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Dr Kellon - Invokana Horse Vinnie 2022-10-18 Labs Update

Nancy & Vinnie & Summer
 

Hi Dr Kellon.

We got our updated labs as follows:

TG 523 was 552
Insulin 56.98 was 37.07
Glucose 100 was 97
Acth 18.5 was 17.8

Meds:
225mg canagliflozin (same)
*11.5mg was 9.6mg c pergolide
*I switched labs because i had growing concerns that the current medication I was using was not effective at the same combined dose.  Vinnie has been on the new RX for 6 days at the time of the blood draw so not enough time to fully benefit but I have seen positive changes.  Prior to the change he was experiencing hay belly, loss of top line, lethargy, decreased interest in things, increase urination, up and down footiness,  Post RX change, within 3 days he started to be more engaged, eating much better, decreased foot tenderness, his mischievousness came back.

Diet:
Free fed hay:
   10 to 13lb of 6.3 esc+starch hay
    2lb 9.9 esc starch
5lb alfalfa mixed in hay bags with grass no more than 1/4 flake per bag
10 cups dry weight rsr beet pulp
4-6 cups stabul 1 added to a bucket to eat at will.
10 cups triple crown sr mixed with beet pulp
6 cups timothy pellets
25g l carnitine split two feedings 
100g pea protein split two feedings 
Drs choice daily start ( 2 scoops) split
Absorb all 2 scoops split
1tsp Thyro L added for Low Thyroid since stopping last year.

Attached is a link to the mini spreadsheet with history (CH is going to take me a while to update, it is high on priority list)
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Vinnie/Vinnie%20Bloodwork/D%27Cruz%20Vinnie%202022-10-18-%20Lab%20Tests%20and%20Meds.pdf

The last month or so has been a little up and down.  I started to notice Vinnie developing a hay belly around Sept 24 in spite of increasing pergolide doses.  He was becoming more lethargic, less interested in his feeds, less interested in walking, more frequent urination, continued crazy hair growth, hypersensitivity to bugs, and these patterns made me think that he was headed towards a little crash.  I didn't thik this was related to TG because he is maintaining a good weight (unlike last time) But he also was beginning to have more inflammatory changes, edema etc. I promptly decided to make a change in CP pharmacy thinking something closer to home may be beneficial due to shipping and stablity etc.  We received our new RX on Oct 12, and within three days I noticed some positive changes, brighter attitude, decreased foot soreness, improved appetite, more engaged and spicy etc.

I am not thrilled with the Insulin or TG numbers on this lab, but I am happy the TG are at least stable. 

I am not sure of my next steps and what to modify.  I think decreasing BP and adding timothy pellets has helped him maintain his weight well, , but I am not sure if that is contributing to the higher insulin.  His am feed consists of 1/4 flake alfalfa with about 3 cups of timothy pellets (tested at 9.3 esc+starch).  Then he gets hay bags to snack on before lab draw.  He received his invokana 2 hrs prior to pull.  I pulled at approximately 10:30am and the temp was 62.  It was the coldest night we have had yet dropping to 52 but I am not sure if that played a role. He was covered with a sheet until the lab draw. 

Please let us know what you think, 

Thanks in advance Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Nancy & Vinnie & Summer
 
Edited

Hi Dr Kellon, Wondering if we should make any changes with Invokana to help the insulin?  Or do I hold and keep things static for three weeks and retest to see if ACTH is influencing insulin?  

I acknowledge that the ACTH is well inside reference range, but it has been increasing in the last two months in spite of a 40% increase of pergolide. 

I also realize we are not in laminitis risk, but I don't want to sustain any more damage to those lamellar connections that are already so compromised, but we are also at the top of the TG risk level so I recognize that is important too.

Thanks in advance, Nancy 

--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Nancy & Vinnie & Summer
 
Edited

Finally made updates to my CH.  I don't think it is perfect as there is about a year and a bit of info that I added, but Labs, Diet and Meds are updated.

https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Vinnie/Vinnie_Case_History_2022_10_21.pdf


Thanks in advance, Nan

--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Nancy & Vinnie & Summer
 

I got a urine strip test today 24 hours after the last dose of invokana. Thought it was interesting that glucose was still moderately high.

https://ecir.groups.io/g/CaseHistory/photo/245855/3508491?p=Created%2C%2C%2C20%2C2%2C0%2C0

In the meantime, I have decreased the TC Sr to 8 cups, decrease beet pulp, increased timothy pellets.  I am hoping this helps with reducing insulin and triglycerides. 

He was moving around much more comfortably today which I think is a good sign. However, he received his 6th part of the loading dose of adequan last night. So I need to factor that in to his improvement.
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Pamela Swartz
 
Edited

I’ve been reading your posts for awhile now - absolutely amazed and impressed at your diligence helping Vinnie. ***** 5 stars! 


I have 3 PPID/IR horses so I know the pain of caring for them and the cost of bloodwork. Once again, I’m so impressed with your frequent lab draws. Whew! If only I had clients so willing  


I’m a hoofcare provider (barefoot) and have taken Dr. K’s NRC Plus course. Balancing diet is a passion of mine. It’s been my experience that feeding alfalfa to PPID/IR horses often makes them footsore and increases insulin. I’ve also noticed with my own horses and client horses (hi Joy V. and Willie!) that Stabul 1 feeds made the horses footsore. I’ve also noticed the starch in pea protein to be an issue and opt for isolated whey protein if protein supplementation is needed. However, high protein been shown to cause foot tenderness for metabolic horses. 

I’ve had the best results with my metabolic horses and client horses who are feed r/s/r beet pulp (pellets ok) and TC Timothy Balance Cubes as the sole carriers for supplements and weight gain/stabilization. My 25yo Arabian mare who is on 25mg compounded pergolide daily lost a lot of weight when we moved from California to the PNW early this year. Twice daily HUGE tubs of r/s/r beet pulp and TCTBC and free choice ESC+starch 7-8% orchard hay has helped her gain almost all the weight back. She’s never been footy or had higher insulin and she’s still a pistol on our short rides - although I’ve limited those to direct her energy into weight gain. 

I never meant this comment to be this long! Just wanted to share with you what has worked for my 3 and many client horses over the years. I find doing the least often makes for the best results and prevents my head from exploding! This is what I feed my horses daily:

free choice 7-8% orchard grass hay
varying amounts of TCTBC and r/s/r beet pulp based on their weight as the carrier 
2 scoops California Trace plus
8 oz ground flaxseed (more for older mare)
3 tablespoons plain white loose salt
1000 iu Vitamin E capsule in oil 
5 g Mg oxide
64 grams/1 scoop psyllium husk from Uckele

I often salt their hay in the hay bags too. They drink plenty  of water and live outside so I don’t have to worry about changing bedding. :)


Pamela Swartz/Vinda, over the rainbow bridge
Fanny 25yo mare, Beau 20yo gelding, Finney 14yo mare

Nancy & Vinnie & Summer
 

Joy V
 

Willie said he misses you Pamela... sniff sniff (that's me crying tho lol)


--
Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos

Nancy & Vinnie & Summer
 

Dr Kellon,

Over the weekend, I sort of stumbled across some information about MFM and what I thought interesting, while Vinnie is not in endurance nor ever was, in his past he had experienced 1 episode of mildly tying up. The episode was after doing some canter work and we stopped, and I was talking to my trainer for about 5 mins, and as soon as he went to walk off, he was lame in one front leg, then the lameness switched to the other front leg, then he almost stumbled to his knees.  We called a vet and got him to his stall and by the time the Vet arrived he was fine.  He was about 11 at the time and we decided to modify his diet and it never happened again.  But he has always had hind end stiffness which was puzzling.

I mention this because in reading the MSU study they suggest that in Arabians with this condition, there is a suggestion that oxidative stress impacts the processing of fatty acids and supplementation of cysteine with other aminos is recommended.

What if Vinniehas a mild case of MFM and could this contribute to high tryglicerides?

We have had Vinnie on Pea Protein, but wondering of I should trial a switch to whey protein which I guess has cysteine and other BCAA.

Or do I go fully into the MSU recommended Ker MFM pellet ( stop my other aminos) and KER coq10?

Just thinking out loud...

Thanks Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Eleanor Kellon, VMD
 

First of all, you shouldn't do anything without a diagnosis. The muscle biopsy is a very minor procedure and can tell you what you need to know. Pea protein also has cysteine and BCAAs. Cysteine is not a BCAA. It's a sulfur containing amino acid. The BCAAs are valine, leucine and isoleucine. MFM is not associated with elevated triglycerides.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Nancy & Vinnie & Summer
 

Nancy & Vinnie & Summer
 
Edited

Thought I would send a quick update. We had dentals done today, and Vinnie did have some things going on that could have affected his ability to chew his food appropriately.

Fingers crossed the changes we made today will result in improving tryglicerides.
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Nancy & Vinnie & Summer
 

While we are still working on improving Vinnie's labs, I thought I would post a quick update on how he is doing overall. 

I modified his diet a little by reducing 2 cups of the TC sr, increased his timothy pellets to 8 to 10 cups and kept beet pulp between 8 and 10 cups per day.  With the Equithrive Original Joint and finishing the loading dose of adequan and some tweaks to his trim, he us doing pretty fabulous.  I will do some more labs in early Dec to see if the dental changes has helped the TG.  The change in RX for pergolide to 11.5 mg seems to have stabilized his PPID.  Fingers crossed!!

In the meantime check out this bad boy...  ps I don't own the rights to this music :)https://youtu.be/T6ViXobZ_xs


--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Joy V
 

Nancy, that video is awesome.  Vinnie looks amazing (and his tail!!!!!  wow!!!)  He is adorable.  I love him going over the rails.  He is so cute.  Just wonderful  <3 


--
Joy and Willie (EC/IR)
Nevada County, CA - 2019
ECIR Group Moderator

Case history:  Willie's Case History
Willie's photo album:  Willie's Photos

Nancy & Vinnie & Summer
 

Thank you Joy!! Knock wood this is a new beginning.  The last three years in November he has had an episode!! I truly owe it to Dr K and this group!! The support, guidance, knowledge and wisdom shared here has made all the difference. ❤
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Eleanor Kellon, VMD
 

That's good news - but don't let him gain any more weight. He's now overweight.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Nancy & Vinnie & Summer
 

Thanks Dr K.  I keep a tight watch on his weight too. No crest and I can still.see and feel ribs.:) He tapes at 985 to 1000lb
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Sherry Morse
 

I can't even begin to tell you how happy this video makes me Nancy, he looks fantastic!

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891

Nancy & Vinnie & Summer
 

Nancy C
 

ps I don't own the rights to this music :) https://youtu.be/T6ViXobZ_xs
Dino! Perfect choice. Lovely to see Vinnie alert, content and willing.

Strong work.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President 2021-2022

HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993

Nancy & Vinnie & Summer
 

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