Advice Please- our first laminitic episode


Kelly Gilmartin
 

Could the heat have caused this? We had seversal days of 100+ temps and Nothing changed in his management.....need advice- would you soak the hay whose analysis I have left in my case study even though esc+starch is under 10%? Also, how soon after the episode can I walk him? He is in a run out and we have noticed the last few days he is going outside to poop so he is more comfortable moving but if insulin is high how can I get that down without exercise and starvation? I am feeding only beet pulp without molasses, his supplements and hay.  How much beet pulp should I feed and for how long= can he stay on beet pulp instead of TCLite which is what he was getting before. He only got 1/2 lb of TCLite AM and PM which is a lower starch food.  I am feeling so guilty about it all. 
--
Kelly Gilmartin/Buddy
Western Massachusetts 
member since 2020
https://ecir.groups.io/g/CaseHistory/topic/76050923


Lorna Cane
 

Hi Kelly,

 Can you substitute this link in your signature,for the one that is there? It will go directly to your case history for Buddy. 

https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Buddy/Kelly%20and%20Apostrophe%20GCH/BuddyCaseHistory.pdf

Can you add the lab numbers,so that we can get a handle on how he's doing in that area?

Are you still feeding 25 pounds of hay a day?
We never want to think about starvation .There is a safe way to help take the weight off,without making the horse miserable, and more details would help addressing this.

Morgan's are IR poster ponies, so you are not allowed to feel guilty !
You're here, and that's great for Buddy.

Thanks!
--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Lavinia Fiscaletti
 
Edited

Hi Kelly,

You do the best you can with knowledge you have at the time, so no more feeling guilty. Let's just get things tightened up even more so Buddy gets back on track.

Here is the link to Buddy's photo album:

https://ecir.groups.io/g/CaseHistory/album?id=251736

It would be helpful if you would add this to your signature .

You can definitely use beet pulp as a safe carrier for supplements - there's no limit on time for that. Use the minimum needed to get him to eat his supplements as beet pulp is more calorie dense than hay. TC Lite isn't recommended to feed to an IR horse as the ESC+starch numbers are not guaranteed and have been found to be more than 10% when tested. Beet pulp needs to be rinsed, then soaked, then rinsed again before feeding.

We need to see all the results of any blood work that has been done as there are none in his Case History. Did you have the TRH Stim test redone after starting him on the Prascend (pergolide)? Have you had insulin and glucose tested? Have you had any blood work run this year? PPID is a progressive disease so it may be that his dose of pergolide is not controlling his ACTH well enough now that the seasonal rise period is starting. Although early for normal horses, ones that are PPID tend to start their rise earlier, as well as going higher and lasting longer.

His diet needs to be mineral balanced to his hay analysis. If he should weigh 900lbs, he should be receiving no more than 2% of his ideal body weight daily in total food intake or 1.5% of his current weight, whichever amount is larger.. This includes hay, feed, pasture, beet pulp (dry weight). That means no more than 20lbs total is he weighs 1000lbs now and has  BCS of 9 (looking for that to be a 5). According to his CH, he gets 25lbs of hay, 1lb of TC Lite (or now BP)  He shouldn't be allowed any grazing at this point due to the laminitis and because he is a Morgan - a breed that is one of the poster children for IR. This isn't starvation - it's what his metabolism requires to maintain a healthy weight. At a BCS of 9, his "off switch" telling him that he is full is definitely NOT working, so you need to help him manage himself. Here's the link to the Diet Balancing folder in the Files. A list of people who can help you balance to your hay is in the Help with Hay Balancing pdf:

https://ecir.groups.io/g/main/files/6%20Diet%20Balancing

The Protandim has been discussed here before - it's a waste of your money. Please do a search in the archives for more info but here are a couple of past messages to get you started:

https://ecir.groups.io/g/main/message/239241

https://ecir.groups.io/g/main/message/237520

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Kelly Gilmartin
 

Hi Lorna,
I updated all the lab values I have.  I welcome your advice. 
--
Kelly Gilmartin/Buddy
Western Massachusetts 
member since 2019
https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Buddy/Kelly%20and%20Apostrophe%20GCH/BuddyCaseHistory.pdf


Lorna Cane
 

Hi Kelly,

Thanks.Am taking a look. Trying to find units that Antech uses for ACTH.Wondering if it's same as Cornell.Anyone?

Kelly,this is a workable link to your case history.( thanks Sherry)
https://ecir.groups.io/g/CaseHistory/filessearch?q=kelly+and+apostrophe

Should replace the one in your signature now. Go to Subscription,replace case history link with this one.Scroll down and hit Save.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Lavinia Fiscaletti
 

Antech would be sending the ACTH out to Cornell in the Northeast, so the ref range would be 9-35pg/ml.

Unfortunately, the results of the ACTH when sent thru Antech are questionable as the sample gets sent out twice, so there's more chances for handling issues. From experience, when one of my horses had his samples sent thru them the result came back as 7pg/ml but sent directly to Cornell, it came back in the 60s. Your mileage may vary but it's something to think about. Leptin had to have gone to Cornell as they are the only lab that does it.

You had said he was originally diagnosed using TRH Stim test. Do you recall why the TRH stim test was used as opposed to just the ACTH? Can you get all of those results as well? If the pre-injection value was in the normal range, you may need to use TRH stim testing to monitor him as well.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Kelly Gilmartin
 

So, can someone help me understand how to use a repeat TRH stim to adjust Pergolide dose of 𝐍eeded? No vets in my area can help and I am
Most likely going to have to explain to them.

Also, does a TRH stim (if results are high) expose my horse to another risk of laminitis? We are still recovering and I don’t want to stress him or risk going laminitic again.


--
Kelly Gilmartin/Buddy
Western Massachusetts
member since 2019
https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Apostrophe%20GCH


Lorna Cane
 

Hey,Kelly,here is the correct Photo Album link,for your signature.
https://ecir.groups.io/g/CaseHistory/album?id=251736

Sorry,can't help with your question.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Sherry Morse
 

Hi Kelly,

I may have missed this, but are the TRH results in your Case History or an email?  Has this test been redone since his intital diagnosis last year?  As per the advice in your welcome email (Re: Follow up Tests to Determine if Pergolide dose is ideal) there should have been a follow-up test after Buddy was on the target dose to see if the pergolide was effective.  At this time of year with the rise starting it's going to be a bit difficult to assess if the dose is working for him or not using TRH so it may be best to just do a straight ACTH test.


Looking at his CH and x-rays the things that are going to help him the most right now are getting his diet in order (meaning no more than 20lbs a day total of hay plus any hard feeds) and getting his trim sorted out.  Has he been trimmed since those x-rays were taken?





Eleanor Kellon, VMD
 

I don't think I've ever seen a good discussion of this but you certainly could use TRH stimulation to determine how much suppression your dose of pergolide is providing. The dex suppression test was used that way in the past. It's not reliable this time of year for diagnosis because no one has determined the seasonal ranges but if the goal is to keep good suppression all year you could use it.

I've never heard of a laminitis flare linked to TRH stimulation, probably because the effect is short-lived.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

On Sun, Aug 9, 2020 at 07:16 AM, Eleanor Kellon, VMD wrote:
you certainly could use TRH stimulation to determine how much suppression your dose of pergolide is providing
Dr Kellon, what would we be looking for to see that effect? Pre- and Post- TRH values fairly close?
 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos 


Eleanor Kellon, VMD
 

The test results will describe the range for a normal response but basically yes, little change with TRH. This doesn't allow for the normal seasonal rise, but in horses prone to laminitis even the usual seasonal rise may precipitate an episode.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001