Requirements for ACTH Testing?


ferne fedeli
 

I just had a terrible shock.  My great vet told me that he is "Hanging up his Stethoscope" and pursuing some other interests!  I just had him all trained too!!!

Anyway, he lives only about a half hour away and testing was no problem.  Now the nearest vet will be 2+ hours away and am having trouble even getting one to return my emails.  I will call tomorrow.  The other vet that I sometimes use says that she is too far away to do the ACTH testing, but I see that you now say that there is a 4-hour window to spin, etc. so seems it should be okay. 

Another possibility might be to trailer my horse 1 hour to the north where I might be able to get one of the vets that visit there once a week to do the testing.  I'm thinking that the trailer stress might cause an inaccurate test--or is that mainly for Insulin testing?  I was just looking at the Table of Contents and couldn't seem to find what I wanted.
Ferne Fedeli
No. California
4/2010


Lavinia Fiscaletti
 

Hi Ferne,


Know how you feel - my trusted vet left the practice suddenly last year.


We do not recommend trailering for tests as that will influence your results. By how much is unknown.


For the ACTH there is a 4 hour window. Glucose really should be separated more quickly. My vet just brings a portable centrifuge so there is no issue. Then all the vet needs to do is keep the samples cold until s/he returns to the office to freeze and ship. A few cold packs and a cooler will do that nicely. If the vet doesn't have a centrifuge you could look into getting one yourself - my vet got one on ebay for $40.


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team




Bonnie
 

Hello Ferne,

My horse vet is more than 2 hours away. She only comes here once a year and trailering is not possible for me. I approached a small-animal vet who comes to our remote location monthly. He likes horses and is willing to do a blood draw per the group's instructions.

He does the draw early in the morning before his regular appointments. I drive to the horse vet's clinic with the chilled samples. Her staff then prepare and ship the blood samples for me, all within the 4 hour window. Now I am able to do several checks on Lad's numbers yearly.

Perhaps you can find someone to work with you in a similar way. Good luck with this,

Bonnie Ivey, Ontario 12/08
Lad, IR, PPID, shedding some hair!!! ;-)


ferne fedeli
 

The vet that does my dental work came through.  She said she could come and do the blood draws.  I need to try and find some other appointments for her down my way if I can--better for her and for me!  She now uses IDEXX for her lab work and I told her I wanted her to use Cornell and would help her with the process.  I did that for my other vet and we were both a little unsure about the first time, but it worked just fine...

Thanks so much for the advice/reinforcement of my thoughts, etc.
Ferne Fedeli
No. California
4/2010


On Fri, Jul 11, 2014 at 10:03 AM, shilohmom@... [EquineCushings] <EquineCushings@...> wrote:
 

Hi Ferne,


Know how you feel - my trusted vet left the practice suddenly last year.


We do not recommend trailering for tests as that will influence your results. By how much is unknown.


For the ACTH there is a 4 hour window. Glucose really should be separated more quickly. My vet just brings a portable centrifuge so there is no issue. Then all the vet needs to do is keep the samples cold until s/he returns to the office to freeze and ship. A few cold packs and a cooler will do that nicely. If the vet doesn't have a centrifuge you could look into getting one yourself - my vet got one on ebay for $40.


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team





Mandy Woods
 

Hi Ferne,
Any body can draw blood for you.   You,  a neighbor etc.    Do you have a local small animal vet that would spin the blood and separate it?   It would be even sweeter if THEY would send it off for you under their name/account.    That’s how I started with Asher.    My vet didn’t even own a centrifuge but the local cat/dog vet did!
 
Just a thought........
Mandy in VA
 


Nancy C
 

You've gotten great experienced ideas Ferne.  Just wanted to add that it really made life easier for me when my vet taught me how to do the draw.  she is 90 minutes away from me.  I cn take it to the small animal vet  5 mins away and she will spin for me as a favor.  (I've been faithful to her for 14 years now).  I then freeze the serum and take to my equine vet for shipping to Cornell.


If you are not queasy about it, learning how to do it makes life a whole lot easier.


Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
http://ecirhorse.org/index.php/equine-cushing-s-and-insulin-resistance-group-inc



---In EquineCushings@..., <bittersweetfarm@...> wrote :

Hi Ferne,
Any body can draw blood for you.   You,  a neighbor etc.  
 


ferne fedeli
 

Thanks to everyone for all the good ideas.  Since my (formerly) alternate vet said that she would do the draws for me, I guess I am okay for now anyway.  I will have some alternatives for the next time.  I will ask my small animal vet about the possibility of them doing the spin, etc. if I ever need to do that in the future.  I've been a customer of theirs for close to 20 years with lots of dogs and cats over that time, so they would probably be willing to help me out.  (Once I had to take a dog to this vet in the middle of the night and assist him in surgery...  Everything worked out just fine!)
Ferne Fedeli
No. California
4/2010


On Sat, Jul 12, 2014 at 8:20 AM, threecatfarm@... [EquineCushings] <EquineCushings@...> wrote:
 

You've gotten great experienced ideas Ferne.  Just wanted to add that it really made life easier for me when my vet taught me how to do the draw.  she is 90 minutes away from me.  I cn take it to the small animal vet  5 mins away and she will spin for me as a favor.  (I've been faithful to her for 14 years now).  I then freeze the serum and take to my equine vet for shipping to Cornell.


If you are not queasy about it, learning how to do it makes life a whole lot easier.


Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
http://ecirhorse.org/index.php/equine-cushing-s-and-insulin-resistance-group-inc



---In EquineCushings@..., <bittersweetfarm@...> wrote :


Hi Ferne,
Any body can draw blood for you.   You,  a neighbor etc.  
 



gentpony
 

Hi Ferne,

 

Not sure if the following will apply.

If also doing glucose, and there will be a 1 hour delay in separating the cells, the vet needs to use a grey top tube, not a red top tube for the glucose sample.  Also keep it chilled with the lavender top tube to slow bacterial growth. The grey top tubes might need to be ordered so make this request to your vet well ahead of time. 

 

To avoid confusion, mark on the submission form that the grey top is for the glucose test.

The additives in the grey top tube can interfere with other tests, so use this one just for glucose. 

For labs that require serum for insulin, use a red top tube for that. 

(Cornell uses the lavender top plasma for both ACTH and insulin).

 

We have a plastic ice cream container with refrigerated water plus ice that goes out to the barn when the vet arrives for the blood draw.  After gentle inversion to mix, all the tubes go into the ice water bath immediately, then the whole container with lid is transported in a pre-cooled (refrigerated) cooler bag, even though the vet’s office is only a few minutes away.

 

The following posts are by Dr Kellon:

 

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/64951

“…sample should be kept cool (not frozen) and if they won't be able to process the blood within an hour (serum) or even sooner (plasma), should use a grey topped tube (fluoride) for the glucose test. This tube stops the red cells from eating up the glucose giving you a falsely low result.”

 

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/87294

“One big problem though is that glucose levels will tend to degrade for as long as the blood cells are in contact with the serum, and over time because blood is not collected sterilely and some bacteria inevitably get into the sample. If you get a low reading, first to do is probably repeat it. Either borrow a human glucometer if you can, or request a glucose be run using a grey top collection tube (oxalate - stops the red cells from "eating" the glucose).”

       [*my note for newcomers- need BOTH Glucose and Insulin from the SAME blood draw]

 

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/62888

“Just a quick note here on glucose testing. Unless you are doing a complete chemistry panel (which needs serum), ask your vet to take the sample for glucose into a grey top tube (oxalate). This will give you more accurate glucose readings.”

 

For Info on tubes:

http://www.mayomedicallaboratories.com/customer-service/faq/specimen/collection-tubes

 

On rates of glycolysis:

http://www.ncbi.nlm.nih.gov/books/NBK248/

“Both red cells and leukocytes contain glycolytic enzymes. Therefore glucose will be consumed and the concentration of glucose in a sample of whole blood will decline with time. The rate of loss is generally said to be approximately 5% per hour, but may be as rapid as 40% in 3 hours. Consumption of glucose in whole blood samples can be prevented by adding sodium fluoride to the specimen to inhibit the glycolytic enzymes.

 

Rapid separation of the sample or cooling will also prevent glycolysis and will allow the sample to be used for other determinations. Unhemolyzed samples that have been separated within 30 minutes of drawing are generally considered adequate. Rapid cooling of the sample followed by centrifugation is even more effective in preventing glycolysis. “

Eva

SW Ontario,  Mar 2005


ferne fedeli
 

Mercy!  Good thing I'm skipping Glucose.  I'm just doing ACTH, Insulin & Leptin...  My guy has consistently higher insulin than he should, but the Leptin has been within limits the last couple of times (barely).
Ferne Fedeli
No. California
4/2010


On Sun, Jul 13, 2014 at 12:54 PM, gentpony@... [EquineCushings] <EquineCushings@...> wrote:
 

Hi Ferne,

 

Not sure if the following will apply.

If also doing glucose, and there will be a 1 hour delay in separating the cells, the vet needs to use a grey top tube, not a red top tube for the glucose sample.  Also keep it chilled with the lavender top tube to slow bacterial growth. The grey top tubes might need to be ordered so make this request to your vet well ahead of time. 

 

To avoid confusion, mark on the submission form that the grey top is for the glucose test.

The additives in the grey top tube can interfere with other tests, so use this one just for glucose. 

For labs that require serum for insulin, use a red top tube for that. 

(Cornell uses the lavender top plasma for both ACTH and insulin).

 

We have a plastic ice cream container with refrigerated water plus ice that goes out to the barn when the vet arrives for the blood draw.  After gentle inversion to mix, all the tubes go into the ice water bath immediately, then the whole container with lid is transported in a pre-cooled (refrigerated) cooler bag, even though the vet’s office is only a few minutes away.

 

The following posts are by Dr Kellon:

 

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/64951

“…sample should be kept cool (not frozen) and if they won't be able to process the blood within an hour (serum) or even sooner (plasma), should use a grey topped tube (fluoride) for the glucose test. This tube stops the red cells from eating up the glucose giving you a falsely low result.”

 

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/87294

“One big problem though is that glucose levels will tend to degrade for as long as the blood cells are in contact with the serum, and over time because blood is not collected sterilely and some bacteria inevitably get into the sample. If you get a low reading, first to do is probably repeat it. Either borrow a human glucometer if you can, or request a glucose be run using a grey top collection tube (oxalate - stops the red cells from "eating" the glucose).”

       [*my note for newcomers- need BOTH Glucose and Insulin from the SAME blood draw]

 

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/62888

“Just a quick note here on glucose testing. Unless you are doing a complete chemistry panel (which needs serum), ask your vet to take the sample for glucose into a grey top tube (oxalate). This will give you more accurate glucose readings.”

 

For Info on tubes:

http://www.mayomedicallaboratories.com/customer-service/faq/specimen/collection-tubes

 

On rates of glycolysis:

http://www.ncbi.nlm.nih.gov/books/NBK248/

“Both red cells and leukocytes contain glycolytic enzymes. Therefore glucose will be consumed and the concentration of glucose in a sample of whole blood will decline with time. The rate of loss is generally said to be approximately 5% per hour, but may be as rapid as 40% in 3 hours. Consumption of glucose in whole blood samples can be prevented by adding sodium fluoride to the specimen to inhibit the glycolytic enzymes.

 

Rapid separation of the sample or cooling will also prevent glycolysis and will allow the sample to be used for other determinations. Unhemolyzed samples that have been separated within 30 minutes of drawing are generally considered adequate. Rapid cooling of the sample followed by centrifugation is even more effective in preventing glycolysis. “

Eva

SW Ontario,  Mar 2005



Elva J Mico
 

On 7/14/2014 10:26 AM, Ferne Fedeli fedelif@... [EquineCushings]
wrote:
Mercy! Good thing I'm skipping Glucose. I'm just doing ACTH,
Insulin & Leptin... My guy has consistently higher insulin than he
should, but the Leptin has been within limits the last couple of
times (barely). Ferne Fedeli No. California 4/2010
Ferne, I think be glad his leptin isn't too low. Beau's is very low and I guess he thinks he is full and I have serious problems getting him to eat at all. I can't find his last reading, it's here somewhere but I think his leptin level was 2.something....can't remember the numbers of something, maybe like 72. Will try to find the last blood report.

Elva and angel Satin
2004/NM
Beau and Whiskey


Lavinia Fiscaletti
 

Hi Ferne,


A leptin of 2 is a fantastic number - I'd be ecstatic over that. Normal is 1-4. Higher Leptin is not something you want to see.


Has he always been this picky, uninterested in food or is this something new?


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team




ferne fedeli
 

His Leptin wasn't borderline low, it was borderline high.  the range is 1-4 and he was 4...
Ferne Fedeli
No. California
4/2010


On Mon, Jul 14, 2014 at 10:00 AM, ejm ejmico@... [EquineCushings] <EquineCushings@...> wrote:
 

On 7/14/2014 10:26 AM, Ferne Fedeli fedelif@... [EquineCushings]
wrote:


> Mercy! Good thing I'm skipping Glucose. I'm just doing ACTH,
> Insulin & Leptin... My guy has consistently higher insulin than he
> should, but the Leptin has been within limits the last couple of
> times (barely). Ferne Fedeli No. California 4/2010

Ferne, I think be glad his leptin isn't too low. Beau's is very low and
I guess he thinks he is full and I have serious problems getting him to
eat at all. I can't find his last reading, it's here somewhere but I
think his leptin level was 2.something....can't remember the numbers of
something, maybe like 72. Will try to find the last blood report.

Elva and angel Satin
2004/NM
Beau and Whiskey



ferne fedeli
 

That was Elva's horse with the Leptin of 2, my Magic was 4.
Ferne Fedeli,
No. California
4/2010


On Mon, Jul 14, 2014 at 11:41 AM, shilohmom@... [EquineCushings] <EquineCushings@...> wrote:
 

Hi Ferne,


A leptin of 2 is a fantastic number - I'd be ecstatic over that. Normal is 1-4. Higher Leptin is not something you want to see.


Has he always been this picky, uninterested in food or is this something new?


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team





Lavinia Fiscaletti
 

Hi Ferne,


Sorry about that. Meant to post that to Elva  :(


Been arguing with Neo and lost my train of thought.


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team








ferne fedeli
 

Don't let Neo get the best of you, Lavinia!!!!
Ferne Fedeli
No. California
4/2010


On Mon, Jul 14, 2014 at 2:26 PM, shilohmom@... [EquineCushings] <EquineCushings@...> wrote:
 

Hi Ferne,


Sorry about that. Meant to post that to Elva  :(


Been arguing with Neo and lost my train of thought.


Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team









Nancy C
 

Amen.  This work is too important.

Thanks for the uplift Ferne.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
http://ecirhorse.org/index.php/equine-cushing-s-and-insulin-resistance-group-inc



---In EquineCushings@..., <fedelif@...> wrote :

Don't let Neo get the best of you, Lavinia!!!!
Ferne Fedeli
No. California
4/2010