Date   

Case History

Carla Anderson Peters
 

Hello,

How do I start a case history, on Groups.io?

Thank you,

Carla Cupcake (Dec.12) and Gunnar

WI


Re: Oral Sugar Test

 

I have to add my own soap-box moment here, as a practising veterinarian.  First, DO NO HARM.  That is an axiom of any medical field.  It has been shown that non-fasting insulin and glucose levels in horses can indicate insulin resistance and risk of laminitis..  If you have a high index of suspicion for IR, it doesn't hurt to give the horse/pony an IR diet.  If the horse or pony is suffering from laminitis, and you have a clear indication that insulin and glucose levels show no IR (by the Virginia Polytech study proxies), then look further; 15% to 20% of laminitis is due to non-endocrinopathic causes. However, if you think your horse or pony is one of the 80% to 90% of equids that is suffering foot pain due to endocrinopathic issues, cranking up the glucose and insulin by the oral glucose test is just insane.


PS - I hate that my spell-check is unable to distinguish between the noun form of "practice" and the verb form of "practise"  

--

Jaini (BVSc),Merlin (over the bridge) ,Maggie,Gypsy

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




Re: Results of recent blood work

 

Good advice from Lorna and Lavinia; I will add my two cents worth. 1) Treat the horse, as well as the numbers.  2) Both the horse and the numbers say to increase the pergolide.  If Gunnar were mine, I would be cranking it up to at least 2 mg, maybe 3, and re-test 3 weeks after the target dose.  Normal horses will be on the down-swing for ACTH by December; our PPID horses will have high ACTH for a longer period.  You can also tweak the pergolide by clinical signs; I use crest firmness and eye-hollow deposits in between testing.  Patti had a great list of signs here:  https://ecir.groups.io/g/main/message?msgnum=111558  

My experience has been that unless a horse is very sensitive to pergolide (goes off feed, gets spacey), then a little too much pergolide in the seasonal rise period is better than too small an amount of pergolide, which leaves you chasing the seasonal rise.  This is just my opinion, based on members' experiences on the list, and my experiences with my three horses. 

--

Jaini (BVSc),Merlin (over the bridge) ,Maggie,Gypsy

BC 09
ECIR mod/support

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy




Re: Results of recent blood work

Lavinia Fiscaletti
 

Hi Carla,

As Lorna said, we really need to see the case history to be able to answer fully. However, I'll mention a few key points in the meantime.

It takes 2-3 weeks for the maximum, steady benefit of a dose of pergolide to be established. If you wait 4-5 months to retest you will be coming into the natural seasonal low for ACTH levels so one would expect any horse to have lower ACTH at that point than they would now when we are at the peak of the rise. You can't compare those two times to gauge whether the pergolide dose is correct or not as you are trying to compare apples to oranges.

Cornell's range for ACTH is 9-35pg/ml. For diagnostic purposes, during seasonal rise the range from 35-100 can be a grey area. Anything above that is confirmed uncontrolled PPID. A result of 395pg/ml in an already confirmed horse that is on pergolide is 400% higher than the high end of the grey zone - so makes no sense to say "that level isn't high". Plus you have foot soreness which always trumps test results during seasonal rise.

The insulin level also makes him IR, which is going to be worsened by the limited exercise and uncontrolled ACTH.

That you noticed a change in his foot comfort after raising the pergolide (Prascend) dose tells you it was necessary. The blood work confirms that the dose is still too low to be adequately controlling the ACTH level. If this was one of my horses, I wouldn't even think of lowering the dose now and would be working hard to get it increased.
--
Lavinia, Dante and George Too

Nappi, George, Peanut over the Bridge

Jan 05, RI

EC Support Team


Re: Backing the toe

Lavinia Fiscaletti
 

Hi Ernie,

Added some mark-ups to Cheyenne's album:

https://ecir.groups.io/g/CaseHistory/album?id=1709&p=Created,,,20,2,0,0

If that link doesn't arrange the latest mark-ups at the front of the album, click on the "sort by" tab in the top right corner of the album, then click on "Posted with the downward-facing arrow".

Toes are still too far forward, the heels are run forward/under, flaring of the walls all around. Too much height in the back of the foot relative to the front. However, it doesn't look like there is much overall excess height in the hoof capsule so going to need to be careful with how much is removed from the bottom of the foot. Soles appear to be fairly flat so they are likely thin. Frogs are stretched forward. Again, suggest you consider getting some xrays to actually see the exact location and orientation of the coffin bones.

RF medial: Green line follows the upward curve of the coronary band, Purple is where it should be - level all the way around but sloping downward as it goes toward the heels. The pushed up area corresponds to where the walls are too long relative to the adjacent wall - follow the horn tubules to the ground to see exactly what needs to be adjusted. Black line follows the angle of the new growth coming in under the coronary band and gives an idea of where the toe should be backed to. The curved dorsal wall outside the line shows how much laminar wedge is present. Do not rasp this flat to match the angle of new growth - just back the toe from the top and allow this to grow out gradually as it is helping to stabilize the weakened structures underneath and provides protection. Dark blue is were the heels should be growing down and hitting the ground, yellow is the "missing" heels. Light blue is where the heels need to be lowered from to start backing them up. Red is the DO NOT TOUCH zone on the bottom as this is the area that is protecting the leading edge of the coffin bone.

RF sole: Yellow is where to bring the walls inward and toe back to, from the top. Idea is to bring inward rather than lowering overall vertical height. Purple is where the heel buttresses are currently located, green is where they should be, even with the widest part of the frog. How quickly this can be corrected will depend on how much excess wall height there is in the back half of the foot above live sole plane. The less depth there is to work with, the longer this will take to accomplish. At the very least, run a rasp over the heels to slightly level them further behind where they are now and repeat at each trimming. The lateral bar is leaning outward and putting pressure on the wall at the quarter, causing it to bulge outward as well. The hoof capsule appears to be twisting inward, with breakover shifted medially rather than aligned with the true center of the foot - note the point in the toe as you move laterally around the edge.

LF sole: Similar to the RF. Yellow is a guide to where the walls and toes need to be brought in to. Purple is the where the heel buttresses are now, with the medial heel slightly forward of the lateral one. Green is where they should be, even with the widest part of the frog and with each other. Hoof capsule appears to be twisting slightly outward, with the breakover also shifted laterally. Red is about where the true tip of the frog is. Blue highlights the bars that are overgrown and overlapping the sole. Thjey will need to be tamed but don't amputate them - work to gradually remove the excess from the outside moving inward. One reason they have become so prominent is that they are working overtime to provide support and stability to the rest of the foot due to the flaring of the walls and thinning of the soles. Removing too much too quickly will leave the feet with nothing to support the internal structures.

RH sole: Again, heels under run - purple where they are and green where they should be. Yellow is the general outline of where the walls need to come in to and the toe back to. The hind feet appear to be too tall vertically in the front half of the foot in relation to the rear of the foot, which places the coffin bones into a negative plane scenario, causing a lot of excess strain on the ligaments and tendons. Backing the toes relieves some of this but will also need to work to lower the height in the front half of the feet while preserving as much height as possible in the rear half. Again, will need to finesse the heels back slowly and steadily over time so as not to make the negative plane situation worse. Frog is stretched forward - red is about where the true tip of the frog is.

Under run heels and long toes take on a life of their own, seeming to shoot out overnight. The trim cycle needs to be short, at least initially, or you find yourself chasing your tail.
--
Lavinia, Dante and George Too

Nappi, George, Peanut over the Bridge

Jan 05, RI

EC Support Team


Re: New photo album

Lavinia Fiscaletti
 

Hi Karin,

Hear ya on the flip phone - have one myself. The photos it takes are perfectly fine.

In general, Inky's feet are a lot better than most that we see so kudos to you and your farrier. If you'd like a bit more in-depth info, need some more pix, taken with the phone at ground level. See here for info:

https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions
--
Lavinia, Dante and George Too

Nappi, George, Peanut over the Bridge

Jan 05, RI

EC Support Team


New photo album

Karin & Inky <ksherbin@...>
 

I created a new album with a few photos of Inky. Are any good enough for review? I have just an old flip phone for photo-taking. I would appreciate any feedback on the feet themselves or the need to re-take the pictures. 

Thanks!

Karin & Inky

Forest, VA

IR/Cushing's

July 27, 2015

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

https://ecir.groups.io/g/CaseHistory/album?id=1979

 


Re: Results of recent blood work

Lorna Cane
 

On Fri, Oct 28, 2016 at 04:58 pm, Carla Anderson Peters wrote:
His test results are as follows: ACTH 395 pg/mL, insulin 24.39 uIU/mL, Leptin 6.27 ng/mL. My vet recommend that I "decrease" his dosage to 1 mg, because he hasn't been on 1.5 mg long enough to truly know if it is effective, and that level isn't high. Then we should keep him at 1 mg for 4-5 months and retest. That is where we are at.

 If  Gunnar were mine I would definitely up the pergolide dose.But we need more details, so please put up the case history link as soon as possible.
--

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



Results of recent blood work

Carla Anderson Peters
 

Hello,

I have received Gunnar's blood work today (from Cornell per group instructions), and my vets recommendations. To give a bit of background ( I need to complete a history ). Gunnar is 25 years old, and I noticed that he was getting lethargic and not himself ( I have also had a CBC panels done yearly with all good results). So, on July 16th, he was started on 1/2 mg of Prascend ( target was 1 mg ), then increased to 1mg, on July 21st, with good results...meaning improvement in his lethargy (back to his naughty self :) ). Then around September 29th, his pasture buddy had a capped hock and required a lot of bandaging and care so the horses were stalled, but hand walking and turnout as able (which was daily), anyway I noticed that he was getting foot sore, with that observation and awareness of seasonal rise, I suspected that his Prascend may need to be increased, so I did (to 1.5) on October 6th, and saw an improvement, but not perfect...So, I called my vet and set up an appointment for testing. His test results are as follows: ACTH 395 pg/mL, insulin 24.39 uIU/mL, Leptin 6.27 ng/mL. My vet recommend that I "decrease" his dosage to 1 mg, because he hasn't been on 1.5 mg long enough to truly know if it is effective, and that level isn't high. Then we should keep him at 1 mg for 4-5 months and retest. That is where we are at.

Thank you,

Carla, Cupcake ( Dec. 13) and Gunnar 

WI


Re: Tis the Season Course Special Sale

DawnC
 

I have always wanted to take one of your courses since joining the group but thought I would try to gather information & understanding in this group first as I was a bit overwhelmed when I joined. I know I have a long way to go in the learning process but feel I may have a grasp on IR issues with my mare. With help from this group she is back to her old self, has had a complete overhaul of her diet and has had 3 fantastic foals. She is a PRE and I know within the PRE-Pure Spanish Horse/Andalusian & Lusitano breeds, IR or any metabolic issue is prevalent but never mentioned, a blemish among breeders and most hide their prize horses that have foundered or are severely laminitic. I tell everyone interested in the breed about it. I would really like to gain more insight so that I can effectively give diet/feeding instructions to people who buy foals from me. The last two foals have been grain free and basically eating the same diet as the dam with no issues. The ones before that all had some form of physitis or minor ocd when fed the usual "growth" feed specifically for foals. I was told that this could also because by rich pasture or the dam's milk. I have read all the course outlines and would love some input on which course to take. I don't know if I should start with NCR Plus, Management for Pregnancy and Growth or Cushings and Insulin Resistance. I have read the outlines but don't know if there is a specific course that comes first or if I take the Management for Pregnancy and Growth does it have to be tweaked for IR horses? Any help is greatly appreciated.

Thank you,

Dawn & Roma

Delaware

August 2011


Re: Oral Sugar Test

Eleanor Kellon, VMD
 

Just to add to Nancy's excellent post, the solution to the bridge between "false negatives" with low insulin when fasted and the risk of drenching your IR horse with Karo syrup is simply not to fast the horse but feed only hay or pasture night before and day of the test.  Pasture only is what was done in the pony study that validated the proxies we use in the IR calculator.

Common sense falls by the wayside sometimes.......


--

Eleanor in PA

www.drkellon.com

EC Owner 2001


Re: Oral Sugar Test

Nancy C
 

Hi Nicole.

Coincidentally, I've just been reviewing this material. This may be more than you want to know but writing for others following along.

If members wanted to go to bat with a vet re; the Glucose tolerance (Karo) test, one could ask if they will guarantee bolusing syrup in won’t make them more sore. We’ve asked Dr Frank - developer of this test - about it and he has side stepped the issue.

This is Dr Kellon on the risk

They have stopped short of saying the glucose challenge is always safe, and we don't know how many, if any, horses have had foot soreness result from it.

As a very general statement, the better controlled the IR is, the lower the risk. For example, we've had horses that were well controlled break out onto grass for a few hours and they were fine.

*********************

Based on my experience, and reviewing experiences here over the years, the basis of the test is faulty to this lay person.  The only time Beau tested in the normal range was while fasted. The fasted test is based on human research. We know horses are not humans.  Other horses from the group have also tested as "normal" while fasted.  Most of them were clearly presenting as IR.  Many were laminitic. As I understand the rationale for the Glucose Tolerance test, it is to see if these fasted horses who tested normally, are really IR, based on bolused Karo syrup.

Add to this the fact that insulin in the 20 or so range would be considered "not IR" by these researchers and well.....

Goal here is no laminitis.  This group is the only one that bridges research and real life.

Thanks for allowing me this soapbox moment.
--
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: Rated G - several questions

Eleanor Kellon, VMD
 

You can also request what your need through Dairy One - profile 10 under wet chemistry with add on starch and ESC = $52 total

http://dairyone.com/analytical-services/feed-and-forage/services-and-pricing/
--

Eleanor in PA

www.drkellon.com

EC Owner 2001


Re: New lab results for Kali, increase Prascend?

 

Will do- thank you!
--
Gayle August 2016

Alabama, USA

Kali Case History, Photo Album





Re: X-rays, hoof pix (not the best), and Insulin results for Majik

Lavinia Fiscaletti
 

Hi Shannon,

Hope the meeting with the new farrier went well.

Agree totally with Jaini's comments on Majik's feet. Need to get the trim tight to be able to resolve the thin soles.

If you would like mark-ups, I'll need a full set of pix. Please have a read here in the Wiki for more info on which angles are necessary:

https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions

--
Lavinia, Dante and George Too

Nappi, George, Peanut over the Bridge

Jan 05, RI

EC Support Team


Re: Tis the Season Course Special Sale

Maggie
 

Just in case you forgot or didn't realize, you can retake the NRCPlus class at any time, at no additional cost.   
--
Maggie, Chancey and Spiral in VA 
March 2011 
EC moderator/Primary Response


Re: Question about testing for Cushings and seasonal riseextra water (understandably)

Deborah Ide
 

Thank you all for your responses.I'm sorry if this message contains too much information in the way of the message I'm responding to. I don't know how to delete parts of the message I'm replying to and put in the carats that I see others use. I'll have to find out how to do that.

Tara has a pretty good winter coat now. It has been hot here in Tennessee, over 80 during the recent heat/warm spells. She does sweat well, though. It was very, very hot and humid here last summer( many days between heat and humidity feeling like it was 106 or even more sometimes) and she was drinking extra water (understandably) and licking her salt block besides eating the salt I gave her in her feed. I kept an eye on her water consumption and saw that it was greater than normal but I feel that she needed the extra water because of the heat and sweating.Now that it is fall and not so hot all the time, she seems to still be drinking more than usual(although as I mentioned it has been hot here lately also so maybe that's why she's still drinking more. Her water consumption lessens somewhat on days that are a bit cooler, I think, but still she drinks a good deal).  I'm thinking I should have her ACTH and insulin, glucose and leptin tested next week so I have a better idea of what is (or is not) going on. Again, thanks for your thoughts and if you have any other advice please let me know.
Deborah in Middle Tennessee
November 2012


Re: X-rays, hoof pix (not the best), and Insulin results for Majik

Patty
 

Hi Shannon, 

Just curious, are you keeping shoes on her?  My guy has shoes all around.  As much as I'd like him barefoot, I'm not sure that is best for him.  I would love to see pictures after she's trimmed.  My horse should be having his feet done on Tues next week.  Not sure what my farrier will do.  I've sent him the information and this will be first trim/reset asking him for changes.  


- Patty 
Sept 2016
Kernersville NC


Re: Rated G - several questions

Patty
 

I realized last night they sent me the wrong package for hay analysis. They sent package for Dairy One, and not Equi-analytical. When I call a number for equi-analytical and ask for forage test kit, that's what I thought I'd get. Didn't know there were different packages. So, now have new and hopefully correct, forage testing package coming and will hopefully get this done next week. 

- Patty 
Sept 2016
Kernersville NC



New file uploaded to main@ECIR.groups.io

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