Finally - ACTH results back on what...

papballou <PapBallou@...>

I went over to trim Hope this AM. I was pleasantly surprised to see
her navigating about with her boots and pads. Owner says that for the
last several days she has been off her feed and lying down *a lot*.
However, after a 15 inch snowfall two weeks ago, we still have ice and
hard snow all around, so Hope is not happy walking in those
areas...but on cleared ground, not bad.

She did show some slight rotation in the RF on x-rays from about a
month ago. There is a slight bulge in front of the frog on that foot
and is reactive to hoof testers. She has a short toe/low heel trim
that I touched up. She has been obviously laminitic for 5 weeks now.


Insulin and glucose were reported almost two weeks ago...

Insulin 188 microU/ml range 0-65
Glucose 92 mg/dL range 70-120
ACTH 34 mg/ml No range reported but a comment of >50 pg/ml support
possible PPID

Hope is on the emergency diet but still considers beet pulp to be a
poison ;) Grass is double soaked with TCSSF used for morning meal.

No T3 T4 drawn but vet wants Hope on Thyro-l. Owner also using bute.

Hope is getting J-herb and AAKG.

Hope has lost quite a bit of weight...100 pounds? I'm not a good
judge of horse pounds. Some is obviously related to diet, and some
due to some days of not wanting to eat. You now have to really look
to find her crest - it wasn't too big to begin with, but now it's
almost gone.

Faith, Hope's pasture mate...very hard crest that runs length of neck.
Definitely considered fat, but has no lameness symptoms.

Glucose 94 mg/dL range 70-120
Insulin 92 microU/ml range 0-65
ACTH 27 pg/ml

Faith is barefoot with short toe/low heel trim. Also on emergency diet.

Vet wants her on Thyro-l, but no T3/T4 drawn. Owner's concerned over
possible glucose rise from thyroid meds so have withheld it. Faith is
getting J-herb just in case.

Getting grass analyzed is going to be tough since it's hard to find
grass around here to begin with.

Owner's questions/concerns -

Start thyro-l?
What else to do?
When to redraw glucose and insulin?

And the biggie - how long can this take?

I am the intermediary since the owner's don't have internet access.

Thanks a million -


Eleanor Kellon, VMD

The Thyro-L is kinda at vet's and owner's discretion. Since she's
losing weight fine on her own, personally (as in personal opinion) I
probably wouldn't use it, although it might perk her up. Can't test
thyroid function while on bute.

Speaking of which, I'd stop the bute. The J and AAKG can't work with
bute on board. Also wouldn't automatically put her on the AAKG. Start
with J only.

Were her feet underrun to begin with? Soles flat? When you have
laminitis with rotation and a bulging sole it's very important to
push that hoof capsule back underneath them ASAP. If you don't, it
often ends up that their center of weightbearing is directly under
the rim of P3 - ouch! Also try a cutout in any padding to take the
pressure completely off spots that react to hoof testers.

If she hasn't abscessed and has been on bute all this time, good
chance she needs to go through an abscessing cycle before she's going
to improve. Owner should be made aware of that. Do NOT bute her if
she seems more uncomfortable. Hot soaks and warmed poltice packs can
make her more comfortable.

How long? Control of the metabolic component is usually the easiest
part. Healing of the feet takes a lot longer but will start as soon
as the metabolic problem is controlled, trim is correct and
abscess/fluid collections have mobilized.


papballou <PapBallou@...>

--- In EquineCushings@..., "Eleanor Kellon, VMD"
<drkellon@...> wrote:

Were her feet underrun to begin with? Soles flat?
Thank you for the feedback. Hope was a head bobbing lame *navicular*
horse 15 months ago. I have been trimming her starting 15 months ago
and she has become a very happy, willing mare for arena work, trails,
etc. Then this...we all feared something happening because of the
body type, but for almost a year the vet would not draw labs. But,
no, no underrun/long toe syndrome.

I suggested to the owner that she talk with you but she said she'd
feel so uneducated in what to say to you...I think she'll get her
husband to arrange a consult.

Again, we ALL thank you!