PPID driving IR and fluid(?) behind eyes?


Kirsten Rasmussen
 

Shaku just had a checkup and while both his vet and I think he is looking good, we also both feel his IR has not improved enough with the new management, which has been in effect since the end of May (over 4 months).  She thought more time might be needed.  I know I can improve on the exercise component, which should help, too.  Shaku is still growing hooves with laminitic ripples despite no grass.  He gets 15lbs/day hay with ~7% ESC and 0.1-0.2% starch, plus 0.5lbs/day Ontario Dehy Complete cubes, and a little beet bulp with appropriate minerals balanced to his hay, as per his case history, which is up to date.  Still has fat pads, although these are slightly (only a tiny bit!) reduced in size over his eye.  His vet said it would be at least 10 days before we have new bloodwork results but in April his ACTH was normal.  However, now we are thinking about a Prascend trial to see if PPID is driving his IR.  He has no distinctive signs of PPID, although he has goopy/runny eyes and "swollen" eyelids (not sure when this started) and this summer for the first time ever I noticed he was shedding continually until his winter coat started to come in a month ago, even though he seemed to have lost last year's winter coat normally (?) in the spring.  Is it too late into the seasonal rise to do a trial of Prascend?

Another thing we noticed on examination, when I asked about his swollen eyelids, is that he has protrusions of fluid forming a bulge at the top of the iris of his eyeball on both sides.  Further examination when his head was hanging down, after sedation for floating and other procedures, showed that the fluid-filled protrusions had emptied and left the iris wrinkled where they had been. Pupil function was normal on both sides.  I will try to get some photos today to post.  He also has a fluid filled cyst on the pupil of 1 eye.  His vet said that his eyelids aren't so much swollen as they are protruding, and she thinks there is pressure from behind on both eyes.  She did not have an ultrasound machine with her but she was fairly confident it is fluid.  She is investigating this further by consulting an opthomologist, but my question here is could this be a sign of an enlarged pituitary gland/tumor related to PPID?

In addition to the Cornell EMS panel, she is also doing a general blood panel to look for other issues through IDEXX.  Unfortunately his blood was pulled after all the procedures this time for reasons outside my control, which I know will affect his insulin results, but at least it was not fasting.
 
--
Kirsten and Shaku (IR)
Kitimat, BC, Canada
January 2019

Shaku's Case History: https://ecir.groups.io/g/CaseHistory/files/Kirsten%20and%20Shaku  
 

Shaku's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=82559&p=Name,,,20,1,0,0   


Eleanor Kellon, VMD
 

Instead of a Prascend trial at this point I think a TRH stimulation in December would be more informative.

Not sure what the eye issue is but it's not PPID related.

Unfortunately, the sedation will make your lab results impossible to interpret.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Ro Sykes
 

Could this be glaucoma?
--
Rosalind  Sykes
France
joined2017


Kirsten Rasmussen
 

Thanks for the quick response Dr Kellon.  So the insulin, glucose, ACTH and leptin tests will be a complete waste of money?  If that's the case I will make sure the samples are not sent out on Monday, no point in spending 500$ for useless numbers.  What about the full blood panel?  Will the sedation have affected that, too?  I was so adamant that the blood be pulled before anything but unfortunately it was out of my control.   My vet doesn't think the sedation and procedures have any effect.

I may not be able to get him resampled now until next April/May when his vet returns to our area, unless a tech from the small animal clinic will do it.  The TRH stim test isn't a realistic possibility for us, I did discuss it with his vet but it was very expensive.

--
Kirsten and Shaku (IR)
Kitimat, BC, Canada
January 2019

Shaku's Case History: https://ecir.groups.io/g/CaseHistory/files/Kirsten%20and%20Shaku  
 

Shaku's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=82559&p=Name,,,20,1,0,0   


Lorna Cane
 

On Sun, Oct 6, 2019 at 12:41 PM, Kirsten Rasmussen wrote:
I was so adamant that the blood be pulled before anything but unfortunately it was out of my control.   My vet doesn't think the sedation and procedures have any effect.
Hi Kirsten,

Maybe next time he'll humour you, and do as you ( the- ahem-client) ask.
 
--

Lorna Cane
Ontario, Canada
2002


 


Kirsten Rasmussen
 

I emailed Shaku's vet and told her I was going to stop telling local clinic from sending the blood sample.  Her reply:

"He is in a low stress environment at your place and the sedation should have minimal effect on his results, however, the decision is completely yours"

Am hoping someone from the small animal clinic can come collect a sample this week that can be sent in under the original requisition.  He is on Bute at the moment for his other procedures, should I wait until that is discontinued before having his blood pulled again?

It would be so much easier if our vets all understood this as well as Dr Kellon! Then all we'd have to worry about is our horses, which is plenty(!), and not have to deal with vets that aren't on board with ECIR procedures.  That said, Shaku's vet is the only one in our area that will see us and she leaves her practice for a couple weeks 2x a year and travels 6 hours to be here for her clients in the area.  Without her we'd be lost.

--
Kirsten and Shaku (IR)
Kitimat, BC, Canada
January 2019

Shaku's Case History: https://ecir.groups.io/g/CaseHistory/files/Kirsten%20and%20Shaku  
 

Shaku's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=82559&p=Name,,,20,1,0,0   


Nancy C
 

I defer to Dr Kellon, but personally would wait until he is off Bute for several days, before blood sampling, if at all possible.

From personal experience, your situation is exactly why I asked my vet (at the time) to teach me how to pull my own blood.  He was delighted to show me how. My current vet is also on board with this set up. I take my vials to my small animal vet for spinning and sending to Cornell.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA


Kirsten Rasmussen
 

Yes, I wonder if she would show me how...it would be nice to test at other times of the year, too, not just when she is here.

--
Kirsten and Shaku (IR)
Kitimat, BC, Canada
January 2019

Shaku's Case History: https://ecir.groups.io/g/CaseHistory/files/Kirsten%20and%20Shaku  
 

Shaku's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=82559&p=Name,,,20,1,0,0   


 

Kirsten,  I accidentally had blood drawn for an ACTH test *after* floating Logo’s teeth one spring.  There was a marked unexpected increase in the ACTH.  My vet consulted with Cornell and they determined it was most likely a result of just having floated.  We repeated the test several weeks later and all was back to ‘normal’.
If the blood has been shipped, I think you could call the labs and have the tests held.
--
Martha in Vermont
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)
July 2012

Logo's Case History: 
 


Cori.stephen@...
 

I am the vet being referenced in this conversation and I feel there is a need to defend myself and other rural vets and let this group know the following:

1. Shaku and Kristen have been a part of my practice for many years and I do the best I can to support her and him. As rural mixed animal vets it is extremely difficult to know everything about everything so please be kind to those of out there doing the best we can for all owners and patients; including dogs they may have  

2.  I am not the reason this horses blood is “a waste”.  I do listen to my clients; all of them and I also listen to my patients. I don’t cop an ego or think I am more knowledgeable than them on a topic of their passion but I do have knowledge. The above comment in reference to that was a bit out of line on a professional list service.

Shaku’s blood was drawn on arrival however due to processing delays; remember I am working in the field 6 hours from home which means no centrifuge and no freezer we were relying on another small animal clinic to do this. They were the reason for the blood draw while sedated as they were closed when Kristin arrived to drop her horses initial “on arrival” samples off.  I was concerned about the length of time that sample was going to sit at ambient temp without being processed and froze and therefore made the decision to redraw blood at the end of his appointment.  Dr Kellor; is there a clinical paper(s) that shows the effect on these values being ran at Cornell on a sedated horse; if so please post the link; if not please share the reasoning  I am aware of the glucose mobilization but not of other changes.  

3. Due to location and time between visits (Kristin does not have a trailer and is not able to haul  Shaku without some logistical challenges to an equine clinic); I recommended she still submit the EMS panel. There are many horses affected by stress prior to blood draw and also just the time of day and temp of the day and time of feeding are all factors resulting in variables in results. 

4. At this time, unless the sample is frozen as per the instructions left with Kristin to give to the clinic processing the sample the, the sample going to Cornell is useless

5. The sample going to idexx should still go

6.  As an FYI; there are many of my hours and my amazing technicians hours put in keeping up to date on this every changing dynamic syndrome and disease. Please, as you post and read and worry about yours and all the affected horses, that we also are trying our best to do the same. 

Thank you Kristin for being such an advocate for Shaku. 


Eleanor Kellon, VMD
 

I'm sorry you feel the need to defend yourself. All I said was the results would be difficult to interpret. Please see messages 182526 and 222970 for references.  This is a drug effect, not a stress effect.

True that shipping, fasting, different feeds etc. can influence the metabolic results and that is exactly why we recommend a strict protocol in sampling including no shipping https://www.ncbi.nlm.nih.gov/pubmed/27651674, https://www.ncbi.nlm.nih.gov/pubmed/18315878. 

I hope you will be able to stop in often and peruse www.ecirhorse.org as well as the free proceedings from our last three conferences. Our goal is to stay on top of publications in this field and pass that information on to our owners and their hard-working caretakers.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kirsten Rasmussen
 

Thank you Dr Stephen for jumping in, you and your team do provide the highest standard of care for Shaku (who has other problems in addition to IR) and you already know how much we rely on you and appreciate everything you do.  You genuinely care and I see that in how you ask after the dogs and how you were upset by Anna's death in the spring.   Without you and your team I don't know what Shaku's life would be since he needs regular procedures...he likely would have been PTS.

I should have re-emphasized that the reasons for pulling blood post-sedation were outside our control, as Dr Stephen explained, rather than not making it clear that Dr Stephen was not at fault in any way, so I must apologize for not making it clearer.  Despite arranging with the small animal clinic a drop off at 1215pm, no one was there and I waited 30 min with the sample (not on ice because it's just 2 min away) hoping someone would come back from lunch and process it.  We both agreed a new blood sample would be better than one not processed immediately, but I wanted to make sure so that evening I asked the group for feedback and learned the post-sedation blood was not going to give accurate numbers.  Money being very tight for me (truly, after this year's hay bill for low sugar hay etc I am completely broke), I decided to ask the small animal clinic to dispose of it.  I am still waiting to hear if they have someone who is comfortable doing a blood draw on horses to come out and resample.

I feel sick thinking that Dr Stephen feels attacked and that my words have been a part of that.  I am truly sorry.


--
Kirsten and Shaku (IR)
Kitimat, BC, Canada
January 2019

Shaku's Case History: https://ecir.groups.io/g/CaseHistory/files/Kirsten%20and%20Shaku  
 

Shaku's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=82559&p=Name,,,20,1,0,0   


Lorna Cane
 

Thank you Dr. Stephen, for taking the time to come here, and for providing a fuller picture of the situation with Shaku's blood work. 

Kirsten and Shaku are lucky to have you on their team.

I hope you'll be able to find time to come here again.......not because you feel it necessary to defend yourself,though. Just to join us , so that we all can learn.

--

Lorna Cane
Ontario, Canada
2002