Date   

Re: Cornell test costs

Lavinia Fiscaletti
 

Hi Karin,

I'd be really happy if that was all my vet charged for that set of testing.

The Cornell prices are what the vet must pay to Cornell to do the tests once they receive the blood. It doesn't include any of the costs on the vet's end - supplies (needles, syringes, blood collection tubes, shipping container, ice packs), time, general overhead (equipment, gas, heat/electricity at clinic, staff, insurance, etc) - that must be covered in part by every client. It also doesn't include the profit that they need to make to stay in business as that is where their paycheck comes in after all the other costs are tallied up.
--

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team


Re: veterinary consult

Paula Hancock
 

Hi Amy,

How is Kat doing?  It sounds like your vet has made up her mind and has her reasons, whether right or not.  Did Kat have gut issues when she was on antibiotics before?  Instead of giving up and in, figure out what support you can get from this vet while you look for someone who is willing to work with you.  You may find it helpful to chat with people at tack shops, feed mills or other horsey venues to see who they use.  You will still need to interview any prospective vet to see if they would be more helpful than the current one, but networking can be very useful.  The closest person in the members data base is in Oswego and you can contact her to see who she knows.

https://ecir.groups.io/g/main/files/9b%20Pulling%20it%20Together/ECIR%20Regional%20Members%20Database%20.pdf

Best regards,
Paula with Cory (IR) and Onyx (IR)

Bucks County, PA, USA

ECIR Primary Response

NRCplus 2011  ECIR 2014 

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Cory

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Onyx


Re: Cornell test costs

Nancy C
 

Hi Karin

IME. Yes it is standard.
--
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
ecirhorse.org



Re: Cornell test costs

Leigh Jacobs
 

Hello Karin,
Your charge is less than what we would charge for all four tests($170) and shipping($35).  And we are considered reasonable in our area of Arizona.
Leigh, Ace, Shadow
Tucson 2011?


On Thursday, August 11, 2016 2:14 PM, Dogged <ksherbin@...> wrote:


 I just got the vet bill for the last round of testing for ACTH and insulin;glucose and leptin. It was $125 just for the tests. I looked up on the Cornell web site to check the prices and saw that they offer ACTH, insulin, glucose, leptin and T4 for $91.50 (metabolic syndrome diagnostic panel).
Is it normal protocol for vets to mark up the cost of the test on the patient's bill? The bill also included the farm visit, an exam (she checked his crest and looked for fat pads) and the shipping charge. Vets have to make a living, but wondering about if the test mark-up is standard practice. If it is, fine. If not, suggested language for broaching the topic?

Karin & Inky
Forest, VA
IR/Cushing's
July 27, 2015







Cornell test costs

Dogged <ksherbin@...>
 

 I just got the vet bill for the last round of testing for ACTH and insulin;glucose and leptin. It was $125 just for the tests. I looked up on the Cornell web site to check the prices and saw that they offer ACTH, insulin, glucose, leptin and T4 for $91.50 (metabolic syndrome diagnostic panel).

Is it normal protocol for vets to mark up the cost of the test on the patient's bill? The bill also included the farm visit, an exam (she checked his crest and looked for fat pads) and the shipping charge. Vets have to make a living, but wondering about if the test mark-up is standard practice. If it is, fine. If not, suggested language for broaching the topic?


Karin & Inky

Forest, VA

IR/Cushing's

July 27, 2015

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Inky






Re: New Hay analysis, need some help

Lavinia Fiscaletti
 

I  suggested thinking about nerve blocks in response to your saying it has been difficult to do enough work on the hinds due to the pain the horse has been in on those feet. Nerve blocks only take minutes to do and the effect wears off in an hour or two. All ithey do is keep the horse from feeling pain in the area that has been "anesthesized". They can be helpful if pain in the feet is keeping the horse from being able to stand on three legs for the farreir to work without making him dopey or otherwise compromised. Just another idea for your toolbox.

Until you get those rear toes backed up you won't be able to grow any appreciable sole depth as the long toes keep pulling the sole along with them, stretching it thinner in the process. Backing toes does not involve touching the soles. Bringing in any flaring of the walls will only make the hoof capsule stronger as it relieves further pressure from already damaged structures. Have a read here:

http://www.hoofrehab.com/HorsesSole.html

http://www.hoofrehab.com/Breakover.htm
--

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team


Re: New Wiki Page!

Maggie
 

LeeAnne, you rock!!!!  Thanks!

Maggie :)


From: "LeeAnne" <ecir.archives@...>
To: main@ECIR.groups.io
Sent: Thursday, August 11, 2016 3:52:06 PM
Subject: [ECIR] New Wiki Page!

A new page is now in the Wiki with How-to instructions for members using iPads, smart phones and tablets for case histories and photo uploads. 

--

- ​LeeAnne, Newmarket, Ontario - Email me

ECIR Archivist 03/2004

Are you in the Pergolide Dosage Database?

View the Database Stats
Dawn's 10 Year Case History
Taken For Granite Art - Lightweight Cement Sculpture and Memorials



New Wiki Page!

LeeAnne Bloye <ecir.archives@...>
 

A new page is now in the Wiki with How-to instructions for members using iPads, smart phones and tablets for case histories and photo uploads. 

--

- ​LeeAnne, Newmarket, Ontario - Email me

ECIR Archivist 03/2004

Are you in the Pergolide Dosage Database?

View the Database Stats
Dawn's 10 Year Case History
Taken For Granite Art - Lightweight Cement Sculpture and Memorials


Re: New Hay analysis, need some help

Carolyn Guttenfelder
 

I have not thought about nerve blocks. My vet is 75 minutes north and my farrier is 90 minutes south. They are too far apart to work together physically. My farrier can/does use sedatives but not blockers. I guess I am curious if he isn't in crisis why going to such extreme would be warranted? IS it worth the pain and discomfort he would be in after the blocker wears off?? I am not familiar with this method so I don't know how long it lasts. I just don't want quality of life to be over shadowed by quantity if he is in pain. So far we seem to be figuring things out at a slower pace, but it is working?? He seems to be happy and comfortable and we are able to enjoy trail rides together. I am reluctant to take that away from him as he loves his rides and I know he hates being separated from the pasture and other horses.

One of the concerns that slowed our progression on the rear feet are the abcesses. They were so bad when they happened that there is a lot of repair work being done in the sole. Are we wrong in allowing him to heal and re grow a bit before getting aggressive? I am keeping him on a 4 week trim cycle and that seems to be ok. I can't get a farrier here any sooner than that. The good ones are booked solid and the bad ones are not worth the money and time. My new one is very good but very busy!! In just the last trim we shrunk his front shoe size by one entire size. I will forward the suggestions you gave regarding coming back a bit farther and try and get a new set of pics.

I have found help for the mineral balancing. THANKS for the referal.
--

Carolyn Guttenfelder-IA

Member 2016


Re: Triple Crown now controls ODTB from Southern States

Aurelio Henriques
 

I am confirming that Eleanor is correct. TC only distributes and sells the cubes.
Regards,
Aurelio
Ontario Dehy

On 08/11/2016 2:23 PM, Eleanor Kellon, VMD wrote:
Just to clarify, TC only distributes and sells the cubes. Ontario Dehy still makes them.  The move to a TC bag has been in the works for a long time now.  TC's other cubes also come from Ontario Dehy.
--

Eleanor in PA

www.drkellon.com

EC Owner 2001



Re: Triple Crown now controls ODTB from Southern States

Lavinia Fiscaletti
 

If you go to the Triple Crown website, under their Naturals heading they have the Balanced Timothy Cubes as "coming soon". No other info available on the site.

Anytime you have a question regarding the ODTBC you can always call Aurelio at Ontario Dehy directly for information as well.
--

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team


Re: Triple Crown now controls ODTB from Southern States

Eleanor Kellon, VMD
 

Just to clarify, TC only distributes and sells the cubes. Ontario Dehy still makes them.  The move to a TC bag has been in the works for a long time now.  TC's other cubes also come from Ontario Dehy.
--

Eleanor in PA

www.drkellon.com

EC Owner 2001


Re: Banjo, 32yo Paint Gelding

Paula Hancock
 

Hi Steve,

Welcome to the ECIR group.  Banjo sounds lovely—and very lucky to have you to look out for him.  When you sign your emails, continue to add your and Banjo’s name and add your general location, so we can focus our suggestions with that in mind.  It looks like you tried to attach a document but that doesn’t work in this email area.  In order to help us help you, we need you to fill out a case history and include test results and observations:

 

https://ecir.groups.io/g/CaseHistory

Follow the instructions to:

Download a case history template

Fill it out

Save it to your computer

Upload it into the ECIR History files section (make a folder first, with your name and your horse’s name on it, so Steve and Banjo)

Thanks in advance for doing that!  Once you have the case history, please include a link in your signature each time in case we need to check something before answering your questions.

 

The approach we follow here is based on the most up to date information and tons of experience on how best to help horses with Cushings/PPID and insulin resistance (IR).  It sounds like you suspect he is both, so it’s urgent he is managed well to avoid more issues.  Uncontrolled IR can trigger laminitis of varying levels of severity and uncontrolled Cushings/PPID can increase IR, reduce shedding, cause muscle wasting as well as depress the immune system.

 

DDTE stands for Diagnosis, Diet, Trim and Exercise:

 

DIAGNOSIS:  Is done with blood work. We recommend having blood drawn to test for Insulin, Glucose, Leptin and ACTH. ACTH is used to diagnose PPID (Cushings) while insulin, glucose and leptin are used to diagnose Insulin Resistance (IR). The samples should be drawn at home and NON-fasting as fasting will produce artificially low results and are a holdover from human testing protocols. Cornell is the recommended lab in the US. A horse can be only IR, only PPID, neither or both. It would be great if you could post what tests he has already had with the results and the ranges - add them to your case history file. Just because the results come back "within the labs normal ranges" does not necessarily mean they are negative. Also, many times vets have been known to call results that are a "little bit outside" normal range normal negative, which is clearly not the case. Most vets and farriers/trimmers do not focus on the most recent information on PPID and IR or have tons of experience.  We do.  Prascend (pergolide) is the treatment for PPID, with 1mg being a common starting dose. It sounds like you are using pergolide powder, which has a limited shelf life of no more than 30 days.  The drug will work less and less well over time, not controlling Banjo’s ACTH and wasting your money.  We have found good success with getting powder in capsules, no more than 30 days supply and keeping it in the fridge.  Prascend, the brand version of pergolide, is sealed in blister packs and is more stable but also more expensive.

 

In the Wiki, there is a LINKS section which lists (among other things) pharmacies you might want to look at. Here is an abbreviated version of the ECIR Group policy on Compound Pharmacies:

 

Compounding Pharmacies are listed on ECIR groups.io for the convenience of the ECIR outreach group members.  Each pharmacy has been used and recommended by individual members. This does not however mean that listed companies are in any way endorsed.

 

DIET:   To provide a low carb, (less than 10% ESC sugar+starch) low fat (4% or less), mineral balanced diet, we use grass hay, tested to be under 10% ESC sugar + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E.  This diet is crucial for an IR horse, but also supports the delicate immune system of a PPID horse.

 

Until you can get your hay tested and balanced, we recommend that you use the Emergency Diet.  Though not intended for long term use, the emergency diet addresses some of the most common deficiencies.  More details about the emergency diet can be found on our this page of website:  http://ecirhorse.org/index.php/ddt-overview/ddt-diet  It does involve soaking your hay (if untested or over 10% sugar+starch) for an hour in cold water or 30 minutes in hot water to remove ~30% of the sugar content.  Make sure you dump the soaking water where the horse(s) can't get to it.  And then to a safe carrier such as rinsed/soaked/rinsed beet pulp, you will add the Iodized salt, Vitamin E, ground flax seed and magnesium in the amounts as outlined on the webpage.  It takes some horses awhile to acclimate to beet pulp as it has a different "mouth feel".  Some horses love it though!  Other safe carrier choices if you can't or don't want to use rinsed/soaked/rinsed beet pulp, are dampened Ontario Dehy Timothy Balance cubes, Nuzu Stabul1 and soy hull pellets. The LMF Low NSC Stage 1 is also an acceptable option.

 

What you don't feed on the IR diet is every bit as, if not more important, as what you do feed!  No pasture.  No sugary treats, including apples and carrots.  No brown/red salt blocks which contain iron and sometimes molasses, and interfere with mineral balancing, so white salt blocks only.  No products containing molasses. Adding fat is not advised as that will exacerbate IR.

 

 EquiAnalytical  is a good lab to use for hay testing.  You want the #603, trainer's package.  Call them ahead of time and ask them for some free forage kits.  They contain everything you need (except the hay probe) for sending your sample in for testing, including a postage paid envelope.  Here's a link to EA's "supplies" page:   http://equi-analytical.com/supplies/  If you don't have or know anyone that has a hay probe, try your local extension office or coop.  They often have one that they will lend out.

 

Once you get your hay tested you can look in this file for a list of people who can help you with mineral balancing:

 

https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/Getting%20Help%20with%20Mineral%20Balancing%20.pdf

 

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot.  Though important for all horses, it's essential for an IR and/or PPID horse to have a proper trim in place since they are at increased risk for laminitis.  And it's often the missing link in getting a laminitic horse comfortable again.  Look on the following pages of our website for more information about a proper trim. 

 

Here:  http://ecirhorse.org/index.php/ddt-overview/ddt-trim

 

and here: http://ecirhorse.org/index.php/laminitis/realigning-trim 

 

You are welcome to post hoof pictures and any radiographs you might have to an album in the Photos section of the case history site so that we can look to see if you have an optimal trim in place. – NO photos in your case history file, please.

 

 Here's a site that explains how to take good hoof photos: 

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

 

 EXERCISE: The best IR buster there is, but only if the horse is comfortable and non-laminitic. Once the laminar connection to the hoof has been damaged, it doesn’t really repair, it has to grow out and be replaced. If there has been laminitis, we recommend no riding or exercising in tight circles until at least 1/2-2/3 of the hoof damaged by laminitis has grown out (at least 6-12 months, sometimes longer). Also recommend the use of boots and pads as needed for comfort vs shoes/appliances as frequent realigning trims will be needed, which is difficult to do if there are shoes. We also recommend using NSAIDs sparingly if at all as they interfere with healing and can allow a horse to do more than its fragile feet are ready to handle.

 

That highlights the main points of our philosophy, Steve.  I know it’s a lot of information.  You might find it useful to either save this email or copy and paste it into a word type document.  You can also add any useful links to a word document.  I've answered your questions to the best of my ability without further details from you.  If there is anything I missed, one of the moderators will jump in.  Hang in there!  We can help you, we just need more info!  This is a great group of vets, scientists and experienced PPID and IR horse owners, who volunteer their time and knowledge to help people like you with horses like your Banjo.

 

Best regards,

--
Paula with Cory (IR) and Onyx (IR)

Bucks County, PA, USA

ECIR Primary Response

NRCplus 2011  ECIR 2014 

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Cory

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Onyx


Re: veterinary consult

Kathy Brinkerhoff
 

Meant to give you the Endocrinology Department (Dr. Schanbacher)  number which is 607-253-3673


Kathy


Re: veterinary consult

Kathy Brinkerhoff
 

Hi Amy,

I think your plan to look for a new veterinarian in your area is a good idea.  When you contact them and before you have them out and are charged a farm call ask him/her how she treats PPID horses in her practice?  Will he prescribe a compounded pergolide?  What if your horse is not controlled based on blood work results from Cornell on her current dose?  Will he/she up the dose based on test results or does he treat based on "appearance"?   I am sure other members can add to this list. :-)

FWIW, your vet's comments that she consulted with her colleagues at Cornell rings as kind of vague to me.  Who is/are the colleague/s?  My response any time I have asked a question regarding PPID treatment, etc, is that Cornell runs the tests and does not recommend treatments.  I called just now and the staff veterinarian is on vacation until Monday.  Her name is Dr. Barbara Schanbacher.  I asked the woman who answered the phone if it's their policy is to not recommend compounding pharmacies for PPID treatment and she said that is not within their realm so no they wouldn't say you can't use a compounding pharmacy nor do they recommend Prascend over a compounding pharmacy.  Nor do they make dosage recommendations. Anyway, I will make a call on Monday and run these same questions past her to confirm that what I was told is correct.  This woman also offered to transfer me to the Serology Department to ask about their recommendations on treating Lyme's and if they in fact said no to Kat's treatment based on her latest results.  I was routed to voice mail and didn't leave a call back number.  I suggest you call the Serology Dept.  I always identify myself as horse owner so there is no confusion on who is calling.  The switchboard number for Diagnostic Health is 607-253-3900.  Explain what information on Lyme's that you are looking for and ask them to direct you to the appropriate person/department.

I am sure other members will have suggestions for you.

Kathy Brinkerhoff

SE/WI  10/12


Banjo, 32yo Paint Gelding

george_the_mule@...
 

Hi All!

I'm new here, and trying to sort things out with your interface, so please forgive any transgressions.

Banjo is a 32 years young Paint Gelding. He is about 90% recovered from a long bout with lameness that nearly resulted in his being put down. The cause of the lameness has never been determined; best guess is a soft tissue injury in his chest, but he could barely walk when I first met him :-(

His feet were, and are in great shape; he is barefoot, and gets trims on a 7 week schedule, same as the rest of the herd (23yo Appendix gelding, 16yo black mule gelding, 10yo Paint mare).

He is happily taking me out for easy trail rides this season, and continues to improve with light exercise.

In the Spring of 2015, I noticed that he was slow shedding his winter coat. My vet at the time simply declared "Cushings", and as there were no other symptoms, suggested a "wait-and-see" approach. She was subsequently canned (for other reasons), and my new vet tested Banjo this Spring, and put him on Pergolide. It is being supplied as a powder, and his current dosage is 1 small scoop (perhaps 1/4tsp, I _think_ 1 gram) daily.

Since Spring, he has also been getting a "ration balancer" pellet along with his breakfast cereal (~1lb Oats, and 1/2lb sweet-feed). The animals are on free-feed good quality Timothy hay, with 24/7 turnout on 10 acres of relatively poor pasture. They are all happy, healthy critters.

Here is a "summary" of his test results:

-----------

"Hello Steve- please find attached your T4 lab results for Banjo.  He is on the very upper level of the T4 analysis.  Banjo is still showing signs of insulin resistance but it is not due to his thyroid. "


---------------

Sorry, was unable to cut-paste the relevant parts.

Banjo is a sweet, intelligent old fellow, and is dear to me; I would like to see him remain healthy and happy thru his senior years. I would appreciate any comments or suggestions on caring for my friend. TIA!

Steve and Banjo




Upping Dose

Suzanne Mansolilli
 

I seem to have hijacked LJ's thread "how much of a pergolide increase is needed", so will start my own, with virtually the same question.

This is Monty's  2nd fall rise, and hoping to get control. I'm shooting for an ACTH of around 19 and insulin below 20.  I'd like to take a stab at estimating what might be an effective dose, and would appreciate guidance.  Someday I'll be able to do this on my own!

 I just uploaded new numbers in Monty's CH with his latest ACTH.  

It goes like this:

From May 2015 - Dec 2015, ACTH went from 29 to 19 with a 2mg increase in Prascend.

From Dec 2015 - May 2016, ACTH went from 19 up to 29 when a normal horse's would have decreased (I'm assuming).

From May 1016 - late July 2016, ACTH stayed virtually the same (29) with a 0.5mg increase.

Note: I changed from Prascend to compounded pergolide 20 days before the latest (July 2016) ACTH blood draw.  I did not keep it refrigerated -- now know better -- and still have 30 more days of same prescription --now know better about that too.  

Would it be reasonable to increase pergolide by another 1.5mg (which would be equivalent to 2mg compounded), titrating dosage over a couple of weeks?

Would it be recommended to buy fresh compounded perg. before increasing dose?

Thanks,

--
Suzanne July 2014

Western CO

Monty Case History, Photo Album


Re: veterinary consult

Lorna Cane
 

On Thu, Aug 11, 2016 at 06:21 am, Amy wrote:
I guess I give up

 Whoa, Amy !!

Deep breath. Deeper breath.

Lots of members have been there.

We'll help walk you through it. I'm not as experienced with this particular battle first hand,but I know that others who have are vibrating, and anxious to jump in.


--

Lorna in Eastern Ontario,Canada
ECIR Moderator 2002



https://ecir.groups.io/g/main/files/PPID%20and%20IR%20Success%20Stories/Success%20Story%20%233%20-%20Lorna%20and%20Ollies%20Story.pdf



Re: Triple Crown now controls ODTB from Southern States

Maggie
 

Hi Dawn,

I was at SS on Tuesday and the the guy told me that the packaging was going to change.  He also stated that the product was unchanged.  Meant to give everyone a heads up about it but got distracted and forgot.  Thanks for letting us know!

Maggie, Chancey and Spiral in VA 
March 2011
EC moderator/Primary Response


veterinary consult

Amy
 

My consult with vet about continuing treatment of lyme and cushings did not go well. Vet stated she would not treat lyme again, did not think there would be enough benefit from doing oral antibiotic to balance the benefit against potential hit to gut etc. I had already increased prascend dose to 2 without her blessing and she wants me to put it back to 1 1/2 and test in October. She thinks we are "too soon out the gate" to go high as 2..thinks max benefit of dose hasn't been reached yet. She said she consulted with colleagues at Cornell and they all said no to lyme. no to compounding and no treating the seasonal rise. I guess I give up and in or look for another vet which there are few of in my area.?!?
--

Amy and Kat

May 2016

Hammondsport, NY

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Kat

https://ecir.groups.io/g/CaseHistory/album?id=1227

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