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Re: Help interpret Bloodwork Results

Nancy C
 

JIC = Just in Case

The long term is to test your hay and balance the results with DIY or custom supplement mix. 

It is also the most economical.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room


New member post/inquiry

Kelley
 

Hello all,

So glad to have a place to ask my questions, I really appreciate it!

Warning: lengthy post!

I have an 18 yrs old Morgan mare, Tansy. I had a new to me vet out for the spring exam and she was concerned that the 3/5 lameness on her L front was potentially being caused by laminitis. Upon exam, she found no evidence of swelling or pain in her leg, but did find a slight digital pulse, and soreness on either side of the point of her frog.  The vet tried to explore her foot to see if she could find evidence of a potential abscess, but had no luck. Her other front leg is normal with no digital pulse and had no reaction to the hoof testers. When she did a sharp turn to the left, Tansy had rocked back to avoid loading that foot.

Tansy is overweight (she got a 7/9 for body condition) and fits the classic EMS look—cresty, fat pads in the EMS spots, and of course her breed is prone to it.

The vet advised me to place her on stall rest for two weeks, monitoring pain response/digital pulse, along with weighing out her grass hay (which I have not tested) for 1.5% of her better weight. I divide it up into 2 nets, one with 1” holes and the other with 1 3/4” holes. She is on a low sugar/starch organic ration balancer from Modesto Mills—also weighed out for her 2x day feedings. The vet also had her in 1 1/2 grams of bute 2x day, to be tapered down as her comfort level improves. At this point there is no change from when we started a week ago, so I have dropped her to 3/4 gram 2x day. She has free choice iodized sea salt, clean water, and her stall is heavily bedded with shavings. When I updated how she was doing on Thursday the 18th, she encouraged me to keep her in for the full two weeks.

I am really having a hard time adhering to this protocol of stall rest—generally they are on 24/7 sacrifice paddock turnout with access to a run in area of the barn and are rarely stalled except for extremely prolonged periods of wet weather. I am all for the weight reduction and will definitely keep the weighing and limiting up, but I am struggling with the bute and stall rest. We had a Shetland pony who had bouts of laminitis and Tansy shows no sign of anything else beyond the mild digital pulse and soreness at the tip of the frog. No rocking back, shifting of weight, reluctance to move, extra laying down, etc. In addition, I am confused about one foot being affected—I thought that was more  of a problem when one leg is injured and the other one experiences the unilateral laminitis.

I welcome your thoughts and advice—I so appreciate my vet trying to prevent a much more devastating flare of laminitis—but I’m not sure the stress of being stalled is balanced out by the caution.

Thanks for reading through my long post!
--
Kelley in Mn 2021


Re: Help interpret Bloodwork Results

Michele Goldberg <ladipus@...>
 

Hi Nancy..please forgive me what is JIC? Dr Kellon has looked at my low sugar Timothy hay analysis in the past and thought Uckele U Balance Foundation would best balance it of the commercial balancers but I can’t afford to feed that to 5 horses ...so I’ve opted for Vermont Blend/Ontario Dehy Timothy Balance Cubes, Flax , Vitamin E and some Nuzu Stabul One as the most economical ...it’s sort of more or less the emergency diet ...if that’s not meant to be on indefinite than what is or would be?? 
--
Michele Goldberg
Bernville, Pa 
joined 5/19/2016


Re: Is anyone in the UK using Invokana

Caroline
 

I found this  https://sites.tufts.edu/equineendogroup/files/2020/09/200592_EMS_Recommendations_Bro-FINAL.pdf
There is a recommendation for Invokana for horses where metformin doesn't work.  Andy Durham from Liphook is a member of the group that published it, so either your vet didn't speak to him or there is some other reason that it's not recommended.
Hope this helps
--
Caroline
Spalding, Lincolnshire, UK
September 2019
https://ecir.groups.io/g/CaseHistory/files/Caroline%20and%20Evan
https://ecir.groups.io/g/CaseHistory/album?id=231916


Re: Active abscess and testing for Cushings

Maxine McArthur
 
Edited

Hi Trisha and any other members who struggle with searching
After Cass’s timely reminder, I went and refreshed my meagre search knowledge here:

https://ecir.groups.io/g/main/wiki/1993

Good ‘ol Wiki! 

--
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

 


Re: Do the Vitamin C and NAC dosage amounts from Dr. Kellon scale with weight?

AnnCN
 

Thanks Kirsten!  I already get my spiralina and jiaogulan from My Best Horse.  I'll look into adding Chondroitin to the mix.  

And to Lorna's comment, I'll bring my coffee grinder out with me next time and see if that maybe helps too.  I don't know why I hadn't thought of that before....

Ann
--
Ann Carney Nelson
"mom" to Lolly (20 yr old EMS/PPID Welsh pony who foundered in July 2019)
Joined ECIR in Sept 2019
Eugene, Oregon

Case History:  https://ecir.groups.io/g/CaseHistory/files/Ann%20and%20Lolly 
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=234320


Re: Is anyone in the UK using Invokana

Eleanor Kellon, VMD
 

Jenny,

In addition to signing the consent form for "off label" use of a medication, you can specifically offer to sign a form that absolves your veterinarian of any fault in the event of an adverse outcome. When the alternative is euthanasia, that is entirely reasonable. You can also work together to determine a timeline for when you will "pull the plug".

Again, many medications are legally prescribed for horses when there is no species specific approval. That includes metformin and the Glyburide that Liphook has used. Whether or not someone in UK has used it is irrelevant.

All of that said, no medication is a magic bullet. You still have to control PPID if that is present, maintain an appropriate diet and a good trim.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Is anyone in the UK using Invokana

Eleanor Kellon, VMD
 

LJ,

Sending medication like that is both illegal and dangerous.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Is anyone in the UK using Invokana

Lorna Cane
 

Hi Jenny,

Would you be able to take a video of his walking ?

Hang in. Keep breathing.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Re: Is anyone in the UK using Invokana

Eleanor Kellon, VMD
 

LJ,

I can't recommend that approach. Invokana is a new medication, incompletely studied in horses (and horses are not people, very different metabolism). It must be used only under the direction and supervision of a veterinarian who understands the metabolism, can set up appropriate testing schedules and monitor the horse. If the veterinarian is reluctant even with signed informed consent forms, try to find another that is not.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Is anyone in the UK using Invokana

LJ Friedman
 

If I didn’t mail out the invokana , I wasn’t using it for another member, I would gladly mail you 30 tablets if I had them. Perhaps a member in the US can mail you 30 tablets.???
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Re: NEW MEMBER NEEDING HELP WITH DIET

Eleanor Kellon, VMD
 

Balancing correctly requires analyzing your hay and working from there. More hay is your first line source for fiber and energy but if you need a more concentrated source consider Maxisoy.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Is anyone in the UK using Invokana

LJ Friedman
 

following this thread, you can’t completely fault your vet for not prescribing Invokana as he did speak to a specialist and they didn’t give “a move forward answer.”answer. Additionally, to think about putting your horse to sleep because you can’t get the Invokana would be awful. What I did, and what I suggest you do, is just get Invokana anyway you can. And then after testing, show the results to your vet and I’m sure he will prescribe it. 
is there no one in UK that can loan you 30 tablets? 
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Re: New Test Results for Bella & Destiny - Dr. Kellon, asking for input about possibly starting Invokana?

Eleanor Kellon, VMD
 

Hi Lynn,

Difficult call! As a rule of thumb, any horse with insulin over 80 to 100 is at increased risk of acute laminitis but even lower levels are causing damage to the laminae. Regular exercise is the best method to control insulin but obviously not possible when they're lamintic.

You can NOT use heat and pulses alone to indicate laminitis. Too many other things can change them. Pain and reluctance to move also have to be present.

Since she is comfortable now, or at least still improving, whether to change depends on your treatment goals. If you treat by signs/symptoms, it would be reasonable to continue with metformin for now. If you want to treat for the best possible numbers, you would switch. You might want to split the difference and get her Chemistry screen and triglycerides checked now so you would be ready to go if you decide to switch to Invokana.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Do the Vitamin C and NAC dosage amounts from Dr. Kellon scale with weight?

Eleanor Kellon, VMD
 

Spirulina dose for lung issues is 20 grams twice a day. If using powders, pair it with Jiaogulan. Chondroitin is for skin problems.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Pergolide and Diarrhea- Not sure what to do

Eleanor Kellon, VMD
 

There is no set dose on the CTB because the strength of sources varies. Are you using an extract or whole powdered berries?

Any improvement with Equi-Winner Patches is pure coincidence.

When your vet is there, be sure to get his urinary tract checked out  with exam of penis and sheath, rectal exam of bladder, urinalysis. That behavior suggests either obstruction or urinary tract infection.

You can feed psyllium indefinitely.The short course then stop is for sand removal. When you feed it  continually the hind gut will break it down and ferment it. No problems with minerals either.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Help interpret Bloodwork Results

Nancy C
 
Edited

Hi Michelle

Your understanding of "lab normal" may be getting clearer, but JIC, and for others who are just starting their journey, here is an article as to why not lab reference ranges are not "normal".  It includes a review of the issue with reporting fasting insulin as well.

https://www.ecirhorse.org/FastingInsulin-LabRefRanges.php

The emergency diet is not meant to be used indefinitely.  You may know this too, but again, JIC. The first line of defense and treatment for EMS/IR equines is diet. Dr Kellon goes into in in depth in this 20 minute film.

https://www.ecirhorse.org/video.php

Glycocemic Eq has been described by Dr Kellon this way: "Glycocemic EQ is a "starter" mineral supplement with the minerals most frequently deficient...".  Lost more in the message archives.

The best approach is still through understanding what is in your hay.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room


Re: Active abscess and testing for Cushings

Trisha DePietro
 

So, I just want to make sure I get this- Be in the group ie  Main group as an example, then I should highlight messages, then type into the search box? When would I search the files or the wiki? I guess I need a remedial training on searching better!!! :) 
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Is anyone in the UK using Invokana

Eleanor Kellon, VMD
 

No, it's not licensed but neither was pergolide until a few years ago. It's perfectly legal to prescribed a drug being used in humans if there is no veterinary alternative. Invokana is approved for human use in the UK. You are supposed to be informed of risks and to sign a consent form.

BTW, metformin isn't  licensed for horses either.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Help interpret Bloodwork Results

Michele Goldberg <ladipus@...>
 

Hi Kirsten ...I thought because his numbers were within the normal range that he’s considered not IR/EMS...I’m partly wondering if his results were what they were due to having a heaves flare?? I was wondering if Uckeles Glycocemic Eq would be beneficial as I think I remember Dr Kellon recommending to others before? Good news is Oskar is in full work and exercised regularly. 
--
Michele Goldberg
Bernville, Pa 
joined 5/19/2016

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