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Dr. K please? Was updated Oden's Case History

Cindy Giovanetti
 
Edited

Dr. K, 

I've just asked my vet to do an ACTH test on Oden, and he is pushing back.  He's a mobile vet (not with a big clinic), and this test is complicated for him to handle.

I asked him if there was any chance the insulin test was handled incorrectly and if rerunning it might give me a less Cushings-feeling result (up from 100 to 150).  He said no.  It was handled properly.

Is there anything else to try before insisting on the ACTH test?  Invokana? Metformin?  Anything else?  Oden is 12 and has no other PPID symptoms.

--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125

Lorna
 

Cindy, some of us used to do the grunt work, to make it easier on our vets. Not sure if it is still allowed for owners to be hands on, but with the proper paper work to clear you, it might be possible for you to take the vial to a small animal clinic,for spinning down,then put sample in your freezer overnight,label correctly, and ship it off next day to lab. 
Maybe.

--

Lorna Cane
Ontario, Canada
2002


 

Eleanor Kellon, VMD
 

Hi Cindy,

Agree with Lorna's suggestion on how to get the blood work done. Would also offer to pay the small animal vet's office to handle shipping to get it to Cornell frozen or at least still cold.  ACTH is much more sensitive to handling than insulin.  The insulin rise isn't necessarily PPID-related though. We're heading into winter.

Your horse's breed evolved attuned to surviving in cold weather with little food. Once calories stop going to growth they are highly attuned to packing on fat unless being worked - really worked! Your latest feeding changes look good but I wouldn't try to go much lower.  You would have to get to near starvation levels to force weight off him this time of year. The best thing you could do for him is look into breaking him to drive. It's ideal exercise because most of the work is on the hind end but pulling weight is serious work.

You could consider metformin or canagliflozin, especially since he's been sore again recently (thank goodness he has a good trim!). *If* canagliflozin effects on fat metabolism are similar to those in humans, it may be the best overall choice for horses with this pony-like metabolism because it stimulates the protein (lipoprotein lipase) that breaks down circulating triglycerides. If you want to try it, your vet will have to agree and I can send him some background information. You need to check a blood chemistry at the start and 2 months in. Also buy some urine test strips and monitor his urine for signs of infection about every 2  weeks or if he shows any signs of urinary tract infection (see previous threads).
--
Eleanor in PA

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

hinecedark
 

Hi Cindy, 
This may be old news, but just to be sure . . . . In the "old days" my mobile vet used to groan at the idea of doing bloodwork for ACTH . . . specific tubes, refrigeration until spun, etc. And I used to put the samples on ice and take to the clinic for him. He now uses a kit which contains everything needed, including a cold pack. As long as he has a kit on his truck, no problem. I've never asked where he gets these, they are pre-packaged, self contained. My first guess in looking for them would be Cornell, as that's where he sends the samples. Is it possible that your vet hasn't found these yet and if you could show him an easier way it might help? If one of his problems is that he has to get back home and spin the sample himself, could you find a nearby small animal clinic that might do that part for him?
HTH,
Melinda
IN  2010

Cindy Giovanetti
 

When I follow the ACTH testing section in the file, there are numerous test available through Cornell. Can somebody please just verify which one I want.

Cindy

--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos: https://ecir.groups.io/g/CaseHistory/album?id=91125

Sherry Morse
 

Hi Cindy,

The most 'bang for your buck' is the Equine Metabolic Syndrome Diagnostic Plan even though the T4 isn't a number we generally use.  Go to https://www.vet.cornell.edu/animal-health-diagnostic-center/testing/diagnostic-plans-and-panels/equine and then scroll down.

It includes:




Cindy Giovanetti
 

Thanks, Sherry, but we just tested insulin, glucose, and leptin a month ago. The only thing we didn’t do is ACTH. Specifically, the vet asked if I wanted baseline or stem. But I would appreciate your pointing me to the exact test.




--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden/Oden%20case%20history%20%288%29.doc
Photos: https://ecir.groups.io/g/CaseHistory/album?id=91125

Lorna
 

Cindy, you can go back to the link that Sherry provided.
Look under the picture at top of page, and click on testing.
Follow that link to Tests and Fees, type ACTH into the search box that appears,and it will take you to equine ACTH baseline, $28.00, third test down.
That gives you the individual test, instead of the panel.

-- 

Lorna Cane
Ontario, Canada
2002


 

ferne fedeli
 

I always have my vet order the ACTH, insulin & leptin panel & then add glucose.  I'm sure it is a little cheaper & I don't want T4.

--

Ferne Fedeli     2007

No. California
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Deb Walker
 

Right now, at least for us, all of the tests are important, but I am specifically looking at ACTH this time of year. I am waiting to January to re-test everything and just see where *we* are at.
--
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:
 https://ecir.groups.io/g/CaseHistory/files/Deb%20and%20Scotty
Photos:
https://ecir.groups.io/g/CaseHistory/album?id=90619