Date
1 - 20 of 55
Flea on Invokana
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Jennifer Murphy
Flea started Invokana on Monday. My vet drew blood to get insulin, ACTH, and do a CBC profile before his first dose. The insulin came back at 270, I don't have the other results just yet. She returned 24 hours later and drew blood again for just insulin, and again yesterday. She'll be back on Tuesday for a 1 week blood draw, then it will probably go to 2 weeks, then a month. Today I was very disheartened to find Flea barely able to walk again. Temperatures dipped into the low teens last night, and he's very sensitive to the cold these days. I'm disappointed because everyone else seems to have garnered miracles within days, and I'm not seeing an ounce of relief yet. I'm not going to give up; he's only had 4 doses. I'm looking forward to the Tuesday blood draw to see if there is any difference.
My farrier will be here tomorrow to trim and I will get hoof pictures to add to my album, as well. -- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0 |
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Jennifer Murphy
Socks, leggings, and a heat lamp in his stall. I've never been able to find a blanket to fit him properly.
-- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0 |
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Hi Jennifer don't despair, it took almost 8 days for Vinnie to move more comfortably and I changed to a different boot and then modified breakover by.raspong the underside of the boot to make him more comfortable. Vinnie is still in the process of healing and he still takes some mincy steps in hard surfaces of he hits the ground wrong. We were day 12 before I was 100% confident to wean off all rx pain meds.
-- 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 |
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Why so many consecutive testing of the insulin ? Why not wait two weeks?
i predict tomorrow things will improve -- LJ Friedman Nov 2014 Vista, Northern San Diego, CA Jesse and majestic ‘s Case History
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Jennifer Murphy
LJ, my vet and I are sharing the results with a pharmaceutical company, and in exchange they're paying for the blood work. They have a specific schedule that they want us to follow. It was supposed to be 24 hrs. before the first dose, 24 hrs after the first dose, then 1 week, 2 weeks, 1 month, etc. but Cornell spun a sample they weren't supposed to on the 24 hrs post dosage, so we had to pull a 3rd sample.
Nancy, thank you for that. I'm hoping we'll see results soon. :) -- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0 |
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Just a note that Boehringer Ingelheim holds a patent on the use of all SGLT2 class drugs in horses for control of insulin https://patents.google.com/patent/US10864225B2/en . No other company will be able to market it for this use.
-- Eleanor in PA www.drkellon.com |
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Jennifer Murphy
Dr. Kellon, that's who we are working with.
-- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0 |
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Jennifer Murphy
Flea's been on the Invokana for just over a month and I've seen amazing results...up until now. My vet came out last Thursday to do a one month blood draw, and Flea was visibly sore. He's been sore - though not as bad as previous episodes - since.
My vet held the blood sample for a few days because we were supposed to get a snow storm and she didn't want it delayed in the postal system. She must have sent the sample to Cornell early this week, because she just got the results yesterday. Normally she sends results to me in an email, but this time she called and left a message saying Flea's insulin is up quite a bit (last reading was 88, case history updated) and we needed to talk about a plan going forward. I don't know the exact number yet, but will have it later today. I'm very worried, but for my part my plan would be to retest his blood and get the sample out ASAP, but does the length of time it's in a vial affect the results? And we haven't been checking anything but insulin, so I'd like to know his ACTH numbers, as well. There is nothing in his diet that has changed; same hay, same feeds, same supplements minus the spirulina and ALCar, which I stopped while he was still on Metformin. I have not been able to get a urine sample from him - he just doesn't pee when I'm around - but I haven't seen any indications of discomfort or signs that we're told to look for as far as infection/irritation. He is still much brighter overall than he has been, and his appetite is fantastic. Water intake seems to be about the same. He's still booted, and the last time my farrier came she was so happy to see how well he was moving that she really took down his heels and brought the toes back more than usual. I was hoping he was just sore from the aggressive trim rather than an insulin spike. I'm hoping my vet doesn't suggest discontinuing the Invokana. I've seen better results in the month he's been on it than the years we've been pumping Metformin into him. Has anyone else experienced an insulin spike this early into the Invokana treatment, and if so, what did you do? Should I increase the dose? He's currently on 100mg. -- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0 |
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Jennifer,
I was corresponding with your vet yesterday. It's difficult to evaluate this situation without the urine glucose data but my suggestion was to try 300 mg/day for a month then retest. If it's working well you can try backing down to 150 mg again Are you sure you are giving 100, not 150 mg? The 100 mg tablets cost almost the same as 300 mg. Most people are using the 300 mg and cutting them in half to get 150 mg for smaller animals. If using 100 mg that dose is too low. After reading all the details though, there might be more going on here. The trim would have changed forces within the hoof capsule and could make collections or abscesses leak, causing pain. -- Eleanor in PA www.drkellon.com |
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Jennifer Murphy
Dr. Kellon,
I spoke with my vet this morning and she said she had been in contact with you. Yes, per her instructions I've been giving him one 100mg tablet per day; I'll ask her about going up to 1.5 tablets. We think Flea may have been spitting the tablets out, so from now on I'm going to hand feed them and be sure he's ingesting them. We'll retest blood this week. She said his insulin was back over 200 and she's requesting an exact number from Cornell. My trimmer is due out this coming week, and I want to talk with her about his trim. We are planning to do radiographs again in April, which would be six months since his last radiographs. Do you think I should do that sooner to be on the safe side, or stick to the original schedule? We also discussed the amount of hay I've been feeding; I need to cut it nearly in half. Apparently I thought the pounds per day was pounds per feeding...I feel like an idiot. -- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0 |
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Hi Jennifer, similar situation happened to me, I just don't have the bloodwork to prove out what happened.
After about 32 days on Invokana Vinnie got sore again, looking laminitic. My issue though I believe was because I had stopped prascend thinking he wasn't ppid based on the previous bloodwork. I did start to note a small crest restarting prior to him getting sore. I kept him on Invokana and restarted prascend. 9 days back on prascend and only 4 at the full dose, he is almost back to where he was when he was feeling great on day 22 to 32 on Invokana alone. Crest is almost gone again and pulses have decreased by 90. We have an appt to get more bloodwork on March 8th so I am hoping to make some sense of it. But it may not give the full picture since I didn't get his acth in Jan and we didn't get bloodwork when he got sore again in that interim period. But I am learning to read the physical signs a littlw better. -- 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 |
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You're not an idiot! If you were an idiot you wouldn't be asking questions and figuring things out. If you go to 1.5 tablets you will be at the lowest end of the dosage scale and should get a good drop but I wouldn't expect normal. That might take 300. Even if it doesn't, order the 300 mg tablets next time to save money.
Get yourself a table top coffee grinder. They're around $20. It will be able to pulverize your tablets to a fine powder in seconds. Add the powder to a small wet meal to make sure he gets it all. Could you post current hoof pictures? There was a lot of toe to come off so it was good to hear your trimmer getting more aggressive about that. Just bringing back the toe is never going to harm him. If you see any discomfort it's because collections started leaking or the hind foot structures were weak and need to toughen up. Neither of those things are bad. -- Eleanor in PA www.drkellon.com |
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Just to explain the dosages a little better, 0.6 mg/kg seems to give best results of normal or very near normal insulin. For a 250 kg (550 lbs) animal that would be 150 mg/day. For 500 kg (1100 lbs) it's 300 mg/day. When weight falls in between, go with the higher dose. The drug is available as 100 mg or 300 mg tablets,
-- Eleanor in PA www.drkellon.com |
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TERRI JENNINGS
I’m confused and wondering if Elliott and Finn are dosed too low on invokana. Flea’s weight is listed in the case history at approximately 400 pounds but based on .6 mg per kg his dosage would be 109 mg of invokana. I saw Flea’s picture and he looks much smaller than Elliott who is on 100 mg. I’m wondering if Elliott is dosed too low? We are pulling blood to check insulin in a few weeks.
-- Terri Jennings with Teeny, Finn and Elliott Arcata, CA https://ecir.groups.io/g/CaseHistory/files/Terri%20and%20Teeny Joined 2019 |
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Terri,
Your insulin result will tell you. What is the urine dipstick result? -- Eleanor in PA www.drkellon.com |
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Sherry Hite
The tablets also dissolve in tepid water fairly quickly if you want to skip the grinding. Just before I leave the house I put the pill (1/2 of 300mg) in the syringe with a little water and put it in my pocket. By the time I am ready to feed it is dissolved. Shake the syringe well because the particles will settle. My impression is it doesn’t taste that bad and Pepper is usually waiting for it because she knows her hay comes next. She is also the queen of picky and I wish getting her to take her pergolide was as easy. Sherry
Case History: https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Pepper Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=5798 .
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Jennifer Murphy
Just to follow up on this post, I finally received the insulin results. I was floored that he went from 88 to 375 in a few short weeks. I've been hand feeding him the pills to be sure he's ingesting them and am hoping it doesn't take as long to work this time. He's visibly sore, and we're in a cold snap that's definitely affecting him. My vet was supposed to come out yesterday to retest blood, but it was well below zero with the wind chill, so I asked to postpone. I've never seen Flea's insulin that high. Does being on Invokana cause changes that would allow insulin to spike that high if it's discontinued? I'm still trying to wrap my head around that incredible increase.
-- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0 |
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Any of your readings that just said greater than 200 could have been that high too.
-- Eleanor in PA www.drkellon.com |
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Hi Jennifer did you stop giving invokana for a period before this increase in insulin?
-- 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 |
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