Date
1 - 15 of 15
Mouse's Numbers and many questions
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Kimberly
I think I have uploaded all of my case history correctly on Mouse. I am reading thru the Wiki to see if people comment on the case history. I am a bit confused about how to interpret his numbers. I can see that his Insulin appears to be the problem but not sure how to interpret the G/I ratio, RISQI, and MiRG data. Those numbers on Mouse are 0.64, 0.077 and -44. What do they mean? As I understand his bloodwork and what I have read in other threads both Mouse and Ryn have within the normal range of ACTH. Only Mouse is on Prascend and I think I read somewhere here that we should not change Mouse's dose from 1 a day upwards to 1 1/2 as his ACTH is within range and that Prascend does not affect insulin numbers which is where they are both off the charts. Is that correct? If that is correct, we should suspect metabolic issues. I think the opinion of the group is that NSAIDs, bute/banamine, will not help a metabolic rise in insulin. Why is that? My vet is really wants him to stay on bute. As Mouse has a history of grass induced laminitis, I wanted bloodwork done as was not convinced we were dealing with an abcess. Since it took 2 weeks to get bloodwork back from Cornell, I have no idea where he currently is after being on stall rest, off of grass, soaked hay, etc. We will retest. I also did not feed hay for four hours before the bloodwork but only for about 1 1/2 hours. Could the results be very different when I retest and feed for four hours straight? I guess I should not be concerned with over-feeding for the bloodwork? On Ryn, since I had no clinical signs of a problem, how can anyone know if there is an issue with insulin numbers if you do not periodically pull blood? We did start Ryn on Metformin on 5/24 but not Mouse as he had been on different NSAIDS for weeks, Equioxx since 4/27 subsequently stopped and put on Bute. I mentioned Mouse having fat pads on his tailhead and wither area but has a soft neck. Will adding anything to his diet help with those? Is there any way to calculate how much grass a horse eats with a muzzle in an hour? Without a muzzle in an hour? Or is that just a guess. All of our horses are on very-limited turn out on grass due to their breed. But at this moment I am scared to death to have anyone eat a bite of grass. Ryn is in dry lot and Mouse is in his stall and shed row area with rubber mats. If he did not have an elevated DP in his right front you would not know anything was wrong. His LF pulses are intermittent and almost disappeared. I know this is alot to ask but am looking for any guidance that all of you may have so I can pass it along to my vet. Thank, Kimberly Mouse and Ryn
-- https://ecir.groups.io/g/CaseHistory/files/Kimberly%20and%20Mouse https://ecir.groups.io/g/CaseHistory/album?id=275222 Kimberly joined 7.17.2018 Virginia |
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Let's get it right up front first - absolutely no grass for these two. Grass is an uncontrolled source of simple carbohydrates which flare insulin numbers. There are times of the year more dangerous than others, depending on conditions, but never guaranteed safety. Keep them off or only for short periods with a completely sealed muzzle.
They both have severe insulin resistance and elevated glucose as well so diabetic. Why is Mouse on Prascend? It doesn't help insulin unless he has PPID and his ACTH values have been normal. Obviously it's not helping. PPID is a metabolic issue but neither have it. What they have is metabolic syndrome. The four hour guideline for morning samples has nothing to do with overfeeding. Horses that have been fasted overnight have an exaggerated insulin response to the first meal of the day and it takes about 4 hours for that to level out. I'm pretty sure your repeat tests will be much improved but more because of their diet now than the time interval. NSAID drugs (bute, Banamine, EquiOx) are antiinflammatory drugs for pain. They have no effect on insulin. If they are still painful, Metformin is the way to go but otherwise just retest and take it from there. -- Eleanor in PA www.drkellon.com |
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Kimberly
Thank you Dr. Kellon for your response. Just to clarify, I understand that NSAIDS have no effect on insulin, Mouse was on Equioxx, then Bute as he had DPs primarily in his RF and was lame on that foot. The lameness indicated pain, hence the NSAIDS. Once the heartbars were put on he has been much more comfortable but not 100%. Any hints on what to add to Metformin to entice eating it? Ryn ate it fine for three days and now will not touch his beet pulp/Stabul 1 mix with it in it? I will start Mouse on it as well to see if I have better luck, but he is a picky eater. Thanks for the guidance and clarification. There is alot to know here. Kimberly
-- https://ecir.groups.io/g/CaseHistory/files/Kimberly%20and%20Mouse https://ecir.groups.io/g/CaseHistory/album?id=275222 Kimberly joined 7.17.2018 Virginia |
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Sherry Morse
Hi Kimberly, Have you read the file on Metformin here: https://ecir.groups.io/g/main/files/4%20Insulin%20Resistance/Metformin? If your horses will not eat the Metformin you will have to syringe it and rinse their mouths out afterwards. That is a much more reliable deliver method than adding to feed as it seems most horses do not eat it willingly. As far as Mouse being on Bute - lameness due to elevated insulin will not be impacted by any NSAIDs. What it will be impacted by is getting the insulin level down through diet and possibly medication and getting the trim corrected. Since you're taking all of those steps you can wean him off the Bute.
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 |
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You will probably have to start syringing it in. Mix into Milk of Magnesia then rinse out the mouth with water afterwards.
-- Eleanor in PA www.drkellon.com |
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On Ryn, since I had no clinical signs of a problem, how can anyone know if there is an issue with insulin numbers if you do not periodically pull blood?Most people don't see an issue until the horse is laminitic. Few approach it from a preventative viewpoint and if they do, they usually implement partial/half measures like muzzling for grazing, or only allowing grazing for a few hours a day, which aren't really going to prevent laminitis. Many of these horses have smoldering sub-clinical laminitis that is undiagnosed, which damages hooves over the long term and sets them up for more serious damage when they eventually suffer an acute laminitis. As they age, IR worsens and the complication of PPID may become a factor, making acute laminitis more likely without careful management. There's a lot of misinformation out there and it's hard for owners to know how far to take preventative measures, especially when removing grass is involved....no one wants to do that! In horses not showing physical signs of high insulin (like crest, fat pads, stretched whiteline) but are of a susceptible breed (which is basically everything but drafts, thoroughbreds, standardbreds and quarter horses), a baseline insulin and glucose test should be done at least once after the horse is fully mature, and if negative possibly regularly every few years to monitor. I think most owners just aren't aware of the testing or the risks, and probably some just don't want to know. As you've seen, managing an insulin resistant horse is much more effort and expense when they can't be on pasture and need tested hay. -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Kimberly
Thanks Dr. Kellon. Since it is now apparent that Mouse should have never been on Prascend, how do I taper him off of it? He is on 1 tab per day. Also the vet had him on 1 scoop of Thyro L per day and I want him off of that as well. How should that be tapered? thank you. Kimberly
-- https://ecir.groups.io/g/CaseHistory/files/Kimberly%20and%20Mouse https://ecir.groups.io/g/CaseHistory/album?id=275222 Kimberly joined 7.17.2018 Virginia |
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Kimberly
Yes, I have read the materials. As of now I am mixing it in with soaked orchard grass and getting it done. They are both not eating beet pulp or Stabul 1 at the moment. I may have poisoned it with trying to but meds in. thanks for the info.
-- https://ecir.groups.io/g/CaseHistory/files/Kimberly%20and%20Mouse https://ecir.groups.io/g/CaseHistory/album?id=275222 Kimberly joined 7.17.2018 Virginia |
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Kimberly
thanks Kirsten,
The more you know I suppose. For the last several years, they have all been in muzzles and out a few hours a day in spring and fall. Thought that was pretty safe but Mouse and Ryn cannot handle that. They get a bit more in the dead of winter or with snow. My horses would not have been tested this time had I not insisted on it. I just wonder why there is a lack of veterinary knowledge. Mouse should have never been put on Prascend but here we are. thanks for your time. I so appreciate the support I am finding here. Kimberly -- https://ecir.groups.io/g/CaseHistory/files/Kimberly%20and%20Mouse https://ecir.groups.io/g/CaseHistory/album?id=275222 Kimberly joined 7.17.2018 Virginia |
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No need to taper Prascend.
Instructions here on how to taper Thyro-L: https://ecir.groups.io/g/main/message/265797 But it depends on how long Mouse has been on it. If it's only a few days you can do a faster taper: https://ecir.groups.io/g/main/topic/80685149#261512 -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Wean the Prascend by 1/4 pill each week until you finish a week of 1/4 pill only.
How long has he been on Thyro-L? It's not in your history. -- Eleanor in PA www.drkellon.com |
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Since he's been on Prascend since 2017, that needs a taper too.
-- Eleanor in PA www.drkellon.com |
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Kimberly
Mouse has been on Thyro L this go around for less than 2 weeks. I would need to check the calender but was on 1 scoop for about a week and has been on 1/2 scoop for 3 days so far. My plan was to do 1/2 scoop for 2 more days and then stop based on Kirsten's response but just want to ensure I do it correctly. Just so I am clear on the Prascend, I will give 3/4 tab for one week, 1/2 tab for one week, 1/4 tab for one week and then stop, correct? I do not want to cause a melt-down. Thanks very much.
-- https://ecir.groups.io/g/CaseHistory/files/Kimberly%20and%20Mouse https://ecir.groups.io/g/CaseHistory/album?id=275222 Kimberly joined 7.17.2018 Virginia |
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Kimberly
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