Re: New Blood draw


Hi, Kimberly. 

It’s not easy to track changes you’ve made that would reduce Mouse’s dangerously high insulin of 116.75 as of your last blood draw 7 June 22. Your case history has a box in the first page for the date of the update. Volunteers appreciate that tidbit. Same with your Comments that are dated 2017. It’s easier to know where things stand if your comments are dated in chronological order.

 Is hay soaking new since 7 June? It looks like you discontinued metformin quickly, is that right? 

Insulin that high can cause hoof damage and impair recovery.  I would want insulin reduced ASAP. ECIR encourages us to address all 4 prongs of treatment of EMS, ideally at the same time - DDT+E (exercise as appropriate only). If Mouse were mine, I’d want to know his insulin is better controlled by the changes I put in place. I’d be especially careful to have the blood work drawn more than 4 hours after first morning hay so you’re not catching the insulin spike from breaking the morning fast.  Good review under the EMS heading at this link:

As an aside, I’m learning that DPs are not a very clear, consistent or specific indicator of hoof comfort. They’re a data point, subjective and a bit fickle. 
Cass, Sonoma Co., CA 2012
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