labs done 8/31/2020, in overnite with 12 # soaked hay, about 3 # soaked hay  at 6 am, then out with muzzle 1 inch hole at 7 am, vet here at 1000 and did labs.  i did because he is getting furry early so worried about cushings; all other acth in case history.   these labs show acth at 34.6,  glucose 93, insulin 11.33, no leptin back yet,  risqi 0.3, mirg 5.6, gi ratio 8.21.  no current soundness issues, in regular work 5 days per week.  best labs ever, YEA,  any recommendations for change , he is still out  with   muzzle about 6 to 7 hours per day  early may through early november,  lunch hay about 3 # not soaked;  maybe not soak am hay  what do you think and when to repeat acth, will repeat multiple labs early november to include thyroid as is still on 1 1/4 scoops per day, other supplements as you suggest in case history.   thank you so very much, daisy and tiko
CO, April 2019
Case History:  https://ecir.groups.io/g/CaseHistory/files/Daisy%20and%20Tiko 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=90099&p=Name,,,20,2,0,0

While we have been blessed not to have any obvious case of laminitis..yet, he has lost some weight, gotten some great foot work on his fronts BUT I’ve body clipped him twice this summer and he needs a clip again :/ very disappointing. He had been on half a tablet.5 mg. Now for 2 months 1 mg daily. Vet does not want to draw ACTH labs again until spring 
I am switching him to Crypto Areo which has a an NSC of at least < 6.5 . He is currently off all grain and supplements 
--
Nina and Jadon
Kentucky 2020
https://ecir.groups.io/g/CaseHistory/files/Nina%20and%20Jadon

https://ecir.groups.io/g/CaseHistory/album?id=244202

The flax oil I am feeding has 1000 mg of vitamin E per serving, is this enough for the horse or should I consider that only enough for a preservative for the oil and add additional e.

Thank you, 

--
Cari Johnson
San Diego, CA
2019
Rio's Case History
Rio's Case Photos

Awesome job, Lynn! You and your farrier are an inspiration! 
--
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

 

Rebecca,

His insulins are all normal. I wouldn't bother checking that again but an ACTH in September might tell you if he's at risk for PPID.

The sugars in pasture are not an issue except for EMS horses. Pulses do not automatically mean laminitis.  They can mean inflammation but also are elevated after more movement,  hard ground, hot ground, standing in the sun or after getting up  from the ground when the legs had been folded underneath.  "Thin soles" often means underrun heels and potential negative palmar angle and that = chronic deep digital flexor tendon and navicular strain. The underrun hoof also loses much of the shock absorbing capacity of the frog and digital cushion.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Compare the before and after angles today once the trim is done. If they maintained, wean him off his Soft Rides by allowing him to remain bootless in his stall/turnout for lengthening periods of time.

Then you can start adding walking around for light exercise using the padded Cavallos. Gradually work your way up from there if all goes well at each step.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Kristen,

Thank you. I will look into getting him re-tested in the next month. This may be a stupid question, but if he is not PPID, IR, or EMS does that rule out some kind of subclinical laminitis from sugar in grass or hay? Or do I still potentially need to be wary of turning him out on pasture full time? So far the only symptom he's having now is a slightly strong dp. His symptoms were worse in spring and beginning of summer. I will work on getting photos uploaded as well.
--
Rebecca Evans,  Lexington KY, Aug 2020

--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa )
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )

Thank you Dr. Kellon and Dawn for your replies! We will start him on 4.5 mg CP capsules today!
--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa )
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )

This is all great information.  I will send you the information you’re missing! 
--
Jenna in PA 2020

Great. Thanks for the reply. :)
--
Cassie

March 2017

Washington

Ellie Case History: https://ecir.groups.io/g/CaseHistory/files/Cassie%20and%20Ellie
Ellie Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=10111

Interesting so it could be helping with some foot pain even if it didn’t show more improvement in the actual insulin number. I forgot to mention it did help her glucose number. That was down to 82 at the time I took her 10 days post blood pull. 

--
- Anthie

Northern California
August 2015

Eric's case history: 
https://ecir.groups.io/g/CaseHistory/files/Anthie%20and%20Erin/Erin%20Case%20History%208-19-20.pdf 

Hi Anthie,
I believe you can just stop it.  There is a blurb in the files about metformin usage, which doesn't address this question specifically but it does suggest either stopping and testing to see what effect metformin has been having or going to half dose and then testing, if you think you might still be getting some benefit (either for insulin or pain) you don't wish to give up.  
--

Hi Lavinia - this is great news. I'm actually kind of shocked at the difference in the composites from May and August. So just so I'm clear, Relevante has not been ridden or exercised since you and Dr. K diagnosed his problem with his hind feet in May. Throughout this period he has worn the Soft Ride boots with wedged orthotics on the back feet with movement being limited to him being free to move about his stall/paddock at his own volition. So now, with this improvement are we released to begin bringing him back to exercising and riding? And should this be done initially in the Soft Ride boots or should I consider putting him in the Cavallos on the back feet initially - i would see initial "exercising" being me leading him around the arena in both directions for maybe 15 to 20 minutes and going from there. Before all this started he was doing great transitioning out of the Cavallos into barefoot while riding in the arena (we had not yet made it outside when all this happened).  And of course, above all, i will "listen" to what he tells me and adjust accordingly. THANK YOU SO MUCH!!!!!!
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω

Do you just stop cold turkey or taper the dose? 

--
- Anthie

Northern California
August 2015

Eric's case history: 
https://ecir.groups.io/g/CaseHistory/files/Anthie%20and%20Erin/Erin%20Case%20History%208-19-20.pdf 

Laura, one of the things Cushings interferes with is body temperature regulation. Having better control over ACTH will help Pabatsa deal with the heat a little better. 
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Rebecca, September-October is the time to check if he has early PPID.  All horses have higher ACTH at this time of year, but horses with PPID will have a relatively exaggerated ACTH rise.  Even if he was normal in May, he could actually be elevated now and then you would know he needs meds to get him through this time of year.  Usually fall laminitis is the first sign of PPID.  Also, issues with allergies or other immune-related problems can resolve once PPID is being treated, so it's possible there us a connection there.  The other typical signs of PPID, most notably a curly or long coat that doesn't shed, are very late signs when the disease us in a flow blown state.

I also think you should make a photo album and post some hoof photos and xrays (instructions in your welcome letter).  If it's not PPID-related laminitis, then re-evaluating his trim will be the next major line of investigation.  You'd be surprised at how many horses have trims that are not physiologically correct.

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

Hi Jena,

There are 3 ACTH numbers listed so we'll need dates and times for those to interpret this. Insulin is in a grey zone. When had she last eaten and what was it?  Was she on pasture?

As for the Lyme - yes, it could be coming from that.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

could this be a typo - 29.8 to 293. ??????
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382