Re: Jasper's Lyme Results


 

Hi Nancy,

Here's more clarification, drawing quotes from your prev post (please note that if I use CAPS it is merely for emphasis)

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....."Every time this comes up I am still left with the same question.

Did her insulin come down because she had better controlled ACTH or because she got off the Cubes.  I don't think that has been separated out."....

>>>  Ok, a quick synopsis of Pinky:  diagnosed IR in late summer 2013, a full year before I found this group.  I was able to manage her by soaking her grass hay when her insulin came back high, and eventually found a chopped grass hay made by Lucerne Farms ("Premium Hay") that repeatedly tested at 6-7.5% ESC+Starch (although bc i didn't know better I was using NSC as my "high number").  I would put her on the soaked hay for about a week, would see a visual "drop" in weight (esp crest), and then ease her back onto the unsoaked Premium Hay until the next high insulin test.  In retrospect I think I got her thru the fall of 2013 (with as yet undiagnosed PPID) because she was working HARD -- hunter paced every weekend, 10+ miles each, etc.

Spring 2014 -- same as above, not having as much trouble with insulin.  Still in heavy training.

Summer 2014 -- did well on the same above Premium Hay with some added Hi-Fiber Gold and Chaffhaye (b/c she needed calories for high speed work -- remember, I still hadn't found ECIR group yet).  Mare was a superstar at Fitch's Corner, actually won our division(!!) which was mid-July, 2014.  At Millbrook (last weekend of Aug) is when she started going downhill (and that was only evident by her refusing a jump).  By the Championships in mid Sept, she had completely crashed metabolically.  Looking back, I now understand that it was her undiagnosed PPID that was worsening the IR even though she was working about as had as an amateur-owned horse can.  Her insulin drawn right after the Champs was 130mg/dL so I immed put her on soaked hay only.  She stabilized, as she had done everytime in the past that I put her on soaked hay only.  However, as the rest of Sept wore on and Oct began, she became increasingly lethargic and depressed no matter what I fed her (remember, still not diagnosed PPID).  I still kept her in full work but she was not right -- everyone told me that it was just her age catching up to her.  We only did one more event at the end of Sept (she finished double clear but it was a struggle).  By this point I had discovered ECIR and every "safe" food I tried sent her right back into crisis (b/c of her still undiagnosed PPID; at this point I still thought she was "just IR").  While I was busy reading ECIR info Pinky got worse and worse (while on soaked hay only) until one day in mid-Oct her legs blew up, she had digital pulses, and was stumbling badly.  I had radiographs done by my local vet b/c I was so worried about laminitis (note: this mare is extremely stoic & was never lame).  I floated the possibility of PPID with my vet as a rule-out of the refractory hyperinsulinemia and somehow the subject of consulting with Dr Kellon came up b/c Pinky did NOT look anything like a "Cushing's horse".  Furthermore, her ACTH drawn late Sept 2014 was only 36pg/mL.  Thankfully Dr. Kellon deemed a trial of pergolide worthwhile and she immed improved but it took some months to find the right dose to fully control her insulin.  THAT IS DURING THAT TIME THAT I TRIED THE ODTBC & HER INSULIN SPIKED.  It was well-after the seasonal rise and she was not on enough pergolide yet.  However, when i put her back on soaked hay only, the insulin stabilized.  THAT'S THE POINT I'M TRYING TO MAKE!  By that evidence I understood that her PPID wasn't controlled and I increased the perg., tried the cubes again, same result (deduction:  Pinky must be extremely sensitive to ESC&starch over 6%, the batch of cubes I had at that time must've been betw 6%-10%).  Once I got her up to 2mg pergolide by January, she was able to eat the ODTBC no problem, BECAUSE HER PPID WAS FINALLY CONTROLLED.  As I mentioned before, I put her all the way up to 2% BW of cubes through the harshest of winter (living out) and her insulin behaved and she felt great under saddle! 

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....."As discussed in other recent posts, the symptoms of uncontrolled IR and uncontrolled PPID overlap. I kow you know that.

>>> Yes :)

....."Improvement of foot comfort can come in a matter of days from increased dosages of pergolide, just as it can when switching from high ESC&Starch feeds/diet to lower ESC&starch intake. 

>>>> Yes, completely agree, have witnessed both scenarios...

...."As I understand it you did both at the same time.

>>>> No, and that is the crux of the matter.  I did the "cube trial" well-before I had found her target perg. dose.  The scenario was this:  was on 1mg perg, seemed OK, tried weaning her off soaked hay and adding ODTBC, insulin spiked, usual symptoms returned, reverted to soaked hay only, symptoms resolve (I did these observations and changes over weeks at a time; it was not just a day or two; I gave each time a cahance to fully integrate).  I bumped her to 1.5mg.  Tried easing her off soaked and back again onto ODTBC -- same thing happened, sore feet, stumbling, etc  Bumped her up to 2mg perg, gave it a few weeks, tried the cubes and at this point she was fine.  This was done over many weeks betw Nov'14. and midJan'15. 

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....."Just to be clear for new people ODTB Cubes are not high ESC&starch adn this report is unusual so it is why we are pulling apart the confounding factors. A process that our founder Robin established as and ECIR keystone so long ago."....

>>>> Yes, absolutely!  Hopefully as i illustrated above, my mare was the "problem", not the cubes.  She's doing great on the cubes NOW THAT HER PPID IS CONTROLLED.  She was just unusually sensitive to ESC+starch being over 6% BEFORE HER PPID WAS CONTROLLED.

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....."My take of Dr Kellon's response to this and my own personal experiences is that diet is critical to controlling IR, but the system can be overwhelmed by uncontrolled diseases driving insulin levels far beyond anything you can control with diet alone.  It takes control of the diseases to control the IR.  If you don't control the disease, no amount of diet tweaking will fix hyperinsulinemia.

....."Just like pergolide will not fix "insulin resistance related to genetic predisposition, obesity, diet or any other nonpituitary cause", diet alone will not fix IR from disease states like PPID.


....."I'm paraphrasing but I think Dr Kellon described it as when ACTH, Lyme, Mare issues, iron overload and other are out of control, no feed will be low enough to control hyperinsulinemia.  You have to address the disease. As you did. 


>>>> Yes, yes and yes, all agreed & understood.


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....."As for your gelding, It would be helpful to see the rest of the diet and well, you know,,,,,a CH."....


>>> Ahh, yes, my gelding...he's a wacky one in so many ways :)  His CH is almost UTD; I've just been waylaid by my own poorly controlled Lyme disease and some epic migraines of late.  :(((  Between the horses and myself, it seems I'm always reading about some affliction or another


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....."In any event, in the last go around, it was suggested that Corrine use soaked hay and the emergency diet if she felt that was the best for Jasper, until he was more stable or at least there was a clearer picture of his dx, 


....."I offer this Kerry, with all respect for the work you have done with your horses.


>>>> Nancy and all, I cannot thank you enough for responding so thoroughly and for putting up with my incessant interloping into this thread.  Im only inserting myself b/c I'm trying to learn and/or understand on a deeper level.  My "wanting to give back" aspect probably could be reined in some ;) but it comes from a good place :))


Thank you a thousand times over,


Kerry in NY

Sept 2014

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