Needing a better long-term solution for my mini with uncontrollable IR levels


amyscrivanich
 

I have been mainly a lurker on this group for a long time.  I joined initially for my PPID horse in 2006.  He passed away in 2015 and then in 2018 my mini pony (Mater) had been diagnosed with IR.   I thought I was going to lose her when I couldn’t get control of her pain.    The metformin seem to somewhat lower her IR levels, but the only thing that helped from the onset (for pain) was Thyroid-L.   I didn’t want to keep her on it long term, so after months of doing well, I started to back off her dose to only find that she was starting to get uncomfortable.   So it’s been over 2.5 years and she has still been taking Metformin & Thyroid L.  All was going well, until I routinely did her annual ATCH & Insulin test beginning of May-2021 and her Insulin level was what is was from the first time I tested her back in 2018 ( >200)   She wasn’t showing an physical signs of being uncomfortable, but I took her off of her dry lot (that has some sprigs of weeds coming up) and put her in the padded stall.   Her feet have been trimmed regularly every 7-8 weeks and this time I noticed her feet (all 4) had grown more than her usual 1/4“ (they have always grown fast ever since her bad episode in 2018) and this included her hind feet which seemed to grow normally from 2019 on.   

I have been watching her like a hawk since her bloodwork gave me a heads up that something is wrong.  And she is walking a bit slower and laying down a bit more than usual, but still not too painful with very slight intermittent pulses in her front feet.   The farrier trimmed her up nicely(last week) and I put her cushy soft ride boots(that she wore 24/7 back in 2018) on her feet (more as precautionary since she just got trimmed).   So now I am dumfounded as to what to do.  The vet said just increase her thyroid-L then retest her.   I don’t want her to have another bout of founder as I do not think she would survive it.  She is 19 yrs old and her weight is perfect, and she is only eating ODTB (3-4 x’s a day)   I am not even giving her soaked hay since the IR bloodwork results.    

She doesn’t seem too painful, but her bloodwork will be an indicator that she may go that direction. I do not want to continue to use these meds long-term what are other options??   Please help me come up with a game plan!  

--
Amy Scrivanich and Mater
Charlotte, NC
Nov 2004 (my original PPID horse passed in 2015)

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Mater%20May%202021.pdf


amyscrivanich
 

I also uploaded some radiographs from 2019 as well as a picture from her trimming from last week (that was 7 weeks of growth!!)  

https://ecir.groups.io/g/CaseHistory/album?id=264439

Thank you !!

--
Amy Scrivanich
Charlotte, NC
Nov 2004 (my original PPID horse passed in 2015)


Sherry Morse
 

Hi Amy,

Could you please add your photo link to your signature? https://ecir.groups.io/g/CaseHistory/album?id=264439 (if you need help with that please let us know). If you can add pictures of her feet currently (directions in the Wiki here: https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help) as well as pictures of our body it will help us help you. Looking at her old x-rays we can see where she started but not where she is now. 

Thyro-L is not a pain treatment, so any improvement you've seen was more likely due to changes in management or trimming.  Given that her current T-4 level is now elevated, if anything the amount should be decreased, not increased.

Metformin stops working for many horses and Mater may be in that category now.  However, we don't know what her current dose is, nor if it's the right amount for her weight so it would be very helpful for us if you could provide both her current weight and the actual dose she's receiving.  

Feeding needs to be based on weight so that's another reason we need to know her current weight.  Are you weighing out the amount of cubes she's being fed now?




--


amyscrivanich
 

I think I’ve updated everything to be more clear.  
I totally agree about the Thy-L, but the vet of course doesn’t agree regarding the T4 level; very frustrating and that’s why I’m hoping I can get some better advice here.     So I’ve kept her meds the same since 2019:  Thy-L dose 1 tsp 2x’s daily.  4000 mg Metformin 2x’s daily.   I do not have current radiographs.  The ones we took in 2019 were when she was feeling better.   I have uploaded current picture of her body and her feet.    Since I struggle to keep weight on her, I give her as much as she will eat of the ODTC (Leftovers are given to my other horses so there is no waste ) 

My goal is to find something besides the Thy-L and Metformin to keep her comfortable long term.  

Thank you !

 



--
Amy Scrivanich
Charlotte, NC
Nov 2004 (my original PPID horse passed in 2015)

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Mater%20May%202021.pdf

https://ecir.groups.io/g/CaseHistory/album?id=264439

 


Kirsten Rasmussen
 

Hi Amy,

The Thyro-L might be part of why you struggle to keep weight on Mater.  It is really only useful as a weight-loss booster as it has no effect on insulin regulation.  That said, I was impressed when I saw the first photo you posted of her, she actually looks like she is at a healthy weight for a mini in my eyes, which is not common!

Your metformin dose is correct for her size (30 mg/kg).  Please note that the latest EEG guidelines do allow for increasing the dose to 3x a day, and up to 50 mg/kg, so you could try that.  Here are the guidelines for you and your vet:
https://sites.tufts.edu/equineendogroup/
You will also see here there are other drug options, including Invokana/canagliflozin for you and your vet to discuss.

Is her all diet information up to date in the Case History?  I noticed she is not being fed salt, ground flaxseed and vit E.  These are things that could be added to her ODTC meals (could you please add that you are feeding this to your case history? it looks like you might have had it written there for Hay Type 1, but it was deleted by accident?).  I personally would avoid the fescue hay, although you don't seem to feed it often.

Now I have some house-keeping for you to do.  Mater's case history is currently floating in space in the "Files" area: https://ecir.groups.io/g/CaseHistory/files?p=updated,,,20,2,0,0
Can you go to that link, where you should see it sorted by what was uploaded most recently (so you are at the top, or very near the top of the list), and use the "+ New" blue button at the top of the screen to create a new folder titled "Amy and Mater", then move her Case History in to it?  It would be best if you could upload it as a pdf file so users with Mac can also easily open it, and so there is no chance of a virus affecting anyone.

Also please update the link in your signature to her Case History once you've moved it, using this link: https://ecir.groups.io/g/main/editsub

Thanks in advance!

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


Sherry Morse
 

Hi Amy,

Some quick housekeeping - could you create a folder in the files section of the CH group (https://ecir.groups.io/g/CaseHistory/files) and then move Mater's CH doc into it.  To do that it's easiest to use the search box to find the file and then click on the scissors to the right of the file name and scroll to the very bottom of the list that comes up as that's where the folder will be found.  (If you need help with that just shout).

If my math skills are up to snuff her current metformin dose is ok as long as she's 293lbs.  However, as already mentioned, it does stop working for some horses when used long term so it may be time to discuss moving to Invokana with your vet. 

I'm sure you're aware but pain can cause some horses to go off their feed and this may be the case with Mater.  I would not keep her on a 7 - 8 week trim cycle but on a no more than 4 - 5 week cycle to stay ahead of any excess toe length and pressure on the laminae.  Weight-wise she looks pretty good but I wouldn't want to see her any fatter than she is now so definitely no more than 6lbs a day total (including forage and any concentrates). 

If you're looking for actual pain relief you can try Devil's Claw (many members feed phytoquench pellets which have Devil's Claw in them), but again the Thyro-L will not help with that and would need to be weaned off of gradually to allow her thyroid to start functioning again.



amyscrivanich
 

Sorry for the "tech" issues, I'm definitely struggling trying to get everything in the proper folder.   Please let me know if they are still not correct.
I tried to pick the vet's brain when she was out regarding Invokana and they knew really nothing about it.   Does this replace on of the meds she is currently on?  
And she is actually getting salt & ground flaxseed (I updated the CH)   

--
Amy Scrivanich
Charlotte, NC
Nov 2004 (my original PPID horse passed in 2015)

https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Mater%20the%20mini/Amy%20and%20Mater%20May%202021.pdf
https://ecir.groups.io/g/CaseHistory/album?id=264439

 


Sherry Morse
 

Hi Amy,

Invokana would replace the metformin.




Eleanor Kellon, VMD
 

Amy,

If you are interested in Invokana I have information to send to your vet.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


amyscrivanich
 

On Wed, May 26, 2021 at 08:25 AM, Eleanor Kellon, VMD wrote:
Amy,

If you are interested in Invokana I have information to send to your vet.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Thank you Dr. Kellon, any information would be much appreciated.   Please let me know how to proceed 


--
Amy Scrivanich
Charlotte, NC
Nov 2004 (my original PPID horse passed in 2015)
https://ecir.groups.io/g/CaseHistory/files/Amy%20and%20Mater%20the%20mini

https://ecir.groups.io/g/CaseHistory/album?id=264439

 


Eleanor Kellon, VMD
 

Amy,

Just send me an e-mail at drkellon@... with your vet's name and e-mail.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Carla Anderson Peters
 

Dr. Kellon,
May I send you an email with my vet's name and email, as well?
Thank you!!
--
Carla

 

December 2013, WI

Cupcake and Gunnar's Case Histories 

Cupcake's Photos

Gunnar's Photos 

Ω



Eleanor Kellon, VMD
 

Carla,

Yes, of course.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001