Flame (on Invokana) fall labs- Dr. Kellon
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Reposting in hopes Dr. Kellon had input on Flame’s labs (he’s on Invokana). Original post: I know I got meds titrated and labs done late this year, but life happened. Here are Cornell results for both horses. Flame (EMS & IR)- glucose 100 mg/dl, insulin 138.49 uiu/ml, ACTH 15.4 pg/ml & leptin 5.41 ng/ml. Flame gets 4 pounds of unsoaked Bermuda twice a day, 2 1/2 pounds of TC Timothy balance cubes twice a day, 2 cups Stabul 1, he gets a lunch & night snack of 1 pound of Bermuda, 4 pounds RSR beet pulp. In the beet pulp is 2 ounces of flaxseed oil, 1 teaspoon of liquid vitamin E, 3 teaspoons of Jherb, 1 1/2 teaspoons of AAKG, 2 1/4 teaspoons of carnitine, 2oz salt, Vit A gelcaps, 5mg Pergolide (fall dose) & Invokana 225mg. As a reminder, my head tested too high in nitrates so we are trying to dilute out the hay by giving 1/2 hay, 1/2 TC cubes & increased BP to 4 pounds. Flame is lightly ridden or lunged three days a week, hand walk three days a week and hangs out in his stall/run one day a week. Questions- I know I’m kind of behind the eight ball, but should I increase Diana’s pergolide? If so, to what dose? 5mg did control her ACTH last year. Anything else I can do to try and drop Flame’s insulin? It’s never been under control even on Invokana. I did not draw triglycerides this time since they had been drawn so many times already this year. I will draw them with spring labs next year. I’m trying to update both horses case history but I’m still fighting with a very old and finicky laptop. --Beth & Flame dx 2013 & Diana dx 2020 NV Oct 2013 Flame Pictures |
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Dr. Kellon- reposting in hopes of catching Dr. Kellon’s attention.
-- Beth & Flame dx 2013 & Diana dx 2020 NV Oct 2013 Flame Pictures |
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Hi Beth,
Diana's ACTH will still be coming down over this month. Since she's asymptomatic, I'd be inclined to retest sometime in December. We have had several horses whose insulin remained high but laminitis resolved. I'll take it. Only more exercise is likely to lower it but you should do a double test on the next pull, sending insulin to both BET and Cornell. Please update your case histories. -- Eleanor in PA www.drkellon.com |
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Dr. Kellon-
NV Oct 2013 Flame Pictures |
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Reposting in hopes Dr. Kellon will review & respond.
-- Beth & Flame dx 2013 & Diana dx 2020 NV Oct 2013 Flame Pictures |
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Sorry, Beth. What are your questions. I already commented on Flame. Diana needs more pergolidfe but otherwise labs looks good.
-- Eleanor in PA www.drkellon.com |
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Dr. Kellon, I just re-read your reply from 11/6, I though the entire reply was for Diana. Is this part for Flame- "We have had several horses whose insulin remained high but laminitis resolved. I'll take it. Only more exercise is likely to lower it but you should do a double test on the next pull, sending insulin to both BET and Cornell."?
I do have a new feed question for Flame- I just bought a new batch of hay, had it analyzed & Nancy is working on balancing it for me. The nitrates in the new hay are 0.13% (0.36% was the old hay). Because they nitrates were so high, we were "diluting" the hay at each feeding with TC cubes (4# hay & 4# TC cubes twice a day). Since the nitrates in the new hay are lower, can I go back to feeding mostly hay & decreasing the TC cubes (8# hay twice a day & some cubes as a "snack"? -- Beth & Flame dx 2013 & Diana dx 2020 NV Oct 2013 Flame Pictures |
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Yes, that was the part about Flame.
Yes, you can go back to mostly hay but I would feed 8 mg/day of iodine to protect the thyroid. -- Eleanor in PA www.drkellon.com |
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2 more questions- Flame was on 6 tbs of salt during the summer to encourage drinking for hydration & to prevent UTI from the Invokana. What can I drop him to for winter? Should I give his fall shots or hold off because his insulin is so high? He did not get spring shots because his insulin was high. I don’t take him to shoes anymore, just off the property for occasional trail rides but other boarders at the barn do travel to shows. Thanks in advance.
-- Beth & Flame dx 2013 & Diana dx 2020 NV Oct 2013 Flame Pictures |
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Beth,
2 tbsp is fine for cold weather. He can have access to a block too. No one can advise you for sure on vaccines without a crystal ball but you could split the difference and ask for intranasal flu. Tetanus and Rabies are likely good for at least 3 years. No need for encephalitis vaccines in the fall. -- Eleanor in PA www.drkellon.com |
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Dr. Kellon for IR horses with vaccine sensitivity, what do you recommend for vaccinations: 1. Spring 2. Fall Odin is likely retired but may occasionally travel off-property, and both Bella (my mare) and Fiki (my gelding) do also travel off property. |
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Sherry Morse
Jen, Please see: and do a search of the archives. Lots of information there.
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 |
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Thank you Dr. Kellon!
-- Beth & Flame dx 2013 & Diana dx 2020 NV Oct 2013 Flame Pictures |
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Ideally, check titers for Rabies. Tetanus titers usually are protective for at least 3 years but immunity may wane in older horses. Encephalitis, including WNV yearly or you can follow the state infectious disease data to decide on vaccination. This should be done in late spring. Horses that have had WNV natural infection are immune. Influenza intranasal. No other vaccines. If you must vaccinate, use a different brand and only one vaccine at a time.
Use biosecurity away from home - no grazing in common areas, no use of paddocks used by other horses, no use of stalls on the premises unless you disinfect first, bring you own buckets, no nose to nose contact with other horses. -- Eleanor in PA www.drkellon.com |
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