit rewind and watch it again. There are a couple of ways to evaluate the
carbohydrates found in forage. The first is "digestible" versus "undigestible." The leafy
parts of the hay are the more digestible form of carbohydrates compared to the stems and stalks.
As plants mature, the carb content shifts from digestible to undigestible. What this means,
is if you are looking for the most nutritious hay possible, you would look for the "leafy" hay,
and stay away from the stuff that's "all stems." The more prominent the stems, the less nutritional
content is available for digestion. Another way to count the carbs, is with an actual nutritional
analysis. And that will contain two important numbers - NSC/non-structural carbohydrates,
and WSC/water-soluble carbohydrates. A simple way to think about these two: NSCs are all of
the potentially digestible carbs and WSCs are more specifically, the sugar content, and most
importantly, the carbs we can reduce with proper soaking. So this chart just shows some good rules
of thumb for estimating sugar or carb content in various hays. This next concept may seem simple
or obvious, but don't skip by it. Not all hay is created equally. That's why the wine connoisseurs
know that the '74 Merlot is divine but the '75 is pure rubbish. Different areas and different years
produce different characteristics. Timothy grown in the South is likely different from the Timothy
grown in the West. Even locally, Timothy grown in Greeley is likely different from Timothy grown up
at Steamboat. First cutting hay typically has lower digestible carbs than do later cuttings,
because the first cuttings tend to include the mature grasses from after that last
cutting that overwintered. Additionally, and this is a great transition to the next topic,
some types of hay respond better than others to soaking. So the most accurate way to know the
true nutrition and carb content of the hay you're feeding is to have an actual hay analysis done.
So a quick orientation on the chart behind us - this is the types of hay we're going to
talk about, the original starting content of the water soluble carbohydrates, and these are percent
losses for a 40-minute soak time, 3-hour soak time, and 16 hour soak time. This chart comes
from a study done in the UK that demonstrates both the value and the limits of extended soaking,
and manipulating the carb content of various hays. Quick reminder, you can think of water
soluble carbs is the actual sugar content in the hay. It's a lot like dissolving sugar in
your coffee. You can see that two of the most common grasses grown around Colorado,
Timothy and Orchard, are actually some of the highest in sugar content to start with. However,
they do respond well to the extended soaking. And you can take out a quarter, to almost half,
of that initial sugar content. Conversely, the poorer quality hays, either the less nutritious
species or the more mature hay, actually has less initial sugar content, but it doesn't lose
much in the soaking process. Extended soaking, twelve or more hours, is a great way to reduce
the problematic sugar content. Unfortunately, one of the biggest challenges we face here,
especially in Colorado, is the cold winters. So if soaking hay becomes impossible or unlikely,
regardless of the time of year, consider seeking out less nutritious or poorer quality forages.
This does not mean the dusty or moldy old cow hay, just something like mature, native grasses. These
aren't the easiest to find so an ideal balance maybe something like soaking hay for the nine,
ten, eleven months it is feasible, and having a small stockpile of poorer hay for those times
when it's too cold for soaking. So how much do you actually feed your horse? Again, please talk
with your vet about your horse's specific needs. My rule of thumb is: one percent of their body
weight, spread out in as many feedings as possible throughout the day. So for example, if your horse
weighs roughly a thousand pounds, then it needs one percent of one thousand, which is ten pounds
of hay per day. How do you actually weigh out the hay to know when you've got ten pounds? Hay
nets with hanging scales can be a handy way to measure the amount of hay you're giving. Make
sure to weigh the hay before you soak it. The "one percent" rule is usually a starting point
for basic maintenance. However, some horses might need more, or in some, need even less. Especially
with EMS horses, you may have to limit hay intake so much to manage the carbohydrates, that you
actually need to supplement their diet with what's called a "ration balancer." This is basically a
concentrated form of nutrients that they still need, but are no longer getting because the sheer
volume of hay they are allowed to eat is so small. Lastly, metabolic horses, almost across the board,
need a complete ban on free grazing. The risk is just too high and their willpower is too low.
Laminitis and founder are heartbreaking to go through, so please, please don't play with that
line. If you have a horse with metabolic issues, it does not get to graze freely on a pasture.
The "motivated eaters" can consume as much as 40 percent of their maximum daily needs in as little
as one hour. Ideally, metabolic horses need to live in a dry lot with hay selected specifically
for them. If they are out on pasture, they have to wear a grazing muzzle - no exceptions. Again some
of these horses are so sensitive, that in just an hour or two of grazing in the right circumstances,
they can develop a severe and possibly terminal case of laminitis and founder. Please take this
seriously. I want to take a moment and talk about a common misconception I see. Don't
condemn a horse to a metabolic disease, but also don't ignore a metabolic disease. Common examples
of what I'm talking about are: "Well, he's just metabolic. So he can't lose weight" or "Oh, she's
just easy keeper" also "She's just old and skinny, not much we can do about it" or "We put him on
pergolide. It only helped a little." All of those may be true statements, but also likely represent
only part of the picture. Again, talk with your vet. Address any dental needs. Re-examine your
parasite management - we have a video on that. Do you need to move your horses around and change the
herd dynamic? Watch the weight-loss video. Address the whole picture. Well you made it! We're at the
end of part two of metabolic diseases in horses. If you learned something, if this helped you,
please share it and help others. Thanks for watching. Take care of your horse.