Remy - Seasonal rise concerns - Testing questions added


Nancy C
 

Hi Susan

Agree with Sherry and Martha on their comments.

My goal testing ACTH was to make sure his results were in the teens. That allowed him to do best through the winter even with insulin remaining at 50+ mg/dL

Testing ACTH may or may not give you clear answers, but personally I'd want to do it anyway. Things can change and I'd want the info included.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



 

Hi Susan,
As Sherry mentioned, I have a pony in his late 30’s who has always tested about the same, before diagnosis and after starting pergolide.  He doesn’t return completely normal values but low enough that I wondered about treating him.  My vet said he was obviously PPID and I should start pergolide.  With him, I am able to follow his urine output so I increase his pergolide when I notice his stall bedding is obviously more soaked.

I can also say that with another horse I had, his ACTH appeared to be well controlled by pergolide but I suddenly began to lose that control so I switched him to cabergoline.  As if by magic, symptoms which I had not attributed to PPID disappeared but his ACTH went much higher so things are more complicated with this disease than might appear on the surface.
--
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
 


Sherry Morse
 

Hi Susan,

This is where having a completed case history would be very helpful for us to be able to help you. 

It's true that some horses will be PPID but won't test as high because ACTH is only one of the indicators of PPID - at this point it just happens to be the only one we can test for. For those horses most people treat based on symptoms.  Martha can comment on this more if she sees this thread as she had just such a horse.

Suspensory branch tears can happen in any horse with or without PPID - trying to guess if PPID contributed to the event without knowing any details is impossible.  Same with abscessing. Insulin of 35 is not indicative of a current danger of laminitis but the coffin bone loss and rotation do lean towards long standing issues - whether those mean sub-clinical laminitis or another hoof issue we can't comment without seeing the x-rays and trim pictures. 

The reason Nancy and I suggested doing ACTH now is that we are in the period of the seasonal rise and with horses that don't test out of the reference range at other times of year they may well do so now if they have an abnormal response to the rise. 

Is there some reason you can't tell the barn to withhold the bucket feed until after testing is done?  I would definitely make sure the test circumstances are the best they can be, even if that meant going to the barn and feeding hay 4 hours prior to the test myself (been there, done that).  
















--
Susan Vaughan in Houston Texas
Member since 2004


Susan Vaughan
 
Edited

The following post is a reply/continuation of my post of 1-2 days ago.  
--
Susan Vaughan in Houston Texas
Member since 2004


Susan Vaughan
 

Thanks for replies.
Now I'm confused about the TRH Stim test.
I know it's used to detect early PPID but thought also used - as-  for some reason some horses won't "test" on baseline.?  
I'm convinced Remy has been PPID 3 years or more, but baseline tests normal.
How many years can they be early PPID?
An early PPID horse can show baseline normal (July 2021) then the following month have severe abscessing (LF) and suspensory branch tears (LH)?
To mention prior summers horrible summer sores especially on mouth, sheath and penis.
Sarcoids.  Eye infections. Skin problems.
Surely this means past years his cortisol was high - if not very high?
..
I have vet scheduled for Wednesday morning.
Had thought to do only insulin and glucose.
As in, "why do baseline ACTH when previous BL's showed normal" and the two Stim tests the Pre's were normal/in range.?
Noting the Pre of April (low ACTH month) was 15.2 (2-30) and Pre end of June (rise month) (and on 1mg CP) was 11.
So Remy's Pre's went down:
during start of rise, and,
on 1mg Perg).
(Albeit a small amount in a smallish reference range - or maybe it's significant?).
The Posts:
increase during rise, and,
on 1 mg Perg.
....
Testing for insulin and glucose for stalled horse- hay eaten by midnight - or earlier:
The blood draw needs to be four hours from first bite of hay?
At this new barn I'm not sure what time they feed.
Could be hay at 8am and bucket feed with supps at 10am.
Appointment is at 11am - hoping I can push appt. back an hour.
Should we test with hay only?
Or test with hay and what he would normally be eating at new barn / new feed?
(1/2 pound Mtn Sunrise orchard pellets,
1/2 pound Cavalor Fiber Force and supp Cal Trace).
Sorry so many questions.
So many things have gone wrong past 1.1/2 years - I want to get this part right.

Thanks again,. 












--
Susan Vaughan in Houston Texas
Member since 2004