Dr Kellon/Dr. Clougher - need help re significant increase in triglycerides


Patti SoCal 2020
 

I’ve amended my subject line to include Dr. Clougher in case Dr K is unavailable.  I last gave Invokana to Sunny on April 6 and am hoping for guidance based on the rise in triglycerides:

1. Should I give him half the dose of Invokana  (150 mgs)?
2. If so, should I start now or wait for triglycerides to decrease?

Sunny is still walking well but I am thinking once the Invokana is completely out of his system, his insulin will likely rise again causing foot soreness. I’m hoping to avoid that if possible.

Thanks again.

Patti


Yesterday I received the results of the CBC chem panel for Sunny after 6 weeks on Invokana. His triglycerides had increased from 73 (chem panel run prior to starting Invokana on 2-20) to 1096. He has no obvious symptoms. He is eating, maintaining weight, is neither lethargic nor depressed. I sent you an email yesterday with both chem panels attached as well as forwarding the email from my vet with the results. There were a couple of other areas of concern as well.  I am still waiting for insulin results from Cornell.  I have updated my CH including both chem panels, and will update insulin results as soon as I receive them. 

I'm wondering what my next steps should be. Should I decrease dose to 150 mgs? If so, should I do that now or wait a period of time to allow the triglycerides to normalize? If I wait, how long do you suggest and should I run another CBC/chem panel prior to restarting?  I have reread the threads from both Nancy (Vinnie) and Cass (Cayuse), just to refresh my memory. Invokana has resolved Sunny’s laminitis but I do want to avoid a hospital visit.

To be on the safe side, I have stopped giving him Invokana until I hear back from you. Thanks for your help. It is greatly appreciated.
-- 
Patti 
SoCal 2020                                                 
https://ecir.groups.io/g/CaseHistory/files/Patti%20and%20Sunny
 
Patti
SoCal 2020                                                 
https://ecir.groups.io/g/CaseHistory/files/Patti%20and%20Sunny


Nancy & Vinnie & Summer
 

Hi Patti,

I am not a vet but I can share my experience and what I was told when Vinnie was in the middle of hyperlipidemia caused by hypertriglyceridemia and had to be hospitalized.
Background:
1. His triglycerides were 1100 the day he was hospitalized.
2. He had been experiencing dramatic weight loss, ataxia, on and off really sore feet, lethargy and just wasn't himself for about a month prior beginning Feb 8th.  I believe he had been in hypertriglyceridemia for the month of Feb. We started invokana Jan 8th and he was doing great til Feb 8th.
3. March 1 was when things really seemed to get worse. I actually had "the talk" with my vet about when was enough, enough. That is how worried I was about Vinnie.  He was eating and drinking well so we decided to pull blood and take it from there.
4. March 8th bloodwork came back ( high triglycerides,  high liver enzymes and high cholesterol) and March 10th he was hospitalized. He presented with a gas colic that wouldn't stabilize. When arriving at the hospital colic was ruled out, but liver enzymes, lactate and triglycerides were high so he was hospitalized for hyperlipidemia.

They immediately stopped invokana and treated with glucose and low molecular weight heparin to help the fat (triglycerides) move back into the cells and help his body stop using fat for energy and to build his glycogen store in the muscles for energy.

Vinnie is doing great at home and his liver enzymes are back to normal almost and his hypertriglyceridemia is almost resolved, but we have not yet restarted invokana.

His insulin has jumped up to 68 from normal (30) pre hospitalization. The goal if we put Vinnie back on invokana is to start with a low dose and stop.  Then monitor both urine glucose and blood triglycerides, insulin and glucose to see how long the dose stays in his system and what the effects are on his system. We ( me and my vet) are waiting to do this under the guidance of Dr Kellon.

I hope this helps. Whatever you do please work with a vet to ensure you are both in the same page with next steps etc.
--
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


Patti SoCal 2020
 

Hi Nancy,

Thank you for this information. It is so helpful as Sunny’s liver enzymes and cholesterol increased also.  Yes, my vet and I are working closely on this and we had emailed Dr K about the results. We hadn’t heard back from her which made me think she is not available right now.

Sunny did not have any physical symptoms of his numbers (no rapid weight loss, loss of appetite, lethargy, depression, etc) but his triglycerides were 1096 so we may have been close.

My vet wants to wait to hear from Dr K, and if it’s okay with you, I’d like to share this with him also. He and I are both on a learning curve. I think it’s wise to wait and let Sunny’s numbers stabilize before proceeding with a decreased dose or other action. And, of course, waiting for guidance from Dr K.

One last question..what dosage was Vinnie on?

Again, thank you for your reply!

--
Patti
SoCal 2020                                                 
https://ecir.groups.io/g/CaseHistory/files/Patti%20and%20Sunny


Nancy & Vinnie & Summer
 

Yes please do share with your vet and if you want any records from Davis I am also willing to share those as well.

Whatever you need.

Thanks so much, Nancy 

Also Vinnie's vets at UCD were Dr Camillo Jaramillo and Dr Berryhill if they are colleagues of your vet and if he wanted to speak with them about Vinnie's case.
--
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,
I’ve been following all of your updates carefully. I really appreciate the details you have provided so that I am aware of everything I need to monitor with my two boys. I was wondering if their were subtle signs that you noticed around February 8th that in hindsight might be something I should be monitoring. 

I’ve noticed that Elliott is super annoying in the pasture with our herd (more so than his usual) when his insulin is very high  But he also displays similar but less intense behaviors in the herd when his insulin is well regulated.  I’ve thought about this a lot because I have several children I work with who are diabetic and have ADHD that display similar behavioral issues in times where they have high glucose AND when their glucose is too low.  So Elliott’s ADHD like behaviors are something that I am very tuned into  (And yes, if Elliott was human, he would meet all the criteria for ADHD).  Something else I’ve tuned into is that when his insulin is normal or close to normal he is much more focused in therapy sessions with the kids rather than constantly looking for more stimulation (unzipping my jacket, grabbing my phone from my back pocket, licking a tree, attempting to grab items from the trees on our sensory trail, and countless other annoying behaviors).  Although we have addressed these behaviors with training, they completely disappear when his insulin is normal.  Like I said, it’s the subtle signs that I feel I need to monitor. 

I was also wondering if you could see the fat in Vinnie’s blood when it was pulled at the vet hospital.  Elliott’s samole when his first laminitic episode started was filled with fat  

Again, thanks for all of your updates.  They are super helpful!

--
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
Joined 2019


Nancy & Vinnie & Summer
 

HI Terri,

Yes there were subtle changes in Vinnie's behavior starting around Feb 8th.. He is usually very active and engaged socially with people and he just seemed off.. still nickered when he saw me but he looked at me like he was trying to tell me something.  

He started to get very grumpy and overtly agitated when I did normal chores about him. Putting his boots on he tried to bite me several times.  I thought this may be pain but, he seemed to just be annoyed by touch at times.

He was eating well, but he was getting more picky about hay. The old hay he stopped eating and the new hay that was greener but lower in sugar he would devour.  His poop seemed glossy which I thought was strange and now have learned that is fat in the stool.

He got foot sore even though his insulin was normal. He developed a crest and so I thought it may be early ppid so talked to my vet and we restarted prascend on about Feb 17th. We planned to pull blood in three weeks so titrated up prascend dose to 1mg.

Things deteriorated in small amts daily after Feb 23rd and he looked thin..and he has NEVER looked thin.. I increased his odbtc cubes and I added 1.5 cups RSR beet pulp.  He started to look a little better and then would have days where he seemed out if it. 

March 1st he was really really foot sore on hard surfaces and when he walked he looked neurological in his hind end, but seemed to walk out of it on soft surfaces.  Between March 1sth and March 8th he slowly seemed to improve weight wise but I was also throwing a ton of food at him. He had odd movements now and then like he was drunk. March 10th evening we did a 5 min walk and it was the best he had seemed soundness wise.  He seemed engaged and happy. I fed him his beet pulp while I lunged my mare and then I gave them their evening hay. He normally is happy chomping when I leave but he had gone to the back of his stall and had a sour face and he stared to paw.  I checked for gut sounds and he seemed a bit gassy.  I chalked it up to the increase of beet pulp and called my vet.  We gave him a dose of banamine and anti spaz and I walked him for a few mins. He seemed to stablize but 20 mins later he started pawing and seemd out of it..a little drunk.I called my vet and she said haul to UCD.

Earlier that day we had gotten the blood work back indicating high triglycerides with elevated liver enzymes and high cholesterol. My vet had pulled blood on 3/8 and decided to run a lipid panel because his serum was cloudy. 

Hope this helps :)

Thanks so much! Nan

--
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
 

I also had a little epiphany this evening but I am not 100% certain that this has empirical value... the first urine glucose test resulted in dark brown 110 in 30 seconds. All subsequent tests that were 2 to 4 weeks later never produced a result greater than 30 and most times was 15. I pontificate if this was because his body didn't have glucose store to release into his urine??
--
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
 
Edited

Just want to correct a few misconceptions here.

On Sat, Apr 10, 2021 at 12:53 AM, Nancy & Vinnie & Summer wrote:
He was eating well, but he was getting more picky about hay. The old hay he stopped eating and the new hay that was greener but lower in sugar he would devour. 
Sugar isn't the only determinate of appeal. Horses will also reject a hay that is older and more fibrous in favor of a greener hay. Regardless of why, reducing his hay intake only worsened a negative energy balance.

His poop seemed glossy which I thought was strange and now have learned that is fat in the stool.
That's not fat, it's mucus and is a sign of impending impaction.  Fat/triglycerides do not move out of the body into the gut.
He got foot sore even though his insulin was normal.
That's a sure sign it wasn't laminitis.
He developed a crest and so I thought it may be early ppid so talked to my vet and we restarted prascend
PPID or not, the crest comes from high insulin.  It will appear more obvious if he has some dehydration.

= = = = =

Sorry I've been absent lately but I've been trying to shake off COVID for almost two weeks. Battle not over yet so please bear with me if I'm slow to respond.

 
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Aurelio Henriques
 

Dr. Kellon,
    I hope for your full recovery as quickly as possible. What a nasty virus, this one.

Aurelio in Ontario

Aurelio Henriques
Ontario Dehy Inc.
tel. 519-524-1063
On 04/12/2021 12:32 PM, Eleanor Kellon, VMD wrote:

Just want to correct a few misconceptions here.

On Sat, Apr 10, 2021 at 12:53 AM, Nancy & Vinnie & Summer wrote:
He was eating well, but he was getting more picky about hay. The old hay he stopped eating and the new hay that was greener but lower in sugar he would devour. 
Just want to mention that sugar isn't the only determinate of appeal. Horses will also reject a hay that is older and more fibrous in favor of a greener hay.Regardless of why, reducing his  hay intake only worsened a negative energy balance.

His poop seemed glossy which I thought was strange and now have learned that is fat in the stool.
That's not fat, it's mucus and is a sign of impending impaction.  Fat/triglycerides do not move out of the body into the gut.
He got foot sore even though his insulin was normal.
That's a sure sign it wasn't laminitis.
He developed a crest and so I thought it may be early ppid so talked to my vet and we restarted prascend
PPID or not, the crest comes from high insulin.  It will appear more obvious if he has some dehydration.

= = = = =

Sorry I've been absent lately but I've been trying to shake off COVID for almost two weeks. Battle not over yet so please bear with me if I'm slow to respond.

 
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001



Nancy & Vinnie & Summer
 

So glad you are on the mend Dr. Kellon. Please take care. Thanks for always being here for us too ❤ lots of healing energy to 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


Lecia Martin
 

Dr. K :  So sorry to hear you have been ill.   We are sending healing thoughts and pray for a full recovery
--
Lecia Flyte and Flame
Alberta, Canada


hdavis
 

Dr. Kellon,
so sorry to hear about you being sick with Covid:(. Thoughts and healing prayers to you and hope you continue to get better.  So appreciative for all that you do for us and I know we are all sending u well wishes and prayers. 
--
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


 




riggslippert@...
 

Dr. Kellon,

I am so sorry you have been ill and wish you a speedy and complete recovery.  Your expertise is so appreciated!
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102




Daisy Shepherd
 

take care dr. kellon; try not to come back too fast;  covid virus  can be relentless as you know. we all so dependent  on you; moderators are doing a good job.  daisy and tiko
--
-- 
Daisy, Tiko and Whisper
CO, April 2019
Case History:  https://ecir.groups.io/g/CaseHistory/files/Daisy%20and%20Tiko 
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=90099&p=Name,,,20,2,0,0


Nancy C
 

moderators are doing a good job.  daisy and tiko
Thanks Daisy. All the volunteers appreciate your noticing.

--
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


Cindy Giovanetti
 

moderators are doing a good job

Thanks Daisy. All the volunteers appreciate your noticing.  Nancy

I noticed too.  And I noticed Dr. K was absent.  I was concerned for her.  Love to all.

 

Cindy


--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125