https://www.ecirhorse.org/EMS-calculator.php
latest test thru EMS Calculator
This blood work was done by another lab and number reported in different format than Cornell.  So I plugged in here to see and I think it is bad, if I read the notes on the calculator page.
No time tonight to put the new report into CH, but will asap
Opinions?
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Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062

Sorry Sherry, I thought the calculator would copy my numbers.
I have updated CH with lab results and added the calculator results.  The lab is called ANTECH and is in Calgary, AB.  They are the lab for the companion animal vet who is in my towna dn able to do blood tests for me.  I beleive that most of the times K has had blood work done there has been situations that could skew the numbers including transport, laminitis pain, not at home etc.  I hope that this will reflect how she really is, when she is not having to go somewhere else.
Re: time after feed, the vet had to come at 11:00 so horse had only had since about 7:35am from first mouthfull of BP hay a half hour later.
Is this a problem, re four hours after hay meal?  Is horse to get only hay meal on blood test day?  Is it no more than 4 hours of at least 4 hours from hay meal, started or finished?
Thanks for looking at these numbers.
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Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062

It's fairly high but not "bad".  The cool weather and the timing of her first feed might have elevated it a bit.

About 80 uIU/ml is the critical number where acute laminitis can occur in some horses, although many seem to go higher before we see acute pain.  But it's still high enough that her laminae are likely experiencing some minor stretching/damage.  Your target is to get her below 20 uIU/ml if you can.  Might not be possible without exercise and warmer temps, or soaked hay. 

Soaking Shaku's 7% hay brought his insulin down from 41 to 15 uIU/ml this summer (no idea what it is now with colder temps, but you can see the difference that one decision to soak hay made).  I totally understand the freezing temps and trying to do this without an enclosed barn though, so am not judging or criticizing you.  This is the first winter I've soaked hay and our last cold snap of -20C with windchill up to -35C (which is more like your norm!) was really hard to manage.  Thankfully it was only about 5 days, and he's at home with me so at least I was able to set out hay frequently enough that it didn't freeze completely before he could eat it (well it did freeze a couple times, then I learned to just feed it loose because better he eat it all at once then get nothing because his hay net was a frozen ball!).

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

Sherry and Kirsten,
So weather returning to normal, and so is her eating.  Looked like she was not going to eat her BP and soaked cubes with the AT+ in it again (she has the whole time it's been really cold) so she will likely only be getting hay for now.
Also, I will be able to manage Metformin again, so will restart it tonight.
I thought it was still looking high, but on the good side I have found that I can get some more of the Tim 2 hay, which is lowest I have in my shed so keeping her diet within the sugar/starch levels will be easier.  Just wish she would eat the minerals!

I thought the ACTH was finally good, do you agree?

Kandace
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Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062

No, that is definetly what it says.
OMG, someone said that a small animal vet would be fine as they are very used to dealing with the blood wooks on diabetic canines and felines.
Should I be asking them about this?
Kandace
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Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062

Hi Kandace

I would ask your folks what their thoughts are as to why so low.

Not blaming anybody, just seeking information.

I have used our small animal vet successfully many times to send to Cornell.
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Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room

We have been discussing behind the scenes a bit.  Antech usually/always forwards the ACTH portion of the sample to another lab for analysis and sometimes that second shipping degrades the sample and results in artificially low ACTH.  Its possible something else went wrong, too, but either way it appears K's latest ACTH result is uninterpretable.  You're kind of lucky its so low because it flagged it as questionable; if it was a reasonable number within range you would never know that you can't trust this result.

I'm sure you can request a refund from the vet you used and maybe you can ask your the vet to ship to UGuelph next time.  ACTH is done in-house there.

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

Kirsten, do you have a question on the glucose and Insulin also or is it just ACTH that you are aware they send out?
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Kandace K Rocky Mountains, Alberta, Oct 2
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062

Kandace, Kirsten may weigh in later but there is no reason to suspect the insulin and glucose values as they are not alarmingly low and that testing can be done in Antech’s labs.  The samples for ACTH testing get sent on to another lab (you could ask where) and it is during that second shipping process that the sample often degrades.  Hence, the suggestions you ask to have the samples sent directly to UGuelph.
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