Dr Kellon Invokana and Lipemia - urgent


Nancy & Vinnie & Summer
 

Hi Dr Kellon,

My vet asked me to post. She feels that since starting Invokana Vinnies liver is having problems.  She said that "there is fat in the blood (lipemia). I sent the serum in for the chem panel as his serum was cloudy.  Had already spun down the lavender top tubes so did not have the correct sample to send in for a CBC in addition to the chem panel."  

She asked me to confer with you for next steps on Invokana and if we should stop?

Attached is the latest bloodwork.  We don't have the full chem as she has already spun the blood down for metabolic panel which should be back soon.


--
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


Nancy & Vinnie & Summer
 


TERRI JENNINGS
 

Hi Nancy,
Elliott had lipemia prior to invokana and prior to getting him on tested and balanced hay. His liver values weren’t great just before starting invokana and they got worse at his first blood draw after starting and he had some fat in the vial once again, not quite as bad as the previous episode where he had lipemia. Finn’s pre and post bloodwork was quite similar to Elliott’s except he had no lipemia. My vet also was concerned and thought perhaps we should stop giving them Invokana. I told her they were going to continue to get it regardless. It’s making them comfortable and without it they would not have any quality of life. Going from one laminitic episode to the next with a very short break was no way to live.  Dr K emailed me or posted here that both boys likely have fatty liver disease and that in humans invokana has shown some benefits for the liver. The ECIR diet helps with fatty liver disease so you’re already treating it. I did put both of my boys on SAM E and milk thistle. Our last blood draw shows improved liver values. Not “normal”, but moving in the right direction.   I’m wondering if things have to get worse before they get better. 


If you do try the SAM E just know that it gets very sticky if there is any humidity. It’s a bit difficult to measure in Northern California this time of year. It sticks to me, their medicine bowls and the measuring spoon. It’s super easy to inhale as well so I make sure I wear my mask. 


I’m sure Dr K will have a much more succinct and informative response but I’m hoping our experience helps you. 
--
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
Joined 2019


Nancy & Vinnie & Summer
 

Thanks Terri, we ended up at UC Davis tonight with a colic seemed like gas but couldn't stabilize and we thought because of his elevated triglycerides and this bloodwork looking so different from January which was normal  that we haul in for palliative support.  He has been just off the last few days and with this weight loss I want to make sure he gets the best care for the best possible outcome. Prayers welcomed.

Thanks Nan ans Vinnie
--
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


Nancy & Vinnie & Summer
 

Just a quick update, Vinnie is being hospitalized for high triglycerides and high lactate. Will know more tomorrow hopefully. 
--
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


Eleanor Kellon, VMD
 

When there is some feedback from UC Davis I'll post on this issue. Also in direct communication with Nancy and her vet.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Joy V
 

Prayers for Vinnie.  I hope he is doing better. 


--
Joy and Willie (PPID/IR)
Nevada County, CA - 2019

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


Jennifer Murphy
 


Eleanor Kellon, VMD
 

Nancy will probably update you herself when she can but the news from UC Davis is that he is improving on blood work and doing well, eating well.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lynn
 

Continue prayers for you Nancy and Vinnie. Hang in there! Glad to hear positive news from UC Davis. 
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω


Nancy & Vinnie & Summer
 

Hi everyone. Thanks for the healing thoughts and prayers.

Vinnie is stable. I wasn't able to see him this evening when I dropped off all his food and supps n stuff due to covid rules. But I did see an image of my boy looking a little pekid. 

I will post more tomorrow but in essence Vinnie presented as a gas colic yesterday evening and after being unable to stabilize him plus him acting just off, and in light of the chem we got back showing extremely high triglycerides we decided to haul to Davis.

They ruled out colic right away and were concerned that his lactate and triglycerides were so high and recommended hospitalization. I spent time going in depth about what we have been dealing with metabolically in the last two years and left for the night.

This morning I got word that with IV fluids lactate levels were back to normal and he was chipper and eating. The plan for the day was to add glucose by IV very slowly to reduce triglycerides. Obviously concerned because of metabolics.and there was no plan in place to monitor insulin. 🙄

I.won't go onto all the details as my mind is swirling a bit, but this evening i was told they had taken Vinnie off all his metabolic meds ( invokana, prascend, and thyrol) which was not what I agreed to and I am extremely worried about a laminitic event .  I had only agreed to stopping invokana temporarily and restarting at a lower dose; as we hypothesize that perhaps the higher dose was what put Vinnie into lipemia.  Dr Kellon can explain the latter more completely than I.

The Davis team feels that their main goal is to save Vinnies life by reducing triglycerides and send him home for us to deal with the metabolics.  I implored the doc to at least start prascend and he said that he may at. 50 which is half the dose he was getting. His reason is it can cause inappetance and this can negatively impact triglycerides. He was not willing to administer APF. Ugh! Worried!

That being said; There was some better news today,  we got the metabolics panel back that was taken 3/8 and Vinnie's insulin was 30 and acth 19  which is awesome and hopefully with this being in this range will take time to increase while not on meds.  

I am worried... but hopeful... more to come tomorrow.  Xx Nancy


--
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


Nancy & Vinnie & Summer
 

Update from yesterday. I got word at about 12 pacific time that Vinnie's triglycerides had increased to 1500 from 1000. He was eating well and so their thought was that Vinnie had been in an anabolic state from not having enough digestible energy from his diet being so low in sugar. I shared my hay tests and the diet protocol i had been using and upon doing calculations of DE etc  they felt that was not as big of a factor as hypothesizd.  Actually, they said I had been doing an amazing job with his diet for a metabolic horse. ( thanks to this group..gave a shout out) .

They then concluded that as Dr Kellon suggested the day before; that during the period between 2/17 and 3/8 ( incidentally.. started prascend)  Vinnies insulin dropping well into normal ranges and then perhaps the invokana dumping too much glucose out of the bloodstream and then the DE of his really tight diet not being able to compensate for this loss in glucose, that his body started to dump triglycerides for energy use. This also coincides with the dramatic weight loss and the weird neuro like symptoms I was observing.  (I am guessing this is like what can happen to people when they are in extreme keto diets and go into ketoacidosos??)

**Dr Kellon I will defer to you to share what you think prudent about Invokana with the group in context to Vinnie's case and things that may be necessary to keep an eye on.**

I got to see Vinnie yday he looks thin but amazing.  He was walking sound off meds and more like my spicy old Vinnie "the unicorn" I used to see. He actually dragged me all over the parking lot as I was sobbing uncontrollably with joy....a funny sight to see I imagine for onlookers.. heehee. Then he proceeded to try and drag me back to the barn..( I guess he was hungry heehee)

I got to speak with his main veterinarian overseeing his case. She commended what I have been doing to manage him metabolically and how great his feet look;  commending my farrier. 

He will be hospitalized for a little longer maybe through the end of next week. The plan is to increase his glucose by IV and adding amino acids by IV to nourish his body and try to the get ttriglycerides back to what ever the new normal for his body may be. She said he may never come back to normal ranges they just aren't sure.  I brought another hay up that had a higher esc + starch of 10.1 and they are feeding that to see of they can eventually stop IV and have his body sustain itself on the higher sugar hay.  They are holding off all meds, they will monitor insulin to make sure that he is stable.

I was relieved when I saw how he looks and am really hopeful for when he comes home.

The plan at home will be similar to manage his diet by ensuring he has enough DE so the body uses glucose for energy.  Yes we may use invokana again of he needs it for high insulin. We are planning on doing a
a trh stim to test if he is truly ppid and will  medicate accordingly and monitor to see how or if introducing prascend at the time that we did played a role in this. 

I will continue to update as we know more.  Thanks so much for the prayers and energy.

Now to plan a tack sale as this is a heap of change I didn't plan for this year:) ...

Xx
--
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


Joy V
 

Some good news Nancy, so glad to hear.


--
Joy and Willie (PPID/IR)
Nevada County, CA - 2019

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


Lynn
 

Nancy! I'm jumping with joy over your good news! And prayers that the journey will only continue to improve from here. I also want to thank you for chronicling this situation for all of us. It's been very educational and I'm sure everyone following has learned alot! Hang in there and GO VINNIE the UNICORN!
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω


Jennifer Murphy
 

So glad to hear this!  I was holding my breath waiting for an update. 
--
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


Lecia Martin
 

Dr. K:   I have been following this thread with interest.  I have been dealing with significant weight loss in Flyte.  Ribby, etc. all winter.  So much so that I for the past 3 months he has been on hay free choice.  De of my hay is 1.68 mcal/kg -  s/s 4.8.  I have not done a recent blood draw due to weather etc.  It will be my first call to my vet on Monday.  The other thing that he has is black residue on his anus after pooping.  It was ffw but I have managed to get that under control, but this still persists.  He was on sucralfate for 6 weeks with fairly good results.  He is same, attitude wise, moving well,  not even winter laminitis this year but I am concerned about weight loss.  My question: should I stop the Invokana until I get his blood tested? As always I appreciate your feedback.
Lecia Flyte and Flame
Alberta, Canada


Trisha DePietro
 

Nancy- Really great news. I am so happy your horse is doing well.  Thank you for sharing your updates with us so we can all learn. 
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Eleanor Kellon, VMD
 

Lecia,

As long as he's doing well otherwise and not currently having a rapid weight loss it would be best to test while on the Invokana so you can see what's going on. That's a very low s/s hay. Do you know how much of it he is actually eating? What else is he eating? (I can't get your file to open.) What is his Invokana dose?

Is his manure black too?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


hdavis
 

Good news Nancy!  Happy to hear things are looking up and thanks for sharing this info for the rest of us to learn from. 
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Case History


 




Lecia Martin
 

Dr. K:   I am sorry about my file, I will see what I can do about it. Probably not much techo wizard I am not.

Hay:  It was a terrible year for us, growing conditions were ideal until they weren't.  Too much rain.  This hay is my second cut brome/orchard. He eats about 26 to 30 lbs a day, in a net.  At least this is what I was doing before I went to free choice at nite.  My bales are 450 lbs and two horses on it at nite will finish in 15 to 16 days.  I pull them off in the am.  Then I wait about an hour and give soaked soy hull pellets 1.5c. with a probiotic, salt, aloe vera juice and 12 grams of glutamine.   Around 11am he gets 8 lbs of hay divided into 4 piles on my track.  At 4pm he gets 1cup dry weight rsr beet pulp with 1/2 cup timothy pellets, custom mineral mix from Mad Barn, j-herb 2 tsp., 4oz ground flax, 6 vit.e caps 40grams of spirulina and just recently added chondroitin to get ahead of allergy season.  I give him his meds at that time which includes 1 tab of prascend.  Once done he goes back on the bale.

His manure turns very dark after exposure to air, my other gelding is the same minus the anal residue.

After the bloodwork in the fall my vet thought we should cut back his dose from 300 to 3/4 of that.  So I currently cut the tab at the last zero, if that makes any sense.

Thank you for your guidance, I really appreciate it.

 
--
Lecia Flyte and Flame
Alberta, Canada