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ACTH off the charts


anneefrancis@...
 

It's been a very long time since I've posted as my 20 year old, baroque, Lusitano mare was seemingly doing great.   My vet drew blood this week to test for Cushings  Her ACTH results came back at 360.0 H pmol/L with a reference interval of 2 - 10!!  How is this even possible??  My mare does not show any clinical signs of PPID.  She's buxom and cresty but always has been.  She is compensated IR (I'm testing again to see if that's changed) and has DSLD (she's on Dr. Kellon's protocol).  She was tested for Cushings in 2016 and her results were 5.4 pmol/L.   I've asked to retest her in case the sample for mis handled.  I also wondered in Jiagulan or AAKG could affect the numbers.    Her hay is less than 10% (she is free fed in a slow feed hay net), she has access to balanced hay cubes at night, and get's 2lbs of Brooks Enhancer/day - nutritional analysis is in my old case file.   She is turned out 12 hrs a day on a dry lot and is worked 3 times per week.  I'm gobsmacked by these numbers. I know that I'm going to have to do something but I don't have a clue where to begin. 

I tried to update my case history to no avail.  I'm wondering if I should start a new file.  

Anne & Tricana in Toronto, Canada

May 2016

https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Tricana/Tricana%20Case%20History.pdf

 


Eleanor Kellon, VMD
 

Anne,

All you know at this point is that her current dosage is not enough to control the  rise numbers which, as you have seen, can be quite dramatic - especially in a horse with PPID. Your feeding and exercise routine is working in her favor but it eventually won't  be able to compensate for uncontrolled PPID.

Since she is asymptomatic and we are on the downward side of the ACTH rise you could wait until December to retest her ACTH and take it from there.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hi Anne,

For your CH since you're using the old form you may want to update to the new one if you don't have an editable form saved on your device. Information on how to do your CH is available on the wiki: https://ecir.groups.io/g/main/wiki#Case-History-Help



anneefrancis@...
 

Thanks Dr. Kellon.

To be clear, she's not currently on anything.  I hadn't had her tested since 2016 since she was never symptomatic - lesson learned.   I imagine I need to get her going on something?  I'm keen to try Cabergoline injections as she is soooo fussy - it took me almost a year to get her on your DSLD protocol.    Or would you suggest I don't proceed with anything until I retest her in December?

Best,

Anne & Tricana in Toronto, Canada

May 2016

https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Tricana/Tricana%20Case%20History.pdf

 

 


anneefrancis@...
 

Thanks Sherry!  I'll get on that today.

Best,

Anne


Lavinia Fiscaletti
 
Edited

Hi Anne,

Firstly, breathe. Dr. Kellon has already addressed some of your concerns:

If the sample was mishandled, the ACTH result would be lowered, not falsely raised but no need to panic. One of my horses had his ACTH result come back at 1088pg/ml (ref range 9-35) the first time I had him tested, so exceedingly high results aren't as unusual as one would think. At the time, he was also compensated IR and didn't appear to be in trouble.

Jiaogulan and AAKG will not affect the ACTH.

It would be helpful if you could change the link in your signature so that it goes to your case history folder, rather than directly to Tricana's case history. That way, we can find all of the other documents in your file easily:

https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Tricana

Generally, pergolide is the first line treatment. It is a tiny caplet (Prascend) or a tiny capsule (compounded) that can be hidden in a small treat for dosing. Or, you can easily dissolve the dose in a small amount of water, then syringe it in.
Cabergoline is a lot more expensive and is an injection - not sure if it is available in Canada or not.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


anneefrancis@...
 

Thank you Lavinia.

I've updated my case history and read my way through a good chunk of very informative information :)

Will give Pergolide a go.  

Anne and Tricana
May 2016
https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Tricana


Mary Marshall
 

I have been able to pop the Prascend pill into a peanut shell and just add it to his breakfast.
I just puncture the outside of the shell a little bit and pop the pill in.


--
Mary Marshall
Aiken SC
Joined-10/17/2020


anneefrancis@...
 

Such a great idea, thank you!

This week will be all about trial and error :)

Anne and Tricana
May 2016
https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Tricana