Date   

TRH Stimulation Results

emma@...
 

Hi

We had acute laminitis May 2019. We have not managed to get to the cause. Current management is as recommended for an EMS horse even though bloods suggest not (Karo Light results - high insulin not the problem). He is not obviously lame but clearly has foot pain and now can't walk more than 15m without stopping, even in boots with 12mm pads. Trimmer visits every month - pedal bone aligned with ground but sinking by about 12mm.
 
2019-05-15 ACTH 17.8pg/ml (<23 Seasonally adjusted reference range)
Comment: No evidence of Cushings
 
2020-06-11 (HEACT) ACTH - basal  13.7pg/ml
Non-autumnal range (mid Nov-mid July): Normal <30pg/ml, Equivocal 30-50pg/ml, Increased >50pg/ml
Comment: Normal ACTH concentration, not consistent with PPID
 
2020-07-04 TRH Stimulation
(HEACTP) ACTH Post TRH 33.0pg/ml
10 mins post TRH; Non-autumnal range: Normal < 110pg/ml, Equivocal 110-200pg/ml, Increased >200pg/ml
(MISC) Miscellaneous 14.9 pg/ml
Comment: HEACTP is 10 mins post
MISC is 30 mins post
These TRH stimulation test results are not consistent with PPID
 
 
It really doesn't look like he has PPID. Could he still be PPID (false negative) or would he definitely have shown up with the TRH Stimulation test?
 
Given that we haven't established a cause for the ongoing laminitis, should I just try Prascend, or am I wasting my time?
 
At a loss as to how to resolve this - there is clearly something undiscovered that is causing the problem and preventing his feet from recovering and my guess is that there is now permanent damage to the all the coria.
 
Many thanks
 
Emma


Re: Updated Case History/Bloodwork

Eleanor Kellon, VMD
 

Everything looks good except for the odd thyroid results. Is there any particular reason why you tested her now?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Feeling Defeated

 

Chemelle, as a compulsive correlator, I did lots of testing.  I once asked my vet if other PPID clients had the same difficulty making correlations.  She pointed out to me that, of her clients, only I did that much testing.  I decided about then that I would try becomIng more observant and less reliant on testing.  I had the liberty to make some dosing adjustments on my own after joking to my vet that I needed to purchase a punch card for ACTH testing, with a bonus free test after the card was fully punched.  You’re not likely to do much damage with an unnecessary dosage increase, other than by possibly overlooking a separate issue, and the damage to your pocketbook by increasing the dose will help you think about it carefully and serve to keep you reined in.  And, if it’s no help, you can cut it back.  I did not need to follow insulin carefully as my horse was not IR.  Instead of crestiness and fat pockets, I was looking for skin issues and weight maintenance.
--
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: Feeling Defeated

LJ Friedman
 

I posted recent insulin tests levels. By increasing cabergoline , the insulin went down very nicely. Thinking that increasing pergolide is worth a try at this point no matter what your AC TH level show. It certainly can’t hurt in my opinion
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: Target's trim

Eleanor Kellon, VMD
 

Kathie,

I just want to reiterate that the trim corrections made in early 2019 were exactly what she needed - and needs again now.  She can't regrow a decently aligned hoof wall until the trim fits the bones inside the foot.

By letting her heels and toes get out of control she has developed bone loss and will be painful when she tries to break over from all the pulling on fragile laminae. This also stimulates production of more laminar wedge, making the toe further and further in front of where it should be.  A club foot is defined by the angulation of the bones within the hoof. She did not have a club foot in February 2019.

 Instructions for the clogs have very specific trim parameters, including trimming the heels to the live sole plane and removing all excess toe that does not line up with the coronary band.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Feeling Defeated

chemelle
 

Thanks Martha and Kirsten - I was operating under the assumption that an increase in ACTH from 28.3 to 30.8 seemed relatively small compared to an increase in insulin from 30.0 to 99.1 and was, therefore, not likely to be the causative factor but perhaps they can just be that sensitive?
If that is the case, Is it too late for an increase in pergolide to be effective?
--
Chemelle
Hillsboro, OR
2019
https://ecir.groups.io/g/CaseHistory/files/Chemelle%20and%20Andy 

https://ecir.groups.io/g/CaseHistory/album?id=94380


Re: Need Advice ASAP -- PPID/IR Horse Won't Walk

sbcable@...
 

Thank you Sherry for your response. Here are my answers:

Yes, Aspen has been in Soft Ride boots for over six months. Current trimmer wants me to move to Clouds. Says the design is not good on Soft Rides. So I will! 

He is not off Bute. We just reduced it to 1 gram twice a day. Will continue to wean off slowly. 

I did see the original message from Dr. Kellon and shared it with vet team and trimmer. They all agreed.

I did try breaking up supplements to figure out what he doesn’t like. Turns out he doesn’t like anything added. He’s become really picky and often leaves some of the things he seems to like (LMF). He does eat all his hay (if it’s not too mushy).

The vet team and trimmer suggested soaking for 20 minutes. Vet said that removes 20% and soaking longer does not increase that percentage by much. If he would eat it, I’d definitely use your guidelines here. But he just won’t. Hot water is impractical as is testing in my situation. 

I am prepared for a marathon. I was just a little miffed at the vets’ negative prognosis at this point. I am realistic, but their doom and gloom attitudes were premature IMO. That’s why I sought more input here. 

I have tried the Alfalfa tea. No go. 

Aspen lost a little weight over the past six months but the vets still gave him a body score of 5. 

I will keep moving forward and do the best I can for Aspen.

One last question: Vet suggests keeping Aspen in his 20x30 pen indefinitely. Trimmer said he should be turned out with the herd in the larger dry 120x120 paddock. He said he needs to get blood moving to his feet. But when he starts to feel better, he starts running around. I really think the last time he did this he caused more damage and we’re starting over. What do you think? Turnout or pen...after he is walking better? 

Thank you again for your help. You do so much good for people and more importantly these wonderful animals.

--
Susan C in Central AZ, July 2020
https://ecir.groups.io/g/CaseHistory/files/Susan%20C%20and%20Aspen
https://ecir.groups.io/g/CaseHistory/album?id=253984


Updated Case History/Bloodwork

Jen Stern
 

Hi,

If Dr. Kellon could look at Deva's updated bloodwork/case history and comment.
Thank you, hopefully I uploaded it all correctly!
--
Jen S. NY 2019

https://ecir.groups.io/g/CaseHistory/files/Jen%20and%20Deva

 

https://ecir.groups.io/g/CaseHistory/album?id=243352


Re: Most Effective Timing on Administering Prascend Dose

 

Frances, it depends so much on how the drug works, whether the effective drug is what is administered or, instead, a decomposition or byproduct.  As a grad student, I worked on elucidating the mechanism of action of a commonly prescribed anti epileptic drug.  At the time, we determined that the drug metabolized to phenobarbital, an even more basic drug that served the same purpose.  Now, I see they have found there are several metabolites, all anti epileptics, some working synergistically with the others.  At this point, the half life of the drug has virtually no relationship to how long it is active.
--
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: Target's trim

Sherry Morse
 

Kathie,

You managed to upload Addie, Libby and Sweet Ps case histories into Target's folder. So you obviously can manage the upload process, now you just need to do that with the latest Case History for Target: https://ecir.groups.io/g/CaseHistory/files/Kathie%20with%20LIbby%20and%20Sweet%20P%20and%20Target%20and%20Addy%20and%20Cherokee/Target




Re: Target's trim

KATHIE DORVAL <bokayarabians@...>
 

Did anything happen?
--
Kathie with Libby and Sweet P
Cobble Hill, BC, Canada
Aug 2018
Case Histories
Target Photos
Sweet P Photos
Addy Photos
Cherokee Photos


Re: Vet visit and treats?

Kirsten Rasmussen
 

Hi Pat, good to hear she's at her new barn!

Any chance you could go visit her early Saturday am and give her your hay yourself at 6 am?  We do recommend feeding at least 4 hrs in advance of bloodwork if they tend to run out of hay overnight.  Even if she's done eating before the blood pull, her insulin will still be elevated in her blood in that 4 hrs.  We also recommend sending blood to U Guelph over Idexx if you have a choice.

I think a few Timothy pellets would be ok as hand treats but putting a cup's worth in a ball is past the point of hand treats.  Have you tried the Ontario Dehy Timothy Complete hay cubes?  They are tested and guaranteed to be less than 10% ESC+starch, and I use them in a ball for my horse, he gets 2 cups of them a day.  Of course he is now an expert at getting them out, but there's usually 1 or 2 he just can't get out and he'll go back and try repeatedly to get them out if he's bored.   I would see what her blood work shows first and then you can decide how strict you are going to be about diet.

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


Re: Most Effective Timing on Administering Prascend Dose

nobigdeal@...
 

Thank you for all the thoughtful replies! 
--
Jessica USA 2020


Re: Feeling Defeated

Kirsten Rasmussen
 

That's a good point Martha! 

Chemelle, several members dealing with PPID for years have said their horses do best when ACTH is around 16-17, so aim to keep it below 20 year-round.  To get your vet on board, you can point out that the high insulin is likely at least in part due to the elevated ACTH and insulin above 80 uIU/ml is in the laminitis zone so getting it down is critical.  If you are able to do bloodwork again after the rise is over (Dec/Jan) and you see that insulin has come back down with ACTH, you have a good case for increasing the pergolide dose next year in July at the start of the rise. 

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


Re: Feeling Defeated

chemelle
 

Thank you Jennifer! Hearing stories about other safe things to feed does help a great deal.
--
Chemelle
Hillsboro, OR
2019
https://ecir.groups.io/g/CaseHistory/files/Chemelle%20and%20Andy 

https://ecir.groups.io/g/CaseHistory/album?id=94380


Re: Storm results back glucose and ACTH

Sherry Morse
 

Hi Val,

Guelph can do the testing for you - information is on the Diagnosis page of the website: https://www.ecirhorse.org/DDT+E-diagnosis.php as well as on the Guelph website itself: https://www.uoguelph.ca/ahl/services/equine-ppid-cushing%E2%80%99s-profile-acth-glucose-insulin-equine




Re: Storm results back glucose and ACTH

hdavis
 

Hello,

sorry to hear you are having troubles with your QH.  So hard when we can’t figure out what is going on.  My vet sends the samples to Guelph for the insulin and glucose testing so it is done in Canada. I think others do the same as well from what I have seen. 
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


Storm

Case History



photos

 
 

 




Re: Feeling Defeated

 

Hi Chemelle,
What an excellent case history you have put together!  With your obvious attention to detail, I’m sure you must be frustrated.  I just wanted to remind you that the values Cornell (or any testing facility) present as lab normals should not be read as defining whether your horse’s PPID is controlled.  That range includes horses which don’t appear to have PPID but have elevated ACTH values.  Mid range, or in the teens, is where the horse would be maintained, ideally, all year round.  I was never able to get Logo’s ACTH below the mid 20’s but your CH shows at least one reading in the mid teens.  If this were my horse, I would increase his pergolide.  You may not notice any difference during the rise but we are on the downside of that so things should be looking up.
--
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: Need Advice ASAP -- PPID/IR Horse Won't Walk

Sherry Morse
 

Hi Susan,

Aspen has some pretty significant bony changes in the latest x-rays (ski tips on both feet) which could certainly be causing him foot pain at this point.  Have you tried putting him in boots to see if that helps with his comfort level?  Is he off of bute at this point?  Did you see this message from Dr. Kellon regarding the last xrays? https://ecir.groups.io/g/main/message/255215.  Getting his trim corrected is going to go a long way to getting him more comfortable but adding boots or even taping EVA foam to his feet can help at this point.  Cindy mentioned how to do this in your welcome letter (https://ecir.groups.io/g/main/message/255128)

The fact that he has a good attitude, is eating and playing with the other horses are all good signs.  The fact that his ACTH has come down in the midst of the fall rise and his insulin is also dropping are also signs you are moving in a positive direction.  Since you just bumped his Prascend dosage up you'll want to retest him again at the end of the month to see where he's at but this is a tricky time of year for ACTH control.  Is he still getting the dose all at one time now?

So for your questions:
1 - Aspen is responding to treatment as evidenced by his decreasing ACTH and insulin.
2 - Dealing with PPID and laminitis is a marathon, not a sprint.  At this point you are dealing with trim, possibly abscesses and possible bute rebound issues - trying to figure out which one is the main driver at the moment means weaning off bute if not already done, getting Aspen in boots to see if that helps with his comfort level and then keep chipping away at the trim. It will get better, but it will take time. 
3 - Can you soak the Bermuda in hot water for a shorter period of time? (We recommend 30 minutes for hot water).  It may not end up as mushy as being in cold water for an hour but regardless, any soaking is better than none.
4 - If possible you may want to break the supplements up to figure out which one he's really objecting to. So just do salt for one feed, just flax for another and so on - if he eats all of the supplements individually you can then try adding them together but again I'd do them 2 at a time to start. (Yes it's a pain, and it could be related to a bit of a veil effect or just the way certain combinations taste to him.)

Have you had the hay tested?  Have you tried the alfalfa tea that Dr. Kellon mentioned?  Is he holding weight right now?

Most important - Keep breathing.  I know it sucks to see our kids hurting but he is on the right path.




Re: Storm results back glucose and ACTH

Val McAuley
 

Hi Heather, 
   I am following your case as I have a QH who had laminitis in late winter/early spring. In April I had him tested for ACTH and level was 2.  Due to laminitis we did not do insulin/glucose levels. I am considering having him checked for IR now and need to know where to send to for lab work. I hope it can be done at Guelph university lab. 
I have read information on site but not clear for Canada.

--
Val 
Saskatchewan
Canada
Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Val%20and%20Becky

9881 - 9900 of 262149