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Laminitis, ppid and ir

maed@...
 

Hi,

Still working on my case history- not very tech savvy I’m afraid.  I’ve got most things entered in and saved but that’s as far as I’ve gotten.  


And my horse Eli is having trouble with the Laminitis currently.  In the span of around 3 weeks I’ve had 3 vets look at him and X-rays done and labs.  About the only thing they talked about was the hoof trimming.  Right now he’s got rotation and sinking.  I’ve got his initial trim done, but I’m worried.  And any help would be much appreciated.  I’ve started soaking hay and I’m going to get the other ingredients for the emergency diet today.  He’s wearing the soft rides 24/7.  

The labs were done on 4-29-22 -
    Insulin 82 (normal 0 - 42uu/ml)
    Atch 42 (baseline under 15 of/ml)
    Glucose 97 (normal 70 to 120 mg/dl)

He has a long history of insulin resistance and was diagnosed with Cushings about 2 years ago.  He’s on 1 mg Prascend every morning.

Thank you,

 

 

 



--
Mary E in Wi 2021
Sherry Morse
 
Edited

Hi Mary,
 
The fastest way for us to be able to assist you is for you to create a folder on the CH group (which I see you've already joined) and post whatever you have in your CH now in that folder.  You can always update it as you go but we can't help you without knowing more details.  At this point it would also be very helpful if you could create a photo album in the CH subgroup and post pictures of Eli's x-rays and current trim in there.  Directions on the pictures we need can be found in the Wiki here:  https://ecir.groups.io/g/main/wiki#Photos-and-Hoof-Evaluation-Help  
 
Given Eli's elevated ACTH and the fact that is insulin is in the danger zone for laminitis I would recommend you up his dose of Prascend to at least 1.5mg ONCE a day and plan on retesting in 3 weeks.  Elevated ACTH can drive up insulin in some horses but that's just one piece of the puzzle.  Whatever Eli weighs now, if it's not his ideal weight he should be eating 1.5% of current weight or 2% of ideal weight daily (that includes all hay and a minimal amount of carrier to get supplements in).  If you don't know what his ideal weight we have information in the Wiki that can help you determine that: https://ecir.groups.io/g/main/wiki#Case-History-Help  
 

 

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891
 

 

 

 
 
Eleanor Kellon, VMD
 

As Sherry said, we REALLY need the case history, copies of radiographs and photos of the feet. I can tell you though his pergolide dose is much too low. You should also ask your vet about metformin.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
maed@...
 

Hi Sherry,

It’s confusing cause I asked the vet that did the bloodwork if his Prascend dose should be adjusted and she said no.  She said something about side effects. And I thought she said something (though I could’ve been wrong) about Cushings not causing Laminitis? But I was thinking also that it needed to be increased too.  I wasn’t sure about how they made the dosing determinations etc.  I suppose that it’s a gradual increase though.  The only thing is is that the place that I board at said that they could only give it once daily.    

I will try to work on the case history some more.


Thanks,



--
Mary E in Wi 2021
Sherry Morse
 

Hi Mary,

2 things - one is that I have no idea why I wrote 1.5mg twice a day when I meant one but the other more important one is that we have many, many horses whose owners are members of this group who are on doses of Prascend much higher than 1mg a day.  Your vet sounds like she's going by what BI puts on the package insert and she is most definitely wrong about horses with PPID not getting laminitis because of it.  You will have to remember that you are the one advocating for Eli and your goal should be that he's pain free and living his best life.  The key to doing that is getting his ACTH and insulin levels down and the way to do that is diet control and medication.

Again, my apologies for any confusion on the dosing!

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891
maed@...
 

Hi Dr. Kellon,

Thank you for responding!

 I’m kind of thinking that they’ll say no to a request for the Metformin.  I really pushed for a higher dose of the Pergolide and they still said no.  Maybe they’re afraid of the side effects of it.  But I don’t think that the side effects could be much worse than what’s going on now.  I’ll ask though.  

The vets had suggested the Heiro and the Insulin Wise. I looked at the threads on those, however I’m need something that really works.  I’ve been out at the barn a lot cold hosing his feet and soaking beet pulp and hay, etc. trying to control it. I just can’t do that long term.

I’ll try again with the case history tonight.  I’m just having problems - not much of a computer person perhaps. I did order the Triple crown balance cube naturals (just in case there’s something in the hay setting things off) . And I told the barn owner no grain (even though he was only getting a handful to give with the Prascend).  Are the Beet Pulp pellets (or Timothy pellets ok to use instead for the Prascend?

I’m going to increase the Pergolide.  


Thank you!
--
Mary E in Wi 2021
maed@...
 

Hi Sherry,

No problems- I appreciate the advice.  We’ve decided that we’re going to increase the dose.  He needs it.  To me- it would seem odd to do testing and then not act upon it.   

Thank you,

--
Mary E in Wi 2021
Eleanor Kellon, VMD
 

There is a LOT of misinformation out there about higher doses of pergolide causing side effects when the reality is that side effects are usually limited to when the horse first starts on pergolide, and those can usually be avoided with APF. When horses are already adapted to being on pergolide and the dose is increased the vast majority have no side effects from the increase. If they do occur, again the APF can control that.

Forget Heiro and InsulinWise.

Direct your vet to this study on metformin https://pubmed.ncbi.nlm.nih.gov/18482898/ .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
Sherry Morse
 

Hi Mary,

You're in a tough spot with your vets but you've hit a point many of us have been at which is "I don’t think that the side effects could be much worse than what’s going on now." My 'moment' with my vet actually happened before my mare was diagnosed with PPID when she was having an extremely hard time breathing and my vet was resistant to trying her on Dex.  In not so many words my response was 'my horse, my responsibility and seeing as the other option is putting her down I don't see what we have to lose'.  She lived long enough to develop PPID 4 years later and died at almost 32 and never developed laminitis due to using the Dex so I won that particular battle.  

As you've read in the archives Heiro and Insulin Wise are a waste of money in our experience (and there's many, many collective years of that on this list).  Beet pulp is ok as a carrier but should be rinsed/soaked/rinsed.  Another option as a carrier that would be below the 10% ESC+starch cutoff is Stabul-1 which can be ordered through Chewy.  Timothy pellets may or may not be ok.

If you have problems with the case history let us know EXACTLY where you are running into a problem.  Creating a folder is easy but once you do that Groups puts it at the end of the list so you need to do a search on it (so if you name it "Mary and Eli" you'd then do a search on Mary to find the folder, open the folder and then click the "+New" button to upload the PDF of your case history.  Photos are a bit easier as when you create a new folder in the photos section it will be the first one on the list.

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891
maed@...
 

Hi, 

With the case history- I think that somehow I might’ve messed it up when I created the folder.  There’s so many steps.  And I think the case history went ok - but when it came to creating the file and putting the case history in there - I think that it went under the example on Polly or something?  Oh my - I’m trying.  I’ve got to go tend to horsie for awhile and then I’ll take another look.   

And with his present dose of Pergolide - you wouldn’t even know that he’s on it. He’s still pretty feisty and likes to eat and all.  So it really hasn’t slowed him down one bit.  

I left a message for the vet to call me back though - we’ll see how it goes.  


Also when switching from the grass hay to the Timothy balance cubes - do I have to gradually switch over?  Do I add anything else?  I kind of want to make it as simple as possible for the barn owner.  



Mary E in Wi 2021
Cass in NorCal
 

Hi, Mary. 
I'm sending you a direct email about Eli's Case History. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Sherry Morse
 

Hi Mary,

You did a good job with the folder and the file and you're correct, you did have it in the example folder.  It's now at the main level so you can add the link:


To your signature. How to do that:

1) Go to this link to amend your auto-signature: https://ecir.groups.io/g/main/editsub

2) Look at the bottom of that page for the window where you typed your information already

3) Paste the link to the main folder that I've included here right below your signature info.  You may need to add a space after the link or click enter on the keyboard to make the link 'live' (turn it blue)

4) IMPORTANT: Scroll to the bottom and hit SAVE!


As far as your document - I'm not sure why (I don't use an Apple device) but your whole first 'intro' page which would tell us your information as well as Eli's (date of birth, breed, height, current weight) is missing.  Hopefully one of our Apple using moderators can help with that.

If you happen to know when he started on Prascend including that date is helpful when we look at the testing information.

To switch him to Timothy Balance Cubes from hay - the cubes are fed at a 3:4 ratio to hay so he doesn't need as much of them as he does of hay.  If you want to switch over all of his diet to cubes I would do it over a few days but if you're using them just as a carrier you can replace whatever grain you're using now with them. 

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891
Martha McSherry
 

Hmm.  I’m not sure why the missing pages happened or when.  Mary, do you recall seeing or filling out a page asking for your name, your horses name, his breed, etc?  Is it on the form you filled out before converting the document to pdf?
--
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


 
 
maed@...
 

Hi
     I'm not sure what happened to that first page.  When I first started entering info into the case history I remember it being there.  And then I saved it and pulled it up again to add some info and maybe that's when it might have disappeared?  And it's gone in both copies.  I sent an email over to Cass -     

--
Mary E in Wi 2021
maed@...
 

Hi Dr. Kellon,

I received a voice message from the vet that she’s willing to try him on the Metformin! I was like totally shocked.  I just wasn’t expecting it.  Granted I don’t think that she’s totally comfortable with the idea - but she is willing to prescribe it - which is great!  


And she also talked about the Iron test results.  We sent it away using that form that was listed and you’ll probably be getting some info on it also. She said that they were slightly elevated-
   

    Serum Iron 265 (normal 91 to 240)
    Tibc            563  (normal 270 to 500)
    Ferritin        375  (normal 85 to 726)

Do you think that these numbers are high enough to have a blood draw?  And do you think that it help with his other numbers?  



--
Mary E in Wi 2021
Eleanor Kellon, VMD
 

Here is the latest paper on iron https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971364/ . Those reference ranges are NOT normals. I've spoken with the laboratory director and the population they tested for those reference ranges was mainly senior horses. The article link describes how the founder of that laboratory determined normals.

Would it help to have a blood draw? I don't know for sure because it hasn't been studied but in other species, yes.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
maed@...
 
Edited

Hi Eleanor,

I know that for people there’s the blood removal for higher iron levels.  And so I was kind of thinking that there was just a written up protocol out there for the horses too. It’s interesting getting more of a glimpse into how that happens.  


And the place that I board at - it’s just swimming with excess Iron. The bowls are rusty in the automatic waterers, the hay is higher in Iron and I’ve even seen that there are red salt blocks around.  I told them that this is bad for the horses general health and I’m currently working to try to get them to change some things around.  However I was also reading in the article that there’s other reasons for the Ferritin to come up as high such as illness, injury, and active Laminitis.  And he might have been in active laminitis when we took the blood sample.  Or maybe he has something else going on?  So maybe I’d have to test it again?  And I was also wondering if he’s got some kind of possible anemia going on - that might prevent blood from being removed.  


Still working on getting the CH sorted out and actually my computer and printer as well.  I think that they’re both possessed or something-uggh

 

 



--
Mary E in Wi 2021
Eleanor Kellon, VMD
 

As a guideline, the PCV needs to be 30 or higher and for a full size horse a gallon is removed every 2 weeks until ferritin is below 200.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
maed@...
 

Hi,

Thanks!  The hct is at 31 so I’ll give the vet a call tomorrow morning and see if she’ll be willing to do the therapeutic phlebotomy.  It does seem kind of odd  - but whatever will help him- 



 

--
Mary E in Wi 2021
maed@...
 

Also wondering if the normal levels for the labs on Iron we’re changed?  It has a different listing for lab normals on the case history than what the vet told me.  
--
Mary E in Wi 2021
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