Dr Kellon please Latest bloodwork results- Invokana pony Scout


Suzy Berkowitz
 

I got the results back from Cornell for blood taken on September 26. 

ACTH-54.7
Insulin- over 200
Triglycerides- 104
  Current medication- 8mg pergolide(7mg c.p. Capsule. 1 mg prascend) 120mg Invokana. L-carnitine 4g BID

These results came as a shock to me as Scout is moving around so well all around his pasture. His previous blood test was on July 25. 

ACTH-21.5
Insulin-79.30
Triglycerides-110

Scout was on 7mg c.p. and 120 mg invokana and 4g L-carnitine SID for the July 25 results. 

I added the extra 1mg prascend for help going into the rise but clearly wasn’t enough.  Since starting Invokana his insulin has not gone lower than 52. What do I do? Increase Invokana? Increase Pergolide? Thank you
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20and%20Scout 
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915


Eleanor Kellon, VMD
 

First of all, the fact he is doing well is the most important thing. We have had other horses/ponies on Invokana with high insulins that were doing great clinically. I think that's the most important thing. Triglycerides are also good for being on this drug.

The next time you test, make it a double test. Send insulin to both Cornell and BET https://betlabs.com/testing-available-and-handling/ . We have had other animals come back with insulin levels that did not match the clinical picture.

The ACTH will be dropping at this time so don't do anything else with pergolide. Retest in December.

Is his diet the same?
--
Eleanor in PA

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


Suzy Berkowitz
 

Yes Scouts diet is the same. Beet pulp shreds, triple crown naturals balanced hay cubes, stabul 1. Should I increase the invokana? I weigh it on a scale to get the 120mg dose so it wouldn’t be difficult to up the mg a little bit. Thanks so much
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20and%20Scout 
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915


Nancy & Vinnie & Summer
 

Suzy, what scale do you use and is there a formula for the weight/mg. I would like to do the same to be a little more exact/consistent in my measurements of invokana

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


Eleanor Kellon, VMD
 

Suzy,

Keep everything exactly the same.
--
Eleanor in PA

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


Suzy Berkowitz
 

Dr Kellon, thank you so much for your help.
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20and%20Scout 
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915


Suzy Berkowitz
 

Hi Nancy, the scale was recommended by someone on here. It is the HP-200X professional pocket scale. I don’t remember where I bought it.(the link was provided with the recommendation so maybe you can find it)  I weighed my 300mg invokana tablet and then the local compounding pharmacist helped me figure out how much different mg dosages would weigh. I think the formula was 0.62(the gram weight of my tablet) divided by 300. That number than would be how much 1mg weighs. Then you can multiply that by the mg dose you want. 
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20and%20Scout 
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915


Suzy Berkowitz
 

Hi Dr Kellon, I posted the rest of Scout’s bloodwork results in his photo album. Can you please take a look and tell me what you think. Thank you so much
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20and%20Scout 
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915


Eleanor Kellon, VMD
 

Low neutrophils suggests either a viral infection, Lyme or a bacterial infection somewhere with the neutrophils leaving the blood to go to that area.

There is a mild anemia that is trying to regenerate.

Low BUN is most often from a low protein diet. The triglycerides are only mildly elevated and consistent with metabolic disease.

SDMA is a kidney disease test and that level is normal.
--
Eleanor in PA

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


Suzy Berkowitz
 

Dr Kellon, thank you for explaining the results to me. My vet texted me the results and then never got back to me to go over them. What would you suggest I do for him? Thank you
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20and%20Scout 
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915


Eleanor Kellon, VMD
 

Suzy, I can't suggest what to do for him because the missing piece here is a hands-on physical examination. If your vet has no ideas on what to do further, ask for a referral (are you close enough to the vet school?), or call another vet yourself or a second opinion.
--
Eleanor in PA

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


Suzy Berkowitz
 

I am in the Wellington area, so not close to the vet school. Would you happen to know any one in this area? Thank you so much for your continued help.
--
Suzy in Fl 2020
Scout Case History: https://ecir.groups.io/g/CaseHistory/files/Suzy%20and%20Scout 
Scout Photos:  https://ecir.groups.io/g/CaseHistory/album?id=260915