Hi Martha …OK it’s now letting me get to my link of my case file… I just can’t figure out how to update the info with the latest blood work and pictures… I went to the photo albums and I did manage to upload some front and side body pictures… Hopefully Dr. Collin or somebody can look at those and give some suggestion and advise 
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Michele Goldberg 
Bernville, Pa
joined 2015

Hi Michelle,
Sherry’s link takes me to the correct place to find your case history.  I went there and copied the link.  It looks like Sherry may have posted two links but they both seem to go to your file.

Here’s mine. https://ecir.groups.io/g/CaseHistory/files/Schimpie%20Case%20History
If this doesn’t work for you, I would suggest rebooting your device.
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Hi Sherry …for some reason I can’t access her case history file …I clicked on the link you provided and there’s nothing there …It just brings me to the case history info page ..not her specific file ?? Anyhow …I have been treating her as IR since she came down with acute laminitis back in June of 2020 ..she gets fed a variation of the emergency diet (  small amount soaked ODTBC/ Vermont Blend/Flax /Vitamin E capsules /handful Nuzu Stabul one …along with Uckeles Laminox , Phytoquench, GUT, Spirulina Insulin Wise ,and Tractguard along with tested low sugar Timothy when available and since it’s run out she’s been getting soaked Timothy orchard grass , dry lot …she’s been in light consistent work for well over a year. What would you change in regards to diet ? The only thing not being addressed is the possibility of early Cushings ..she was stim tested last April 2021 and was negative ….
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Michele Goldberg 
Bernville, Pa
joined 2015

Dr Kellon…her leptin came back at 20 
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Michele Goldberg 
Bernville, Pa
joined 2015

I got some more blood results in… Her Leptin was 20… EPM negative… Vitamin E still pending

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Michele Goldberg 
Bernville, Pa
joined 2015

Yes, that's too soon. Give it 4 to 7 days.

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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Hi Dr Kellon …how soon would you expect to see a result with feeding the oats post exercise ?? I fed it yesterday for the first time …so far no different…Is it too soon to make a difference??
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Michele Goldberg 
Bernville, Pa
joined 2015

Michele,

Unless the horse is known to have trouble chewing, whole oats are fine.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Ok will do ! Does steam crimped versus whole oats make a difference?…Triple crown sells both types
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Michele Goldberg 
Bernville, Pa
joined 2015

I would definitely give the post work oats a try. Let us know how it goes.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Hi Dr Kellon…she is in light consistent work ..anywhere from 3-5 days /week usually around 20-30 minutes of mostly flat work in the arena and occasional trail riding and flat work out in the fields….I was wondering if this could be diet related to the low energy and that she needs a boost …I can certainly give this a try.
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Michele Goldberg 
Bernville, Pa
joined 2015

 Michele,

How much work is she doing? I wouldn't put her on pergolide, Metformin or Thyro-L. Her diet may be too low in available carbs to replenish her glycogen.  Try giving her 1.5 lbs of high quality oats (aka racehorse oats) or oat groats immediately after exercise - no other time.

A negative TRH stim test trumps a seasonal ACTH elevation every time. You can repeat that test later though. They can change from negative to positive. It wouldn't be high on my list at her age.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Hi Sherry ..thank you for your response and helpful info …my vet said something about the glucose to insulin ratio put her in the “at risk” category I believe and that’s why he suggested Metformin…I’m guessing her insulin might be what it is due to the elevated acth or vice versa??if I were to go ahead and start her on Prascend what dose would be appropriate? Would that be the best treatment plan ? Or like someone else mentioned would you hold off treating since we’re coming towards the end of the fall rise , and re test with a stim come winter ??
I want to do whatever the best thing is for Schimpie and get her feeling like her usual self. 
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Michele Goldberg 
Bernville, Pa
joined 2015

Hi Kirsten …thank you …that makes sense 
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Michele Goldberg 
Bernville, Pa
joined 2015

Martha …I guess what’s conflicting in my mind is my vet telling me that her acth of 77 is acceptable/normal beings that it’s during the fall rise ?? I understand that it’s considerably higher than April 2021 …..but isn’t that to be expected during fall rise?? Her stim results both pre and post put her in the normal /not Cushings category …that’s why we didn’t stim her again ..and also like mentioned you generally don’t stim during fall rise if I’m understanding correctly….the other conflicts is vet saying she’s far too young to have Cushings and also the other conflict is vet saying she should have Metformin??
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Michele Goldberg 
Bernville, Pa
joined 2015

Michele, an ACTH of 77 in a young horse is indicative of early PPID at the peak of the seasonal rise.  That number would be more normal for an elderly horse, not an 11 year old.  Our understanding of what is normal this time of year is evolving and the 3x rule doesn't hold anymore with new research.  The Liphook charts that Sherry shared the link to show a max of about 55 (normal) at the peak of the rise.  If you want to leave her untreated this fall and redo the TRH Stim in the late winter or spring to confirm the early PPID, that's fine as we are coming out the other end of the rise and Schimpy's insulin is not overly elevated.  But next by July you should have her started on pergolide and then retest her baseline ACTH to make sure it's staying low. 

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Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Hi Michelle.

Agree with all that has been said. I would add, "energy and demeanor" are non-specific signs and could range from diagnosis ,to diet,  to trim, to work issues.  DDT+E.
 
Again, case history please.
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Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022

Michelle, I’m just suggesting that 77.4 is more than five times the value you found when you tested in April so I’m not sure what’s conflicting here, except for your vet’s understanding that 11 is not necessarily too young for PPID.  You should not need to do a TRH stim once diagnosed positive and started on pergolide, neither of which apply to your horse.  You should also not do a TRH stim during the rise at this point because there are no published standards to which you can compare your results.  It’s fine that you didn’t do one but you need to be sure to compare the correct numbers.
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