Topics

Gavi and friends new blood work

Tara Smith
 

Hi,I just posted Gavis new blood work result w insulin levels still off the chart .I'm very worried and needing advice on care from here ?does this mean even tho pracend is treating the cushings piece the high insulin could still have him fall victim to the unbearable pain the fall rises cause?Since He started 1 mg.pracend I believe in march he has only had 1 short term blip w discomfort. He is still presenting pain free ,happy ,comfortable ,playful w his buddies ,alert ,and involve w everything. He also refuses boots!when hes hurting he wants them ,when he is good he basically tells me to get lost w those darn BOOTS MOM!!my other 2 horses I've suspected had something going on and are not in the history yet but now need to be added  are now  in this club !Bob seems straight forward to start pracend ,he has no foot symptoms just, loss of topline ,late shed ,weight and muscle loss ,shivering when wet in 50 degrees ,bug bite reactive w bumps so vet. Recommended  pracend asap .Cloud my little pony also no pain in feet ,very chubby ,cresty neck ,fat pockets on neck and body All horses follow gavis diet  .if someone could please advise ,focus on gavi ,and recommendations for other  horses please ?,Fondly and Thank u,Tara
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Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Eleanor Kellon, VMD
 

Gavi's ACTH end August was controlled but it might not be end September. His insulins are always high enough to  make him high risk and just waiting for a  push over the edge. You might want to talk to your vet about using a preventative extra 0.5 to 1 mg during the seasonal rise and taper off end December.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001

Tara Smith
 

Thank u Dr. Kellon ,could you please share w me other very effective choices for lower that insulin,metformin liquid or pills ,my vets recommendation is the Thyro L but unless something has changed is there any new info stating that it helps w insulin?any other meds avail to help regulate and drop that level ? What would increasing his pracend look like ,just start w adding an extra half or go to a quarter then to additional half ?If you could please comment on my little ponies  blood work with advise please ?are there any natural homeopathic supports or anything from ukele that will help bring insulin down ,I'm very worried .Last winter was so hard on him I dnt know if he could make it through another like that w the level of pain he suffered .But the pracend seem to save him by march a new horse w pracend on board .,Thank u ,Tara
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Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Nancy C
 

Hi Tara

Not Dr Kellon here however, I was an owner of a horse with constant high insulin.  I understand your concern.  I felt this way every fall.

You first need to know there are no magic bullets. Thyrol-L does not help with insulin. There is no homeopathic remedy. Management of DDT+E is your best bet to keep him safe. This how I kept Beau happy until he was 29. He too got better in the spring.  Every year.

Diagnosis - Dr Kellon has indicated he may benefit from lower ACTH.  Start him with .25 or .5 increase would for me be dependent upon his reaction previously.  If you are worried he'll go off feed, start with .25. My Beau's insulin was often where Gavi's is this time of year.  I aimed to keep his ACTH in the teens.  AT the end he was on 14 mg of compound pergolide.

Diet and Drugs - Get his hay test in order and balance minerals tightly asap. This gives great support to his system.

Trim - Do not over look this area.  He needs a tight trim -- no long toes, no high or under run heels -- to keep him from rotating or sinking if the insulin impacts his feet. No high walls.  Load the sole. Trim him more often that you think you need to.

Exercise - Keep him moving if he can tolerate it.

You little ponies also appear to have high(er) ACTH, especially Bob. What I'd do about this is dependent upon the rest of the CH picture.  Thankfully their insulin is okay.

I know this is hard but I also know it can be done.  You can do this.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

Tara Smith
 

Thank u Nancy !!my trim is done by a very amazing farrier recognizes by Pete Ramey and Pacific trim .her name has passed through here many times and is a god send  to Gavi coming every 3 to 4 weeks tops religiously !The hay issue is gonna send me to  Crazy City!!so now onto wet chem if dm is in range and as fed is in range could wet hem typically be much off from those values..calling lab in the a.m. to run all as fed and wets .Gavi is VERY sensitive to the pracend it took almost 2 mths w slow increase to get him to the 1mg and that was w adversions to salt and stabul 1 ,vt blend ,flax.I just started added a bit of E-TEC safe starch,that he gobbles as a mash or little treats .starting to get some vt .blend back in and a bit of vit .E  .salt is over hay .I'm sneaking it in .up to 1 tbs. vt blend !!! Hmmm my farrier said tday soles are very thick, they used to be paper thin ,this could be offering extra comf.? He has happy feet right now . IS he  a different case as we wonder why gavi tests low +normal on the standard (ACTH )test but positive on the TRH stim test ?and that seems to be correct because he did respond to the pracend. What is the flaw in the standard test ? My vet is quest. Dr.kellons strong suggestion to increase  pracend  during the next couple of months in how it will protect him from falling victim to the seasonal rise if insulin remains high? My vet will and wants to read responses and suggestions so I will share responses her if that's ok? Also Bob is a big horse not a pony so I will start him asap on pracend ,but cloud is my little peanut and vet does not want to start him on pracend yet even w clinical signs and blood work .she wants to re check him in Nov before starting it .Is this a mistake and could it hurt to put him on a low dose  .I dnt want to wait to long and he is already chubby ,cresty and lumpy  and some goopy eye discharge. ..uuugh 3 out of 4 babies w issues ..OYVEY,sorry so many issue here please forgive how needy im presenting right now ,Fondly ,Tara
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Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Eleanor Kellon, VMD
 
Edited

Re: ACTH results, PPID produces a variety of hormones other than ACTH. https://www.ncbi.nlm.nih.gov/pubmed/8245232 . ACTH isn't even the hormone usually in highest concentration (that's MSH) but studies have shown ACTH elevation is typically  proportional. However, these studies tend to focus on advanced cases rather than early ones. Results of TRH stimulation show baseline ACTH is not a sensitive enough test to pick up early PPID - at least not using the broad reference ranges labs have.

The focus has always been on ACTH because of similarities with Cushing''s disease in other species but other species only have oversecretion of ACTH. It would actually be better to test horses for POMC levels, proopiomelanocortin, the precursor hormone for all the elevated hormones, but no one has developed that test yet (although kits are available). Until we have better reference ranges or tests are available, we have to use ACTH and understand false negatives are possible.

It's important to know that the other hormones can also have negative effects on insulin, e.g.

https://www.ncbi.nlm.nih.gov/pubmed/6141515 
https://www.ncbi.nlm.nih.gov/pubmed/3035302

This should be further investigated in horses.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Nancy C
 
Edited

We need Case Histories and updates.

PPID drives insulin higher in the IR horse. If the TRH is current and saying positive I'd definitely go with adding more pergolide. The alternative to doing nothing here is not what I'd want to see for my horse. 

Check the actual starch on the "low Starch" E-tech.  Like many "low starch" feeds, it may not be low enough.

Any horse with clinical signs and an ACTH above normal should be started on pergolide. I'd be questioning why my vet wants to wait.  The risk is laminitis.  The downside of putting on pergolide is to your pocket book. Rehabbing laminitis is more expensive,  and most importantly, very painful for your horses.

Keep up with the trim. Learn to recognize for yourself when he needs an adjustment to keep him safe.

Balance the hay.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

Eleanor Kellon, VMD
 

It would help immensely to have a case history on Cloud but signs of EMS in a pony  doesn't mean  PPID is the cause. I agree with your vet that the ACTH result alone does not mean pergolide is indicated. If the pony is aged or has a history of fall laminitis those would be other factors to consider.

If you want to consider other treatment options for persistently high insulin ask your vet to contact me directly.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Tara Smith
 

Thank you Dr.kellon ,yes my vet. would very much like to contact you about how to lower insulin for Gavi .getting metformin into him is very challenging because he so darn picky on pracend. the pracend is very easy to get him to take as he will eat it in a handful of stabul 1 or ETec carb safe.any simple options like that or safe. Injectable?..what would u use and do if this was your horse ?What is the best way for my Vet to reach you ?Is there a fee for this ?also if my vet still does not agree w raising pracend during fall rise but I wish to follow ecir recommendations ,again w gavi if he was your horse how much pracend would u add to his protocol with his numbers where they are without TRH but on 1 mg...I'm pretty sure gavi never tested positive with regular TRH .only with TRH .He dramatically improved once we reached a full 1mg .pracend. w insulin levels in all blood work always around that 102-104 range..
-- I would like to start recommendations asap as the danger is is rushing quickly towards us and I want to protect  and buffer him as much as we can .he needs a little time to have pracend doses increased so he does go off feed completely .,Fondly ,Tara 
Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Eleanor Kellon, VMD
 

First, please update your case history including all diet and lab test details.

When that is done, give your  vet my e-mail of drkellon "at" gmail.com.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Tara Smith
 

DR.kellon ,presently the hay that was just posted with new as fed reads is the hay file that he is currently on.This week I will be requesting a wet read added to the sample result .I'm finding it challenging to get the hay tgether .I have several different loads of hay that came off our farm that we thought were safe based off a DM read ..All my tests I've had from  the past read have  I've gone right to The Dm and there have been so so very many!My understanding was that was the column to focus on.,And for some reason poulin grain (CVAS) accidentally did not have as fed programmed on my account.   I've spent hundred on hay tests.until Nancy recently brought to my attention no as fed was there and wet chem  I planned to do after I could see if hay was an option from Dm and or as fed reads first and   then was going to wet reads as add  on if s tr starch and sugars look ok Sigh...So I have just gone through all test that test within range with Dm and pulled them to have wet reads done next week.  Now that I'm getting the poulin ETec safe starch testing free for a NIR  plus, because I am sampling so many hays to find for gavi I'm afraid if I get wet reads for all il  be broke broker!!financially its alot w all the care from this year and trying to keep up. So what is the simple way to get most accurate reads for ESC +STARCH and minerals if I'm trying to sample so many different hay sources and our in house hay in order to fill the loft ?Oy!! so I dnt know how to offer  you the clearest diet w out wet read avail yet  .we can start w the 1st cut  hay in history that is the first cut billy clark hay, Then hay across from creamery ,I will get numbers on test .I just started adding vt.blend back in still about 2 tbs . That he is excepting and very small amounts of safe option grains ,stabul 1 or Etec.safe starch. Plus salt on hay.  so should I put that all in history ?also I'm very terrible w uploading in history profile ,Jaini loaded for me last time on the history page or she made it so I could type in all updates. I feel I will fail at this and I dnt want to lose time for gavi trying to load info.and if I cant we waste time for med options ..can I hire u as a personal consult then email all my info to u directly if I cant reflect w ecir account history ..I'm so sorry I'm a huge pain in the ARS Please forgive me ,but I desperately need Help !How do I load info directly into history profile page from phone so I can just type in all updates   ? 
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Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Nancy C
 

What kind of phone are you using? Samsung? iphone?

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

Eleanor Kellon, VMD
 

To try to clarify for you a little bit

Results for hay are reported as DM (dry matter) or As Fed - or both depending on lab. I can  interchange them, just need to know what hay analysis goes with which lab result and if that hay isn't on there, please load it to the folder.

Hay testing methods are NRI (not recommended) or wet chemistry. Need to know which was used.

Nancy sent you instructions for updating your history. Do you need them resent?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Tara Smith
 

On Sat, Sep 7, 2019 at 02:46 PM, Nancy C wrote:
What kind of phone are you using? Samsung? iphone?
It's a Samsung smart phone !
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Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

 On Sat, Sep 7, 2019 at 02:46 PM, Nancy C wrote:
What kind of phone are you using? Samsung? iphone?

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

 On Sat, Sep 7, 2019 at 02:46 PM, Nancy C wrote:
What kind of phone are you using? Samsung? iphone?

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

 
-- it's a Samsung 
Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Tara Smith
 


-- I have not seen anything from nancy yet on how to send through my phone .My farrier is going to help me upload present hay and potential  follow up hay ,and any supplements  and grains amount to gavi is recieving to date .Thank u so very very much !
Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Nancy C
 
Edited

Hi Tara

I can't imagine how, but I missed your response to my question re: which device. Apologies.

Here are links to help you with Samsung. Getting someone knowledgeable to teach you is the best approach for long term health for Gavi.  "Knowledge is power." is a great quote from Dr Kellon. You then will need to make the time to do the work. Here you go.

There is more here:

Case History Help

You may need to download word or Apache Open Office. Again, seek someone local to you who can help you learn how to do this.  You can do this.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

 

Tara,
I know you are working from a phone which isn't easy. Just an idea but have you considered using a computer at a library?
Anyway, I wanted to suggest that when possible, it would really help if you removed all OLD hay tests from your case history folder. As long as you have copies of those tests as home (if you want to keep them) what is important is recently fed hay tests and currently being fed hay tests. You can make sub-folders within your case history folder. I suggest making a "Hay Tests" folder and store your current hay results withing that folder. You can also make a sub-folder for "blood/medical tests". Give names to the files with dates in the name. All this will make it much easier to find your data for you and other members.

Just the thought of trying to do this stuff from a phone makes my stomach churn!

Good Luck,

Bonnie
--
Bonnie Snodgrass 07-2016

ECIR Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album

Tara Smith
 

Hi my farrier uploaded last night before we saw current uploading recommendations  she put all of the specific hay being used and wanted to be used along with safe grain recommendations and some minerals .she posted them.in my files if this can somehow. Be checked and followed up w there until I can get everything properly loaded.I m concerned about cost of hay test with equine analytical its 65 $and with poulin grain its 40 for wet chem .the NIR Not recommended is free for as fed and Dm analysis .I go through so many hay samples that up until I started buying etec carb safe cost me a fortune  this year.i still will have to wet read 4 additional.samples and future hay samples needed for more hay to fill the loft ..so at in the end a fortune on hay samples that I just cant afford .I have do much cost involved w all 4 of them now.is there anyway I can have a semi accurate test , when testing several  that will allow me to just use a cover what may be missing mineral balancer like vt blend. This is what we have been balanced to in the past by vt.blend or hay is all in house or coming from local farms in our area any safe shortcuts here ? 
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Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449

Kirsten Rasmussen
 

Tara,

You can request ESC ($11) and starch ($13) only (plus the $8 custom fee) at Equi-Analytical for each of your samples.  Or request their "carb pack" for $37, which adds in WSC (although it is not needed and this package is a bit more expensive).  Add a note to the sample form stating further testing may be done based on initial results so please hold the sample.  Once you get your s/s numbers, call them back while they still have the samples and have them run the full "trainer" or "equine complete" package for only the hays that you want.

Again, DM values will always be higher than as fed values so if you were basing hay choices on DM values you were actually feeding hay that is LOWER in s/s than you thought.  That's a good thing!  The issue is that NIR analysis results can be higher OR lower than the actual s/s determined by wet chemistry analysis, so that is the only problem with your previous testing.

--
Kirsten Rasmussen
Kitimat, BC, Canada
January 2019

Shaku's Case History: https://ecir.groups.io/g/CaseHistory/files/Kirsten%20and%20Shaku  
 

Shaku's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=82559&p=Name,,,20,1,0,0   

Tara Smith
 


--Thank you everyone for filling me in on trying to figure out hay.  I DID UPLOAD ,into files all bloodwork and usable  possible hay options based off of dm and as fed .I called about wet chems an additional 40 $for ea.test and for any new ones !I'm testing so many hay samples to try from my farm first as our hay is free to me if it works ..some 3rd cut is avail now can this ever test low enough ?We did not have enough first cut to supply me till next june so I am having to outsource yet again!So when trying to sample in house hay first and them having to go through outside sources as well is breaking my bank at 40$ a test .What is the answer and god knows I cannot cope w soaking, it just sends me over the edge !I dnt know what to do ?Gavi is comf.and doing well but insulin is still high even tho comfort is present .Gavi always tested low on acth w out TRH test and he did again this time around but is also on pracend .so is it a false positive coming into the rise or is this controlled  by pracend and true this time.?Isnt it the insulin that causes the laminitis?But his has been continuously high but pracend has provided almost 100 %comf.plus diet ,trim .When he get hay that may bother him I see side effects within a few days .IDr.. kelling is waiting for me to upload everything into history that is now sitting in files .My farrier re posted w more clarity,I hope to get the history up for all  soon in the proper area but time is ticking on whether or not I should start gavi on more pracend to buffer him and waiting for history to reflect so my vet can reach out to dr.kellon for insulin reduction options .I'm feeling very unsettled until history is in and wet chems are done but I just dnt know if I can afford right off the bat 4 more wet chems...and 4 more hay options coming up to check as well coming from 2nd and 3rd cuts and outsources hay people for back up if present first cut in file doesnt not work out ..last year I was left w no hay that was ruined by powdery mildew that settled in the loft and lost 1000 baled of free horse hay !!And last year hay season was awful so scrabbling for hay was the most stressful things along w gavi  being so sick ..I just can't do it again..I want my boy  to live to be an old happy guy.I really am trying so hard ,but how do I simplify the hay .Also cant hay be balanced  w mineral based off the region and areas it's being harvested from .I'm in new England western mass. Compared to ny.hay and so on.  2 yrs ago vt .blend balanced our hay and said she knows the deficiencies  based from areas ?Does anyone know a bit more on this ?can I get away go without wet chems ..or just wet chems for s+s and no trace minerals ?So many questions, I'm sorry to be such a pain ..Thank u for all supports ,Fondly ,Tara

Tara and Gavilon
Mass.  Nov 2017
https://ecir.groups.io/g/CaseHistory/files/Tara%20and%20Gavilon

https://ecir.groups.io/g/CaseHistory/album?id=11449