Date   

Re: Stormy - need advice on perg. dose, please

Teri
 

Nancy,

I default all my comments to Dr Kellon!!

But keep breathing!

*** I'm trying!!! Getting labs drawn tomorrow.  I have a feeling it's gonna be a loooong week waiting for results.
Thanks!


Teri, Stormy and Kelsey
Indy 2012
ECHistory5

 




Re: Stormy - need advice on perg. dose, please

Teri
 


Dr Kellon,


Sorry, I forgot Stormy's history link!


Teri and Stormy

Indy 2012

ECHistory5



Re: Stormy - need advice on perg. dose, please

Teri
 

Dr. Kellon,

***I had a talk with my vet today about all of this.  I am very pleased to report that the two of you seem to be on the same page.    Maybe even the same wave length! :-)


Another possibility that can never be forgotten is that the compounded drug was compromised and is not as potent as it should be.  You may be handling the product correctly but it could be the tail end of a shipment to the compounder that expires while you have, or could have been damaged in transport by things like high temperatures in trucks during transport. 

 

***This is so ironic!  My vet said he'd just had a long conversation with the pharmacist at Thriving Pets.   They called him to question the high amount of pergolide that he prescribed.  He explained what had been going on with Stormy and that we had ACTH results to show she needed the higher doses.  They said maybe I was ordering too many at a time...meaning several months worth.  Also questioned if I was storing properly.  He told the pharmacist that if he'd check their records he'd see that I only order a 30 day's supply each time and that I store the caps in the door of the frig.   Then he turned the tables and asked if they were using fresh pergolide. The pharmacist started backpeddling! ;-)    He assured my vet that the pergolide was fresh.  I guess there's no way to know for sure???   I have also worried about the temps during transport.  Can't do much about that, but I try to order at the first of the week so that it isn't sitting in a warehouse somewhere over the weekend.  It usually takes 2 days to get from CO to IN.  I also try to get the pkg out of my mailbox asap on the day it arrives.  


Stormy is a complicated case.  While I don't doubt at all that poor appetite can be one of her symptoms of poor control, there are other possible causes and it's really not a reliable indicator of need for more pergolide.  Even in November 2013 when her ACTH was in the teens she still had issues with appetite, foot comfort and eye drainage.


****I understand and appreciate what you're saying.  I apologize for getting lazy with my record keeping. This info wasn't in her history.   Stormy seemed to level off during the late winter/early spring and her appetite was pretty good.  Then late April/Early May her appetite seemed to be getting worse.  We checked her  ACTH on 5/16...it was 30.3.  Still normal, but up from 17.3 in Nov.   We increased her pergolide trying to get ACTH back in the mid normal range....appetite was immediately better. So I started paying closer attention to her appetite.  Appetite worse, increase pergolide, appetite better. That pattern continued all summer. She was on 14mgs of perg. when tested in May.   By Aug., she was on 20mgs and her appetite was getting worse and worse every day...getting to the point of totally refusing her bucket feed.  My gut said I needed to increase, but I was afraid to add more w/o testing.   Her ACTH was 52.9 on Aug. 15.   So, same pattern...but the increase only lasted a day or two.  One mg. didn't even seem to phase her, so I started increasing by 2, 3, 4 mgs at a time.  So in only 2 weeks we were up to 40 mgs!  I whole heartedly agree that at this point relying on her appetite, or lack of it, is risky.  It made me nervous enough when we were at 20mgs not to mention now!   YIKES!!!


Because of all the unknowns, I don't know if you can really sort out what is going on here but this is what I would try:


- Repeat ACTH on the current dose

I would also strongly suggest you do a complete chemistry blood panel which will show up any issues with organ function.  Not so much concerned about the pergolide for this as for the long course of Previcox and also her age.  This should really be done yearly at least.


***My vet is coming out tomorrow to draw blood for ACTH, CBC and chem panel.   It will be kept in the freezer all weekend and shipped out on Tues. (since Mon is a holiday).


-Get fresh pergolide from another pharmacy


***I just received a new shipment of perg. yesterday.... same pharmacy.  I spent $267 for these meds., so I would hate to toss and order more.   They did assure my vet that the perg was fresh...but I guess there's no way to know for sure.  I will order from a different pharmacy if you still think it's necessary


- If no change in ACTH or higher, drop the dose to 13.5 to 14 mg and repeat ACTH in 3 weeks

- Continue other support of ultra low ESC/starch diet and meticulous hoof trimming


***Will do.  


Thank you so much!!!

Teri and Stormy

Indy 2012



Re: Flax or flax oil?

martha williams
 

We use 1 oz Wellpride fish oil PM. and 2 oz. stabilized ground
flax AM and PM......-----just stir these into food......
   Dubrow/Williams. NY  '08

On Aug 28, 2014 10:40 PM, "ifwesaveone@... [EquineCushings]" <EquineCushings@...> wrote:

 

I've been looking for an Omega 3 that my horse can tolerate to help relieve inflammation and to aid in reducing skin reactions to bugs. He gets completely high on chia seeds after 2 weeks, and he bloats on ground flax seed. Can I use flax oil? What is the dosage for an 1100 lb horse? Will he gain weight? (we don't want that). I did a search in the files, but didn't come up with any recommendations pro or con on flax oil. If there is some previously discussed material, please send me a link or let me know where to look.


Thanks in advance!

Allana and Mojave Moon

Feb. 2011

Northern IL


Flax or flax oil?

Allana KERELUK
 

I've been looking for an Omega 3 that my horse can tolerate to help relieve inflammation and to aid in reducing skin reactions to bugs. He gets completely high on chia seeds after 2 weeks, and he bloats on ground flax seed. Can I use flax oil? What is the dosage for an 1100 lb horse? Will he gain weight? (we don't want that). I did a search in the files, but didn't come up with any recommendations pro or con on flax oil. If there is some previously discussed material, please send me a link or let me know where to look.


Thanks in advance!

Allana and Mojave Moon

Feb. 2011

Northern IL


Re: Hoof pics...please comment?

Lavinia Fiscaletti
 

Hi Karen,


Thanks for doing the labeling. In general, the trim is looking pretty good. I'm tied up this evening but will be able to give you more input tomorrow.


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team


Re: sugar values on hay sample results

PapBallou@...
 

Hi Kristin -

Add ESC (ethanol soluble carbs - simple sugars) and starch.

Linda
EC Primary Response
West Coast
May 2004


Re: Cornell Results: G/I ratio good but ACTH increased?

PapBallou@...
 

Laura -

The seasonal rise, as you know, statistically peaks in October.  Each horse has its own way of doing this, so you need to rely on chatting with your vet, the history of how P has needed pergolide over the past few years through the rise, and his symptoms, if any.

BTW - a local PPID horse peaks in August.

P is just pushing the envelop in leaving the 'normal' zone.  If he were mine, I'd probably consider raising 2mg over the next couple of weeks before testing again...main reason is that it is early in the rise for 'most', and if you increase by 1mg, test and wait for results, it's likely the ACTH will have gone up more in that time it takes to get the results back.  You're playing pergolide catch-up.

It's as much a game of science, history, and a bit of gambling. 

Linda
EC Primary Response
West Coast
May 2004


Re: Hoof pics...please comment?

kansteen5545@...
 

Hi Lavinia -
I was wondering if you could take a look at Bay Lady's hoof pics - I have them all labeled. I am trying to make sense of the laminar wedge that has appeared in the last month. I have seen no founder ring in the past year. The wedge is in both fronts - about 1/8" wide - from the heels to heels. Could this be from concussion? I did trim as suggested.
Thanks
Karen
Scarborough,ME
May 2014
https://groups.yahoo.com/neo/groups/echistory8/files/Karen%20and%20Bay%20Lady/
https://groups.yahoo.com.neo/groups/echistory8/photos/albums/1235401778


new member

Edie Widoff
 

Hi.  I am from Colorado.  I have a 19 yo Arabian Pinto mare.  My farrier noticed that she was developing a cresty neck and suggested she might have Cushings.  My vet ran the blood work through Cornell and her numbers are:   ACTH Baseline: 33.8 pg/mL, Insulin 71.73  ulU/mL, and T4 Baseline 1.36 ug/dL. 

Thankfully the cresty neck is her only symptom.  My vet isn't overly concerned, but I want to make sure I am helping her as best as I can to prevent any serious symptoms.  She is on grass hay at a boarding facility in Aurora, CO.  I have cut out all her grain, probiotic treats, Sand Clear, and have started giving her about 3-4 cups of soaked non molasses beet pulp about every other day, and have been trying to exercise her more.  The facility where I board is a big place, so they go through hay pretty quickly.  I guess I will just get it tested every 3/4 months.  Does anyone have advice for soaking hay at a boarding facility where I can't go out there twice a day for forever?  Any other suggestions?  How will I know if/when I am doing the right thing and/or enough?  Thanks!


sugar values on hay sample results

Kristin Gerlach <kristin@...>
 

I should know this by now, but what values do you add together to get the total sugar value of the sample?
Thanks,
Kristin
Colorado 2013


Re: NEW MEMBER

Nancy C
 

Hi Robin

I just want to second the advice Lavinia has shared and to suggest a read of the ecirhorse.org web site, especially the section on laminitis and trim. Once you have taken a look, I would also urge you to get a second opinion ideally from someone who has successfully rehabbed a laminitis/founder case with other methods before the next tenotomy.  They are out there.

I hope it helps for you to know that we all know how hard this is.  Hang in there.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
Equine Cushing's and Insulin Resistance Group Inc.

 





---In EquineCushings@..., <shilohmom@...> wrote :

Hi Robin,



https://groups.yahoo.com/neo/groups/echistory8/info


Would also ask you to please upload your xrays, venograms and current hoof pictures to the Photos section of ECHistory8. This will help us help you and your boy more quickly and thoroughly. Any blood work that may have been done or other test results can also be added to your history file. Here is a link for taking good hoof pictures:


http://www.all-natural-horse-care.com/good-hoof-photos.html



TRIM: Toes backed and heels lowered so the hoof capsule tightly hugs the internal structures. This is a piece of the puzzle that is often times missing. After you have added your xrays and hoof photos please let us know so the hoof gurus can take a look and make sure your trim is optimized. Although I know you feel you have an excellent farrier, it never hurts to get a second opinion. The trim is going to be critical now that there have been tenetomies done and this is an area where we frequently see errors being made that severely compromise a horse's future soundness.










Re: When the daily ration is gone

thelittlebarnonwhiteoakfarm@...
 

Thank you so much June for providing me with the link to the "hay pillow site".   That's great that they have even smaller holes than 1".   This just might be the answer to my problem.

Thanks so much
Susan in CT
7-2012


Re: Hoof pics...please comment?

Lavinia Fiscaletti
 

Hi Karen,


Here is the link to Dancer's hoof pics - they are in the Photos section of ECHistory8:


https://groups.yahoo.com/neo/groups/echistory8/photos/albums/1126797980


If you look at that RF, the angle of the hoof wall above the abscess blowout area is coming in steeper than the wall below. This is confirmation that there are changes that need to be made to the trim. If you draw a line to the ground that follows this new angle it shows where the toe should be backed up to. The RF is a bit taller and boxier than the LF, a condition called High/Low syndrome. LF needs the toe backed even further than RF. Looks like the rears are a bit under run with the frogs recessed into the soles - is this correct?


I will put up some mark-ups and a better explanation later today.


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team






Re: Cornell Results: G/I ratio good but ACTH increased?

lauramollrich
 

Thanks Linda for educating me regarding the white line issue.  Can you please also address the ACTH that has risen but G:I is good?  Should I increase his Pergolide or keep an eye on him and test again.  If I do test again, what would be the best time.  Do the full panel or just the ACTH?

Thanks!

Laura in CA
1/2012


Re: NEW MEMBER

Lavinia Fiscaletti
 

Hi Robin,


I gave Patti the heads up to get in touch with you so you should hear from her soon. She can answer any questions that you may have as well as provide local sources for everything you might need.


Good job on getting things rolling :)


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support team




Re: Transporting a blood sample from Canada to Cornell

Sue
 

Hi Dr. Kellon and Everyone,

 Unfortunately UPS and FedEX don't have a discounted rate for blood from Canada but they are working on it.   I could send it from Watertown N.Y. and get the discount even without the discount it is only $54. compared to $200. but I would have to take it over the border.   When I spoke to the helpful staff at Cornell they had Dr. Pasnik contact me and he was also very helpful and sent me the following information, I hope it is okay to include this!

  Below is information about becoming eAuthenticated.  Once you complete that process, you can apply for the permit online and import the horse blood from Canada:
To apply for a veterinary import permit, the person located in the US or who operates a business in the United States will need to apply for a United States Veterinary Permit to Import or Transport Controlled Materials and Organisms or Vectors.  The application is VS Form 16-3.  It may be submitted by mail or fax, or, if e-authenticated, submission may be done on-line.   The permit application and instructions, including information on the user fee and e-authentication, is available on our website: http://www.aphis.usda.gov/animal_health/permits/

David J. Pasnik, DVM, MS
Veterinary Medical Officer
USDA, APHIS, VS

This is wonderful of him to send but I can't do this.  It is just too much, I really strugle with Prior Notice for hay testing, this is just too much.
So I either pay the $200. for FedEx to send it or go with Idexx, my vet said that she will ask if Idexx can send it to Cornell but I am beaten otherwise!

Sue and Busy
Kingston, ON
October 2010


Re: NEW MEMBER

Leigh Jacobs
 

Robin,
Beet Pulp can be purchased from any of the feed stores. Either as shreds or pellets.  Make sure that it does not have molasses in it.  Tanque Verde feed store, Arizona Feeds, Taylor Feed and Tack, or Pantano Stables.  Call before you go to make sure that they have what you need.  Vit E caps can be found at Walmart.  Patty Kuvik can do the sampling for you on your hay. Adobe can draw your blood and they are familiar with the requirements for shipping to Cornell.  Make sure the blood goes to Cornell. 
Leigh, Ace and Shadow
Tucson, AZ
2011


On Wednesday, August 27, 2014 2:54 PM, "Robindh1010@... [EquineCushings]" wrote:


 
Thk you for the email! I would love to have "boots on the ground" person! Would they draw blood for the bloodwork or should I contact my vet? I will start soaking hay tnite and no more safe choice. Where can I get beet pulp as u suggested? I will also get vet to send me all X-rays/venogram ASAP. Thks for this!! I will reread all u sent and also get in touch to analyze my hay Robin Tucson,AZ 2014



Re: NEW MEMBER

Robin Hardy
 

Thk you for the email! I would love to have "boots on the ground" person! Would they draw blood for the bloodwork or should I contact my vet? I will start soaking hay tnite and no more safe choice. Where can I get beet pulp as u suggested? I will also get vet to send me all X-rays/venogram ASAP. Thks for this!! I will reread all u sent and also get in touch to analyze my hay Robin Tucson,AZ 2014


Re: NEW MEMBER

Lavinia Fiscaletti
 

Hi Robin,


Welcome to the list. We need to get a bit more information from you in an organized fashion so ask that you join our sister list ECHistory8 and fill out a case history form for your gelding:


https://groups.yahoo.com/neo/groups/echistory8/info


Would also ask you to please upload your xrays, venograms and current hoof pictures to the Photos section of ECHistory8. This will help us help you and your boy more quickly and thoroughly. Any blood work that may have been done or other test results can also be added to your history file. Here is a link for taking good hoof pictures:


http://www.all-natural-horse-care.com/good-hoof-photos.html


We follow a protocol of DDT/E, which is just shorthand for Diagnosis, Diet, Trim and Exercise. Need to apply all the pieces to get the best results.


DIAGNOSIS: This is thru blood work. We recommend a NON-Fasting sample be drawn and sent overnight to Cornell for Insulin, Glucose and Leptin to test for IR. An ACTH test is used to diagnose PPID (Cushings). As your boy started having issues back in 2008 (and maybe earlier) at the age of 8, primary IR may be a factor. PPID is a possible added issue now that he is 14yo. As he is having difficulties now, testing now is recommended. We have a seasoned ECIR member that lives in your area who can help you get all of this sorted out. Let us know if you'd like to have some "boots on the ground" assistance.


Why is on Thyro-L? Primary hypothyroidism is virtually non-existent in horses. IF he tested with low thyroid it is likely secondary to diet deficiencies and/or other disease processes and will correct itself when the primary causes are identified and eliminated. If he was tested while on bute then the results are questionable as bute interferes with thyroid function.


Oral Isoxsuprine has been found to be useless in horses so this is likely a waste of your money.


Why is he on bio-sponge? How long has he been on it?


DIET: Until you know more from the blood work results we recommend starting your boy on the emergency diet that you were sent when you joined. This is a safe, but temporary, feed program that could have a quick and profound effect on his soundness. Soak your grass hay for either 30 min in hot water or 60 min in cold before feeding. Dump the water where he can't get to it. Stop the Safe Choice (it isn't safe), red salt blocks, apples, carrots, alfalfa, pasture. Make sure he doesn't have any access to mesquite beans. The Remission is OK but there are much less expensive ways to supplement magnesium, if you need it at all. The Horseshine is fine for the omega 3's. Add 2000iu vit E gelcaps with oil in them, 2 oz ( 2 heaping TBS) of iodized salt. Can use a small amount of rinsed/soaked/rinsed beet pulp as a carrier for your supplements.


We recommend having your hay analyzed so that you know what is in excess and what is deficient and can supplement accordingly. This will also let you know whether the hay is safe to feed unsoaked. We recommend sending cored samples to Equi-Analytical Labs and requesting the Trainer #603 test. You can contact EA and they will send you sample kits to send them:


http://www.equi-analytical.com/Services/Analytical%20%20supplies.htm


TRIM: Toes backed and heels lowered so the hoof capsule tightly hugs the internal structures. This is a piece of the puzzle that is often times missing. After you have added your xrays and hoof photos please let us know so the hoof gurus can take a look and make sure your trim is optimized. Although I know you feel you have an excellent farrier, it never hurts to get a second opinion. The trim is going to be critical now that there have been tenetomies done and this is an area where we frequently see errors being made that severely compromise a horse's future soundness.


EXERCISE: Best IR buster there is but not going to be appropriate for your boy at the present time.


Ask any questions as they come up, we're here to help. We ask that you please sign your posts with your name (first is fine), general location and year of joining. Adding the link to your case history and Photos folders once you have them enables us to help you faster and helps us keep track of who's who.


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team








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