Date   

Re: Now what

Kirsten Rasmussen
 

Hi Daune,

Without more info from you, the general instructions for a 1000lb horse at maintenance are:

2% of body weight in hay (20lbs), unless they need to lose weight.  You can safely go as low as 1.5% of body weight if they need to lose weight, but no less than that.

Add in minerals balanced to your hay, either a custom mix (highly recommended here to customize minerals to your hay), or one of the recommended balancers (feed the amount recommended for that product on the package):
https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/Acceptable%20commercial%20ration%20balancers/Acceptable%20Ration%20Balancers.pdf

Use a safe carrier to mix minerals in with:
https://ecir.groups.io/g/main/files/5%20Core%20Diet/2.%20Safe%20Feeds/Safe%20Bagged%20Feeds.pdf
Feed just enough needed to get the horse to eat their minerals.  Include the dry weight of the carrier in the total daily weight of hay the horse eats, so 19 lbs hay + 1 lb carrier = 20 lbs, or 2% body weight of a 1000 lb horse.

1600-2000 IU vit E in oil.

2/3 to 1 cup ground flax.

1-2 Tbsp salt, more if sweating, plus free choice salt.

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


Re: Recent bloodwork concerns

jennigrossi.jg@...
 

Just an update:

I'm working on getting a hay corer so I can sample my square and roundbales. I hope to have samples sent to the lab this week.

Working on getting an appointment for hoof rads asap and have taken note of the recommendations for getting good images.

I still haven't heard from the Vet who did the bloodwork. So, a Vet friend who is a few hours away, but has seen Firestorm, has some metformin on the way to me if we think he needs it.

I've left messages for the Vet who drew the blood and for the lab and endocrinology dept at Cornell to see if we could send a new sample for retest. I'm just having a lot of trouble believing these numbers given how Firestorm looks and his past response to Prascend. Because of the correlation between the acth and insulin, I'm not so much thinking it's sampling error as maybe samples were inadvertently switched? If they let me retest, he will have been on an increased dose of Prascend for only 2 to 3 days. So, I don't think we would see it too dramatically reflected in his numbers yet, right?

I've increased his Prascend dose to 2 mg (given 1 mg BID)

Working on getting what I need to send iron bloodwork to ksu

My farrier is on call to come sooner than our scheduled appointment as Firestorm tends to grow fast and long toe when his acth is not controlled.

Deep breath....I think that's it and today I'm going to take him for a walk because we both need it!






--
Jennifer Grossi
Charlevoix, Michigan
2018
https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Firestorm
https://ecir.groups.io/g/CaseHistory/album?id=262822


Re: Cody's test results

Kirsten Rasmussen
 

Hi Sherry,

Cody's recent metabolic bloodwork looks good.  I'd be very happy with his insulin and ACTH numbers if he was mine.  His ACTH seems well controlled for this time of year, is he still on 2mg Prascend?  And can you post the report from his CBC.....maybe one of our veterinarians can take a look and let you know if they see anything of concern.  Did your vet have any input on whether the abnormalities on the CBC are concerning?

One thing I noticed in his Case History though is that he does not appear to be on minerals balanced to his hay, it looks like all the minerals you were feeding have been stopped, except magnesium oxide?  Did I miss something?  The balanced minerals really do help with PPID horses because they will strengthen his immune system and connective tissues, which are compromised by PPID.  Although we strongly recommend customizing your minerals to the hay you are feeding, if that is not possible then feeding a high quality low-iron mineral balancer at the recommended rate is better than nothing.  There is a list of recommended balancers in our files: 
https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/Acceptable%20commercial%20ration%20balancers/Acceptable%20Ration%20Balancers.pdf

As for the FFW, it could be that the hay has higher indigestible fiber in it than he can handle, being an older guy now.  In case you haven't seen this overview on it:
https://drkhorsesense.wordpress.com/2020/10/16/free-fecal-water-syndrome/
Some people have had success trying Uckeke's Absorb-All product but as I can't get that in Canada I have no experience with it.  There are lots of posts on FFW in this group and the Horsekeeping subgroup, with a few success stories, but I think it often comes down to the hay and how easy it is to chew and digest.  Not sure how beet pulp would contribute to FFW, and it could be the added grass that is helping instead, but either way I'm glad this is improving.

What would you estimate his BCS to be at now?

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


question about insulin/glucose testing

nikkibob1994@...
 

Hey all! 
I want to do a group of tests that would show me insulin and glucose levels at a series of check points. Just not sure how to time them. The working theory is that feeding hay prior to and right after being on pasture in the AM could potentially slow down the glucose absorption and and thereby slow down or lower the insulin spike. I plan to start with a baseline insulin/glucose, but am having a hard time finding out how long it takes for hay to move through the stomach and into the small intestine where glucose uptake happens and therefore insulin release.  Any thoughts on this? I would like to run 3 sets of tests. The baseline, then after hay has begun digestion, then potentially a thrid after grass digestion has started. 
Thanks!
--
Nikkibob
Wisconsin, Sept 2018
https://ecir.groups.io/g/CaseHistory/files/Nikki%20and%20Darby 
https://ecir.groups.io/g/CaseHistory/album?id=77396


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Lavinia Fiscaletti
 

To save money on the testing, some vets don't take/send a pre-TRH sample, only the post one. Some may also believe that if you already have a previous ACTH value, you don't need to do the pre again.

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


Re: Free feeding tested hay

Barbara Noble
 

Just my experience re free feeding IR mare.  Before I knew she was IR she was on free choice hay and no kidding...she gained 500 lbs.  Total weight 1700 when 1200 would due!
--
Barbara
Dec 2015, Sequim, WA
Ginger's Case History   https://ecir.groups.io/g/CaseHistory/files/Barbara%20and%20Ginger


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Kirsten Rasmussen
 

That seems highly irregular to not get the pre-test numbers.  Do you have the original paperwork to upload here?
 
--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Candy Elevated Triglycerides on Invokana

Shawn Gould
 

Hi all,
After about 1 month on 150mg of Invokana Candy’s triglycerides were 565 (not fasted). I lowered dose from 300 because of what happened to Vinnie. She showed no clinical signs or behavior changes. It appears from what I see here that this may be a somewhat common side effect while using Invokana. Now I’ve cut her dose again to .75. I wish there was some protocol for dealing with this, but when dealing with a new use for a drug for humans things come up. I’m grateful for what Invokana has done for Candy as she is in hand walking and does not have pulses in her front feet. It has been a long haul and not mine or hers first bout with laminitis. Hopefully, we will continue to be able continue Invokana use judiciously. Oddly enough her ACTH DOUBLED after increasing to 2.5 Prascend. I can’t imagine there could be a relationship between a rise in ACTH and elevated triglycerides, but it is strange. Vet wants me to go to 3mg Prascend. I started creeping up the dose, but also now looking into cabergoline. Labs will be posted after all results in. 

Hang in there everybody, it is a bumpy ride. There are so many variables and things we don’t know yet. But after trial and error, you figure out what is going to work for YOUR horse it makes it worth it.
--
Shawn and Candy
Dec 2020, Santa Cruz, CA
Candy Case History:  https://ecir.groups.io/g/CaseHistory/files/Shawn%20and%20Candy
Candy Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=258140


Peg / 9YO PREG MARE / Cohuna VIC AUS

Misskatielou88@...
 

Hi, 

We have 9yo mare QH in foal and suffering from laminitis, north east Victoria Aus. 

December 20 2020,
returned from paddock in foal and suspected stressed from her experience with stallion. 

Low on summer pasture she was given 2 small squares of Lucerne. We believe this is the catalyst. 

December 30 2020
farrier visit 

Late Dec/Early Jan
Relocated to dry paddock. Only summer pasture available, large round bale - hay ring. 


Jan 9 2021 
Lame, suspected soreness from farrier but I advised that I didnt think it would occur so late after farrier

Jan 20 2021 
vet visit, peg laying down and locked up - bloods, hoof exam. Bute and antibiotics. Found abscess and advised laminitis. Thick neck and crusty build up.
Farrier return full trim for laminitis. setup 3wk visits 

Early feb
Still ongoing lameness. Removed full access to summer pasture bale and hand feed out measure by biscuit. Provided amounts of hygain zero. 

mid feb. 
stopped summer pasture (s/p) - moved to teff only and finished hygain zero. Greatly improved prior to hygain stop but on teff. Cont routine trims. Using boots on and off when. 

late feb
relapse: father in law, couldn’t work out which was teff or s/p. The feeding of Peg S/P for 2 morn/nights and she relapsed. 

Early March
BANNED EVERYTHING BUT TEFF, measured feeds in slow feeder. Tested teff and in range. Peg to lean bumped up quantity of teff hay. Moving fluent and on the up! Farrier impressed too, small opening in hoof but ok. We’re excited!

Mid March - RAIN and lots of it. 
DRY PADDOCK NOW GREEN, PEG IN CRISIS!! 
Right back at square 1, devastated. Bute to assist pain, boots on. Disced paddock, remove green shoots. Back to the start. Farrier could not assess, peg to sore. 

April 6 -
peg still in recovery, still very sore but more fluent. Farrier return and checked, now appear pedal bone has penetrated both front hooves. One is dry, ok and healing - farrier advised this positive - it’s healing and improving. Second (most problematic hoof) is wheeping but expected to dry out and start improving. Managing teff and green shoots, weight is better - still lean but not a concern. Next step, photos of hooves. Planning on hitting hard on emergency diet, speedibeet purchase just need supps. 


--
Katie Brown
Cohuna, VIC, AUS


Re: Free feeding tested hay

Jill B
 

Hi Pat - I've had success in double netting the hay rations.  It's amazing how much longer it takes him to eat his hay.
--
Jill and Tanqueray
February 2021, Central TX
Tanqueray's Case History -  https://ecir.groups.io/g/CaseHistory/files/Jill%20and%20Tanqueray/Tanqueray%20Case%20History.pdf
Tanqueray's Photos - https://ecir.groups.io/g/CaseHistory/album?id=261221


Re: Free feeding tested hay

Sara Gooch
 

Hi Cass,
Just curious, was the oral omeprazole that worked for you the Abler product, Abrazole?
With as many success stories from knowledgeable, experienced horse people, it's somewhat surprising that  most veterinarians ignore and/or dismiss the Abler omeprazole products even when they are fully aware that the Abler omeprazole is the only omeprazole that the client could afford.  I'm sure many ulcer horses go untreated because of the expense of Gastrogard/Ulcergard.

Sara Gooch, 2011, Northeast California 


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Julanne Baker
 

Sherry, Cornell did not provide the pre-test numbers. Sorry.
--
Julanne in Florida 2020
CaseHistory
Https://ecir.groups.io/g/CaseHistory/files/Julanne%20and%20Oreo


Re: Vermont Blend

Sandy
 

Okay thank you - I'll continue using the gelcaps I was using.  I need easy! 
--
Sandy Kemp
Northeast Pennsylvania
Crystal Blue PPID/IR
Tiffany PPID
2021
https://ecir.groups.io/g/CaseHistory/files/Sandy%20and%20Tiffany 
https://ecir.groups.io/g/CaseHistory/files/Sandy%20and%20Crystal%20Blue


Hay Analysis & custom mineral/vitamin blend help

 

I’m considering switching to a custom blend for my low sugar Timothy hay analysis ...my question is ..if I choose Horsetech for instance or even Uckele..do I just show them my hay analysis and they create the blend? Or does someone else need to look at the hay analysis and decide what needs balancing and they recommend what should be in the blend and with that you take the “prescription” so to speak to the custom blenders ??

I switched all of my metabolic issue horses to the emergency diet last June ..then modified it a bit and have had them on Vermont Blend carried with ODTBC/flax/vitamin e ans some Stabul 1..they’re all doing fairly well and they all have lost considerable amount of weight ..however recent bloodwork shows insulin & glucose within normal limits of the Cornell range-but close to the higher end of normal and the G/I ratio says they are IR and high laminitis risk so I’m thinking the hay might need to be custom balanced??
--
Michele Goldberg
Bernville, Pa 
joined 5/19/2016


Now what

Daune Gatenby
 

Now that my horse is not laminitic. How should i feed him. I know to soak the hay and i know low to no sugar balancer, but how much? Still 1 to 2 % of his weight in hay but how much balancer. No grass fields. But how much of everything.


--
Daune and Monty
Southeastern Massachusetts
2021


Re: Acute laminitis

Maxine McArthur
 

Hi Jessi-ra
This message is our welcome message for new members, that contains much important information, and links to further information. Please read it through carefully, and ask questions if anything is unclear. 

If your horse's laminitis is continuing, it means the cause has not yet been found and removed. Laminitis is a symptom, not a disease. So, this group works on a philosophy called DDT/E: Diagnosis, Diet, Trim and Exercise (when the horse is able). The reason Diagnosis comes first, is that until you know what the problem is, you can't treat it effectively. 
You mention that your horse has been put on thyroid medication. Was any bloodwork done to diagnose hypothyroidism? Was any other bloodwork done? There is more on the blood tests we recommend in the message below. High insulin can lead to laminitis, and there are other medications that can be used if a tight diet does not bring insulin down. If the horse is PPID with high ACTH levels, this can raise insulin and worsen laminitis also. We thus recommend testing insulin, glucose, and ACTH. 

You will have received instructions on how to create a case history for your horse, as we need more information in order to offer any suggestions for you. Based on the initial information in your post above, though, I can make the following comments: 
Bute is not recommended for horses with endocrine-related laminitis (as opposed to sepsis-related laminitis or supporting limb laminitis), as this kind of laminitis is not an inflammatory condition. There are some safer pain relief options in the message below, but removing the cause of the laminitis is the only way to bring relief. 
Without knowing your horse's weight (please put this in your case history), it's impossible to say if 18 pounds of hay is appropriate or not. We recommend feeding 2% of a horse's ideal body weight or 1.5% of current weight, whichever is greater, if the horse needs to lose weight. Soaking the hay is a good idea, but what kind of hay is it? We don't recommend alfalfa as it can make some horses footsore. Much more on diet below. 
The Wellsolve feed does not list a value for simple sugars or starch, so we don't recommend feeding it. Rinsed, soaked and rinsed beet pulp is safe, as is soaked soyhull pellets. 
The Soft Ride boots are a good idea, but some horses don't like the raised frog section on the pads, so you could experiment with removing this or using a different pad, to see if it helps his comfort. You can also create a folder in the Photos section of the Case History group and post hoof photos and copies of radiographs for our hoof experts to comment on. 

So, here is the welcome message, chock-full of information. Let us know if anything is unclear. If you get stuck at all navigating around the group, check the "Wiki" (at the bottom of the left-hand menu) for instructions on pretty much everything. 

Hello 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + 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 EMS/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 soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

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 equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 





--
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: Free feeding tested hay

 

Hi, Pat. 

I have an ulcer-prone horse. My vet said he could spot it when he came to scope her. I wish I’d skipped the scoping and followed this excellent suggestion: “ Another option mentioned in previous posts is to try a few days of GastroGuard or Ulcerguard to see if her condition improves; if yes, then she likely does have ulcers that would benefit from the full treatment.”

I saw results and improvements that were NOT just wishful thinking within 4 days of starting treatment.
My ulcer-prone horse has had a second episode. I skipped the scope and treated her.

Thought I’d mention the trial treatment option. I can’t give my horse meds by syringe, but I found an oral omelrazole option that worked for us. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Sherry Morse
 

Hi Julanne,

Do you have the actual test results?  It would be helpful to know what the pre-test numbers as well as the post-test numbers are.  Also, the TRH stim test is not recommended to be done during the fall as there is no adjusted reference range during the rise.  Dr. Kellon explains that in this message: https://ecir.groups.io/g/main/message/257556.  So having the pre-test numbers particularly for November would be very helpful.



Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Julanne Baker
 

Both tests were ACTH PostTRH1 tests, sorry, did not know there were different kinds. My first rodeo with these labs.
--
Julanne in Florida 2020
CaseHistory
Https://ecir.groups.io/g/CaseHistory/files/Julanne%20and%20Oreo


Re: WAS: Stabul 1 / NOW: Julanne and Oreo

Julanne Baker
 

Thanks, I thought that’s what you meant. Good to know you had to go lower. These air ferns are tough!

--
Julanne in Florida 2020
CaseHistory
Https://ecir.groups.io/g/CaseHistory/files/Julanne%20and%20Oreo

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