Low numbers, sick horse


hinecedark@...
 

Good Morning,

 I am hoping for confirmation or information about what I am seeing in my horse, Cato. Initially (in 2010) I had a hard time understanding how he could be so sick with mid-normal ACTH values, but it was indeed the case. Once I got my head wrapped around that, I have been "treating the horse, not the numbers" with spectacular results. Cato has regained his weight and topline, been comfortable and working, silky coat, clean sheath, etc., and life has been good. :>) His compounded perglide dosage has increased from 8mg to 12mg daily in that time, based pretty much solely on signs and symptoms. We check his ACTH (always below 25), Insulin (always below 12 until this time) & G, once or twice a year, have gotten a baseline leptin value, which was 2.61.

Beginning in late August of this year he has displayed all the signs that prompt me to increase his pergolide, i.e.: inappetance/refusal to eat anything but hay, two minor ERU flares, coat coming in rough not silky, slight hoof tenderness, sheath needing frequent cleaning. I increased dosage from 11 to 12 mg with no noticeable results, so we sent blood to Cornell early in October with the following results:

ACTH - 16.5 pg/mL

Insulin - 13.83 uIU/mL

Glucose - 73 mg/dL

These numbers, while not substanially different from his results in April when he was in great shape, result in proxies of:

GI ratio - 5.28

RISQI - 0.27

MIRG - 9.48

I have been soaking his hay since beginning to feed this year's new crop approximately a month ago. Just received the hay analysis with ESC of 9.7% and starch of .5%. He gets his flax/mineral supp sprinkled on the wet hay.

Our vet called yesterday suggesting a chem panel, which I have agreed to, to check for any other problem. He too observed all the symptoms I mentioned when he last drew blood and agreed that, compared to April, Cato was definitely "off".

My "gut" says to just increase his pergolide some more, but the numbers are really giving me pause. Can anyone reassure me that it is possible that he needs even lower ACTH to relieve symptoms? Any similar horses out there? I read digests faithfully, even though I haven't needed to be active asking questions for quite some time. But this is a problem I have not seen discussed. I'm quite familiar with the "The correct dose of pergolide is the one that controls ACTH", quotation, but not with the definition of "control".

I apologize for not including history link - the one I have doesn't work anymore, I assume due to neo intervention since I last used it. I can't even find our history to update it, thought it was in ECH5, but must be confused, as I can't find it there. Will search earlier files when I get the  chance. Meanwhile I hope I have given enough information to begin a discussion of "just how low can you go" . . . .

Thank you,

Melinda and Cato

IN                2010



Lorna Cane
 

Hi Melinda,

 >I can't even find our history to update it, 


Here is your CH link:

https://groups.yahoo.com/neo/groups/ECHistory3/files/MelindaIndy/

Lorna in Ontario,Canada
ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

Support the ECIR Group while you shop. It's easy.  

http://www.iGive.com/EquineCushingsandInsulinResistanceGroupInc




hinecedark@...
 

Thank you,Lorna. No wonder I couldn't find it, I have been removed as a member of that group. Do I need an invitation to rejoin it? I don't find a "join" option on the "Oops" page it shows me.


Melinda

IN  2010


https://groups.yahoo.com/neo/groups/ECHistory3/files/MelindaIndy/


Lorna Cane
 


I've sent you an Invite,Melinda.


Lorna in Ontario,Canada
ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

Support the ECIR Group while you shop. It's easy.  

http://www.iGive.com/EquineCushingsandInsulinResistanceGroupInc 



hinecedark@...
 

So . . . while I struggle with getting Cato's case history updated, the general questions remain:

I am assuming since all horse have ACTH, that it is necessary to them. Is that correct? Is it known "how much" is necessary? If the high end of the reference interval is "too high" in many cases, then is the low end "too low"? Is it possible to take it "too low" with pergolide? If a low level of ACTH is enough to tip the horse, non-IR at baseline, into IR, then is "too low" a worry at all?

I realize these aren't the standard question/concerns, but they are mine for a reason. I can't believe I have the only horse ever to be this sensitive. If the group with the most experience with ECIR doesn't have answers, where do I look?

Thank you,

Melinda

IN 2010


palomino.1982@...
 

Hi Melinda~

No answers at the moment...but a quick question:
What lab is used for analysis of ACTH, etc. ?

Susan
EC Primary Response
SoCal 2007



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

So . . . while I struggle with getting Cato's case history updated, the general questions remain:

I am assuming since all horse have ACTH, that it is necessary to them. Is that correct? Is it known "how much" is necessary? If the high end of the reference interval is "too high" in many cases, then is the low end "too low"? Is it possible to take it "too low" with pergolide? If a low level of ACTH is enough to tip the horse, non-IR at baseline, into IR, then is "too low" a worry at all?

I realize these aren't the standard question/concerns, but they are mine for a reason. I can't believe I have the only horse ever to be this sensitive. If the group with the most experience with ECIR doesn't have answers, where do I look?

Thank you,

Melinda

IN 2010


Nancy C
 




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

So . . . while I struggle with getting Cato's case history updated, the general questions remain:

I am assuming since all horse have ACTH, that it is necessary to them. Is that correct? Is it known "how much" is necessary? If the high end of the reference interval is "too high" in many cases, then is the low end "too low"? Is it possible to take it "too low" with pergolide? If a low level of ACTH is enough to tip the horse, non-IR at baseline, into IR, then is "too low" a worry at all?

I realize these aren't the standard question/concerns, but they are mine for a reason. I can't believe I have the only horse ever to be this sensitive. If the group with the most experience with ECIR doesn't have answers, where do I look?

Thank you,

Melinda

IN 2010


Nancy C
 

Not finding or recalling any cases where ACTH was "too low".

Hope to have Dr Kellon in on this.  She and all of us will benefit from seeing your updated History.

If Cato were here, I'd be getting he blood work your vet suggested to rule out other issues.

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
Equine Cushing's and Insulin Resistance Group Inc.

 


hinecedark@...
 


Nancy C
 

Hi Melinda

Went through your case history. Thank you for updating.  I would have done what you did, ie remove alfalfa, oats.  Would have also done as you are doing, getting more blood work.

As I think you recognize, hoof tenderness and sheath could be  higher insulin from causes other than ACTH. His insulin being up could also be from cold (40 degrees can trigger some) iron overload, lyme disease.

Hoof tenderness can also be from trim or mechanics but based on previous conversations I bet you are on top of that.

Sorry, nothing concrete here.  Just wanted you to know we were paying attention since you loaded your CH. It will be interesting to see CBC and Chem once that comes in. 

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
Equine Cushing's and Insulin Resistance Group Inc.

 







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