Date
1 - 12 of 12
Candy Update: Invokana on board Questions and Concerns re. symptoms and diet
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Shawn Gould
Candy began Invokana on 1/25/21, 225mg due to insulin at 88 and sore feet. Increased to 300mg after one week. Retested insulin and ACTH after 3 weeks on Invokana. Insulin dropped to 23.1 Idexx norm 4.5-20. (Glucose strips consistently ay 30 range after 30 seconds and drug kept in barn at 40' for a week until I found out it is suppose to be kept ay 68'-77'!, So lucky efficacy was not effected in this case.) This is the lowest Candy's insulin has been to my knowledge. ACTH 22 norm 9-35, after increase of Prascend in August to 2.25 even though ACTH tested normal then as well. So you would think everything might be good. It is not, we still have a long ways to go. Vet thrilled at response to Invokana, but Candy still has many symptoms. (I watch Candy eat all the pills so I know she is getting all of them consistently)
They include: Suborbital bulges, slightly gooey eye d/c, a crest (Body score 4-4+), coat changes (I had to clip her so much last year, I'm not sure where we are on this), heat intolerance, sore feet, (Although this has improved a lot and her weight shifting is much improved as well) with pulses in front, intermittent in back. Again vet said treat the symptoms. Prascend increased to 2.5 on 2/19/21. I don't completely understand how using Prascend and Invokana work in tandem. So even though Candy's insulin is almost normal all these symptoms persist. So does that mean the seemingly normal ACTH is not controlled and is fueling the the insulin levels? If that is the case, how could the insulin drop so much. Or is it just too early to see symptoms dissipate? It seems like most people see an abatement of symptoms very quickly on Invokana. Another question is when treating with Prascend which comes first, symptom abatement or a drop in lab numbers? How long should I wait before testing again or do I just keep increasing the Prascend every 3 weeks until symptoms improve, since I'm treating those and not responding to the lab number? I tested Candy's hay: 6.6 esc + starch and a protein of 15.9. Two different tests have been done on this hay, one by me and one by the grower. The grower's numbers were 7.8 e + s and 13.6 protein. I can only assume he had a much bigger sample than I did. I only could get to 8 bales. That being said, if protein was contributing to symptoms could that be mitigated by increasing TC Timothy Natural Balance cubes and decreasing the hay? Another missing link is balancing this hay. I have not submitted it yet because I have so much trouble getting Candy to eat balancers. I was hoping to have a hint about a direction to go in. She eats around the pellets of U Balance and Grass Select. I need to have a fairly fool proof way to get minerals into her before I spend so much money on them. Candy is notoriously picky, hates flax and won't eat anything wet or damp. She tolerates Cocosoya. Taste tempters don't really apply to her unless it's TC Senior and I have decided to drop it all together in case it is contributing to her being foot sore. Plus it didn't work that well either. However, I do use one tablespoon, literally to give her all her pills. So far I have had the most luck is giving all supplements separately with high ratio of Timothy Pellets esc + starch 7.4. Thanks in advance for some guidance, Shawn and Candy Dec 2020, Santa Cruz, CA Candy Case History: https://ecir.groups.io/g/CaseHistory/files/Shawn%20and%20Candy Candy Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=258140 |
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TERRI JENNINGS
Hi Shawn,
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Jennifer Murphy
Flea's ACTH is within normal range for the first time in years, and his insulin was 270 when I started him on the Invokana. I didn't see outward signs of relief until around the beginning of week 3, even though his insulin had dropped to 88 by the 1st week. I think each equine must respond differently.
-- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0 |
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Hi Shawn,
It sounds like the Invokana is helping with the high insulin caused by Candy being a horse with EMS, which is a genetic type she has always been, but the remaining signs you are describing are more likely to be related to poorly controlled PPID, which is an age-related disease condition she likely developed in the last few years. They are 2 separate conditions, although the typical signs overlap to some degree. The insulin does not have to be high for the physical signs of PPID to manifest. The heat intolerance and coat changes in particular are indicative of PPID, but so are all the other signs you listed. Her low body score is another sign that PPID isn't being fully managed. There are some cases of PPID where the ACTH just doesn't provide a measure of the disease, so if Candy's is 22 and you are still seeing these signs, try to get it in the the middle 'teens. Many of our members report that their horses do best with ACTH around 17. You are lucky you have a vet that says to treat the signs, not the numbers... If you get a custom mineral mix made for your hay, it will be a granular powder that Candy cannot "eat around" after you mix it in to her carrier. Or, some people dampen their hay and just sprinkle the minerals on top of it to get their picky eaters to actually eat the minerals! I don't know if she'll eat her hay dampened? With that high protein, you should run a nitrate test. If nitrates are high, the hay will need to be soaked to be safe to feed. -- Kirsten and Shaku (IR) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Just going to add to my post (now that I have more time!), you definitely could feed more Timothy Balance cubes and reduce the hay. I'll reiterate again that the high protein in a grass hay, and that it is California hay make me very suspicious that nitrates are elevated. They could easily be in the toxic range so I really think you should have nitrates tested and in the meantime soak it for 1 hr (cold) to remove as much nitrate as you can. You can add this test to the sample you already submitted if they still have it. See also this post on a possible worsening of laminitis pain due to high nitrate in the diet:
https://ecir.groups.io/g/main/message/237335 Cass, one of our Moderator is very experienced with hay and is familiar with high nitrates in California hays so maybe she can add to this if she see this. Here, she is commenting about high protein California orchard grass hay and if you read the whole message chain you can see that irrigated 2nd and 3rd cut can be too high. https://ecir.groups.io/g/main/message/237362 Great news that you got Candy's insulin down!! Her insulin is low enough that her hooves should start to grow in much more healthfully. Optimizing her trim and providing soft footing or padded boots are the best things you can do for her pain right now. She is on the mend though! -- Kirsten and Shaku (IR) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Hi, Shawn.
Protein of 15.9% in an all-grass orchard grass hay is highly suspicious for high nitrates. Sometimes grass hay that contains some alfalfa or other legume can have a profile similar to this hay and not have high nitrates. The only way to know is to test for nitrates. Checking is a fast and easy test through Equi-Analytical. -- Cass, Sonoma Co., CA 2012 ECIR Group Moderator Cayuse and Diamond Case History Folder Cayuse Photos Diamond Photos |
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Can you convert nitrogen to nitrates? And 9f so what is the calculation for example if hay has a test of 2.10 nitrogen as fed?
-- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Hi, Nancy.
We evaluate nitrate in forage using Dry Matter values. EA quantifies nitrates in two ways: 1- PPM Nitrate-Nitrogen, which means parts per million of nitrate as nitrogen 2- % Nitrate [ion] Other references (including posts I've made) also use a third way to quantify nitrate: 3- PPM Nitrate [ion] To convert PPM Nitrate-Nitrogen to % Nitrate, multiply PPM Nitrate-Nitrogen by 0.000443. To convert % Nitrate to PPM Nitrate ion, just move the decimal place 4 spaces to the right (multiply by 10,000). So if PPM Nitrate-Nitrogen is 226, then % Nitrate ion is 0.1 and PPM Nitrate ion is 1001. I'm happy to say that the nitrate guidance in Files doesn't require any math conversion from EA reports: both PPM Nitrate-Nitrogen and % Nitrate Ion are listed. https://ecir.groups.io/g/main/files/5%20Core%20Diet/1.%20Hay%20Information/Nitrate%20Guidelines%202012.pdf An easy rule of thumb is that if % Nitrate is 0.25 or less, the hay is probably safe for most equines. I personally use % Nitrate of 0.1% or less (PPM nitrate ion of 1000 or less) as ideal, based on Dr Kellon's informed opinion and the inherent variation of nitrate within any load of hay. We wish there were detailed research on equines to confirm these levels of safe nitrates, but to the best of my knowledge, there isn't. We do know that high nitrates can cause laminitis, and, at a very high level, death. -- Cass, Sonoma Co., CA 2012 ECIR Group Moderator Cayuse and Diamond Case History Folder Cayuse Photos Diamond Photos |
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Thanks Cass, the Dairy one test for this same hay has a row for Nitrogen at 2.18 assuming %. In the context of the info above which element is it? I am confused by nitrate vs nitrogen and I am totally dumb when it comes to math. ;)
I bought some of this same hay too and have a test out on it including nitrates :) it is lovely grass so I hope it works out. -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Nancy,
We're deep in the weeds, and we're heading OT for this thread. Further details, assuming I can answer your questions, belong in the Horsekeeping subgroup. Total nitrogen is what is actually measured at a forage lab that reports Crude Protein. Total protein includes both true protein (organic compounds containing amino acids) and non-protein nitrogen, such as nitrates. So Crude Protein is only an indirect calculation of actual protein in the hay. Total Nitrogen doesn't tell us anything about how much of the total nitrogen is from nitrates. A separate test is required to detect nitrates within certain ranges. -- Cass, Sonoma Co., CA 2012 ECIR Group Moderator Cayuse and Diamond Case History Folder Cayuse Photos Diamond Photos |
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Thank you:)
-- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Shawn Gould
Thanks to everyone for your thoughtful responses. I just called the lab and they still have the sample and can test for nitrates for $11! So between Nancy and I we will get a good number. My other question is regarding ACTH. Does anyone have a sense of which comes first, symptom abatement or a drop in lab numbers? I ask this because I’m wondering if after 3 weeks if there is no change in Candy’s PPID symptoms I should increase Prascend again by quarter tab? Thanks |
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