Re: Updated Case History, Suggestions Needed


>Insulin is not a stagnant number.  It goes up and down in response to the glucose.  Again, the "normal" used by the labs are too high for use in determining IR<

I normally have the vet draw insulin/glucose with spring/fall checkups but this fall we haven't yet. The vet felt tat due to the laminitis we wouldn't be able to get an accurate level. As soon as we notice a difference he will have his levels drawn again. I really think that the increase from 13 to 24 was due to the diet change I was unaware of at that time. The deal that was made is I prep his beet pulp with the rinse/soak/rinse method and he will not be taken off the beet pulp and nothing will be added in.

>I am confused about is Opie's ACTH.  You state that his levels (plural) have always been "well within the normal range", but I only see one ACTH in his CH.  It says "24?"<

I apologize. He has only had the one ACTH level done. I couldn't remember the exact level but know it was in the 24's and in the low normal range. The vet office is emailing me with all of his labs so I can properly input them. The levels were sent to the barn owner instead of me with that test. The plan was to do ACTH levels every 2 years as long as he did not show any symptoms. Unfortunately, he does seem to have symptoms. However, I'm not sure if it is due to potential early PPID or to prolonged stall rest for rehab of his torn check ligaments.

>The fact that Opie's crest "continues to flair up" and that he has laminitis (which actually started during the seasonal rise period) means that something is driving his insulin up, either his diet, or a high ACTH.  If Opie is early PPID, which is suggested by the fact that he is doing better on the Prascend, after your 60 day trial period, we will be out of the seasonal rise period.  That, in combination with the Prascend may make his ACTH when you recheck it, come back normal.  Some early PPID horses only need pergolide during the seasonal rise.  Please go back to my original post and reread the information in all the links I sent you.  There's lots of information in those links that will help you to manage Opie.  IR and PPID are progressive diseases and require constant adjustment in management.<

Like I said, it's hard knowing whether the flair ups are caused by early PPID (which I am inclined to think due to immediate changes on the Prascend) or from his IR and prolonged stall rest. He went from working 6 days a week to very strict confinement for several months. I will ask the barn owner if one of the vets are coming out earlier to possibly draw a new ACTH but regardless if he doesn't get it for 60 days he will still get spring testing during that seasonal rise, on top of the 60 day testing. With his IR I tend to be highly neurotic and check him over daily during grooming for any potential changes. We have only had these issues since stall rest and it is so frustrating! I also forwarded all of the info to the vet so we can make an appropriate plan. The vet is very supportive of this site and speaks highly of it. :)

>As far as the multi vitamin supplement goes, I'm not sure why you feel like you need it.<

Even without balancing the hay I do know it is HIGHLY deficient in pretty much everything. Due to our boarding and inability to do the analysis the vet felt that a multi vitamin would be the best bet when we took him off the ration balancer for the stall rest. I am looking more towards one of two vitamins that are produced specifically for the PNW tight now so it is more targeted towards the actual deficiencies rather than an abundance of everything. Once I get the ingredient list it will be easier to decide.

>Still, balancing your hay is the best way to feed Opie.  Lots of members have found innovative ways to store hay that they purchase and store for their own horses.<

I will speak with the barn owner today to see if we can make one area specifically for the storage of Opie's hay. I really don't have any other options if we can't. I should have an answer today on that. If it works out and I can get storage and analysis I am very poor at math and will need lots of hand holding lol.

Do IR horses suffer from seasonal rises in insulin without having PPID? Can they respond favorably to Prascend if they are just IR? The stall rest has taken so much out of him. I will have time to dig through all of the links tonight for more specifics. I am also hopeful to load pics in tonight into his file. He really has gone through a huge change since coming to us. He taped at 850lbs on his pre purchase exam (13.1hh) and is now taping at 685lbs. You are correct that we do not know how long he suffered from high insulin prior to purchase. He was constantly on grass and fed grain before I bought him.

Kendra and Opie


July 2013


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