Topics

Weight Gain Woes


lindsaykrauland@...
 

So far, Audi just can't seem to gain and hold weight.  Perhaps it's still too early in his treatment to notice a difference, but it's really bothering me.  There are several body shots in my album, including one I posted just now. 

Brief history:  Audi began pergolide in early June and titrated up to 1 mg/day as of June 25. Audi tolerated the meds very well and never showed any sign of the veil.  I gave him APF along with the meds initially.  His ACTH was not particularly high, and the vet initially didn't even want to treat but came around to a trial of pergolide after we had a discussion about it and I presented him with some data from here regarding the many signs of PPID.  Initial ACTH was 45 Pg/mL via RIA, a borderline result per the lab.  Since initiating pergolide, I've seen a nice improvement in many of Audi's PPID signs: better energy,  improved skin & smoother coat, slightly less weepy eyes, new hoof growth looking good.  Initially, I think he was also urinating & sweating less, although I've noticed a possible uptick in that the past week or two.  Audi is due for his ACTH recheck, and I intend to have that sent off this week.

Our hay is low in protein, and we've considerd that as a possible cause of Audi's weight/muscle loss.  Since June 23, Audi has been on a diet which Dr. Kellon suggested to help combat a potential protein deficiency:

*Free choice hay + custom balancer
*5 lb TC Safe Starch (In reality, I offer this as his PM meal and just keep filling his bowl until he leaves it.)
*4 lb TC Timothy Balance Cubes
*2 lb TC Golden Ground Flax
-Plus 3000IU Emcelle E, salt, jiaogulan, Get-Away, and Move-Ease
 
Is it too early to expect to see an improvement in his weight?  Should I try changing up his diet again?  (He has a good appetite and pretty much finishes everything I put in front of him.)  I've been tape-weighing him, although I get somewhat inconsistent results and wonder whether his weight is really fluctuating or whether I'm holding the tape badly.  My CH is up to date, except for today's weight.  In addition to switching up his diet, I also dewormed him several weeks ago, although he had a clean fecal in late April.  The weights I've gotten are:

*6/4: 1050#
*6/25: 1065#
*7/13: 1098# (Thinking this might be my error)
*7/27: 1065#

All in all, it's looking to me like maybe he's not being controlled on 1mg.  Or maybe he has something else going on in addition to the PPID.  I'm going to have a chem panel run on him in addition to his ACTH.  However, is it at all likely that he wouldn't be controlled on 1mg, given that his ACTH wasn't super high to begin with?

Finally, as I said, I'm going to re-check his ACTH and get a chem panel this week.  I'm pretty sure the chem panel will include glucose, and I'll order a separate insulin test.  Is there anything else I should strongly consider?  The vet really wants to send off to Texas A&M again so that he can directly compare the ACTH results.

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Sherry Morse
 

Hi Lindsay,

So the positive - I think Audi looks a lot happier and he does look overall better than he did compared to your original pictures.  The fact that he still has a good appetite and is cleaning up his food is good, but I agree that the lack of weight gain would have me worried as well.  How have the temperatures been down there during all this? 

I think we've checked most of the boxes on the weight loss checklist: https://ecir.groups.io/g/main/files/5%20Core%20Diet/Weight%20loss%20check-list.pdf but have his teeth been checked recently (sorry, I just can't remember)? Is he dropping any feed that you know of or not chewing anything completely? 

For peace of mind I'd want to do a complete CBC on him just to make sure nothing's being missed while you're focusing on his ACTH but having the insulin and glucose numbers in addition to the ACTH will be helpful as well.

My response to the vet would be something along the lines of you're paying for the tests, you want them sent to where you want them to go; but if he wants to have them tested at A&M on his dime you wouldn't object to that just to see how it compares. Your mileage may vary on that :-).


Eleanor Kellon, VMD
 

I agree with the chem panel and would send to both A&M and Cornell for ACTH. His body condition and skin issues certainly look like uncontrolled PPID (or is that dried sweat on his coat?)

Do you know how much hay he is eating?  The other items are supplying only about half the calories he needs for his size. Is the hay stored outside?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


lindsaykrauland@...
 

Thanks for the replies! 

Sherry, the temps down here have been intolerable, basically. We've had a couple weeks of 100*F or higher every day, with little relief overnight. We had one day of rain and cooler temps this past weekend, but now we're back up in the high 90s/100s and no rain in sight.  Typical south Texas summer, unfortunately! And Dr. Kellon, you are seeing some dry sweat on Audi. However, he is also scurfy, especially in his mane and along his flanks & hips. However, I think his skin is looking better overall. Previously, he was getting weepy skin lesions, in addition to the "dandruff."

Yes, we've checked off most of the weight loss boxes. I've not had him worked up for ulcers, and the insulin/bloodwork levels are pending. Otherwise, we've considered everything else. His teeth were last done by an equine dentist in March or April- I'd have to double check my records, but it wasn't very long ago. She was pretty conservative in her treatment and overall felt his mouth looked good for an older guy. He has worn teeth, naturally, but none are missing, loose, or worn to nubs. She recommended yearly exams/treatment unless we noticed problems sooner. I really haven't noticed him dropping food lately. And as for what comes out the other end, his manure generally looks indistinguishable from our younger gelding's. 

Dr. Kellon, do you also agree with a CBC in addition to the other tests? Certainly, I want to get to the bottom of Audi's issues, but I also want to be careful to target the most reasonable potential causes. We are really throwing quite a lot of money at this guy, between the meds, x-rays/exams, labs, twice-monthly hoof care (he's currently in casts), etc. As we run an entire farm, we have to be especially careful to be good stewards of our money, partly to ensure something is available for other animals who may need it. For that reason, I really can't justify sending ACTH to both A&M and Cornell. His last ACTH was $105, and I can't justify doubling up on that. However, might you have something- a study or just personal experience- that I could show the vet as a means of justifying sending everything to Cornell instead of to A&M? Unfortunately, he's not familiar with ECIR, save for what I've told him, so simply saying ECIR prefers Cornell has not swayed him. 

When I last weighed the hay bags, I calculated an average intake of 17.5 lbs/horse/day. I tried running the numbers, and my calculations indicate Audi should be getting sufficient protein and calories assuming that intake amount.  The hay is stored outside. 

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Sherry Morse
 

Hi Lindsay,

Not sure what to do about the vet but FWIW to run ACTH, glucose, insulin, leptin and T4 at Cornell should be $100 (not counting what the vet may charge you for sending it there and pulling blood).  I'm not sure how that $105 fee for just the ACTH was calculated but seems like it's awfully high to me.  To get it slightly more apples to apples ACTH + insulin is $46 at Cornell.

As far as the heat question - many PPID horses don't seem to do well with the heat. I'm not sure if that would effect his ability to gain weight if he's still finishing all his food, but just something to keep in mind.





 

Lindsay, I keep a fan trained on my horses when they are outside in the heat.  It’s out of their reach but they take turns standing in front of it, especially those that are PPID, even with a short coat.  Believe it or not, summers can be pretty hot here in Vermont, the first thing we noticed when moving here from med/grad school in Houston, years back.  
We have a farm here as well.  We only have horses, chickens and dog at the moment but for years we had cows, sheep, llamas, geese, goats.  You name it.  I understand how it can stretch your resources thin to care for them all but fortunately they generally did not all require extra attention simultaneously.  And, if I ever needed to justify an expense, it would be as a learning opportunity for my kids.  
I agree that Audi looks more comfortable - I think I mentioned that last photo round - but I’m disappointed he hasn’t added more weight.  I feel the same about a 30 yo Anglo Trakehner I have.  He has added some weight, just not enough, but is slick and shiny.  I increased his pergolide and give him as much in the way of balance cubes as he’ll eat, plus his hay.  Older horses require a lot of loving care!
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


LJ Friedman
 

My understanding is that most vets  will double or triple what they pay to Cornell
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


lindsaykrauland@...
 

Sherry, I am somewhat frustrated by the ACTH cost last time. The A&M fee schedule says ACTH is $34 + $7 lab fee. The vet informed me shipping was $30-ish. I'm guessing the rest was the vet's handling fee, which is quite annoying, as I drew the blood myself and hand carried to them. All they needed to do was spin it down & package it. I have asked them for clarification on the fees but haven't yet heard back. The price they quoted me today was $68 for ACTH and $42 for Insulin/Glucose. Both of those are twice what A&M states in their online fee schedule. Again, I'm pulling the blood myself. Certainly the vets are well within their rights to charge a handling fee, but if I am correct and that fee is double the cost of the tests, I do feel that is excessive.  What do you all think? I've used these particular vets for years, so I really have no idea what other clinics charge.

Today I was quoted $68 for ACTH, $42 for insulin/glucose, and $40 for chem panel. Again, I'm waiting on clarification, but I don't think that includes shipping, based off what I paid last time. I also don't expect those costs to change significantly if I go with Cornell. The Cornell & A&M fee schedules looked quite comparable when I compared them last week.

I have wondered about the heat. It's getting to everyone here, for sure.  No one has lost body condition like Audi has, though! Our other gelding really should lose weight, honestly. I need to take a hard look at his diet soon. I highly suspect he's IR but at the moment I just don't have the bandwidth or the dollars to start testing him, too. In the meanwhile, he's getting the same feeds as Audi, just in very different amounts, so I hope managing him similarly to a PPID/IR horse will keep him under control. 

Martha, I absolutely want to do what's best for the animals, and I do realize that takes considerable resources. It really is a balancing act, though, for us.  You're right that most of the animals don't need special care at any given time, but in addition to Audi, we have one barn cat on lifelong treatment for stomatitis and a house cat on whom we recently spent $100s to save her eye. One of the dogs recently suffered a minor injury but needed treatment for the resulting infection. And  allthe animals are on the highest quality, physiologically appropriate diet we can reasonably offer. I honestly don't mean to sound defensive, and all the animals do reasonably receive what they need, but again, we have the responsibility to seriously consider our expenses and use our finances wisely. If Dr. Kellon or our personal vets believe Audi should be tested for something other than what we have planned, we can certainly give it a go, but we can't be testing indiscriminately. 

I am glad the consensus is that he's looking generally better!

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


lindsaykrauland@...
 

LJ, yes, that seems to be the case. We cross posted regarding the fees.
--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Kirsten Rasmussen
 

Wow.  For perspective, I just paid 250$ for ACTH, insulin and glucose here in Canada, plus 80$ shipping and a 45$ collection fee (which does not include the call-out and travel charges for the visit)...I know our $ is worth less, but not THAT much less!

My only suggestion is that you think they are each eating 17.5 lbs, but if they are kept together you don't know for sure?  I wonder if the younger one is eating more than his fair share at night when no one is watching and Audi is napping?  I used to keep 2 horses penned together and every moment when the hard keeper wasn't eating, my easy keeper was...guess who got fat and who stayed slim.  Just a thought.

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History  
Shaku's Photo Album   


ferne fedeli
 

Wow, Kirsten, $250 is really expensive.  I'm sure it is less than $100 at Cornell and then there is a $5 secession fee and the overnight shipping is $15.  I looked at my last draw and the ACTH, Insulin & Leptin was $72 & I'm thinking the Glucose was like $12 or something...  My vet only charged me $25 to do the draw and I told her it wasn't enough!  My other vet used to charge $50 I think...
--

Ferne Fedeli  Magic & Jack   2007

No. California
Case History

 

 


Maxine McArthur
 

On Wed, Jul 29, 2020 at 07:41 AM, Kirsten Rasmussen wrote:
Wow.  For perspective, I just paid 250$ for ACTH, insulin and glucose here in Canada, plus 80$ shipping and a 45$ collection fee (which does not include the call-out and travel charges for the visit)...I know our $ is worth less, but not THAT much less!
And here in Australia, I pay $110 for ACTH, $120 for insulin, plus call-out around $80 and handling $50+. Double the test costs for two horses. It's a great incentive to keep their diet tight and save on the insulin test... 
If I come away with change from $500 I'm thankful (sometimes I manage to share call-out fee with someone else on the property). 


--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Joy V
 

Wow!  Last draw I paid $145 for ACTH & $168 for insulin/glucose.  This is Northern California.  My vet uses an in-house lab and the prices went up from last year.  Maxine, I'm the same, no matter what it seems like the vet bills are always right under $500.  But my pony *is* worth it.
--
Joy and Willie (PPID/IR)  

Case history:  https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Willie
Willie's photo album:  https://ecir.groups.io/g/CaseHistory/album?id=242526


lindsaykrauland@...
 

Kirsten, yes, you are correct that there's a chance the other horse is eating more than his share of the hay. I've not separated the horses and weighed Audi's hay apart from his buddy's. That said, the hay nets are never allowed to run out, so Audi has the opportunity to eat as much as he wants. I realize there could be a chance that he's not chewing thoroughly and/or isn't fully digesting his hay, but all in all, I don't think that really explains his inability to gain. He's been on his improved diet for more than a month now, and the diet is providing a significant number of calories & nutrients in a form that should be easy for him to chew and digest.  Since he was previously receiving *far* less bagged feed, I think he should have showed some gain by now if his main problem had been his lack of/inability to derive nutrition from hay. However, he really isn't showing any significant change in body condition that I can appreciate. I think that highly suggests something else is going on, but please someone correct me if I am wrong.

There's such a wide variation in test prices! Interesting!

I pulled blood this morning for Audi's new labs. I should have the chem panel results by the end of the day, as they are running that in-house. I also requested ACTH & insulin. Interestingly, I noticed  that A&M lists insulin as a referral, and the lab they send out to is Cornell's. Bah!

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


 

I just completed a two month experiment trying to feed two horses together so they would get equal amounts.  Had it down to 9 feedings a day of a ration of a little less than 16 pounds per horse.  The non IR horse was dominant, but they were Fjords , so were willing to eat side by side.  IR horse still got too much.  He just chewed faster.

--
Gail Russell 8/30/2008

 

 https://ecir.groups.io/g/CaseHistory/files/Gail%20and%20Brother%20-%20Odin%20-%20Decaffe%20%20-Gunthar .


lindsaykrauland@...
 

Despite his bag o' bones appearance, Audi is definitely the dominant horse, so I'm sure Mo is not stealing his food. (Actually, now that Audi is less lethargic on pergolide, Mo has been sporting quite a few war wounds from trying to cross Audi. Nothing serious.) And they are generally happy to eat side by side, plus their "hard feeds" are always fed with them separated, so I am sure each horse is getting his calculated amount of the cubes,flax, safe starch, and minerals.

Admittedly, feeding the hay while the horses are on track has beena challenge. Audi needs all he can get, while Mo is an air fern. I've considered a grazing muzzle for Mo (no actual grazing on the track but rather to slow down his hay intake), but fussing with putting it on and off is just one more thing to mess with each day. More importantly, I'm not sure eating the hayis doing Mo any harm. Our current hay is very low s/s. Mo's maybe slightly overweight but not cresty. And as for Audi, he still has all the hay in front of him that he can/wants to eat, so I think they should both be fine with the current arrangement?


Sherry Morse
 

So Lindsay,

Where are you have you having the ACTH done if A&M is shipping the insulin out to Cornell anyway?




lindsaykrauland@...
 

I had emailed the vet a couple days ago to ask about labs & pricing but didn't get a reply. (To be fair, they are usually really good about responding and are probably completely sick of me at this point!) So yesterday I simply emailed to let them know my husband would drop off the samples this morning and that I trusted whatever they thought was the best deal  asfar as pricing. I did ask them to consider the economy of sending to Cornell vs A&M.  My husband tells me they told him both ACTH & insulin are going to Cornell. So Cornell it is, I guess! 

I am pleased that this will make it easier to compare Audi's results with much of the published data.

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Maxine McArthur
 

On Thu, Jul 30, 2020 at 01:56 AM, Gail Russell wrote:
IR horse still got too much.  He just chewed faster.
We have this problem. The mare eats twice as much as the geldings in the same time. The only way we manage is to give the non-IR gelding some extra grazing time, and both geldings get more in their buckets. And the mare gets regular exercise. But it’s a logistical challenge and sometimes I feel like the ring-master of a large circus!
 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


lindsaykrauland@...
 

I added the serum chemistry lab results to Audi’s case history.  Everything came back within normal limits.  If anyone sees anything interesting in the results, please let me know.  Otherwise, he looks good from that standpoint.

Still waiting on ACTH & insulin from Cornell.

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156