Update on Apollo - One year since onset of laminitis.
Bloodwork done 09-14-2022. Not sure why whole panel done but maybe less expensive than individual tests through Cornell. Blood sample obtained 5 hours after nighttime fast ended. Fed dry grass hay until blood draw. Received morning Metformin dose by syringe.
Glucose 93 mg/dL (reference range 71-122); same as 8/15/22
Insulin 47.35 uIU/mL (reference range 10-40); decreased from 62.60 on 8/15/22
ACTH 20.1 pg/mL (reference range 2-30); increased from 10.3 on 8/15/2
Leptin 8.35 ng/mL (reference range 1-10); decreased from 13.06 on 6/3/22
T4 2.58 ug/dL (reference range 1-3); increased from 1.50 on 4/19/22. Last dose of Thyrol-L was 1/2 tsp on 9/11/22.
Metformin: needed 2 syringes to give 20 tablets/20,000 mg dose. Put 10 finely ground pills in 25 ml of wild cherry Milk of Magnesia in feeding syringe with angled metal tip. Rinsed mouth with water after dispensing medication from each syringe and then fed hay. Apollo took medication well but unfortunately, it depressed his appetite and made him sluggish, almost like Pergolide veil. First noticed eating less of timothy balance cube mash with supplements. Tried manipulating type and amounts of supplements and added various flavorings but eventually wouldn't even eat plain timothy balance cube mash. Would eat all of his hay, but much slower than normal. On 9/17, noticed him yawning a lot when just standing out in paddock during day. Then on 9/18, after giving evening Metformin dose, he kept his mouth open, moving his lower jaw/making faces (not chewing and yawning motions). Did same thing with his mouth again next morning when given Jiaogulan by syringe but this time was acting like something was stuck in his mouth. I couldn't get a good look inside when I tried so did not give Metformin and decided best to put on hold. Also noticed he hadn't eaten any of plain timothy balance cube mash given night before which was unusual. Apollo started eating some plain mash again on 9/20 and more eagerly eating hay so I started reintroducing supplements. On 9/23, had couple of yawns/mouth chewing motion after giving morning Jiaogulan but was eating normally. Did not appear foot sore on any of these days. Today when farrier was here to trim other horse, I noticed Apollo doing a lot of yawning in his stall. Couple of days ago, I started a new bag of Jiaogulan (from Horsetech) which he doesn't like it as much, it's brown and smells like tea whereas previous Jiaogulan (from MadBad) was dark green and smelled more like grass. Now he sometimes does chewing/mouth opening when he gets new Jiaogulan. Think getting his teeth checked would be a good idea.
Doesn't seem to be having hoof pain. No shifting from foot to foot at rest. In Cloud boots with pads 24/7. Walked about 500 feet on blacktop road last night. Moved freely, at good pace, heel first contact most of time but sometimes more foot flat but not toe first. Currently keeping him outside 24/7 when has dry place to lay/sleep so he can move more. Hasn't been running in paddock as has in past but may be because he's weightbearing on his soles more now. No drastic changes in trimming/rasping, Have been gradually (every 3-4 days) working on hoof flares and taking toes back on fronts. Also working on back hooves. Hoof trimmer found through ECIR gave some suggestions but thought we were doing well. Will be taking new hoof photos this weekend.
Since Apollo's current hay was tested by hay grower, I had Equi-Analytical retest Apollo's this hay for ESC+starch. Hay grower's results done by Holmes Laboratory: ESC 3.88 + starch 1.92 = 5.88%; my retest results (based on sample from 20 bales): ESC 4.9 + starch 1.2 = 6.1% which is difference of 0.3% and average of two tests is 5.99%. Seems low enough to not have to soak. I've decreased Apollo's intake from 28 lbs/day to 26 lbs/day. Cresty neck still significant but feels much softer and nuchal ligament easily palpated. Fat pad by tail also seems smaller and softer. I've added new body pictures to his photo album. Kathleen is doing hay mineral balancing.
Apollo is definitely doing better now than a year ago but still has a long way to go so it's hard not to feel discouraged at times. Hoping we can start hand walking soon to help with insulin. Don't know about trying Metformin again given "pergolide veil" effect it had on him and concern about mouth ulcers. The expense and potential side effects of Invokana are quite concerning. A big thank you to all who suggested increasing Apollo's pergolide dose in June as his ACTH went from 10.3 on 8/15 to 20.1 on 9/14. Very pleased to see his T4 at 2.58 without Thryol-L.
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album: https://ecir.groups.io/g/CaseHistory/album?id=275817