New blood work in CH - Insulin worry


Kandace Krause
 

Hello all,
I have done some more input to CH including latest bloodwork results.  Once again, I had to utilize caompanion animal vet and their lab as my vet was unavailable at the right time.  Having had decreasing (improving) numbers all along I was quite shiocked to see the latest insulin number given that I have been very careful in feed management.
Two things I can think of
1) I have a borrowed horse paddocked with K this summer so I could have a horse to ride.  Because of that, the hay doled out is the full amount for them both.  CH indicates daily amount, I feed twice daily and divide it to appx 18lbs total am and 20 lbs total pm.  K looks to have put on weight and I have given them a little bit more daily, about an hour before evening beet pulp feed.  She is the top of pecking order but she actually will stop eating and go stand in the sun off and on thru the day whereas her paddock mate does not.  Because there are two there is a lot more movement around the place going from hay to hay to hay, in slow feed nets between 4 and 6 nets per feeding.
2)about mid August I started to feed appx 4lbs per feed of my 2019 Hallets hay, soaked for 40 minutes cold water.  I have choosen 40 minutes as this hay is "okay for most horses" but maybe too high for K.    I did this for a few reasons, mostly to ensure they were getting more water into themselves as we have been experiencing an unprecidented hot and dry summer.  Also, as this is "colic season" now, with a huge temperature swing, again I am trying to get them more water by feeding the hay soaked.

Could either of these impacted the insulin this much?  The other numbers are still decreasing and, to date, no new lameness apparent, so much so that I have restarted actual exercise of twenty + minutes of handwalking, which I had hoped would also have improved the insulin number.  Is there something else?
Disappointedly,
--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Sherry Morse
 

Hi Kandace,

The fact that she's put on weight could be contributing to the insulin and as she has put on weight I would not think that they're eating equal amounts just because she stops eating while the other horse does not.  You might want to consider muzzling her to slow down her consumption if you can't separate the 2 horses.  The Hallett hay should be ok as long as it's soaked but I would definitely keep a close eye on her comfort level at this point.






Eleanor Kellon, VMD
 
Edited

Judging by the January photo she didn't need to gain any weight but studies that have studied the effects of weight gain on insulin have been negative - no change.  Agree with the muzzle.

Another consideration is season. Of all the POMC derived hormones in PPID, ACTH is at the lowest concentration while the others can also affect insulin. CLIP for example directly causes insulin release. It wouldn't hurt to add more pergolide if your veterinarian approves.  If not, I would retest ACTH and insulin late September to prove the point.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Kandace Krause
 

Thank you Dr Kellon for your input,
I weight taped K today and she was 969lbs average of 5 tapes.  This is up from low of 923lbs  (May or June) so not too much but up.  She has no crest but still has one sided hard lump in front of near side teat.  Her paddock mate is gone this Sunday so it will definately be easier to verify her fed hay.

I am concerned about the amount of pergolide that she already takes.  What else is it doing to her body when starting dose is 1mg and we are 2.5 mg now?   If I keep going up, will it ever be able to come back down?  As I have said in the past, I am in no position to have a horse that has no functionality and I am worried that this amount of pergolide is indicating a horse that will never recover to functionality.  Do you have an opinion or idea for me on that?

I will plan for retest late Sept. as well as discuss upping pergolide.  My vet was concerned with efficacy of compounded formula ( I can get capsules, not suspension).  Do you?
--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Kandace Krause
 

Thanks Sherry,
Comfort level is fine, at this time, with her Easyboot Clouds on.  She does spend appx 10 hours a day out of boots in paddock at farriers direction, but she does show less comfort then.  Weight taped today shows gain of about 46lbs. since May or June when at her lowest weight.  How do people keep their horses if they can not keep them together?  Can I expect improvements with exercise when other numbers all seem wonderful?
--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


LJ Friedman
 


-- Why 10 hours out of boots at the farriers direction? Is your Farrier some specialist? I remember when jesse  was in pain I had one hour of 24 without boot for aeration purposes
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Sherry Morse
 

Hi Kandace,

If 2.5mg is controlling her ACTH now it's unlikely she will ever go back to a lower dose.  Many horses have started on 1mg and had their doses increased as needed to continue to keep their ACTH in the 'normal' range over the course of their lives.  We have had several on the list who have ended up on doses of 20mg or higher. 

It's easier to answer what happens to a horse if you don't use the medication to control PPID.  Beyond the excessive hair coat and pot bellied appearance many horses experience an increase in drinking, excessive urination, obviously the possibility of laminitis, overall loss of muscle, issues with tendons and ligaments, issues with wound healing, and immunosuppression and the issues that go along with that.  Uncontrolled PPID is very ugly, particularly in the later stages. 

Using pergolide allows a PPID horse to live a normal life and once they have their ACTH stabilized many are able to return to their former level of work.  As you may already know AERC allows horses on pergolide or Prascend to compete as does USEF.

As far as using the compounded version vs. the BI version - many members on the list use compounded pergolide (Island Pharmacy is the one in Canada comes to my head but there are probably others) with no issues. Capsules are the preferred version as they are more stable than suspension.

If K is more comfortable in boots I would leave her in them.  If you could post pictures of her current trim we could advise on what might be improved to help her be more comfortable.




Kirsten Rasmussen
 

How do people keep their horses if they can not keep them together?
If you have horses with different needs and eating habits you can keep them separated by an electric string or panels.  I am set up so that each horse has a space in the run-in shelter, with metal panels dividing the shelter inside, and an electrified string splitting the paddock outside.  This way they are separated but can still be next to each other, even mutual groom or play over the metal panels, but not in with each other because they have different diets.  When there is no food out between feeding times, I can open the string and let them run around together.  After about 15 min together they get bored of that and want to have their own space back again.  Right now Shaku can't run around so I just keep them separated all the time, but his buddy is always right there on the other side of the panel/string.

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


Kandace Krause
 

Hello LJ,
He is just wanting her to have more natural movement with in her foot to keep blood flow and growth back to normal.  My previous vet kept this mare in clogs with a real rocker on the bottom, I understood to keep DDFT safer.  When they declined to treat my horse any longer, I was introduced to a farrier who had treated another horse after the clog removal and was successful.  Her feet looked terrible and no heels after having been inside these clog things for about 4 months with only two reshaping trims inbetween.
My new vet suggested wooden clogs, but was not averse to me following this barefoor farriers advise.  Frankly the money already nvested had me ready to pull the plug at that time.  So far all I see is improvement and when exercising I put her boots on.  I also find that her feet are staying healthier and drier than in boots all day.

Hopes this answers.

--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Kandace Krause
 

Dr. Kellon, 
What is CLIP?  I shared this comment with my vet but have not heard back yet.
Thanks
--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Kirsten Rasmussen
 

Corticotropin-like intermediate peptide, aka "big ACTH": it has a similar effect to ACTH in elevating cortisol, but weaker. 

See also:
https://ecir.groups.io/g/main/message/268355


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


Eleanor Kellon, VMD
 

CLIP is actually a breakdown product of ACTH while big ACTH is the prohormone that is shortened to produce ACTH. CLIP is important because it directly stimulates insulin release.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Sometimes this is easier to see in color:

Adrenocorticotropic Hormone
POMC - proopiomelanocortin - is the parent hormone in the intermediate lobe and at the top of this flow chart.  It is broken down in several steps to get the hormones pictured here. CLIP is blue. Big ACTH aka pro ACTH is an intermediate step between POMC and ACTH where the amino acids in grey between gamma MSH and ACTH in the POMC prohormome are still attached to the ACTH.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001