Date   

Re: Potential PPID on a deadline

Eleanor Kellon, VMD
 

Hi Tiffany,

First, thank you so much for the detailed CH. It makes it much easier for us.

ACTH is easily elevated into a false positive by shipping, strange environments, exercise. With the normal repeat test I wouldn't worry about that.

Easy weight gain doesn't necessarily mean he has insulin resistance/EMS. Even among grossly obese horses, only about 35% have insulin issues. It can simply mean there is a difference between calories in versus calories out, especially when you can't control the amount and there is no formal exercise. His insulin level is abnormal but persistent EPM infection could potentially be causing that (have you followed titers?), as well as undiagnosed Lyme which can also present as neurological issues.

His radiographs do not show any convincing evidence of laminitis.  His coffin bones are beautiful. The horn lamellar zone looks very normal. Sinking, aka distal descent, is not limited to laminitis. It's actually quite common and your horse's long toe and low palmar angle contribute http://hoofrehab.com/DistalDescent.htm . Your vet's initial assessment of bruising may well have been correct, or possibly subsolar abscess or collection. Those can exit along the frog and the  drainage is easily missed. The low palmar angle also irritates the navicular area and stresses the deep digital flexor.

I would suggest trying to get testing to rule out persistent EPM and Lyme.  Leptin and an oral glucose challenge would give you more information on the liklihood of baseline EMS. Would recommend trimming according to the linked article.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Potential PPID on a deadline

Kirsten Rasmussen
 

Is it possible he still has PPID or does the last normal ACTH indicate he's ok? Are there other tests with regard to that I should be pursuing?
It's possible he does not have PPID.  Your last result would indicate a negative, but there can be false negatives (conversely, a false positive is extremely unlikely...but your positive was not extremely high and there was stress involved....Dr Kellon really should be the one to comment on that).  If insurance will pay for it, you could request a TRH stim test to confirm that negative as it can be successful at detecting early cases where ACTH is normal at this time of year, but elevated in the fall.

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History  
Shaku's Photo Album   


Re: Stabul 1 availability

Kim Rice
 

Laura,
I get 20 # boxes sent to me and I usually get two at a time but he will send more if you want.
--
Kim R, Lafayette, CA  2019
https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Shomee


Re: Potential PPID on a deadline

Kirsten Rasmussen
 

Tiffany,

An insulin result in the 20's in not normal, unless Hollywood had just eaten a grain meal.  He should have been tested on a belly full of grass hay, at least 4 hrs after his first meal of the day.  If that's what you did, and his insulin was over 10-12, then he needs to be managed as if he has insulin resistance.  This is consistent with some of the signs you are seeing, like laminitis and crest neck starting to form.  The lab "normals" are actually just a reference range, which Dr Kellon explains here:

Again, a lab's ranges are NOT normals. They reflect the age, breed, sex, activity level, diet etc. of the horses they tested to get a range - not all ages, breeds, activities, diets and may not reflect sexes equally. They test a group of animals, average the results, tack on 1 or 2 standard deviations and that is their range. Some things, like blood pH, are very tightly controlled under a wide range of conditions. Other things, like insulin, have huge normal variations depending on fasting versus fed, when fed, what was fed.  The ECIR calculator values are normals for the specified condition of hay or pasture only night before, overnight and day of the test.
It is not as common for a QH to be insulin resistant, so it would be wise to try and trace down any other possible causes of elevated insulin and laminitis, such as Lyme disease, PPID, and/or iron overload.  Sherry has already mentioned this.  I know tests can be expensive, so you'll have to prioritize.  In the meantime, manage him as an insulin resistant horse. 

You are doing a great job already by keeping him on a dry lot.  We strongly recommend no pasture access.  I'm assuming he is turned out with other horses on the dry lot and that's why you cannot restrict his hay?  Otherwise, if he can be fed separately, I would suggest you order some slow feed hay nets online and have them delivered to the barn, then ask the staff to weigh out his total hay (1.5% of current weight, or 2% of ideal weight) for the day into 3 or 4 nets and, if at all possible, soak them for an hour in cold water or half an hour in hot water.  The soaking will reduce the calories and make the hay more filling, in addition to reducing the ESC content.

Also, from Sherry in your welcome message:
Ideally you want to have his minerals balanced to the hay he's eating and not use a commercial ration balancer as most of them don't meet our ESC + starch recommendations.  
I'll add the most balancers also don't meet the nutritional needs of horses, partly because hay varies and partly because some ingredients (like Cu) are almost invariably too low,  and some ingredients (like Fe and Ca) are often too high.  The Buckeye senior, for example, contains 500 ppm MINIMUM of Fe.  That's actually the upper safe limit for iron in hay, but we try to keep iron in hay below 200 ppm.  Obviously the amount of Buckeye he gets is a relatively small portion of his diet, but high iron can worsen insulin resistance so we try to minimize it in the diet if we can.  Plus, your boy doesn't need the extra calories.  We strongly advocate having the hay analysis reviewed by a trained balancer, then supplementing as per their recommendations.  We have a list of approved balancers in our files, as well as suggested ration balancers that are generally low enough in ESC and starch to be fed to our IR horses.  There is no point in paying for inadequate (and in some cases potentially harmful) supplements.

One last thing: not sure what your reasons are for the hemp seed oil but we recommend supplementing omega-3 essential fatty acids (for horses on hay-only diets) with flaxseed meal or chiaseed meal because, like grass, they have an omega-3:-6 ratio of about 4:1.  Hemp is reversed at 1:3.

The above are just a few ideas of what you can work on to reduce Hollywood's risk for another laminitis event and to improve his diet.  DDT+E: start with Diagnosis (especially if you have an insurance deadline), then work on his Diet and Trim followed by increasing Exercise if he is sound (and when you can get back to the barn).

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History  
Shaku's Photo Album   


Re: Potential PPID on a deadline

Sherry Morse
 

Hi Tiffany,

You would need to ask your vet what he will charge for the Lyme titer. I can only tell you that you can look up pricing on Cornell's website and be aware that there will be a markup to cover the blood draw and shipping.  

Body photos as well as any current hoof photos are almost always helpful, just let us know when you've uploaded them.




Re: Cabergoline not available—emergency—Dr. Kellon

LJ Friedman
 

mary,
 with each dose, how many  ml are you using for your horse? when is the next dose due?
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: Cabergoline not available—emergency—Dr. Kellon

Eleanor Kellon, VMD
 

I'm guessing 0.5 mg only for this specific case and the twice a week is based on human dosing and limited feedback from a veterinarian using it. Not  much to go on.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Cabergoline not available—emergency—Dr. Kellon

Eleanor Kellon, VMD
 

Yes, numbers are correct. Wedgewood compounds oral for dogs.They can't help you with horses.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Cabergoline not available—emergency—Dr. Kellon

Eleanor Kellon, VMD
 
Edited

There's no evidence at all that cypro works, either synergistically or on its own.  Over 20 years ago Dr. Schott's Cushing's Project demonstrated that cypro was no better than no treatment alone. That isn't the only one either.  A study out of New Bolton showed the same thing. Initial promising results did not account for seasonal changes (they weren't recognized at the time). Cypro was resurrected fairly recently when horses were not adequately controlled within Prascend's recommended dosage ranges but with absolutely no new evidence to back up the recommendation.

If you do decide to try the 0.5 mg of oral cabergoline, I would definitely have APF on board first just in case, and you can retest in a week or so to see if the benefit you saw with injectable is being sustained with the oral dose. I've reached out to  my equine clinicians group again to see if I can locate anyone using it orally.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Stabul 1 availability

 

I’ve been through all the same with Randy and TSC and Stabul 1 losing its ‘palatability’ factor.  This was years ago and I switched to a different low carb pellet for a few years.  Once Stabul 1 became available through Chewy, I started using it again.  I just ordered 4 bags from Chewy recently, not even considering it might have been on their shelf for too long.  I sure hope that’s not the case!

I’m not understanding your reason for not wanting to work with Chewy.  Is it the cost?  My horses seem to be totally addicted to ODTBC now.  I hope that continues as I just purchased a pallet of it from my feed supplier.  Nicole Sicely of Vermont Blend spent considerable effort trying to set up a Vermont source for Stabul 1.  This was after I’d already given up on using the product so I’m not sure where that stands.  You might check with her as she was recommending it to her clients.  I even had some interest in working as it’s supplier but I did not want to interfere with Nicole’s business dealings.

--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Re: Continued use of soaking water

Maxine McArthur
 

Hi Tori
No, you can't re-use the soaking water to soak again. The whole point of soaking is to leach out the sugars. So the sugar is in the soaking water. If you soak dry hay in sugar water, it won't leach out any more. Also, the soaking water may ferment, which is potentially dangerous. 
Please tell whoever asked that they should drain the soaking water where horses can't drink it. 

--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Continued use of soaking water

Tori & Floss
 

I have been asked if the same water for soaking hay can be safely used for a week?
I understand people sometimes need to save money and water too but is this safe to use the same water every day to soak your hay?
Thanks for your time.
--
Tori

 

December, 2016

Adelaide Australia

Case History  https://ecir.groups.io/g/CaseHistory/files/Tori%20and%20Floss 

https://ecir.groups.io/g/CaseHistory/album?id=3347

 

 

 


Stabul 1 availability

Irene Collins-Fotino
 

Thank you all for this information. I will call Randy on Monday. 
Dawn - I understand the shipping, distribution etc., costs, but interestingly enough Kim is able to get
feed shipped directly to her. 
I did speak to Randy earlier this year and he told me that for him to ship to me would be cost 
prohibitive for me. If I can't get Stabul at a decent cost, I will have to switch Logan to another 
feed - not something I want to do and I'm afraid that might not be good for him. 

I'll let you all know how my conversation goes with Randy. 

Thanks all!


--

Irene & Logan
NRC 2009
Hudson, NH

https://ecir.groups.io/g/CaseHistory/album?id=9598

https://ecir.groups.io/g/CaseHistory/files/Irene%20&%20Logan


Re: Cabergoline not available—emergency—Dr. Kellon

Mary T
 

I just had a conversation with Dr. Douglas.  He said the drug has been stuck in customs 12-14 days.  He thinks it may be in NYC—it is in the US.  He mentioned some other clients were going to call their congresspeople.  I am going to do that on Monday—I have two good Senators.  Anyone else heading into a situation like ours might consider doing the same.  The description is 25 GM cabergoline for horses, the only one (any other veterinary cabergoline would be for dogs).  I am afraid with all the horrific human tragedy, animals are being forgotten or pushed aside.

Dr. Kellon, he can’t compound from Dostinex due to the fillers.  He mentioned adding Cypro to the Pergolide for synergy until I can get the cabergoline again.


Re: Stabul 1 availability

gypsylassie
 

Kim, what size bag do you get shipped directly from Randy?
Laura K Chappie & Beau over the bridge
2011 N IL


On Apr 17, 2020, at 6:31 PM, Kim Rice <kimberztaz@...> wrote:

Randy at Anderson Feed ships directly to me; call him on Monday.
--
Kim R, Lafayette, CA  2019
https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Shomee


Re: Potential PPID on a deadline

Tiffany
 

I should probably add he's not showing any signs of active laminitis currently either. His digital pulse is back to normal.
--
Tiffany
Lincoln County, MO
April 2020
Hollywood Case History: https://ecir.groups.io/g/CaseHistory/files/Tiffany%20and%20Hollywood
Hollywood Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=245376


Re: Potential PPID on a deadline

Tiffany
 

Thanks Sherry. I have reached out to the Equi-Analytical and will wait for response to complete the hay analysis. This is completely new to me as the only analysis the stable provided didn't include ESC or other horse pertinent info and I'm in unfamiliar territory sorting that aspect out also.

With regard to the metabolic panel, I will ask for these add'l blood test when we draw ACTH again which I'm hoping will be soon. I placed a call to the vet yesterday and am awaiting response. I'm very familiar with advocating on behalf of my horse which I have had to do passionately and research/educate myself a great deal these last few years. It has paid off. I do have a great vet, but my horse is a complicated case. For example, when he had ulcers all outsiders swore he didn't and were willing to bet on it, yet he had severe ulcers but not typical symptoms. Same when he was diagnosed with EPM...all my equestrian friends thought he was fine and I was jaded due to my experiences. However, with the lyme I would like to test but am still a bit hesistant. I have been told repeatedly lyme is rare here in MO and we have serious medical expenses in my family, not even considering that of my high maintenace canine and equine fur babies so sadly I'm forced to prioritize. My insurance will cover the metabolic due to the claim, but I don't feel confident they will cover the lyme. Do you by chance know what that expense would be? I just don't have any other signs that cause me to suspect lyme and the EPM is well controlled. However, I have heard of many PPID horses experiencing spooky behavior and my vet confirmed that with his experience also.

With the Outlast -- the link you included gives the NSC not the ESC which you mention I should be concerned with. I knew the NSC as I researched it and brought my concerns to my vet with that info combined with the alfalfa and molasses. Unfortunately I have not had success with keeping his tummy happy with other supplements despite my best efforts. Its further complicated by the fact that many ulcer supplements contain ingredients that will interfere with the absorption of his diclazuril/levamisole for his EPM so it has been a challenge to find something that is manageable for both the staff and his medication. This supplement has been successful for us so I feel like I'm walking a tight rope in ways.

Have you all seen PPID cases that originally had normal tests? Is it possible he still has PPID or does the last normal ACTH indicate he's ok? Are there other tests with regard to that I should be pursuing? Would body shot photos be helpful even if they're not exactly as requested? I do have some before the lockdown I could share that are recent.

I know we're a complicated case, and very much appreciate your time!
--
Tiffany
Lincoln County, MO
April 2020
Hollywood Case History: https://ecir.groups.io/g/CaseHistory/files/Tiffany%20and%20Hollywood
Hollywood Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=245376


Re: Cabergoline not available—emergency—Dr. Kellon

LJ Friedman
 

you suggest. .50 mg.   assuming every 4 days?  ( you didnt mention frequency). thanks 
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: Cabergoline not available—emergency—Dr. Kellon

LJ Friedman
 

are these correct numbers?? 400 mg cp?  11 mg cabergoline?
--  i posted dr douglas is referring us to wedgewood.   
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: Cabergoline not available—emergency—Dr. Kellon

Mary T
 

Thank you.  I have a call in to Dr. Douglas.  My question is whether the fillers that are in oral pills preclude their use for compounding for IV.  

thanks again!

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