Bloodwork, PPID, EMS Invokana and Pergolide


Nancy & Vinnie & Summer
 

Hi Dr K and all, I have been thinking a lot trying to figure out what the root cause of Vinnie's latest foot soreness that began on Feb 8th. 

I am a little confused because I honestly thought I had his metabolics managed after about 22 days on Invokana with the remarkable response he showed.

A little background:
-Vinnie started to get sore again off and on around mid to late  November. At that time I thought my hay that was supposed to be only blue grass; and I found alfalfa.  This hay I did retest and it came back at 9.3 esc+starch. I started soaking hay and looking for a replacement.

Around Dec. 19 the footsoreness got worse so managed to get an appt for bloodwork and Radiography. Started metformin.

- dec  21 we did bloodwork and rads and things looked ok..no new rotation etc..
12/26 bloodwork came back with insulin out of control at 198.37, acth 20.2.  Vinnie was on prascend .50 mg at this time.

We went the route of trying invokana

Started inovkana jan 8th , stopped prascend the same day. And stopped metformin.

Based on his test results we didn't think PPID, and he was still exhibiting symptoms of the veil even after being on pergolide for months.

Retested insulin on 1/12 and got some new rads. Planned on doing a trh stim but wasn't sure if needed based in the 1/16 result. we did not test acth since he was normal on 12/21.

1/16 got the results that Vinnies insulin had dropped to 40.94, leptin and glucose had improved dramatically too. Great news.
 
Vinnie had improved every day from 1/16 thru 1/31 having some great walk days up
through 2/8. 

1/30 and 2/4 administered adequan IM injections for  beginning loading dose 

2/7 pm noted pulses returned in the front.

2/8 am pulse noted by Shockwave therapist and we did some Shockwave on hips si, neck and hocks.

2/8 he was moving fantastic all day moving like he was feeling back to normal. Did a little free trotting in the arena.

2/9 very sore looked laminitic with pulses in fronts.

He has been sore since 2/9.

2/17 noted alf in the tested new grass hay that i had only fed about 20% of total  forage beginning about 2/4. This hay also has yellow foxtail

Vinnies diet is dialed in, I weigh and test everything. Even the hay that I ended up finding trace amts of alfalfa and foxtail tested at about 4.8 wet chem esc starch with the latest test at 6.8. I retested iron several times on all the hays to determine the baseline and then the shaken and sifted. Vinnie is eating the finta orchard right now and no more getting the new Vaca hay as of last night.

The thing that this seems to point to is possibly stopping prascend was not the best idea.

So, my question is, as I look at him being EMS and presumptive ppid, why was his insulin so high on the test where his acth was normal and diet balanced and..then after stopping prascend why was his insulin able to drop so dramatically on invokana without prascend on board for 3 days?

Does prascend have a half life where it remains in the system so 3 days after stopping it was still able to control acth enough to enable the insulin to come down so fast?

Body condition wise he has lost his crest, puffy eyes, fat pads..I mean he looks amazing.  I am perplexed.

Can adequan cause an insulin response?

I am going to put him back on .25 prascend tonight titrating up to .50. I had stopped APF so hoping starting apf and prascend in the same day still controls the veil.

Thanks in advance.

--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

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