Received results from Romke's most recent blood panel.

His LDH was 585 with a reference range of 150 - 450. since January of 2008 it has 
gone:
459 - 514 - 490 - 558 and now 585. Is this cause for concern?

 He is exercised daily.



WBC - 4.7 (ref range 5.5 - 12.5) It has been a big problem since I own him (2001) and I
don;t know 
how to get improvement. I am giving him colostrum daily and a equi-stim
shot every 3 
months. Should I increase the equi-stim shots?



Glucose is at 75 (ref range 70-120) and insulin 38.2 (ref range 0-65) IR Ratio 1.96 / 
Risq.
0.16 He is on a full ODTB cubes diet. It has progressively gotten worse. His feet have been
warm to hot the since the middle of November. I have increased his pergolide by .5 mg
because of the hot feet, his irritability and my becoming allergic to him again (an indicator
that I need to raise it).



Everything else is normal. I did this one with Antech - will be doing another with 
Cornell
end of January. ACTH is not in yet. 


When Romke came out of the hospital with his pneumonia (2004) they suggested that I
vaccinate him for flu/rhino every 4 months. At that time he was not yet diagnosed with
Cushings & IR. Should I continue this schedule or cut it back to every 6 months? He does
not have a negative reaction to the shots but the vet visits obviously stress him (he stands
in the corner of is stall and starts quivering when he sees the truck pull up).

Your suggestions for improvement and your assistance will be much appreciated.


Thank you.

Loes & Romke
So. Cal. January 2008

If all his other enzymes and chemistries are normal, I wouldn't worry
about an isolated finding that is just slightyly out of range. What
was the differential on his white count? (% of neutrophils and
lymphocytes). PPID can depress white counts, particularly the
lymphocytes, but if his differential is normal (roughly 50:50
neutrophils and lymphocytes), that white count may be normal for him.
As for the Equi-Stim and vaccines, it really depends on his level of
exposure. If he's in a busy barn, it might be warranted although
personally I'd go with the intranasal influenza and the modified live
EHV vaccine then stick to a regular vaccination schedule. A more
important factor though is whether his PPID/ACTH is controlled. If
not, that is suppressing his immune system and he won't be able to
respond. As for his G:I ratio, have you ever checked it at Cornell?
Is the blood being rapidly processed to avoid artificial drops in
glucose?

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001

Dr Kellon:

Thank you.

Neutrophills were 2632 (ref range 2700 - 6700) / lymphocites 1921
(ref range 1500 - 5500)

I did the 9/26 panel at Cornell Glucose 88 (ref range 75-117)
Insulin 29 (ref range 10-40) Ratio 3.01

Did a 8/18 panel at Antech Glucose 65 - Insulin 17.60 Ratio 3.69

Since I do so many I switch back an forth (per my request) between
Antech & Cornell - never seems to be much difference between ratio
only that his IR is progressively getting worse.

The blood is processed within the hour. He draws and goes straight
to his office (15 - 20 minutes). They have been very, very cooperative.
Initially they didn;t want to send it to Cornell but they understand
the importance and will send it where I want.

My vet and his staff do everything they can to accommodate my
requests, I am fortunate.

Loes & Romke
So.Cal January 2008