Olafs ACTH - Dr Kellon


Cecile Johnson
 

I received the results back on Olafs ACTH that were done on 9-29.  I have put a copy in his album.  His ACTH was 81.9 pg/ml and insulin was 25.62 uIU/mL.  His baseline insulin in February of this year was 13.70. His glucose taken in August was 92.

So what does this mean?  He is currently on .5 mg of Prascend.   Does that need to increase to 1.0 mg?  I realize we are in the rise so I don’t know how high is too high during this time of year in order to increase it.  He is really foot sore right now and lays down a lot   I’m having to syringe Laminox and Acetylene L with a bit of water as he won’t eat it.  

Kathleen analyzed my Bermuda hay and overall indicated it was a good quality hay.   I am getting the custom mineral mix from Horsetech this week.  

I do need to find a good supplement for arthritis and something to help his sesmoiditis.   Would PEA be something I should look at?  

Everything is up to date in his case history (except for these latest blood tests) and X-rays and labs are in his album.  

thank you

--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Sherry Morse
 

Hi Cecile,

It means that the amount of Prascend he is on is not enough to control his ACTH and he needs to be on AT LEAST a 1mg dose.  As you do not have any previous ACTH results in his file we can't really guess what he was at prior to being put on the .5mg dose.  Therefore I would expect he's going to probably need more than a .5mg bump to get his ACTH into the range we'd like to see it - upper teens to low 20s year round for a PPID horse that's well controlled.

Were this my pony given that he's already so high I'd get him on 1mg now and plan on getting him retested at the beginning of November once he's been on that dose at least 3 weeks and when you'll be well after the peak of the rise (which was last week).  If he is still well above where he should be then I would bump him up another mg and test in the early spring so you know if 2mgs is enough or if he needs more before next year's rise.




Cecile Johnson
 

Thanks Sherry.  I will increase his dose to 1.0 milligrams.  I planned on retesting him per Cornell’s instructions with the lab report.  They do recommend the TRH test along with insulin and leptin.  Should I retest ACTH with insulin and leptin or TRH? 

Also can Dr. Kellon please help me with my question around sesmoiditis and arthritis relief?  I’ve seen several products mentioned including PEA, Conquest, and Equithrive Joint for arthritis but I know nothing about sesmoiditis and the vet indicated he had it from his latest X-rays (in his album).  
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Eleanor Kellon, VMD
 

Hi Cecile,

While his rear sesamoids show some irregularity at the insertion sites of the suspensory branches there is no increase in vascular channels. I guess it could still be considered sesamoiditis but I would approach it more as a ligament insertion issue and use Tendon EQ. There is no evidence of arthritis in any of the visible joints. The major issue in all four feet is the trim and a suspicion of bone infection in the RF. Has he ever abscessed?

If he is still on Devil's Claw Plus you should stop that because of the Yucca. Consider Hemp Joint at the horse dose.

ACTH is too high for a horse dealing with laminitis. Fine to increase to 1 mg and retest in December. There is no reason to do the TRH response since his ACTH is clearly elevated.  His insulin isn't high enough to account for acute laminitis pain. I would focus on the trim and possible unresolved abscesses.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Cecile Johnson
 

Thank you Dr Kellon.  For the possible bone infection are you referring to the dark spots on the RF?  If it was a bone infection, would his white blood count be elevated?  His CBC results don’t indicate that but do show a slight decrease in his red blood count.  We thought before he might have an abscess due to a dark spot but determined it wasn’t.  

I will try the tendon EQ for the back legs.  I appreciate your help! 

--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Eleanor Kellon, VMD
 

I'm suspicious of bone infection because he has more bone loss on that foot than the others. Bone infection is difficult to diagnose in the coffin bone. It wouldn't be likely to show up in his CBC.

I would strongly suggest you ask Lavinia for a trim mark up to guide his trim. I could make a huge difference in his comfort and also will likely result in the mobilization of abscess collections that really need to drain. Contrary to popular belief, most abscesses/collections are invisible on radiographs because they are the same density as the soft tissue. The only time they show up as black areas is if the organism is one which produces gas.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Cecile Johnson
 

Thank you.  He is currently on Laminox and Acetyl-L Carnitine.  I see Tendon EQ has J herb in it.  If I give this, do I stop the Laminox and what is the dosage for Tendon EQ for Olaf?  Also what is the Hemp Joint for?  Do I give them together and stop the Laminox and Acetyl-L?  I stopped the DC Plus as he wouldn’t eat it.  
--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Eleanor Kellon, VMD
 

You can do the  Laminox and Tendon EQ together.  Hemp Joint has a therapeutic dose of Devil's Claw for pain. Continue the acetyl-L-carnitine since that is for chronic neurogenic pain which is known to happen with chronic laminitis.

Again, remember you need to get major revisions done to the trim.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Cecile Johnson
 

Thank you. I want to be sure I understand.  I’m to continue Laminox, Acetyl L Carnitine and add Tendon EQ and Hemp Joint?  What is the dosage for Tendon EQ?  

--
Cecile J in OK 2022
Olaf Case History:  https://ecir.groups.io/g/CaseHistory/files/Cecile%20and%20Olaf
Olaf Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=272407


Kirsten Rasmussen
 

The dose on the label for Tendon EQ is for 850 to 1000 lbs, so adjust accordingly for Olaf.
 
--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Eleanor Kellon, VMD
 

I would hold off on the Hemp Joint unless you find he needs something more for pain.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


cathyjomitchell
 

What is the horse dose of Hemp joint.  is it 2 scoops?

--
Cathy and Mikey (Arabian)  in MN
joined 2008