Prosthetic Parity

Off topic for an equine nutrition blog? Not really...

My friend Kathleen, who sent the email below to her friends, is a co-moderator on the Equine Cushing's group and is part of a group we call "The Balance Babes" - helping those who arrive at the EC List (often with a severely laminitic or foundered horse) sort through the options.

Kathleen is the kind of person we all learn from - not just about horses and nutrition, but about life. She initially lost her lower leg in childhood

; an injury in the Fall of 2007 led to above the knee amputation.  While not without some down times, her progress from goal to goal has been an illustration of grit, determination and spirit.

Not only has Kathleen given unselfishly to other horse owners, as "Dr. Gustafson" her research is making a difference in human pre-natal care.

It's only a small payback to ask you to take a minute to read her note and sign the Amputee Coalition of America petition at  Prosthetic Parity Petition 

Hello All - a quick note - I'm doing well. I've been riding a few times and walk short distances without assistance. The plan was to upgrade my hydraulic knee later this year to the C-leg, a microprocessor knee that essentially "thinks" for the user, making walking as close to "normal" (like you all!) as possible. It basically takes the thinking out of walking and requires less energy to walk. As it is now, I still have difficulty with uneven terrain, have to plan every step and can walk about a half a block then need to stop and rest before I can go on. I still have to drive across campus to get to my other lab when I used to walk there several times a day. I plan to do more therapy hoping that my stamina will increase.

 

Unfortunately, I found out last Friday that my insurance (Blue Cross and Blue Shield of Kansas) will not cover the C-leg. This is not a huge surprise as insurance companies have been reluctant to pay for prosthetics. Often they limit coverage to "one leg for life" (bummer if you lose your leg as a child!) or cap the bill at $1,000 to $5,000 leaving the amputee to pay the rest. My existing leg cost $30,000 and the C-leg can cost twice that. However, what makes this especially bitter is that Medicare, Medicaid and other Blue Cross and Blue Shield Plans (including BCBS of Kansas City) *will* cover the C-leg. I find it especially ironic that I work for the State of Kansas at the state's premier medical and research facility and watch others exit the prosthetics clinic with a C-leg that my state insurance plan will not cover.

 

As it happens, this is the "National Week of Action" to support a federal bill to ensure access to prosthetic care. http://www.amputee-coalition.org/ I'm writing to ask you to go online and sign the petition:

 

http://www.amputee-coalition.org/advocacy/petition/ 

 

You have my permission to forward this email on to others. Please ask your friends to sign the petition to support this much needed bill.

 

Thank you so much,

 

Kathleen Gustafson

Kansas City, MO

Slick & Pretty or Pretty Slick?

There's a million ways to get your money in the horse world - most are not new but a slicked up version of something pretty basic.

"Ration analysis"  or "ration balancing" programs seem to fall in this category.

You can go to the NRC Nutrient Requirements of Horses Computer Model website and determine your horse's basic (minimum) requirements for free. No fancy graphs or bells and whistles - but the information is calculated for you in a clear, readable format. You enter your horses weight, class and activity level and the protein. When you click on "Other Nutrients", protein, DE and major mineral requirements are shown on the bottom of the page, with the trace mineral and vitamin requirements listed in the center of the page.

You can then enter "dietary supply" - either by selecting from the provided database (which is somewhat limited) or by entering information from a known hay/feed analysis. This will provide information for protein, DE and major minerals only.  

The downside is this does not provide any information concerning correct mineral ratios, how to correct for competing mineral excesses or deficiencies, or identify potentially troublesome excesses (such as high iron or high manganese). To do this, you need to enlist the help of an equine nutritionist, learn how to do the math yourself (it's not really that difficult) or learn how to use the spreadsheets available either in the Equine Cushings group files or you can request them from me at no charge.* 

Enter Slick & Pretty

FeedXL, a program that is initially only addressing feeding conditions in Oz, works much the same as the NRC computer model.  They are using an interesting subscription concept, rather than purchasing the program. This does have the advantage of allowing for ongoing updates to their forage and feed databases, along with keeping it more affordable for an average horse owner (for a "one day" one time calculation - monthly or yearly cost begins to approach program purchase costs).

They have done a nice job on this - the "results" are displayed in clear, easy to read numerical and graph formats, using correct nomenclature. 

If all we were concerned with was meeting or exceeding NRC requirements (and they're quite clear that the program's recommendations are higher than NRC), I would suggest that this online model is what we've been looking for. And this could be all many horses need.  But, in our experience with metabolically challenged horses, we've learned that balance is not simply meeting/exceeding requirements, but also involves paying attention to mineral ratios.

Green is Good?

The FeedXL tour example indicates iron at 506% of requirement "... is no cause for concern..." and has an iron to copper ratio of 12:1. This could be problematic for an insulin resistant horse or a horse with inflammatory issues, as excess iron is becoming well documented as a factor in IR and inflammation.  "Green" (i.e. no deficiency) is NOT good if an excess of a mineral is problematic.

It becomes fairly complicated to explain mineral ratio corrections - each correction affects other minerals which then also may need adjustment. In a computer model, this becomes a multi-step process, but not difficult for a sophisticated program to handle (my spreadsheets actually do it quite easily) but does require some interpretation to ensure recommendations remain within safe limits. 

I didn't see a provision for entering your own hay analysis results, and only Australian feeds are currently in the database.

So, as slick and pretty as this program is, I don't see any real advantage over what you can get from free from the NRC model, plus a little math.

*While I do charge for consultations and assistance, I have always made the spreadsheets available at no charge for individual use. I appreciate a "donation" if you find them useful, but it is not required.