Date
1 - 10 of 10
New Blood draw
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Kimberly
Just looking for advice on how long to wait to do another blood draw. Our current plan is to draw blood on 7/6 which is 30 days from our last draw on 6/7. Is this too soon to expect better insulin results? In June Mouse's insulin had dropped to 116.75, Glucose 112 and Ryn's was 73.66, Glucose 110.. Mouse is still not in work as he is still lame on RF. I am waiting to schedule a lameness with exam with Timothy Ober, hopefully soon. I suspect at this point with stall rest, little movement, heartbar shoes, no pulses, that we have another issue with the RF that is possibly, not metabolically driven. Ryn is losing weight and in regular work 5-6 days a week. His weight loss is slow and still needs to drop about 100 lbs. How quickly should he drop weight? I do not want to go to fast, but it is really slow to come off. He is getting 17 lbs of hay/concentrates a day. Thanks for any input.
-- 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, Mouse's case history has disappeared. Is he on Metformin at this point? It's possible the right front issue could be an abscess or it could be the lack of sole on that foot. Current trim pictures could help us help you assess that. You don't want to drop a horse to drop weight too fast so as long as Ryn is steadily losing, that's fine. You can always increase his work time or the amount of work he's doing to help with that and/or decrease the amount of hay & concentrates he's taking in per day although you probably do not want to drop past 15lbs a day total. Since you originally had him as being at 1000lbs currently and an ideal weight of 900 you may need to update what his ideal should be and run numbers based on that.
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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Kimberly
Hi Sherry, I reloaded Mouse's case history. I have no idea where it went. I used to be able to find both Mouse and Ryn's on page 35 but it looks like they may have moved? I am still trying to learn the system! Mouse initially presented as if he had an abcess, which we treated accordingly. It never blew after several weeks and in the interim, we did blood work, new x-rays and his insulin was elevated. Hence we determined metabolic issue. This started in April on the RF. As we have continued on with adding Heartbar shoes, medical plates (to protect the thin sole), soaked hay, emergency diet, appropriate supplements of flax, r/s/r beet pulp, Stabul1, Vit E, magnesium and iodized salt, he still had a mild DP/ medial RF. That has been gone since June 9th. He is sound at the walk but off on the RF at the trot, 2 out of 5 going to the right. Going left he is sound at the trot. I have suspected that we are missing something here so I am pursuing a lameness expert. He will be trimmed this Monday the 4th and I will take new pictures. Dr. Kellon after last trim said his feet looked good and we are following all protocols as we understand them. On Ryn, he is bigger boned than Mouse but a 100 lbs heavier so I think he needs to drop 100 lbs. 900 may be a bit lower than he should be but I need to be a bit closer to see how it looks. I use the calculation of HG squared x length divided by 330 for the weight. My question about the bloodwork is that to me, we ran blood a month ago, diet is the same, exercise for Ryn is more but for Mouse is just walking in his paddock so wonder if doing bloodwork now is not prudent or if we should wait until Mouse can be exercised which cannot be until he is sound. Just looking for some guidance. Many thanks for the response.
-- 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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Hi, Kimberly. It’s not easy to track changes you’ve made that would reduce Mouse’s dangerously high insulin of 116.75 as of your last blood draw 7 June 22. Your case history has a box in the first page for the date of the update. Volunteers appreciate that tidbit. Same with your Comments that are dated 2017. It’s easier to know where things stand if your comments are dated in chronological order. Is hay soaking new since 7 June? It looks like you discontinued metformin quickly, is that right? Insulin that high can cause hoof damage and impair recovery. I would want insulin reduced ASAP. ECIR encourages us to address all 4 prongs of treatment of EMS, ideally at the same time - DDT+E (exercise as appropriate only). If Mouse were mine, I’d want to know his insulin is better controlled by the changes I put in place. I’d be especially careful to have the blood work drawn more than 4 hours after first morning hay so you’re not catching the insulin spike from breaking the morning fast. Good review under the EMS heading at this link: https://www.ecirhorse.org/DDT+E-diagnosis.php As an aside, I’m learning that DPs are not a very clear, consistent or specific indicator of hoof comfort. They’re a data point, subjective and a bit fickle. |
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Kimberly
Hi Cass, not sure I am clear on what you mean about the update. When I update their case history it shows on the page that I updated it. If I add new data, like blood work I add the date and if I make changes to diet/exercise that has a date block I add the date? Is there something else that I should be doing? We grow our own hay and test it and it tests at or below 10% ESC/starch combined. A current small batch I have is at 10.2 so I am soaking it. Of that 10.2, the Starch is 1.7. Previous years' hay usually tests with starch at .7 or so and ESC 5-7 %. I am soaking because I am doing everything I can. Yes, we discontinued Metformin quickly as both horses stopped eating. Yes, we are using DDT+E as appropriate. I guess my question should have been if I am doing everything right, (except for exercise for Mouse), what should my expectations be of a significant insulin drop? If it is not going to get there without the exercise piece for Mouse, that will have to wait as he is lame. I do not know if that is the insulin or a tendon/ligament injury or something else. When Mouse has had laminitis in the past, he has never been lame or unsound but DPs were the only clue without bloodwork. In Mouse's case, his DPS have been a clear indicator of pain or a problem for many years so I do rely on them pretty heavily. Ryn has never been lame nor has he had bounding DPs and I did bloodwork on him as he and Mouse are genetically close. I am under the impression that 4 hours of feeding hay is what should be done before blood testing(if they run out overnight and they will ) but are you saying it needs to be more than four hours? Can Timothy Balance cubes be part of the morning meal as they get sick of wet hay for four hours. Thanks for the input!
-- 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, Page one of the Case History form has a box for the date you initially filled it out and immediately under that a box for the date of the last update. As of the upload you did the other day you have updated information for June under the medication and bloodwork sections, but not a date in the 'Date of Latest Update' box which is what Cass asked you to fill in as it helps us know that information is current. In the comments section you have everything entered in one box that has a date of 2017 on it but only part of that comment actually seems to refer to 2017. My impression is that this is actually from 2017: Mouse over-weight, diagnosed with laminitis, never presented tender or lame,
but had pulses in all four hooves. Emergency diet implemented, bloodwork
done, put on Thyro-L (short-term) and Prascend Then this entry should be in its own box from April of 2022: Has had spring/fall bouts of
laminitis in subsequent years, never presented lame until 4/27/22 when pulses
in RF, medial, suspected abcess. And this bit should be in a box with a date of May 2022: As of 5/17/22 abcess not resolved, pulses in
LF diagnosed with laminitis. Blood work pulled waiting results, took new xrays, feet trimmed 5/11/22. Heartbar shoes applied with medicine plates,
trimmed according to ECIR specs, And then the last line should be in a box for June of 2022: blood work updated 06072022. For horses that do not respond to diet changes and subsequent weight loss to bring insulin down we look to medication - Metformin and then - if that doesn't work or stops working - Invokana. For a horse that has an insulin level as high as Mouse's is you need to do something to get it down to a safe level ASAP. Diet changes are part of our approach and exercise is as well - when the horse can tolerate it. If they can't tolerate exercise (which is where Mouse is right now) you need to consider other options to reduce the insulin. Again, that puts you in the category of needing to use medication for him - either Metformin or Invokana - to get the insulin down while you are working on diet and weight loss. Cass was reiterating to you that blood work should be drawn 4 hours after the first meal of the day to avoid an insulin spike if you expect they will run out of hay overnight. That meal can be hay or any concentrates - the testing just needs to be done 4 hours after feeding whatever you're feeding.
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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Kimberly
Thank you for clarification on these issues. I just want to ensure he can have beet pulp, stabul 1 and supplements as well as hay for at least four hours. I have previously only fed hay. Thanks so 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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Hi, Kimberly. I'm so glad Sherry answered your questions. I'm sorry I dropped off the face of the earth to find an emergency vet for a family pet over this holiday weekend.
A couple of details on feeding before the blood draw. It should be at least 4 hours after first forage of the day, so it can done more than 4 hours after that feed. Soak the hay the same way you usually do. No, do not feed Stabul 1and BP before the blood draw. Feed afterwards. The standard we try to match for these tests is that the equine is fed forage only. This information is outlined on the link I gave to ECIRhorse.org: To avoid a false-positive result, the horse should have hay available at all times the night before and day of the testing. If that's not possible (e.g., a ravenous horse that will inhale as much of anything you put out as quickly as possible), make sure the blood is drawn at least 4 hours after the first meal of the day, keeping some hay in front of the horse until the testing is done. The horse should not be fed anything except hay prior to testing. The horse also should not be exercised within four hours of the test; avoid shipping before testing if at all possible. Stress and exercise influence glucose, insulin, and leptin dynamics. I know the CH details seem picky, but volunteers will look there first. Sifting through 43 messages to track details leads to omissions. Think of Dr Kellon and the rest of the volunteers as air traffic controllers. They can offer the best guidance and observations when all the information is before them in one place.-- Cass, Sonoma Co., CA 2012 ECIR Group Moderator Cayuse and Diamond Case History Folder Cayuse Photos Diamond Photos |
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My question about the bloodwork is that to me, we ran blood a month ago, diet is the same, exercise for Ryn is more but for Mouse is just walking in his paddock so wonder if doing bloodwork now is not prudent or if we should wait until Mouse can be exercised which cannot be until he is sound. Just looking for some guidance.I'm not sure this was answered. You can do bloodwork as often as you like. Usually for best value we advise it after making a change (diet, exercise, medication), or seeing a change in the horse (increased/decreased pain and/or voluntary movement for example). I know it's a lot of working keeping 2 up to date Case histories, let alone the details we are asking to be corrected, and what we are asking applies to many ECIR members (not just you!!). But it really helps. :) -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Kimberly
Thanks Kirsten, I am working on getting Mouse's cleaned as I can. We did bloodwork and xrays or Mouse on the 6th as well as trimmed his front feet. Back were done on the 4th. We pulled blood for Ryn as well. Will post pics and results when we get bloodworkback. Thanks for the assist.
-- 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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