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Dr. K please? Was updated Oden's Case History

Eleanor Kellon, VMD
 

 The seasonal effect in primitive breeds is independent of temperature.  I wonder if the observed links with temperature are really temperature related.  Could be  both.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Cindy Giovanetti
 

Temp was 55 on the recent ACTH and insulin tests. I don’t remember about the previous test (around February), but it was not extreme, and it’s in my case history. _,_._,_
--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125

Nancy C
 

Cindy

May I ask what the ambient temps were day of testing? Texas was probably warm, but just wanted to check.

Thanks

--
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

Cindy Giovanetti
 

Wow, that’s really interesting. Because this is the first year I’ve been tracking all this, it’s the first time I’ve been aware of the cycle, or whether it even is a cycle. Time will tell.




--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos: https://ecir.groups.io/g/CaseHistory/album?id=91125

Eleanor Kellon, VMD
 

All other things being equal, yes. Seasonal effects should wane and he would go back to his baseline levels.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Cindy Giovanetti
 

So if season is driving this independent of ACTH, would I expect his insulin to go down naturally as winter warms into spring?



--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos: https://ecir.groups.io/g/CaseHistory/album?id=91125

Eleanor Kellon, VMD
 

 Reminder that season may be driving this independent of ACTH:

https://ecir.groups.io/g/main/message/242523?p=,,,20,0,0,0::Created,,primitive,20,2,0,39770764
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Eleanor Kellon, VMD
 

Metformin is less expensive, has a longer history of use, acts quickly and has no recognized side effects. Cons are it doesn't always work and may lose effectiveness quickly, has to be given twice a day, larger volume of drug. Limited experience with canagliflozin but it appears very effective at 0.6 mg/kg, can be given once daily, also acts quickly. Cons are labs before starting, price, risk of urinary tract infection and monitoring for that.  Discuss with your vet.

 With either one you could recheck insulin in 1 week to see if it's working.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Cindy Giovanetti
 

I posted a couple weeks ago that Oden‘s insulin had gone up from around 100 to around 150.

The recommendation was that I have is ACTH tested, which I have done. His ACTH came in at 13, but his insulin is up to around 200. So we can remove PPID as a piece of the puzzle for now, but we are still moving fast in the wrong direction.

Diet is clean. Exercise is not zero. (I’m putting in a track.)

I am out of town and do not have access to his case history. But this is what Dr. K said about a month ago, before the ACTH test was redone

“You could consider metformin or canagliflozin, especially since he's been sore again recently (thank goodness he has a good trim!). *If* canagliflozin effects on fat metabolism are similar to those in humans, it may be the best overall choice for horses with this pony-like metabolism because it stimulates the protein (lipoprotein lipase) that breaks down circulating triglycerides. If you want to try it, your vet will have to agree and I can send him some background information. You need to check a blood chemistry at the start and 2 months in. Also buy some urine test strips and monitor his urine for signs of infection about every 2 weeks or if he shows any signs of urinary tract infection (see previous threads).”

So, what should I try first, Metformin or canagliflozin? Or does something else come to mind?

Cindy

--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos: https://ecir.groups.io/g/CaseHistory/album?id=91125

Deb Walker
 

Right now, at least for us, all of the tests are important, but I am specifically looking at ACTH this time of year. I am waiting to January to re-test everything and just see where *we* are at.
--
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:
 https://ecir.groups.io/g/CaseHistory/files/Deb%20and%20Scotty
Photos:
https://ecir.groups.io/g/CaseHistory/album?id=90619

ferne fedeli
 

I always have my vet order the ACTH, insulin & leptin panel & then add glucose.  I'm sure it is a little cheaper & I don't want T4.

--

Ferne Fedeli     2007

No. California
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Lorna Cane
 

Cindy, you can go back to the link that Sherry provided.
Look under the picture at top of page, and click on testing.
Follow that link to Tests and Fees, type ACTH into the search box that appears,and it will take you to equine ACTH baseline, $28.00, third test down.
That gives you the individual test, instead of the panel.

-- 

Lorna Cane
Ontario, Canada
2002


 

Cindy Giovanetti
 

Thanks, Sherry, but we just tested insulin, glucose, and leptin a month ago. The only thing we didn’t do is ACTH. Specifically, the vet asked if I wanted baseline or stem. But I would appreciate your pointing me to the exact test.




--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos: https://ecir.groups.io/g/CaseHistory/album?id=91125

Sherry Morse
 

Hi Cindy,

The most 'bang for your buck' is the Equine Metabolic Syndrome Diagnostic Plan even though the T4 isn't a number we generally use.  Go to https://www.vet.cornell.edu/animal-health-diagnostic-center/testing/diagnostic-plans-and-panels/equine and then scroll down.

It includes:




Cindy Giovanetti
 

When I follow the ACTH testing section in the file, there are numerous test available through Cornell. Can somebody please just verify which one I want.

Cindy

--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos: https://ecir.groups.io/g/CaseHistory/album?id=91125

hinecedark
 

Hi Cindy, 
This may be old news, but just to be sure . . . . In the "old days" my mobile vet used to groan at the idea of doing bloodwork for ACTH . . . specific tubes, refrigeration until spun, etc. And I used to put the samples on ice and take to the clinic for him. He now uses a kit which contains everything needed, including a cold pack. As long as he has a kit on his truck, no problem. I've never asked where he gets these, they are pre-packaged, self contained. My first guess in looking for them would be Cornell, as that's where he sends the samples. Is it possible that your vet hasn't found these yet and if you could show him an easier way it might help? If one of his problems is that he has to get back home and spin the sample himself, could you find a nearby small animal clinic that might do that part for him?
HTH,
Melinda
IN  2010

Eleanor Kellon, VMD
 

Hi Cindy,

Agree with Lorna's suggestion on how to get the blood work done. Would also offer to pay the small animal vet's office to handle shipping to get it to Cornell frozen or at least still cold.  ACTH is much more sensitive to handling than insulin.  The insulin rise isn't necessarily PPID-related though. We're heading into winter.

Your horse's breed evolved attuned to surviving in cold weather with little food. Once calories stop going to growth they are highly attuned to packing on fat unless being worked - really worked! Your latest feeding changes look good but I wouldn't try to go much lower.  You would have to get to near starvation levels to force weight off him this time of year. The best thing you could do for him is look into breaking him to drive. It's ideal exercise because most of the work is on the hind end but pulling weight is serious work.

You could consider metformin or canagliflozin, especially since he's been sore again recently (thank goodness he has a good trim!). *If* canagliflozin effects on fat metabolism are similar to those in humans, it may be the best overall choice for horses with this pony-like metabolism because it stimulates the protein (lipoprotein lipase) that breaks down circulating triglycerides. If you want to try it, your vet will have to agree and I can send him some background information. You need to check a blood chemistry at the start and 2 months in. Also buy some urine test strips and monitor his urine for signs of infection about every 2  weeks or if he shows any signs of urinary tract infection (see previous threads).
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Lorna Cane
 

Cindy, some of us used to do the grunt work, to make it easier on our vets. Not sure if it is still allowed for owners to be hands on, but with the proper paper work to clear you, it might be possible for you to take the vial to a small animal clinic,for spinning down,then put sample in your freezer overnight,label correctly, and ship it off next day to lab. 
Maybe.

--

Lorna Cane
Ontario, Canada
2002


 

Cindy Giovanetti
 
Edited

Dr. K, 

I've just asked my vet to do an ACTH test on Oden, and he is pushing back.  He's a mobile vet (not with a big clinic), and this test is complicated for him to handle.

I asked him if there was any chance the insulin test was handled incorrectly and if rerunning it might give me a less Cushings-feeling result (up from 100 to 150).  He said no.  It was handled properly.

Is there anything else to try before insisting on the ACTH test?  Invokana? Metformin?  Anything else?  Oden is 12 and has no other PPID symptoms.

--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125