Labs results for review


 

Hi Vicky,
I don’t think it matters when he gets his pergolide as long as it’s consistent.  I never put pergolide in my horses’ feed because the chances are good that one of them will spit it out somewhere and I’ll never know, unless I happen to notice it someday in the corner of the stall.  I insert it in the cheek pocket, way back but avoiding the teeth, and then watch for a bit.

I don’t think you’ll notice if you give him “too much”.  He appears to tolerate it well.  With my own horses, I check ACTH levels fairly regularly but I will increase the dose without testing if it seems it might help.  If the pergolide readjustment does not result in any desired changes, cutting it back is always an option, aiming for a single dose each day.  The bigger problem is increasing the dose too quickly.  The general guidelines are that if he becomes somewhat dopey, standing around staring into space, go back to your starting dose and increase more slowly.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Maxine McArthur
 

On Thu, Jul 22, 2021 at 05:22 AM, vicky monen wrote:
I have posted a new pic in my album to see if you think he is a body score of 7 as I do? 
Vicki, he’s at a bit of an angle so it’s  hard to see his neck and rump profile—there seems to still be some lumpy fat on his rump? Without hands on, I’d 
 be hesitant to give a number, 7 might be pretty close, but I’d like to say that he looks a lot healthier than most of the haffies I see here—they are a very tough breed to manage without working them hard all day, every day. If hay soaking helps to counter reduced exercise, it’s worth trying.
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


vicky monen
 

On Sun, Jul 18, 2021 at 06:41 AM, Kirsten Rasmussen wrote:
Martha has made 2 really good points about getting Samson's weight down, and about how he is only getting half the effect of pergolide by dosing 2x a day.
I have posted a new pic in my album to see if you think he is a body score of 7 as I do?  Also with the splitting of the prascend, we are essentially saying he is getting basically 1 mg of the 2 mg split per day, correct?  I am going to start to titrate him up to a single dose per day instead of splitting the dose.  What symptoms should I look for that would suggest the prascend is too much, as I am titrating him up?    As he seems to be doing well on the current dosage.

Is there a better time of day to give the single dose? 

He is currently not eating his breakfast well. I wonder if the splitting of the prascend would affect him more in the morning than the evening. 

Sorry for all the questions, but once again I get myself caught up in the small details. 

Thank you for continued  help! 

Vicky Monen and Samson

Aug 2015, Alpharetta Ga.

https://ecir.groups.io/g/CaseHistory/album?id=1226

https://ecir.groups.io/g/CaseHistory/files/Vicky%20and%20Samson


Eleanor Kellon, VMD
 

Soaking what looks like safe hay is similar to using Invokana except instead of pulling it out of the body into urine after it got there you are removing it before feeding.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Yes, it's entirely possible the exercise is the missing factor.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kirsten Rasmussen
 

Hi Vicky, 

Some horses seem to have elevated insulin no matter how tight the diet is.  In your case you do have the complication of PPID despite normal ACTH, making dosing of pergolide VERY difficult.  Martha has made 2 really good points about getting Samson's weight down, and about how he is only getting half the effect of pergolide by dosing 2x a day.  Both of these could be changed.  I would also add that soaking hay could help, and I speak from personal experience.  I am in a very similar situation with Shaku, who has IR.  On a 7% s+s hay his insulin was about 42 uIU/ml.  When I started soaking it, his insulin dropped to about 15 uIU/ml.  It's possible you would see a similar reduction in insulin if you try soaking Samson's hay.  Other physicals signs of EMS also improved on the soaked hay, most notably Shaku's goopy eyes cleared up, he has less smegma, and his weight came down from a BCS of 5 to a BCS of 4.5.  It now appears he is also PPID, and like Samson his ACTH is normal, but it is likely that the PPID is making his EMS very hard to control despite all dietary measures I've made.  So now my focus is treating the PPID adequately based on physical signs, as well as continuing to soak hay.

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


 

Hi Vicky,
You’ve mentioned he has lost weight but still score him at 7.  I try to keep my IR horses at 4.5, no higher than 5.  Losing weight is good, achieving an adequate weight loss is even better.  I mentioned some other things in my first reply.  Your effective pergolide dose is potentially half what you think it is.  It apparently controls his ACTH but you suggested it’s never been elevated.  Exercise is frequently described as the best insulin buster there is so if Samson is comfortable being ridden, that would help with both his weight and his insulin.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


vicky monen
 

Hi,

I am super perplexed as he is on tested hay that is low 6 %s/s, fed in ultra slow feed hay nets and he is rationed his hay in 4 small servings per day.  He is only in a dry lot with sand. (but he does not get much movement as he is alone due to his lameness issues)  He gets a very small amount of speedi beat 1/4 cup 2x day and he gets stabul1 as his carrier for his supplements and meds.  He is on 2 mg prascend per day.  He does need more exercise which has been limited to walking only since he has been lame for a very long time.  Just recently his lameness has improved to where I can ride him under saddle at the walk and hoping to add light trot work on long straight lines.  If his diet is balanced and tight, what else would be contributing to the high insulin levels since last year? 

He has finally lost weight and I absolutely thought his insulin would be within normal range. 

Could the exercise be the only missing key?  Or am I missing something else? 
--
Vicky Monen and Samson

Aug 2015, Alpharetta Ga.

https://ecir.groups.io/g/CaseHistory/album?id=1226

https://ecir.groups.io/g/CaseHistory/files/Vicky%20and%20Samson


 

Hi, Daisy.  I want to make sure you saw this thread about Speedibeet and high iron content. https://ecir.groups.io/g/main/message/266586 
Lavinia still gets bags of Speedibeet with the guaranteed analysis label on them specifying ESC of 5% or less. I'm concerned about high iron in all BP, so I RSR Speedibeet just like BP Shreds to reduce the iron.
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


Lavinia Fiscaletti
 

Hi Daisy,

Correct, it has guaranteed low ESC+starch levels - just need to rinse it well initially to get rid of as much dirt as possible. It will soak up water as you rinse, so it's ready to feed when done.

Rinse/soak/rinse is for beet pulp pellets or shreds that do not have a guaranteed analysis of the ESC+starch amount.
  - First rinse is to remove dirt/iron.
   - Soak is in a lot of water - more than it will absorb - to soak out possible excess sugar, then dump off the excess water after the soak period.
  - Final rinse is to wash any residual sugar sticking to the beet pulp after the soaking.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Daisy Shepherd
 

so no need to r/s/r if using standlee speedibeet no added sugar?? thank you, 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


Lavinia Fiscaletti
 

Vicky,

There is no need to double soak and rinse Speedibeet as it is guaranteed to be low sugar+starch. Just rinsing it well will remove surface iron and it rehydrates at the same time.

Saves a lot of time, water and effort.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


 

Hi Vicky,

I’ve been thinking about this a bit and don’t want you to feel ignored.  Maybe if I post some thoughts, someone else will come along to correct them, if need be.

I also have an insulin resistant pony with PPID which isn’t able to be monitored with ACTH testing.  Because I know I’ve done everything else, he’s at a low weight and not foot sore, I tend to increase his pergolide in the hopes of decreasing his insulin, which is high but not dangerously so.  At 35 plus years of age, he’s not getting regular exercise, which might help him more than the pergolide.  I have dewormed him with ivermectin.

An increase in hormones precipitated by the fall rise also causes insulin to rise but I’m not sure what portion of that is caused by ACTH or how much of a change to expect in his insulin.  We try to keep things in a normal range throughout the year, but try not to make pergolide dosing changes during the rise as it appears to be less effective.

What is Samson’s body condition?  Is he still overweight?  Do you see inappropriate fat pads?  Beet pulp has pretty much had all the sugar extracted but it is overloaded with iron, the reason for all the rinsing.  Excess iron is not good, especially for metabolically challenged horses.  Are you using the beet pulp as a carrier?  If you can find soybean hull pellets, I’ve heard that’s a great easy option.  Is he still having issues with lameness?  Did those all clear up with the coffin bone injection?  What was injected?

Since this is causing you some understandable anxiety, I would increase the Prascend soon and watch carefully for any signs reflecting that the increase was a good idea.  As you’ve split the dose, he’s effectively getting less than 2 mg of Prascend, perhaps half.  Can you slowly change that by titrating up the morning dose, while titrating down the evening dose?  Most people seem to turn to split doses when their horses appear to have issues tolerating a larger dose.  

--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Eleanor Kellon, VMD
 

His insulin is considerably above normal. It should be no higher than 12 or so with an EMS friendly diet.  However, it is below the threshold for triggering acute laminitis so if he can tolerate exercise, go for it. There's nothing better for insulin. Existing studies are contradictory on whether or not there is a seasonal insulin rise but that is probably because they didn't test exhaustively for PPID. It makes sense the insulin would go up with the seasonal rise.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


vicky monen
 

Hi,

Samson's blood work is in from Cornell.  His Insulin has went down since last year, but its still not within normal range.  Is it possible that having his chiropractic and acupuncture first could have caused it to be elevated?  

ACTH   9.25 pg/ml
Insulin   50.68  ulU/ml

I did not have the glucose ran, but should have. 

His ACTH is low normal which is typical for him.  He is up to 2 mgs prascend per day but split doses am. and pm.  Currently he seems to be doing well on this dose, but I will watch him during the seasonal rise for symptoms.  Vet had me increase it to 2mg end of last year suspecting chronic laminitis due to ongoing long term lameness.  Currently lameness improved after vet did coffin joint injection. 

My question is with his Insulin little above the normal range at 50.68 Ul/U/ml,  is it ok to go ahead and deworm him with ivermectin?  

Also I am having the speedi beet removed from his diet as they cannot double soak and rinse it.  By not double soaking and rinsing, how much can that affect the insulin? 

The only symptom I have been seeing lately is after I clipped him in March he grew his coat back in very fast and very course with guard hairs.  Which I just reclipped him.   Since going into the seasonal rise, I always hold my breath. I have never had to increase the prascend based on his ACTH numbers, but rather on symptoms only, as he is early suspected cushings.

Should I retest his Insulin again during the seasonal rise?  I am hoping that with more exercise his insulin will come down some.  Is it normal for the seasonal rise to affect the insulin? or just the ACTH?

Thank you so much for your help!
--
Vicky Monen and Samson

Aug 2015, Alpharetta Ga.

https://ecir.groups.io/g/CaseHistory/album?id=1226

https://ecir.groups.io/g/CaseHistory/files/Vicky%20and%20Samson