questions re: IR and Cushings


Karen Warne
 

I have several questions as I work toward managing Luke's care.  Hi CH is up to date.

So, on 8-24-17 Luke's non-fasting labs were redrawn. :

Insulin is down to 11.4, (yeah!), glucose is 88, ratio is 17.  The calculator shows he is "compensated IR and at risk for laminitis".  So, what do I do now besides continue with his tight diet, exercise as much as I can (thank God I am retired), and keep up on his trims?   Does a horse with IR ever reach a point where their labs don't show a risk for laminitis?  Is there anything else that can be done?  

My vet wants to keep Luke on Thyroid, but in reading, it seems Dr. Kellon does not recommend this...?  My vet feels it improves the cell receptors that metabolize the sugars...?  Is there some recent research I can read to learn the pros and cons of keeping him on Thyroid?  I know each medicine has it's own side effects so want to be cautious about what I'm doing.

Also, despite Luke's symptoms that make him look like preCushings (longer summer coat, sweating), his ACTH came back even lower this check (3.64), despite it being end of August.  My vet said that based on Luke's symptoms and the fact that he is IR, she's open to one of these options:  1) just continue to monitor symptoms and recheck ACTH every 6 months,, OR 2) do TRH Stim in the spring, and/OR 3) start him on a 90 day trial course of low dose pergolide and see if his symptoms lessen, (However, we are going into winter, so I would not expect him to shed now, so I'm not sure if this would be a good 'test').   Do you have any thoughts on these or other suggestions?
--

Karen and Luke 

May 1 2017

Northern California

 

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921


Nancy C
 

Hi Karen

Great job on your Case History!

It is not unusual for vets to want to continue the Thyrol-L.  A lot have members have found through addressing any correctly diagnosed issues like PPID, diet corrections, weight loss through correct amount of calories and adequate iodine, they have corrected a perhaps previous sluggish thyroid.  If you take him off the meds however, you need to taper it off slowly, so that his own thyroid begins to contribute as it should again.

In looking over your CH, I see you have sent your labs to Idexx and UC Davis.  If Luke were here, I would repeat testing next time through Cornell. Through side-by-side testing some members have found that the lab results can be inaccurate and, when faced with a horse with symptoms, a Cornell result might confirm your suspicions. If this has been discussed with you previously and I missed it, please forgive me.  Sometimes our California friends feel the need to go to Davis b/c it would avoid overnight shipping issues. Cornell offers discount labels and once shipped, overnight is still overnight, no matter where it originates.

If D Kellon and/or Dr Clougher believe TRH is warranted, I bow to their recs.

If your current labs are accurate, it appears he is compensated IR at baseline and, as such, will always be more "at risk" to outside events than horses who do not have this diagnosis.  Compensated is way better than outright uncontrolled IR, like my  boy was.

You are doing a fabulous job.  Keep on a nice tight diet and keep him working with a good trim and you will side step a lot of problems.

Good work.
--
Nancy C in NH
ECIR Moderator 2003

 

Save the date! The ECIR Group Inc. NO Laminitis! Conference, October 27-29, Tucson, AZ

Learn the facts about IR, PPID, equine nutrition, exercise and the foot
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
ecirhorse.org



Eleanor Kellon, VMD
 

Yes, some horses reach the point where their numbers do not show IR, but many do not and with an 11.4 uIU/mL insulin the risk of laminitis is extremely low **if** you continue the same management. Something would have to drive that insulin considerably higher for laminitis to occur.

There is no equine research that can answer your questions about thyroid supplementation. In fact, in the studies where horses on thyroid supplementation improved it may have been weight loss and/or the low NSC diet. The only study that utilized a control group still has not been published. The earlier study used nonobese, non-IR horses.  To see any change in IR horses it is necessary to use dosages high enough to cause hyperthyroidism.

In mice, there is little effect:

http://escholarship.org/uc/item/4729306n#page-2

Your best options for picking up an early PPID horse are testing ACTH during the seasonal rise peak (end of September) or the TRH stimulation.  If he doesn't shed  in the spring you could consider trying pergolide.
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


LM
 

Dr. Kellon, as I have said I'm not big on messing with another hormone feedback system like the thyroid. I was just wondering some argue its not just about the weight loss but the reduction of fat tissue as they are saying they are releasing inflammatory chemicals. Is that true to your knowledge?
Thank you
--
LM
March 2013
New Springfield, OH/Ft. Collins, CO

ShineysLittle Pistol
https://ecir.groups.io/g/CaseHistory/files/LM%20and%20Shineys%20Little%20Pistol
https://ecir.groups.io/g/CaseHistory/album?id=9106


Karen Warne
 

Nancy,
Thank you so much for your thoughts and suggestions.  I have talked to my vet regarding sending labs to Cornell, but her hesitancy is due to the distance the blood needs to go.  I will ask again with our next blood draws in the spring.  
Thank you again... 
karen
--

Karen and Luke 

May 1 2017

Northern California

 

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921


Karen Warne
 

Thank you Dr. Kellon,

i appreciate that explanation, as I am goal oriented so it's helpful to have a number that is a goal... I am managing his diet and life as tight as I can, to the point everything revolves around him.  Lol.  He is my horse, but more importantly, he is my therapist, so I will keep it up as he does look so much better... except for that worrisome sweating and his longer than normal coat - unless I bodyclip him, which I've done twice this summer.  

A question regarding the l-thyroxine:  If the L-Thyroxine is making him a little hyperthyroid, could that be contributing to his sweating?   Also, could it also make him a little more jumpyn shopping  than normal?  He almost never spooks, but recently I am noticing him worrying about things a little more when there is something new...

Given your suggestion for the ACTH, I think I will plan on the TRH Stim test in the spring ~(March) when I retest his insulin Nd glucose.  

Thank you and God bless this group for your amazing help with Luke!  As an aside, I've changed all my Amazon shopping to the smile.amazon.com with the ECIR group being the beneficiary of the donations.  What a great and easy way to support this group as you all help our horses...

--

Karen and Luke 

May 1 2017

Northern California

 

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921


Eleanor Kellon, VMD
 

I'll be spending an hour looking at this question of inflammation and fat in equine IR. Bottom line is that it is not the same as the human condition. There are contradictory studies, and ponies appear to be different from full size horses which do not show the clear evidence of inflammation found in people.
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


Eleanor Kellon, VMD
 

Just as a P.S. here, weight loss *is* fat loss if you do it correctly. You don't need thyroid hormone to get weight loss.
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


Eleanor Kellon, VMD
 

Yes, the Thyro-L could be contributing to sweating and spookiness.
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001


Helen Temps
 

Karen, my Vet has sent to Cornell for me with no problem.  Have your Vet get the pre-paid overnight shipping labels from Cornell for $15.  There should not be any problem.  I am also in No. Cal.
--

Helen Temps and Chloe  June 2017
Placerville, CA
https://ecir.groups.io/g/CaseHistory/files/Helen%20and%20Chloe.
https://ecir.groups.io/g/CaseHistory/album?id=6929


 

I am near Santa Rosa California.  No problem to ship to Cornell.  You just have to get your vet to contact them and learn the ropes.

Gail Russell
Forestville CA
July 2009


Nancy C
 

On Thu, Sep 7, 2017 at 04:51 am, Eleanor Kellon, VMD wrote:
I'll be spending an hour looking at this question of inflammation and fat in equine IR.
Just to be clear, and especially for new folks ---

Dr. Kellon is talking about an hour at the 2017 NO Laminitis! Conference, October 27-29,2017 in beautiful Tucson, AZ.

Veterinary and hoof pro continuing ed credits available.

Early bird pricing of $250 expires 09.23.17

All speaker and lecture info, continuing ed info, conference registration and Hilton reservations can be found at www.nolaminitis.org

Thank you for the opportunity to get this commercial in one more time!
 
I am so looking forward to this and to seeing you all.
--
Nancy C in NH
ECIR Moderator 2003

 

Save the date! The ECIR Group Inc. NO Laminitis! Conference, October 27-29, Tucson, AZ

Learn the facts about IR, PPID, equine nutrition, exercise and the foot
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
ecirhorse.org



Karen Warne
 


Karen Warne
 

Thank you Helen... yes, we are actually close so should meet someday.  I am in Shingle Springs.
--

Karen and Luke 

May 1 2017

Northern California

 

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921


Karen Warne
 

Thank you... I had wondered, knowing that hyperthyroid is an issue in humans too.
--

Karen and Luke 

May 1 2017

Northern California

 

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921


Karen Warne
 

Dr. Kellon,

Inflammation is a huge disease stimulator in humans, and I believe more and more that there must be a definite connection with the inflammatory processes and our horses.  Ever since I got Luke as a youngster, he has had inflammatory responses to grass (he had gingivitis which I figured out was due to the grass sitting on his gums, so I brush his teeth everyday... of course, now he has no grass at all), and he reacts to vaccines (I just did titers for WN this year due to past severe reactions), and bug bites have bugged him relentlessly (until I put him on flax several years ago), but the bug bite reactions are almost non-existent this summer since Claire suggested 10-12 Gms Chondroitin Sulfate/day.  That plus he's on his balanced diet with as low sugar as I can make it.  
--

Karen and Luke 

May 1 2017

Northern California

 

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921


Karen Warne
 

I sure wish I could go... sadly, I have a different commitment, but would love to come to a future conference!  
--

Karen and Luke 

May 1 2017

Northern California

 

https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Luke

https://ecir.groups.io/g/CaseHistory/album?id=5921