Did Cornell ACTH reference range change


TERRI JENNINGS
 

I just got Finn and Elliott’s latest bloodwork back. Did Cornell change their reference interval?  That’s how it appears. 

Also, Elliott’s triglycerides went back up despite adding L carnitine and beet pulp. I’m not sure if I should be doing something different. My vet is concerned. 


How much should I increase Prascend to get these boys’ ACTH lower? My vet is reluctant  


Thanks


--
Terri Jennings with Mr. Beefy, Finn, Elliott and Teeny (over the rainbow)
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny/Terri%20and%20Beefy
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny/Terri%20and%20Elliott/Elliott%20Case%20History.pdf
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny/Terri%20and%20Finn/Finn%20Case%20History.pdf


Joined 2019


Sherry Morse
 

Hi Terri,

Yes the new upper limit is 30 now.  I would bump up to 2mg at least for the rise for both of them and then plan on retesting in January to see if that's keeping them in the low 20s range we like to see with confirmed PPID horses.  If it is I'd leave them there going forward. 





Eleanor Kellon, VMD
 

Are you feeding free choice, unsoaked hay? Do you have any liver enzyme values? Your vet may feel better after seeing this article https://pubmed.ncbi.nlm.nih.gov/23663085/ .  As for the ACTH, I'm not sure you need to increase it but you could ask about a 0.25 increase for the rise then back to the lower dose in December.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


TERRI JENNINGS
 

I am feeding free choice hay.  I’ll have the vet run liver enzymes  

I was thinking about increasing .25 for both of them. With the high end of the reference being lower than before do I need to aim for lower than 20?

Should I up Elliott’s L carnitine or wait for labs on liver enzymes?
--
Terri Jennings with Mr. Beefy, Finn, Elliott and Teeny (over the rainbow)
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Mr.%20Beefy,%20Finn,%20Elliott%20and%20Teeny
https://ecir.groups.io/g/CaseHistory/album?id=258266 
https://ecir.groups.io/g/CaseHistory/album?id=261227 
Joined 2019


Eleanor Kellon, VMD
 

It's always the lower the better with ACTH but I think the 0.25 increase during the rise period should cover you. L-carnitine should be 1 gram per 100 lbs bodyweight and you can give that twice a day. Are you sure Elliott is eating well? Is his weight accurate? His TGs aren't in a red zone by any means but our goal is to control all abnormal levels, not one at the expense of another. That said, insulin is paramount because of laminitis. How much beet pulp are you feeding? It yields a greater level of acetate which substitutes for glucose in the cells.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


TERRI JENNINGS
 

Elliott is eating well and he never runs out of hay. He has some fat pads but also I can start to see his ribs. This is the weight I try to keep him at. He had put s few pounds on in May but is back to his “goal” weight. He gets 10 cups (measured when dry) of Standlee beet pulp pellets each day divided into 3 feedings. He loves his beet pulp and I’m certain he would eat more if he needs it. I am only giving him L carnitine once per day but I could up it to twice a day. 

I’m wondering if I should recheck his triglycerides in a month or 2 if this could be from the recent weight loss (which he needed to lose).  He had found a way to eat little bits of grass thru his blocked grazing muzzle. This smarty pants comes up with a new trick every spring. 

Thanks
--
Terri Jennings with Mr. Beefy, Finn, Elliott and Teeny (over the rainbow)
Arcata, CA
https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Mr.%20Beefy,%20Finn,%20Elliott%20and%20Teeny
https://ecir.groups.io/g/CaseHistory/album?id=258266 
https://ecir.groups.io/g/CaseHistory/album?id=261227 
Joined 2019