Hi,
Dante has lost too much weight since December.  Brief history he has always been a fairly easy keeper and he has never cleaned up all the food he has been given. Diagnosed as PPID in September started Pergolide. Weight stayed constant till December, then the weight started to come off and hasn't stopped.  In December he was removed from pasture. The tested hay he gets is on the mature side which he eats but not enough of, lots of waste.  This week he is started to eat all of his grain again (on approved list) only if I remove all of his supplements which I now do.  Started on untested alfalfa hay two week ago which he eats only the leaves and not the stems, currently up to a flake a day. (No sore hooves)  

He is in great spirits.  Teeth done is January.  Wormed in November, fecal count was zero in November and January.  Poop normal.  Two complete blood tests since January - both normal.  Treated for Ulcer in November, due to not wanting to move forward, he is back to his old self, so don't think ulcer. Pergolide increased end of January due to test results. Currently has eye infection and being treated.

I'm looking for help in trying to figure out weight loss.  There are two other items that concern me, but I don't know if they mean anything. He likes to dunk his hay in water, has done this in the past but usually stops after his teeth are done, but didn't stop when he had his teeth done in January.  The other thing is that he yawns a lot.  I read recently that yawning can mean pain if not for sleepiness or some type of release.  Dante is yawning when none of those apply.  If pain, how is the cause found?  

Vet will be here next week.  He will retest ACTH and insulin.  The vet is kind of baffled. 

Any idea on what's going on?   Other tests that should be completed?  Suggestions on safe food to put on weight.  (Based on his test results, I don't think IR hasn't been ruled out.)

Case History up to date and current pictures added.


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

Hi Liz
Quick question--have you retested his ACTH since increasing his pergolide dose? We usually suggest retesting after three weeks, especially if symptoms haven't resolved yet. Unexplained weight loss is often a symptom of ACTH creeping up. He may just need more pergolide. 

There is a weight loss checklist (also found under the Core Diet folder https://ecir.groups.io/g/main/files/5%20Core%20Diet  and the Pulling It Together folder https://ecir.groups.io/g/main/files/9b%20Pulling%20it%20Together) 
I've copied it below for easy reference.
I know you said his teeth were done in January, but it might not be a bad idea to get them checked again. And re 2) insulin--his latest insulin result of 62 uiU/mL is much higher than we'd like to see. A diet review is in order.

1) Cushing's is not controlled, and a pergolide increase is needed (this is surprisingly common with Cushing's horses)

2) Insulin resistance is not controlled, and diet needs to be tightened up. Check the insulin levels, review diet.

3) Poor chewing ability, even though the teeth look okay, because the jaw muscles are weak due to age or to uncontrolled Cushing's

4) Teeth need attention

5) Insufficient protein, or insufficient safe calories (again, surprisingly common)

6) Parasites

7) Ulcers

8) Other health issues, such as renal failure, liver disease, cancer (all rare compared to above)

HTH
--
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

 

Liz,

His insulin and PPID are not controlled yet and that needs to be addressed but I think the most significant part of this story as far as weight loss is coming off pasture. Older horses with poor chewing forces often do quite well on high moisture pasture and poorly on dry diets.  I would send a sample of the Haystack Low/Low for testing and start feeding him increasing amounts of well soaked product until up to 10 lbs. You could also use TC Timothy Balance cubes instead without worrying about testing and balancing. Also soak your hay to soften it and you can sprinkle flax, salt, supplements onto soaked hay.

If the yawning started after the dental work in January the most likely reason is TMJ irritation. This will also interfere with good chewing and can take months to resolve.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

PS.  He shouldn't need any dental work per se if done in January but should be checked for loose teeth (from PPID), food impacted in diastema and gum disease.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Thanks for all the suggestions.  
--


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

Liz-   In addition to the suggestions Dr. Kellon made, you may also want to have a horse chiropractor check out your horse.  Per my horse's chiro guy, having dental work, especially if a speculum was use, can get the jaw and poll to go out of joint and cause pain.  Yawning is a symptom.   At least that was one symptom I saw with my horse.  I now make a chiro appointment about a week to 2 weeks after dental work.
--
Ronelle and Yoyo
2015 Bend, Or, US

Update:
New test results from Cornell: ACTH 33.6 pg/mL, Insulin 39.0 uIU/mL and Glucose 109 mg/dL.  The ACTH and insulin are still high per ECIR group standards. Dante's pergolide was increase the day after the blood draw from 1.1 mg to 1.5mg.  Awaiting Vit E and Selenium test results.
Also awaiting various muscle disease tests from UCDavis.

The vet (who did his teeth in January) was sure it wasn't a tooth, gum etc. problem and didn't recheck his mouth. The vet was leaning toward autoimmune event related to 6 way vaccine given at the end of November.

The soonest I could get a chiro is next Thursday. 

Dante is now eating about 8 lbs of grain daily, made mostly of Haystack low/low (waiting for ESC/Starch test results) LMF- low NSC, timothy pellets and RSR beet pellets.  He also gets 4 lbs of alfalfa and 5 lbs of local grass hay which he still doesn't eat completely.

Per tape measure his weight has stayed constant for the last 2 weeks and is his usual perky self.  

Any comments or additional thoughts?






--


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

Vaccine reaction from November is highly unlikely - and autoimmune even more unlikely. Did you look into getting the Ontario Dehy cubes either from one of their distributors or Triple Crown?  You may need to replace all his hay with softened cubes.

Agree with pergolide increase. The insulin isn't normal but it's not in acute laminitis range either.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Hi Liz,
I you decide to try replacing his hay with the balance cubes, keep in mind that they contain more digestible energy than the equivalent weight of hay.  We recommend replacing 4 pounds of hay with 3 pounds of cubes.  I have some experience with this myself and was amazed at how quickly they can add weight.  As I was not aware of the 3/4 ratio, I unintentionally overfed.  Muscling in the jaw for chewing becomes less effective as horses age but especially if they have PPID.  Their teeth might be fine but they might not have the jaw strength to get the job done.

The medications chart in your CH needs a little attention.  You have him starting pergolide in 9/22, which hasn’t happened yet.  I’m not clear what is meant in your dosing.  All pergolide is a mesylate salt.  Some pergolide (Prascend) amounts are calculated by weighing just the pergolide portion of the salt and some (compounded) weigh the entire salt, so the same amount of drug would be described by two different weights, depending on how it’s sold.  I would just leave off the mesylate part of your description but denote that one was Prascend, if that’s the case.  

In the problems and issues section, you have not included PPID, although his TRH stim test is positive and you are treating him accordingly.  For those of us reading through the CHs, looking for hints, it’s very helpful to have all that in order.
--

I was trying to avoid the Ontario Dehy cubes, due to the fact they would need to be soaked. Dante is at a fairly large boarding barn and to get the cubes soaked three times a day probably isn't going to happen as regularly as I would like.  I bring the RSR beet pulp from home, and he gets it as an additional meal/snack. But after saying this I'll try to source the cubes, so I have a backup.

I made corrections to the case history.  I hope I corrected the dosage of pergolide correctly. when Pet Health went to Avrio they changed from measuring pergolide mesylate to pergolide.  I changed the prior dosage of .85 pergolide mesylate to .66 mg pergolide so all the doses are now stated in mg of pergolide. 


--


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

Liz,
Unless Tasha has a chewing issue, the Ontario Dehy cubes don’t have to be soaked, they can be fed wet, damp, or dry. One of my horses prefers them dry. If your stable has hot tap water, they break down well in 2-3 minutes if you want them softer. I put enough hot tap water to almost cover them. By the time I add the supplements, they are ready to feed. Even in cold water, it only takes about 7 minutes. 
--
Kim 10-2014

Clover, SC

Dually: IR; Grits and Bella: PPID, IR; and Eeyore (deceased, but not PPID related)

Case History https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Grits%20-%20Eeyore%20-%20Dually

Photo album Grits https://ecir.groups.io/g/CaseHistory/album?id=1314

Photo album Eeyore https://ecir.groups.io/g/CaseHistory/album?id=6586&p=Name,,,20,1,0,0
Photo album Dually https://ecir.groups.io/g/CaseHistory/album?id=9046&p=Name,,,20,1,0,0
Photo album Bella https://ecir.groups.io/g/CaseHistory/album?id=64978