Candy Update: Invokana on board Questions and Concerns re. symptoms and diet
Candy began Invokana on 1/25/21, 225mg due to insulin at 88 and sore feet. Increased to 300mg after one week. Retested insulin and ACTH after 3 weeks on Invokana. Insulin dropped to 23.1 Idexx norm 4.5-20. (Glucose strips consistently ay 30 range after 30 seconds and drug kept in barn at 40' for a week until I found out it is suppose to be kept ay 68'-77'!, So lucky efficacy was not effected in this case.) This is the lowest Candy's insulin has been to my knowledge. ACTH 22 norm 9-35, after increase of Prascend in August to 2.25 even though ACTH tested normal then as well. So you would think everything might be good. It is not, we still have a long ways to go. Vet thrilled at response to Invokana, but Candy still has many symptoms. (I watch Candy eat all the pills so I know she is getting all of them consistently)
They include: Suborbital bulges, slightly gooey eye d/c, a crest (Body score 4-4+), coat changes (I had to clip her so much last year, I'm not sure where we are on this), heat intolerance, sore feet, (Although this has improved a lot and her weight shifting is much improved as well) with pulses in front, intermittent in back. Again vet said treat the symptoms. Prascend increased to 2.5 on 2/19/21. I don't completely understand how using Prascend and Invokana work in tandem. So even though Candy's insulin is almost normal all these symptoms persist. So does that mean the seemingly normal ACTH is not controlled and is fueling the the insulin levels? If that is the case, how could the insulin drop so much. Or is it just too early to see symptoms dissipate? It seems like most people see an abatement of symptoms very quickly on Invokana.
Another question is when treating with Prascend which comes first, symptom abatement or a drop in lab numbers? How long should I wait before testing again or do I just keep increasing the Prascend every 3 weeks until symptoms improve, since I'm treating those and not responding to the lab number?
I tested Candy's hay: 6.6 esc + starch and a protein of 15.9. Two different tests have been done on this hay, one by me and one by the grower. The grower's numbers were 7.8 e + s and 13.6 protein. I can only assume he had a much bigger sample than I did. I only could get to 8 bales. That being said, if protein was contributing to symptoms could that be mitigated by increasing TC Timothy Natural Balance cubes and decreasing the hay?
Another missing link is balancing this hay. I have not submitted it yet because I have so much trouble getting Candy to eat balancers. I was hoping to have a hint about a direction to go in. She eats around the pellets of U Balance and Grass Select. I need to have a fairly fool proof way to get minerals into her before I spend so much money on them. Candy is notoriously picky, hates flax and won't eat anything wet or damp. She tolerates Cocosoya. Taste tempters don't really apply to her unless it's TC Senior and I have decided to drop it all together in case it is contributing to her being foot sore. Plus it didn't work that well either. However, I do use one tablespoon, literally to give her all her pills. So far I have had the most luck is giving all supplements separately with high ratio of Timothy Pellets esc + starch 7.4.
Thanks in advance for some guidance,
Shawn and Candy
Dec 2020, Santa Cruz, CA
Candy Case History: https://ecir.groups.io/g/CaseHistory/files/Shawn%20and%20Candy
Candy Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=258140