Re: New bloodwork- please advise
Nice to see that Flame's I/G numbers have dropped some but he is still severely IR/high risk for laminitis. Plug the numbers into the IR calculator here:
His ACTH is fine and as he's only 11yo it makes sense. Being 1/2 Arab, 1/2 Saddlebred makes IR pretty common also. Was this batch of bloodwork done fasting and at Idexx? If so, it is artificially low and his numbers are, unfortunately, worse. Really urge you to have next set of tests run thru Cornell for insulin/glucose/leptin and NON-Fasting. The I/G ratio listed on the labwork is incorrect - it should be G/I. Have a read in this file for more in-depth info on IR:
It is likely e is staving off major laminitic issues because he is in work. If that stops for any reason he may be tipped over the edge into a laminitis/founder episode. Would you be able to get some pics of his feet posted to ECHistory7 Photos so his trim can be assessed? Optimizing it will help to keep founder issues at bay.
The PalaTech thyroid meds contain sugar as a flavoring (apple and molasses), which is not a good idea for an uncontrolled IR horse. As he is underweight it makes no sense to increase the thyroid supplementation. Primary hypothyroidism is virtually non-existent in horses. The low thyroid numbers that were on his original and current bloodwork are secondary to the uncontrolled IR and existing dietary imbalances. Correct those and the thyroid will correct itself. For the most comprehensive thyroid work-up need to test T3, Free T3, T4 and Free T4. The samples should be sent to MSU as that is the only lab capable of testing FT3 in equines.
The SmartPak Metabo-Lean contains several things not recommended for IR horse: cinnamon (which may lower glucose, not an IR issue); niacin/thiamine; rice bran oil, vegetable oil (inverted omege 3:6 ratios); chromium is only needed in areas where the hay is grown in alkaline soils; american ginseng. Would recommend stopping it.
The TC Low Starch isn't. The starch is a whopping 10.4% (converts 100% to glucose) + 3.1% ESC = 13.5% .Also has high iron, high fat and high protein. Looking for under 10% total with starch being less than half of that amount. At 4lbs per day this is not safe.
The ODTBC are a great idea and definitely safe and mineral balanced. Another option would be the Nuzu Stabul 1 grain, which is also a mineral balanced, under 10% s/s option.
Really need to get Flame's diet much tighter. How much hay, by weight, is he receiving? Do you have any idea the general area that the hay is coming from? Could you get the barn owner to set aside several month's worth somewhere so that it could be tested/mineral balanced? Until more is known about it, really should be soaking the hay.
Need to be giving at least 2 oz per day salt in his meals for basic maintenance.
Really need to revisit the DDT/E basics and get all of that in place in order to make lasting changes in Flame's IR control. As Dr. Kellon has said "halfway measure get halfway results". The goal is to PREVENT laminits/founder at all cost, not treat it after it has reared it's ugly head.
Metformin may or may not help. When it does work, it is only a temporary fix as it loses effectiveness after a short time. We recommend saving it to use in emergency situations when you have shy-high insulin/glucose and laminitis/founder going on while you get dietary fixes in place.
Here's the link to his folder:
Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team