HIgh Insulin - looking for recomendation


Liz7033@...
 

Many thanks for pointing me in the direction of PPID (or seasonal PPID), otherwise I would thought he was just IR and put all my effort into diet and exercise.  He has been on .5mg pergolide since 9/21 and will increase to 1.1 mg when his medicine arrives.
--


Liz
SW Washington
January 25, 2020
https://ecir.groups.io/g/CaseHistory/files/Liz%20and%20Dante
https://ecir.groups.io/g/CaseHistory/album?id=268141 Dante photos


Tasha photo album
Case History


Eleanor Kellon, VMD
 

Liz,

That's a positive test.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hi Liz,

You can read about using TRH during the rise here:

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848300/


Based on the endogenous results for the peak of the rise I wouldn't necessarily say that Dante is PPID at baseline but he may well be early PPID with that exaggerated response.  Are you saying that you have now started him on Prascend?




Liz7033@...
 

Update ---Didn't start pergolide until after blood draw on 9/21.  The vet did a TRH  Stimulation Test at Cornell results were Pre 33.4 (2-35 reference interval) and Post 954.0 (2-110).   Is there any reason since the test were taken during the seasonal rise not to interpret as PPID?  Or is the problem only when the results aren't as clear cut?  


Liz
SW Washington
January 25, 2020
https://ecir.groups.io/g/CaseHistory/files/Liz%20and%20Dante
https://ecir.groups.io/g/CaseHistory/album?id=268141 Dante photos


Tasha photo album
Case History


Eleanor Kellon, VMD
 

Liz,

Next week is fine. That's when the seasonal rise peaks. Just do ACTH.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Liz7033@...
 

I reread the ECIR web page for seasonal rise.  Regarding the subtle signs, Dante does have an increase in appetite (not leaving as much hay), insulin resistance worsening (per test results), lethargic and possible some change in shedding. I suppose if I can't get blood drawn this week to confirm rise in ACTH, I could start pergolide now or right after blood is drawn based on symptoms I am seeing. (This is when it is handy to have a horse already on the medicine)  Since I would be chasing the rise, not sure of dose or if it would work. But I would start pergolide at approximately .5 mg and go from there to resist the veil. 

From Sherry response above and rereading the webpage, looks like the Stim test should not be done but the ACTH at this time of year.

Any comments or disagreements?

Liz
SW Washington
January 25, 2020
https://ecir.groups.io/g/CaseHistory/files/Liz%20and%20Dante
https://ecir.groups.io/g/CaseHistory/album?id=268141 Dante photos


Tasha photo album
Case History


Liz7033@...
 

Eleanor,

Dante was tested on July 5 for ACTH and his result was 23.6 pg/mL.  When I retest should it be the regular ACTH or TRH Stimulation test?  Vet is on vacation till next week, based on your ASAP note I guess I need to find someone else to draw blood.

Noted exercise is probably not vigorous enough for him, but due to age and his conditioning, we are steady increasing. 

--Liz
SW Washington
January 25, 2020

https://ecir.groups.io/g/CaseHistory/files/Liz%20and%20Dante/Dante%20Case%20History%20.pdf
https://ecir.groups.io/g/CaseHistory/photo/268141 Dante photo


Tasha photo album
Case History


Sherry Morse
 

Hi Anthie,

If you test now you'll see an exaggerated rise in a horse that may not have any clinical signs.  The other option would be the TRH Stim test although that can be a bit harder to interpret this time of year since we are already in the rise.




Anthie Booras
 

Just curious but if you are worried about exaggerated seasonal rises due to early PPID  is that something you can really test for now or is now not a good time to test because of it being the seasonal rise period? Would  you definitely want to do a TRH stimulation test for that?

--
- Anthie

Northern California
August 2015

Erin's case history: 
https://ecir.groups.io/g/CaseHistory/files/Anthie%20and%20Erin/


Eleanor Kellon, VMD
 

Liz,

That might not be vigorous enough exercise but the other big consideration this time of year is ACTH. He could be having exaggerated seasonal rises due to early PPID. I would check that ASAP.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Liz7033@...
 

Hi,
My 21 year old, Lusitano ( I suppose one of the many poster horses of EMS) was diagnose in July as ESM.  As mention in case history, I thought it was a fluke, but the following month his insulin rose from 69 uIU/mL to 114 uIU/ml at Cornell.  In August, started exercising more at a trot in round pen  starting at 10 minutes trot  working our way up to 15 minutes 2 to 3 times a week. The other days I rode mostly at a walk 30 minutes. One day off a week.  Lab results beginning of September even higher at over 200. (waiting for exact number). Currently up to 20 minutes trotting 3 times a week, the  other 3 days riding mostly walk for 45 minutes. 

Other information, not lame, but I admit could  be sub-clinical laminitis.  Always been very forward horse, but lethargic the last week or so, not sure if pain or increase in exercise is slowing Dante down.  His timothy hay is 7.7 ESC plus starch.  On a bare pasture for 8 hrs a day with hay and buddy . Today removed all weeds on fence line, which could of contribute to problem,   Plan to retest beginning of October.
  
So my questions are 1) how long do I continue exercise before I throw in the towel and say this isn't the answer for him.2) what else is recommended?

Thanks in advance


Liz
SW Washington
January 25, 2020

https://ecir.groups.io/g/CaseHistory/files/Liz%20and%20Dante/Dante%20Case%20History%20.pdf
https://ecir.groups.io/g/CaseHistory/photo/268141 Dante photo


Tasha photo album
Case History