Newly diagnosed, questions


Bonnie Eddy
 

Allie has just been diagnosed with PPID. 
I would like my labs looked at, as I have several questions. 
The stem test showed just 45 on the pre, but 84 on the post draw, which is within normal range. I would think the post sould be elevated?

My vet said it appears that Allie has some inflammatory process going on. She didn't know if it could be related to the cushings or is there another possibility? What do you think?

I couldn't understand the insulin/glucose relationship numbers even though I did the calculations. What do they show?

Anything else on the labs look like a concern?

Allie is on a number of supplements due to her chronic ulcers and allergies. Right now she seems well controlled in these areas. Any further advice?

Thank you very much,
--
Bonnie with Allie and Racham (over the rainbow) from Southern California, Nov/2016

https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Allie
https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Racham


Sherry Morse
 

Hi Bonnie,

45 is outside of the reference range for Cornell so she appears PPID at baseline regardless of the post TRH test results.  However, in my experience the elevated ACTH could be from a positive Lyme test. I'm not sure if that's a concern in your area and you have the element of allergies and not shedding as well which do point to PPID so it's a bit of a conundrum.  

If Lyme is a possibility you may want to run that bloodwork as well.  For my guy he had an ACTH reading of 45 when his Lyme titer was up around 9000 and once the Lyme was treated his ACTH dropped to 20.9 pre-TRH and 69.5 post-TRH.  

As far as the insulin number - if she was fasted prior to testing I'd be concerned but if she had hay in front of her all night it's not in the range where I'd be panicking at this point. 




Eleanor Kellon, VMD
 

Bonnie,

Was she fasted? Does she have a fever?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Bonnie Eddy
 

She was not fasted, had hay in front of her all night. 
No fever
--
Bonnie with Allie and Racham(over the rainbow) from Southern California, Nov/2016

https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Allie
https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Racham


Eleanor Kellon, VMD
 

OK. Her insulin is minimally elevated. Her ACTH response is equivocal but with the coat changes pergolide is worth a try. The anemia could be due to some hemolysis but her white cell picture is concerning and suggests Ehrlichia to me. Some older horses have lower than normal white counts but she's not old enough to fit that category.It wouldn't hurt to check for Lyme at the same time. Did she have any other signs that something was wrong?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Bonnie Eddy
 

On Tue, May 24, 2022 at 06:51 AM, Eleanor Kellon, VMD wrote:
OK. Her insulin is minimally elevated. Her ACTH response is equivocal but with the coat changes pergolide is worth a try. The anemia could be due to some hemolysis but her white cell picture is concerning and suggests Ehrlichia to me. Some older horses have lower than normal white counts but she's not old enough to fit that category.It wouldn't hurt to check for Lyme at the same time. Did she have any other signs that something was wrong?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 On Tue, May 24, 2022 at 06:51 AM, Eleanor Kellon, VMD wrote:
OK. Her insulin is minimally elevated. Her ACTH response is equivocal but with the coat changes pergolide is worth a try. The anemia could be due to some hemolysis but her white cell picture is concerning and suggests Ehrlichia to me. Some older horses have lower than normal white counts but she's not old enough to fit that category.It wouldn't hurt to check for Lyme at the same time. Did she have any other signs that something was wrong?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 The sample of blood from Antec (wbc, rbc etc) did say at the very bottom that the sample appeared hemolyzed. Vet said she wasn't concerned about it, it was maybe the vacuum.
 
Other than the severe allergies this year (hives finally subsided from withdrawal of Teff hay), she becomes reactive, nervous spooky,  with any little saddle fit issues, and seems a little grumpy at times. But no other signs of the Ehrlichia.

Vet did mention that if we were in an area where lyme was prevalent, she would suggest the test. Maybe do it anyway?

I feel something isn't right but what?

What about the indication of inflammatory process going on?

Thank you so much, 
--
Bonnie with Allie and Racham(over the rainbow) from Southern California, Nov/2016

https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Allie
https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Racham


Sherry Morse
 

Hi Bonnie,

Given those symptoms I would test for both Lyme and Ehrlichia, even if you do start her on pergolide.  It may just be a coincidence but again, based on my experience, I'd want to rule it out rather than wonder.  With my guy I had a feeling he had Lyme and my vet was literally drawing his blood while telling me it was the weather and even her 25 year old was acting stupid and she was shocked when his titer came back so high.  His symptoms were 'stupid spooky' and being super reactive and not wanting to be touched.  My massage therapist couldn't even get a hand on him and that's when I insisted on getting him checked.




 

Hi Bonnie,

Definitely have her checked for a tick disease.
When one of my geldings had Lyme, his personality changed -- didn't want to be brushed, became a little grumpy, etc.

--
Amy & Baldur, Franklin, NY
April 2022

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


Eleanor Kellon, VMD
 

Hemolysis won't lower the white count. I'm not sure what she thought indicated inflammation.  Platelet clumping is normal in horses. Fibrinogen was normal. Low neutrophils can mean there is an area of active infection and they are being drawn out of the circulation but there's no fever and that does not explain the low lymphocyte count.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Bonnie Eddy
 

Vet did mention the possibility of an infection somewhere. She wanted to start the pergolide, and take blood again in 60 to 90 days and see what the numbers are then. Infection somewhere, but how, where and how can I find out? 
But having cushings should have no relationship to low lymphocytes or low wbc, right?
So there must be a separate issue. What can I do to find out?
Thanks so much again, 
--
Bonnie with Allie and Racham(over the rainbow) from Southern California, Nov/2016

https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Allie
https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Racham


Eleanor Kellon, VMD
 

PPID can lower the lymphocytes, but increases the neutrophils. First thing I would suggest is to check for Lyme and Ehrlichia infections. If there was a bacterial infection somewhere to cause that picture you would probably know it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Bonnie Eddy
 

One more question please.

I don't understand the glucose and insulin numbers. Is Allie IR or? From Cornel, all labs are in her CH

Insulin 17.22 ulU/mL
Glucose 95 mg/dL

Thanks again,
--
Bonnie with Allie and Racham(over the rainbow) from Southern California, Nov/2016

https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Allie
https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Racham


Sherry Morse
 

As she had hay in front of her I wouldn't consider her IR at baseline at this point, but once you get her ACTH number sorted out (whether it's from Lyme or PPID) you may want to run that number again to see where it's at.  Glucose is in the reference range and nothing to worry about right now.




Eleanor Kellon, VMD
 

Allie's insulin is only very mildly elevated. As long as you keep feeding her as you were on the day of that test she will be fine. The pergolide should lower it further.

If I didn't mention it before, being off by a minute or two in timing the collection of the second sample can have a large effect on the result https://onlinelibrary.wiley.com/doi/10.1111/jvim.16362 .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Bonnie Eddy
 

I was interested in joining the trh stem test study, but if the post draw was normal, then Allie wouldn't be eligible?

Along with the Lyme and Ehrlichia testing is there anything else I should ask for? 

The vet wanted to retest ithe acth in 60 to 90 days, but I'm thinking I shouldn't wait that long for the Lyme etc? House calls are very expensive nowadays but if it's either of the 2 diseases, Allie should be treated right away.

Again, I appreciate all the attention and advice.
--
Bonnie with Allie and Racham(over the rainbow) from Southern California, Nov/2016

https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Allie
https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Racham


Sherry Morse
 

Hi Bonnie,

If you started Allie on pergolide you can retest in 3 weeks.  I would not wait to test for the tick borne diseases. 




Bonnie Eddy
 

Dr Kellon,
Since Allie's TRH Stem test was normal on the post draw, does that mean she is not eligible for your study?
Thank you, 
--
Bonnie with Allie and Racham(over the rainbow) from Southern California, Nov/2016

https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Allie
https://ecir.groups.io/g/CaseHistory/files/Bonnie%20and%20Racham


Eleanor Kellon, VMD
 

Bonnie,

Yes, that's right.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001