Positive for early cushing`s?


Anthie Booras
 

I finally got all of Erin`s most recent bloodwork back. Given this is the second year in a row her insulin has spiked with the seasonal rise I decided to check her ACTH. I'm hoping I got the link updated correctly in my signature with her updated case history. I put her test results and hay analysis in the folder as well with the chem panel results too. Here's what came back.

ACTH 57.6
Glucose 78
Insulin 46.09
Leptin 11.41

I'm super happy her leptin is staying lower. I increased her overnight hay net to 10 lbs and I think it's been helping. She's not chewing on wood like she has previously when it's been higher. The lower glucose was a little odd for her. I do my own blood pulls and follow the protocol to a T. I don't pull until at least 4 hours after her first meal and give her enough hay for breakfast that it's less than 2 hours between when she finishes and I'm able to pull the blood. Hence the consistant 11:30 blood draws. 

--
- Anthie

Northern California
August 2015

Erin's case history: 
https://ecir.groups.io/g/CaseHistory/files/Anthie%20and%20Erin/


Kirsten Rasmussen
 

Hi Anthie,

I'd say that ACTH result is pretty borderline.  It was done a few weeks after the peak of the rise, so it's possible it was higher, but it will be coming down now.  Next year you might want to consider putting Erin on 0.5 mg pergolide in late July to be proactive, then retest right at the peak (fall equinox).  I'm not sure why her glucose would be lower than normal unless there were issues during shipping that may have caused it to be partially metabolized, in which case your ACTH and insulin would also have been affected a bit.  If you call Cornell they can probably tell you when the sample was received.

The increased peeing could be explained by the increased salt consumption.  But not sure why she would be craving salt at this time of year.  It's definitely something to keep an eye on and make note of since it's seasonal and unusual behaviour for Erin.

The lack of forward movement you mention in your Case History could have many causes, but it's possible that her consistently elevated insulin (>40 uIU/ml) is keeping her in the sub-clinical laminitis zone and that alone could result in hoof tenderness.  What does her whiteline look like?  Is it nice and tight, or is it stretched?  Does she have any rippling in her hoof walls?

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Anthie Booras
 

I pulled it on the Sunday. It was spun within an hour and put in the freezer immediately. I shipped it Monday, packed in a styrofoam cooler with three ice packs about noon, and I had the glucose and chem results in my inbox less than 24 hours later. 

The last couple years it’s felt like she does so well at the start of the year into the spring and just as we get to the summer is when she seems to start developing problems. From there it just goes downhill as we get later into the summer into the early fall, and once we get to middle of winter we start fighting back from bad to getting better again. Then she has a stretch of time where she is doing well, comfortable, and happy. And that end of spring into summer starts and we do it all over again. The last two years I have been able to take care of doing her bloodwork myself so I have finally been able to really track her patterns.  Prior to that it was merely tracking her symptoms and what she was doing.

I can re-run the ACTH in about six weeks and see how low it’s come once we get closer to winter. But at this point it makes me feel like trying her on a small dose of pergolide around the time she always seems to start going downhill just to see if I can stop it from happening.

I don’t have any recent photos of her front feet. I did upload two pictures of her right and left front mid trim from a year and a half ago. I feel like she has improved since then. The last couple of shoeings she has not had the red that can be seen in those pictures. That seems to have gone away finally. She recently got switched to EasyShoe Versa’s since they discontinued the flex.

Besides the increased salt block licking her itchiness has gone up this year as well. She’s always been kind of sensitive to things. She used to get hives a lot but seems to have stopped with that. Now it’s mostly being itchy despite being on both spirulina and Chondroitin.
--
- Anthie

Northern California
August 2015

Erin's case history: 
https://ecir.groups.io/g/CaseHistory/files/Anthie%20and%20Erin/


Kirsten Rasmussen
 

If you are seeing her impacted negatively by those changes with the onset of seasonal rise then I think it's fair to trial a low dose of pergolide next year.  I don't see a need to redo ACTH until next July/August, then again after she's on pergolide.

I wonder if the lower glucose could be because her hay prior to the blood pull might have been lower in sugar than usual?  I've noticed lower glucose, too, for my horse's last 2 blood pulls after I started soaking hay that was already low sugar, but I don't have enough data to confirm that correlation and can't rule out sample handling.

Could you add the link to your photo album to your signature?
https://ecir.groups.io/g/CaseHistory/album?id=269097

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Anthie Booras
 

Thank you. I forgot it was a different album. I think I added it but for some reason I don’t see it so far while I’m replying. 


If she’s already starting to spike higher insulin levels by the end of July wouldn’t I want to start her on the pergolide before that? Isn’t it harder to play catch-up than it is to start early?

The total sugar in her hay has slowly been decreasing. The hay I had back in February had a total of 7.8 in sugars, the hay supplier I’m getting from now when I first bought it in July was at 6.2 and now the most recent is 4.7. She is still mostly getting the pay from July as I am weaning her over to the new Hay. At the time of her blood pull she was probably getting a quarter of the new hay and 3/4 of the old hay.


--
- Anthie

Northern California
August 2015

Erin's case history: 
https://ecir.groups.io/g/CaseHistory/files/Anthie%20and%20Erin/


Anthie Booras
 

Someone may need to help me get the second link with her photo album in my signature. I have tried about six times from two different devices and despite it saying it has saved my update there is no change to my signature.
--
- Anthie

Northern California
August 2015

Erin's case history: 
https://ecir.groups.io/g/CaseHistory/files/Anthie%20and%20Erin/


Lavinia Fiscaletti
 
Edited

Hi Anthie,

I checked your signature and the photo album link wasn't there, so I added it for you. Let's see if it works this time.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Anthie Booras
 

I was just messing with it for like the eighth time and came to look and all the sudden saw it up here when I hit reply so I thought I finally did it right or got it to work......and then I saw your post. So I think you did it for me and I didn't do it for me. But thank you for fixing it
--
- Anthie

Northern California
August 2015

Erin's case history: 
https://ecir.groups.io/g/CaseHistory/files/Anthie%20and%20Erin/

https://ecir.groups.io/g/CaseHistory/album?id=269097