Date
1 - 20 of 38
Vinnie and Invokana update 8/2022
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Hi Dr Kellon and all, I just wanted to send a quick update about Vinnie and have a couple questions.
I don't have a new set of labs yet, trying to get that coordinated for this week. Vinnie is doing GREAT! He is probably the soundest he has been in years. We have been playing a little with liberty work in the arena and he is just loving it. Offering trot and canter and overall super playful and happy. Now for my questions: I increased Vinnie's pergolide from 6.6 mg to 9mg over the last month or so. I feel like he needs another bump for the remainder of the rise because he seems to be growing coat at a rate where I could probably clip him every 3 weeks. He is still having some skin issues that do improve with a clipped coat, so I am not sure if that is from sweat or bugs or ?? He just recently had a swollen eye lid that resolved with some antibiotic eye cream with a little hydrocortisone. He is still extremely hypersensitive to bugs. His water consumption has stabilized but I am filling 2 5 gallon buckets twice a day. That is in addition to his main water trough. And just in the last week, he has been a little more lethargic than usual. Based in these symptoms should I increase by a half or full mg of pergolide? And should I consider splitting the dose up to see if he is one of those horses that does better on a split dose? My second question is about diet and invokana with the increased work load. He is currently on 225mg daily and his current diet seems to be managing his weight. Labs will tell us if TG/insulin are managed. I feel like in the last week with the increased activity that he may need something to boost his energy levels. It is just a hunch based on some of his behaviors after work. He seems to be napping more than he did in the past after work and a little slower to recover. But i also wonder, could this be he needs a bump in pergolide? Here is a small video of the other night: https://youtu.be/EFeVLpm6SZQ Ps.. Summer is doing absolutely fantastic too after her ovariectomy in June. No more issues with colics etc, and she definitely has been easier to manage related to her IR. Thanks Nancy -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Bobbie Day
Oh my gosh Nancy, he looks amazing!
Glad they’re both doing so well. What a great mom you are❤️ -- Bobbie and Maggie Desi (over the rainbow bridge 7/21) Utah, Nov 2018 ECIR Group Primary Response https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie https://ecir.groups.io/g/CaseHistory/album?id=271156 https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi https://ecir.groups.io/g/CaseHistory/album?id=78821 |
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Thanks Bobbie!! It takes a village and it is "undoubtedly" Dr Kellon and this group that has made all the difference.. I am truly so grateful. Words can't really express how blessed we feel that we found you all.
-- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Great news Nancy. He looks wonderful. You have worked tirelessly on his behalf and for your girl. Here's to smoother waters for all concerned.
-- Lynn Beavercreek, Ohio March 2018 Relevante Case History Relevante Photo Album Ω |
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Sherry Morse
Hi Nancy, You know him best so if his PPID symptoms are increasing I'd go with your gut and bump his pergolide dosage up. I can't answer the question on adding the extra in as a 2nd dose - you may need to experiment with that to see what works. I'd also want to see if the bump helps with the tired behavior but as always, he may need more calories too. Hopefully Dr. Kellon will have a chance to chime in soon. That video makes my heart sing - so glad to see him doing well!
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 My second question is about diet and invokana with the increased work load. He is currently on 225mg daily and his current diet seems to be managing his weight. Labs will tell us if TG/insulin are managed. I feel like in the last week with the increased activity that he may need something to boost his energy levels. It is just a hunch based on some of his behaviors after work. He seems to be napping more than he did in the past after work and a little slower to recover. But i also wonder, could this be he needs a bump in pergolide? |
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Labs are in for Vinnie and some great news and some frustrating news.
TG 552 was 336 Insulin 37.07 was 108 Glucose 97 was 108 Acth 17.8 was 15.5 Meds: 225mg canagliflozin (same) 9.6mg c pergolide was 6.6mg Diet: 15lb 9.9 esc starch free fed hay 5lb alfalfa mixed in hay bags with grass no more than 1/4 flake per bag 3.5lb dry weight rsr beet pulp 2 cups stabul 1 (mixer for supps) 10 cups triple crown sr mixed with beet pulp 25g l carnitine split two feedings 100g pea protein split two feedings Drs choice daily start ( 2 scoops) split Changes: Stopped cavalor he stopped eating it Decreases stabul 1 from 2.5lb to the 2 cups as he stopped eating all of it. I am trying a new flavor with some success in the last two days. Added the alfalfa because he was dropping weight and I wanted to see if it may help and not impact feet.. so far ) 6 weeks in he looks much better and feet are holding) Other Chem panel had some highs but my vet said not to worry yet Iron and tibc high ( Cornell panel) but not sure of the relevance? No iron in supps and hay is decent..so it could be water ( I can try to get a filter if my barn owner will let me. Dr Kellon, Now for the big question what do we try next for those tryglicerides?? I will add stuff to my spreadsheet and (ch) and add labs to folder. New image coming too. Thanks Nan -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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I updated my spreadsheet that has a high level snapshot of the ongoing labs/meds/diet:
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Vinnie/Vinnie%20Bloodwork/D%27Cruz%20Vinnie%202022-08-30-%20Lab%20Tests%20and%20Meds.pdf -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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With the amount of food he's eating, even before the alfalfa, the fact he could lose weight and still have TG that high suggests he's not fermenting fiber well. I would move him to a soaked diet and replace his hay with OD cubes, soaked. You could also try alternating 200 mg with 225 mg Invokana, retest insulin and TG in 7 to 10 days. Is there a reason you are using TC Senior instead of Stabul 1? It is high fat and that fat is high omega-6.
-- Eleanor in PA www.drkellon.com |
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Hi Dr Kellon, he won't eat the beet pulp unless there is TC sr in it. He had stopped eating stabul 1 so I am adding that back with a new flavor successfully, but he likes that in a bucket dry.
He also won't eat the timothy balances cubes soaked, I suppose I could add some alf cubes as a taste tempter. I will try again. I will try alternating doses and retest. Thanks so much. Nancy -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Have you tried CocoSoya as a taste tempter? It doesn't take large amounts and many horses find it irresistible.
If you can get soaked cubes into him that will improve his ability to ferment them. -- Eleanor in PA www.drkellon.com |
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I have tried everything, he just likes them dry. It is weird. But I will try again, I am just worried that if he turns his nose up then the TG will go higher.
-- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Even dry it would be an improvement because the particle size is much smaller - "prechewed" as it were. You could also add Absorb-All https://www.uckele.com/absorb-all-4.html for both digestive enzymes and probiotics to support getting those VFAs out of fiber digestion.
-- Eleanor in PA www.drkellon.com |
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I have Absorb all too, so I can add that in. For GI support he gets Gut X, uckele GUT, and Drs Choice Daily Start and 1 oz psyllium as prebiotic all 2x per day.
Are any of these contraindicated Absorb All? Do I feed the 3:4 ratio of cubes? So 11lb vs 15lb, and should he have free choice hay as well? Thanks Nancy -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Lesley Bludworth
Dr. Kellon,
Do you know any fiber that preferentially creates butyrate in the gut of rumens?
In humans kiwi pectin boosts
butyrate production and the bacteria that create it.
I can feel a bug difference in my joints when I eat kiwi.
Also green banana flour is good for humans as a resistant starch, I can't imagine green banana flour would be a resistant starch in a horse but if it is...
From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Eleanor Kellon, VMD <drkellon@...>
Sent: Saturday, September 3, 2022 9:34:03 AM To: main@ECIR.groups.io <main@ECIR.groups.io> Subject: Re: [ECIR] Vinnie and Invokana update 8/2022 Even dry it would be an improvement because the particle size is much smaller - "prechewed" as it were. You could also add Absorb-All
https://www.uckele.com/absorb-all-4.html for both digestive enzymes and probiotics to support getting those VFAs out of fiber digestion.
-- Eleanor in PA www.drkellon.com
-- Lesley Bludworth Phoenix, AZ Sophie Case History 7/2022 https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History https://ecir.groups.io/g/CaseHistory/album?id=277749 |
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Dr Kellon, Wondering if the decrease of stabul 1 could have had an impact on TG too, he is now eating it well in the Pina Colada flavor, again so what ratio should I go to for this feed with the addition of the cubes?
Also, was wondering if the fiber fermentation issue is possibly why his insulin resistance has been so hard to manage for so long? Thanks Nan -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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There is no fiber that only produces butyrate. I don't know about all fibers but I do know that wheat bran produces high butyrate levels. Hays and beet pulp produce primarily acetate. Pectins are easily fermented but they don't all result in high butyrate production https://www.frontiersin.org/articles/10.3389/fmicb.2019.00223/full .
Green banana flour would be a resistant starch in any species but it is going to result in high lactate production during fermentation. All resistant starches do. -- Eleanor in PA www.drkellon.com |
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I would start by replacing all the TC Senior with Stabul 1. Replace the hay with the cubes. Keep everything else the same for now. See if he will accept the cubes just lightly wet to start. The water makes a big difference.
The possible issue with poor chewing forces affecting fermentation is more likely to affect TG than insulin. With fermentation, butyrate (low levels with the things we are talking about) primarily feeds the intestinal cells. Propionate, also low levels, can be converted to glucose but won't be unless blood levels are low. Acetate, the major fermentation production, can directly enter the TCA cycle so is a substitute for the glucose that the Invokana is causing to leave the body in the urine but it won't trigger an insulin response like glucose does and if the energy generation stays on track, TG won't be released. Digestion/fermentation begins with effective chewing to reduce the food to small particles which enzymes, bacteria and protozoa can attack from all sides. As horses age, the angle of their chewing surfaces changes so even if the teeth look good on exam the force of chewing is decreased. If there has been aggressive dentistry, it's even worse. -- Eleanor in PA www.drkellon.com |
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Sounds like a good plan. Should I shift the alfalfa to cubes or pellets too?
I will experiment over the weekend with what he will eat with wet cubes etc. -- Nancy and Vinnie and Summer Oakley, Ca Joined Nov 2018 https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie https://ecir.groups.io/g/CaseHistory/album?id=245855 Summer https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer https://ecir.groups.io/g/CaseHistory/album?id=249104 |
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Yes, preferably cubes.
-- Eleanor in PA www.drkellon.com |
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Fine on all these supplements with the Absorb-All.
My only concern with the free choice hay is he will fill up with poorly chewed hay and not eat what he needs to eat. I would stop that. Don't worry about the ratio of cubes:hay unless he starts to gain weight. VERY IMPORTANT: Make this change gradually and if he backs off eating what he should be eating that will be a red flag. -- Eleanor in PA www.drkellon.com |
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