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Bloodwork and possible error

Kandee Rockett
 

Good morning Dr. Kellon and ECIR Group,

Mare's recent bloodwork results ---feel like there's an error--glucose 69 
Initial blood draw 12/27/19--Sample was stored at vet's office for about 7 days before being sent due to the ACTH vial breaking and having to re-draw blood for the ACTH on 1/2/20. The original metabolic panel blood was then sent with the new ACTH sample at the same time.  Cornell received 1/3/20.   My vet reassured me that the red blood cells were separated and stored properly according the Cornell protocol (think frozen ??) 

 My ?s are: Does glucose deteriorate quickly? Could this be the reason it was 69?  Does it matter or should I just go by the insulin #s ? Should I be concerned about her insulin almost doubling even though it's still within the normal range?   Can I use a glucometer like people use to test her blood sugar? (I read something about this on ecir group.  Have to get sample from nostril area and not as accurate ????)    According to calculator--Oct.--she made it to compromised IR @ a 5  Now she's back to uncompromised IR @ a 2      My vet is okay with these bloodwork results and doesn't adhere to compromised, etc. info --didn't address the unusually low glucose.  

I had bloodwork done in Dec. because Bunny quit eating the soaked coastal so I've been giving her un-soaked C. for about 2 mo.  Our hay has not been tested so I'm trying to determine if it is safe for her to eat without soaking.    Un-soaked coastal only change in feed.  She also has access to more of her pasture area since 11/27, but still wears grazing muzzle (taller, dead grass on other side of electric wire--don't think she can get to lower near-the-stem grass due to taped muzzle holes which are small).  She has managed to get a small amt of green winter grass with her muzzle----but very little.

Here's the last 2 bloodwork results for comparison:
The Dec. sample was drawn between 9:30-10 am  She had access to un-soaked coastal and timothy until midnight and began eating only c. and timothy hay again at about 6:20 am.
Oct. 14                                     Dec. 27
Insulin       18.24                     34.66
Glucose    95                          69
Leptin       15.29                      13.15
ACTH       29.7                       35.0  
T4             2.72                       1.83
Has been on 1mg Prascend since July 2019 but has always tested within norm range--highest being 36.5  in Jan., 2019  
  She has freq thirst/urination, had swollen udders but not since on Prascend, hair longest since I've owned her, lethargy, had loose stools--not now, etc.    Vet does not think she's PPID 

Appreciate any input.

Thanks,
Kandice and TWH Mare  Bunny
North Central TX  joined 2/19

Case History: https://ecir.groups.io/g/CaseHistory/files/Kandice%20and%20Bunny

Eleanor Kellon, VMD
 

Yes, glucose is fragile. I'd ignore this value.

Both this insulin and the previous one were abnormal. It might be higher from the unsoaked hay, or the grazing, or the temperatures, or any of those.

Personally  I would strongly suspect PPID and if  PU/PD still obvious it's not well controlled.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

 

Odd that the ACTH increased between October and December, when you’d expect it to be dropping.
--
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
 

The ACTH rising when it should be dropping combined with the frequent urination and long hair is a good sign that her dose of Prascend needs to be bumped up IMO.  



Kandee Rockett
 

Thank you Dr. Kellon!

 

That’s what I suspected. 

I still don’t understand the insulin #s    Cornell’s normal range is 10-40.  How do they determine those #s and why different from what is recommended on this site?  What is considered normal?

 

I do have her on 1mg Prascend and I’m following diet protocol except for the unsoaked hay.  I tried to get her to eat soaked coastal again last night with no success.  I will try soaking 30 min instead of 1 hr.   Dry lot not an option at this point.  She’s not foot sore or showing signs of laminitis and gets trimmed every 4 weeks by a farrier who specializes in treating metabolic horses.

She is still recovering from a check ligament injury so hand walking is the only exercise she gets right now.  I’m hoping riding will improve the insulin   (Hopefully get to start in about 1 mo….but probably won’t be strenuous enough to be significant for a few months).

 

 

Thank you again,

Kandice and TWH Mare Bunny

North Central TX, joined 2/2019


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Thanks,
Kandice and TWH Mare  Bunny
North Central TX  joined 2/19

Case History: https://ecir.groups.io/g/CaseHistory/files/Kandice%20and%20Bunny

Nancy C
 

Hi Kandice

Not Dr Kellon, but here are a few messages that may help with your questions

https://ecir.groups.io/g/main/message/2251774

Hope this helps

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

Eleanor Kellon, VMD
 

****LABORATORY RANGES ARE NOT NORMALS****


I'm not yelling! - just trying to get everyone's attention.  This comes up regularly.

"Normal" insulin depends on the circumstances. Would you expect a fasting horse to have the same insulin as one that just ate a full bucket of sweet feed?  The normals our calculator uses are based on ponies on pasture - so pretty generous for a full sized horse on low S/S hay.

Laboratories have reference ranges, not normal ranges. The usual procedure is to test animals that are externally free of any obvious diseases, various ages, breeds, sexes. How diverse the population is will depend on what is readily available to the lab - e.g. university donations. A minimum of 80 animals are supposed to be tested but that's not always done. Values that are extreme outliers - way above or below most of the results - are supposed to be discarded but that's not always done either. Results are then averaged and two standard deviations https://www.youtube.com/watch?v=MRqtXL2WX2M applied to get the range.  For example, if the average was 50 and standard deviation 10, the range would be 30 to 70.  What the reference range really means is if you test your horse there's a good likelihood you will see a result in the reference range. That does not mean it's normal.It means it was common for the ages, breeds and diets included in their test population.
--
Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001

Nancy C
 

Dr Kellon also goes into Laboratory Ranges in ECIR's film, Getting the Correct Diagnosis.

https://www.ecirhorse.org/video.php

Scroll down.
__
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

 

I’m sorry to say I’ve seen exactly the same effect in both Satra and Cayuse: reasonable in October, higher in January. And here, winter is only vaguely what people in other parts of the country think of winter. Not cold, days in the 60s. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse Case History Folder                Cayuse Photos
Diamond Case History Folder              Diamond Photos 

Kandee Rockett
 

Sorry for the extremely large font again…don’t know how that keeps happening ???  Not on purpose    

  

Thank you Nancy and all for your responses.  I just read Dr. Kellon’s explanation of Cornell’s normal range (10-40).  Making more sense…Now  I remember reading that info on this site before.

According to the IR calculator, insulin needs to be <= 20 to be compensated.  Is that correct?  Her insulin was 34 this time and 18 last time (diff was soaked vs unsoaked hay)

 

It’s frustrating to be told the numbers are okay when I’ve learned otherwise.   Why are some vets not more up-to-date on IR care and data?   I know my mare’s glucose of 69 can’t be accurate, but there was no follow-up or concern about that test result. Shouldn’t my vet realize the fragility of glucose and not hold the sample so long before sending it to Cornell or am I being unreasonable ???    Sorry, I know no one can answer that…just need to vent a little.  It’s costing me so much time and $ and taken over my life.

 

Thankful for this site! Otherwise I would have very little sound advice or direction on what to do for my IR/probably PPID mare.

 

Now, I have to problem-solve how to get her to eat soaked hay again.  I soaked for 1 hour so will try 30 minutes.  I was REALLY  hoping not to have to soak at all   

Seems trivial, I know, but working all day (job that I often take home as well) and then going to the barn after work to give meds/supplements and hand walk for ligament tear recovery rehab and going back to the barn later to let her out of the enclosed area  (she’s on a small grass pasture with a grazing muzzle) is taking its toll on me. 

 

Thank you all for listening.  I will stay more focused with less “whining” on future posts. 

 

 

 

 


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Thanks,
Kandice and TWH Mare  Bunny
North Central TX  joined 2/19

Case History: https://ecir.groups.io/g/CaseHistory/files/Kandice%20and%20Bunny

Kandee Rockett
 

Thank you Dr Kellon!  It’s making more sense.  I’m thinking I should go by the IR calculator and strive for insulin  <= 20   to be in the compensated range.  Which most likely means, I’ll need to soak her hay again. If she’ll eat it !  


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Thanks,
Kandice and TWH Mare  Bunny
North Central TX  joined 2/19

Case History: https://ecir.groups.io/g/CaseHistory/files/Kandice%20and%20Bunny

Sherry Morse
 

Hi Kandice,

I think it's a fair guess to say we all share your frustration with the vets not being up to date on IR care and data.  I know my regular vets aren't as up to date as I'd like them to be and 2 of them are relatively young and 1 interned at one of the bigger clinics in the area which IS more up to date on testing.  

As far as the hay soaking - are you letting the hay sit after soaking but prior to feeding?  That may help with making it more palatable.  Also, soaking in hot water this time of year may help as well.  We routinely soak all our hay in hot water this time of year and then drain it and none of the 33 horses turns their nose up at it.

Occasional whining is allowed, especially in the winter having to do extra running up to the barn when you board always seems to be much more of a PIA than in the summer :-)



Kandee Rockett
 

Thank you Sherry,

 

I was soaking, rinsing, and feeding it to her immediately.  Are you saying I should wait a bit after rinsing?  I wish we had hot water at our barn. 


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Thanks,
Kandice and TWH Mare  Bunny
North Central TX  joined 2/19

Case History: https://ecir.groups.io/g/CaseHistory/files/Kandice%20and%20Bunny

Sherry Morse
 

Hi Kandice,

Yes, you should let it sit for a bit so the water runs off - you can reread the official directions on the Diet page of the website: https://www.ecirhorse.org/DDT+E-diet.php but the recommendation is to wait 10 minutes after soaking.