Good day everyone!

I am seeking alternate veterinary care as I am not happy with my current vet's 'bedside' manner when it comes to Crackers.  In his favor though is his willingness to keep renewing the compounded pergolide prescription through AVRIO.  Among issues with timely test results and no interest in those results, I don't appreciate the dismissive attitude toward the ECIR group but I have read enough of the messages here to sadly realize that a large majority of vets are not very much different.  I contacted a larger practice and explained how I follow the ECIR protocols for Cornell testing and use compounded pergolide and am not interested in changing that. I wanted to know if the practice would accept this and work with me on his treatment.  The reply was they are somewhat familiar with the ECIR group but they follow protocols outlined by Tufts Metabolic Group (https://sites.tufts.edu/equineendogroup/).  I read through the Tufts document: Recommendations for the diagnosis and treatment of EMS (Year 2020).  A most disturbing recommendation is:
"Tests that are no longer recommended: The glucose:insulin ratio and proxy measures of insulin sensitivity are not
recommended as diagnostic tests for use in clinical practice and are not appropriate substitutes for the OST or ITT".

OST is Oral Sugar Test which is too risky for our horses.  ITT is Insulin Tolerance Test which didn't sound too safe either.

Would it be unreasonable to assume that this practice would not be a good fit? Other than these disturbing references, they would be willing to prescribe the compounded pergolide through AVRIO but did suggest their own pharmacy as a possible alternative (not acceptable!) They do use Cornell for Glucose, Insulin and ACTH testing but still believe in the Leptin test.

It is difficult to feel disrespected when trying to provide the best care for my horse and have to choose between the devil I know and the one I don't.  Are there any recommendations for evaluating the care I would like to receive from a vet?

Thank you for any input in my search.
--
Ellen and Crackers
July 2011, Goldendale, WA
Case History: https://ecir.groups.io/g/CaseHistory/files/Ellen%20and%20Crackers
Crackers' Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=1645

Hi Ellen
My perspective on this is that we have to decide where we can compromise with vets. Most important is whether you feel you can have a frank discussion with someone without either side getting defensive. Plus of course, many of us do not have a choice in vet practices, so we have to pick our battles carefully.  In order to do this, you have to be starting from a position of knowledge—read as much as you can, go through our Files, download the research papers Dr Kellon often mentions, get your head around the facts so that, for example, if your vet should say they want to do an OST to check your horse’s insulin level, you can point out that the OST is a diagnostic test that you don’t need as your horse has already been diagnosed as IR—what you need to know is how he/she is responding to the current diet, so you would like a basal, non-fasting insulin test done please. That sounds a lot more reasonable to a vet than telling them your favourite internet group doesn’t like OST (I know ECIR is more than “an internet group”, but that’s how many vets view us still, especially outside the US). 

I do a lot of talking with the vets I use most often. I like to be able to chat about various aspects of my horses’ care, and plant little seeds that may grow, (for non-urgent matters). For example, the other day I asked whether Indy might be a candidate for TRH stim, as although her basal ACTH seems controlled, she’s been getting corneal ulcers that don’t heal well and I’m wondering if her PPID may actually not be as well controlled as we think. The vet had never heard of TRH stim, so I sent him some information. He is very busy and has two small children, so he may never read it. But…he might remember the conversation if he has another client with a horse with similar Issues. And you can bet that in another couple of visits I’m going to casually mention it again.

In Australia the veterinary profession has one of the highest rates of suicide in the country. I try to always remember that and be kind, while maintaining my bottom line of advocacy for my horse—and in the end, the buck stops with us owners. We have the right to refuse treatment if we absolutely believe it is not in the horse’s best interests. 

Hope this might give you some food for thought. 

--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 

Hi Ellen,

Maxine already said pretty much exactly what I was going to. If your current vet is willing to do the testing you want, when you want, and is willing to prescribe as needed you're well ahead of many of us. You may want to keep the second vet just in case but not switch right now.
--

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/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

And remember we are research based - some of it internal but most of it published research. Any vet should be willing to look at and listen to published research so that is your most potent weapon. If you need help, let us know.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001