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Bloodwork drawn once yearly?


Patricia Evans
 

Hi all,
I know it's best to draw bloodwork a minimum of twice yearly, but financial challenges are making life difficult for me as well as everyone. My particular problem is when to draw bloodwork if I can only afford to do it once a year? It was last drawn in September of 2020 (and no, my case histories are not up to date :( , sorry). I know I should have drawn labs on my three PPID horses already this year, but so far I have not been able to get it done. The vet charges me $485 for ACTH and insulin plus a farm fee, and right now it's not within my reach. All three are doing well, but I did need to put Dancer on metformin to get her insulin down last year. The repeat blood draw showed that her insulin did respond well, but no other labs have been drawn since then. 6/15/20 her insulin was 62.72 and after almost 3 months on metformin it was down to 40.80. She is now off it, but it seemed to be a big deal to my vet to get the prescription, since her insulin wasn't in the 100's. Since she has had laminitis twice in her life, I was able to finally talk the vet into giving it to me. 

I did look in the files and messages, but could not find anything about once yearly bloodwork timing. Any answers are much appreciated!
--

Patricia 

North central Florida

July 7 2018

https://ecir.groups.io/g/CaseHistory/files/Patricia%20and%20Dancer%20and%20Nathan
Dancer:  https://ecir.groups.io/g/CaseHistory/album?id=66069

Nathan:  https://ecir.groups.io/g/CaseHistory/album?id=94152
Snickers 
https://ecir.groups.io/g/CaseHistory/album?id=241740 


Lorna Cane
 

Hi Patricia,

If she were mine,because there are numbers for last June,and because at that time of year ,at least the ACTH should be in good range, I would draw again in June this year.
My thinking is that if I wait til September, there being numbers for then,too,and numbers are high I'm at more of a disadvantage than if I find numbers out of line in June.
I can see how others may disagree with this, but without more details this would be my approach.

--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Sherry Morse
 

Hi Patricia,

I agree with Lorna as far as the timing of the testing.  Of the three of them Dancer is the one I'd be most concerned with as her insulin is elevated, even with the metformin.  Is there a reason that the metformin was stopped and was her insulin checked after it was stopped to see if it stayed down or went up when she was no longer on it?




Kirsten Rasmussen
 

I would push the ACTH testing to late July-early August personally, if I had a PPID horse and a choice of when to test.  Summer solstice (Jun 20th, 2021) is technically the start of the seasonal rise but I would not expect to see much of an increase in ACTH until it's a little more closer to the fall equinox in late September (Sep 22/2021).  It's a balance between testing too early and not seeing if ACTH is rising abnormally fast, or testing too late and not being able to increase the pergolide dose in time to be effective on the full ACTH rise.  It's hard if you can only test 1x a year but that is the reality for many people.  My vet only visits our area 2x a year (spring and fall) and I don't get to chose the dates, so I just get the tests done when I can even if the timing is not ideal.

Other members with large herds of PPID horses have said that they based pergolide dose increases based on tracking signs/symptoms rather than bloodwork because of the cost, and that is a reasonable strategy if you are willing to do a weekly assessment of PPID signs in each of your horses, document your observations, then watch for trends/changes.

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


 

My vet prescribes pergolide based on symptoms.  She says, by looking the horses in the eye to see if they look like they do not feel well.  Thus far, her diagnoses have been predictive of elevated ACTH. 

--
Gail Russell 8/30/2008

 

 https://ecir.groups.io/g/CaseHistory/files/Gail%20and%20Brother%20-%20Odin%20-%20Decaffe%20%20-Gunthar .


Patricia Evans
 

Thanks Lorna and Sherry,
I agree that June sounds good and I will have more time to save my pennies ;-)
Sherry,
Dancer stopped eating with the correct dose of metformin, whether it was in her food or syringed. I was giving her omeprazole also, but the only thing she would eat was her hay. No, her bloodwork was not drawn again. I still have some metformin on hand and was going to restart it if I needed to when her labs came back, but so far I have been unable to get it done, hopefully soon.
--

Patricia 

North central Florida

July 7 2018

https://ecir.groups.io/g/CaseHistory/files/Patricia%20and%20Dancer%20and%20Nathan
Dancer:  https://ecir.groups.io/g/CaseHistory/album?id=66069

Nathan:  https://ecir.groups.io/g/CaseHistory/album?id=94152
Snickers 
https://ecir.groups.io/g/CaseHistory/album?id=241740 


Patricia Evans
 

Thanks Kristin and Gail,
I did the s/s and dose increases with my previous vet and she got very upset with me. She said that was not a good way to do it and that the symptoms I used were probably due to other reasons. She was so rude that I took offence and changed services. I can understand and agree with her opinion, but not the manner in which it was delivered.

There are three vets in my current service and one is agreeable with that method, one absolutely against, the third unknown. I routinely use the symptom list to check my three horses and I've still increased based on symptoms when the bloodwork was not an option.   

Thank-you for your thoughts everyone. This group is incredible!
--

Patricia 

North central Florida

July 7 2018

https://ecir.groups.io/g/CaseHistory/files/Patricia%20and%20Dancer%20and%20Nathan
Dancer:  https://ecir.groups.io/g/CaseHistory/album?id=66069

Nathan:  https://ecir.groups.io/g/CaseHistory/album?id=94152
Snickers 
https://ecir.groups.io/g/CaseHistory/album?id=241740 


Eleanor Kellon, VMD
 
Edited

Just to play devil's advocate - or rather veterinarian's advocate! - signs don't trump blood work. This is especially true of very nonspecific signs like goopy/tearing eyes, sensitivity to touch or not running around. For example, if you tell your vet something like "I've been increasing the dose every week because she still has runny eyes" you can expect some pushback and it's justified. If it's something like "I can tell she doesn't feel good", same scenario. You may be 100% correct that she doesn't but there are many, many possible explanations.

It will help if you can be more precise and organized when talking to your vet.  Instead of "I think she needs more because she has runny eyes", "Her eyes have always been an early sign her ACTH is out of control and that is soon followed by laminitis" would be more convincing.

If your horse has a significant problem like PPID there is always going to be a tendency to blame everything you see on PPID. Same thing happens with other disorders like EPSM/PSSM.

Pergolide is generally well tolerated but the real potential for harm here is that something else will go undiagnosed. For example, horses that are not eating well and not feeling well could have a simmering colic issue that could kill them.

If lab work is not an option for whatever reason, talk to your vet about putting together a list of danger signs that fit your horse's presentation as well as known red flags for PPID in general.  For example, unexplained weight loss, loss of topline and weakness of the abdominal muscular wall, slow shedding or other coat changes.  You should both agree on this ahead of time and you should at least let your vet know when you see something and adjust a dosage.
Shop around until you find a vet to work with you on this.

As an aside, horses don't have symptoms. A symptom is something the patient verbally complains about.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001