Hello,

I had a Bio Chem test done for Rio and would like some feedback if possible.

Some of her levels are lower and higher than the lab reference ranges.  Can I get some input on these if possible. Rio is on tested hay with a mineral to balance. I put the hay test in my album as well as the blood test results.

Cholesterol - 2.92 H mmol/L ref range 1-70 - 2.70
Creatine - 69 umol/L Ref range - 80-130 
Bilirubin -  6 L   umol/l Ref range - 21-57

is their any need for concern?  My vet is also curious as she always looks for higher Bilirubin levels and not sure what to think of lower ones.

Rio is on 300mgs of Invokana and compounded Pergolige as well and we wondered if these levels are due to her being on these meds?

Thanks in advance!

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

The mildly elevated cholesterol is often seen in metabolic syndrome. If you haven't also checked triglycerides, you should. Lower end bilirubin has been associated with high triglycerices https://pubmed.ncbi.nlm.nih.gov/36407008/ , https://pubmed.ncbi.nlm.nih.gov/36128497/  in humans although we certainly haven't seen it often here. I assume by creatine you mean the enzyme creatine kinase (?). This can be a result of decreased muscle mass. If you meant low creatinine, most likely cause is the same - low muscle mass.
--
Eleanor in PA

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

Thanks Dr Kellon.

we did blood on triglycerides and they were lower than the previous blood test. Current triglycerides were 0.4 mmol/l

Does medication play a part at all in the higher cholesterol or the lower bilirubin?  Just curious. As for the creatine, I am not sure how to answer your question as it was just noted as low levels. Lab just labeled it as creatine  and was included in the bio chem test.

She does need to build up her muscle mass and that was one reason why we did the labs to make sure we were ok to proceed with our plans of getting her back into more work.

Since her triglycerides are low then the higher cholesterol levels are just due to her being metabolic?  Is there any concern that the higher cholesterol is coming from the fact she is on free choice hay?  With her going back into more work I hesitate to reduce her hay intake, but just wanted to ask.  TIA

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

The cholesterol isn't from diet or medications. What is her insulin now? When her exercise levels is more than 20 minutes or so of walking, let me know.
--
Eleanor in PA

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

Insulin on Oct 19 was 282 pmol/l
Glucose was 5.0 mmol/l
Currently  she at 25 - 30 min of walking each day or every other day and continuing to build.
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Thanks, Heather. If she is not on free choice hay already, start that. Also watch her weight very carefully. If she starts to lose, begin feeding 1 lb of beet pulp with 1 lb of oats immediately after exercise. When you start trotting and get up to 20 to 30 minutes, let me know.
--
Eleanor in PA

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

Hello,
she is on free choice and not loosing weight if anything perhaps gaining a bit IMO.  She has been on free choice since spring of 2021.  Will let u know when we add trotting.  
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Update on Rio. She continues to do well and has managed so far with the cold temps but is blanketed extremely heavy due to her super sensitivity to the cold.  

She is still on free choice hay and we are at 30-35 minutes of exercise which includes trotting. Building up more trot each day. So far she has not lost weight and I think gained some.  Would  reduction of hay ever be something that could be done with a horse on Invokana or something to totally avoid?

thanks and happy holidays to everyone!
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

I would keep her on free choice until you consistently are trotting 30 minutes per day minimum and see what her weight does then.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Thanks Dr. K. I am a wee bit concerned about continuing the free choice hay as I stripped off her blankets today and she has gained weight and is looking more like she did in Feb of 2020 when she got wicked laminitis. Fat pads on shoulders loin, along top of withers and rump. 

I doubt we will get up to 30 min or trot ever during the winter as too cold of temps here to even ask for that not do I ever work any of my horses for 30 min of trot all at once ever.

what options do I have as she is gaining weight on the free choice hay. Or is limited hay just not done with horses on Invokana.  

TIA


--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Every horse reacts to these drugs differently.  Have you done triglycerides and insulin recently? You could try restricting to 2% of body weight and see how that goes.

P.S. You really need to update your case history!
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Hello,

oh shoot, yes good reminder will do this over the holidays.

here is info on her last bloods.

here are her current blood results:

Glucose 5.0 mmol/L. ref range - 3.7-6.7
Insulin 282 pmol/L - ref range > 300
triglycerides - 0.4 mmol/L no ref range

taken on Oct 13, 2022

previous blood results from July, 2022

Glucose - 5.0 mmol/L
Insulin - 166 pmol/L
Triglycerides - 0.8 mmol/L

OK. Are you sure she is getting her full dose of Invokana? Are you checking urine glucose? Cold could be driving insulin up. That triglyceride level isn't too concerning but next time you do bloods do a full chemistry or at least just a  GGT.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Sorry message got sent before I was done.
yes she is getting the full dose as I hand feed it to her. I tested urine about a month ago and all all results looked normal. Will try to grab some another sample this week and test again. 

I did a full blood Chem with the last results and the info is in her photo album. I wasn’t thinking of doing another round of labs until the spring or are you suggesting we do them sooner?  Always a struggle to get them done where I live so try to spread them out to the best times of year.

TIA 

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Spring is fine.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

On Tue, Dec 27, 2022 at 06:10 AM, Eleanor Kellon, VMD wrote:

Spring is fine.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

 Ok thanks. Will reduce her feed during the day but will keep her on free choice overnight.  She has an issue with ulcers so hopefully reducing her feed doesn’t cause them to flare up.  I have reduced her pergolide as well from the bump up we did in the fall and hoping to do a stem test in early spring too. She currently is on 3.75 mgs of compounded pergolide. In the fall she was in 5 mgs compounded. Product is from island pharmacy and stored in fridge door and given via syringe in mouth. 

Perhaps her recent weight gain is from reduction of pergolide as well although only been about 5 days that she has dropped down to the new dose.  

--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

My messages got jumbled so reposting my last one regarding her pergolide dose. Will update her history this weekend. TIA.

Will reduce her feed during the day but will keep her on free choice overnight.  She has an issue with ulcers so hopefully reducing her feed doesn’t cause them to flare up.  I have reduced her pergolide as well from the bump up we did in the fall and hoping to do a stem test in early spring too. She currently is on 3.75 mgs of compounded pergolide. In the fall she was on 5 mgs compounded. Product is from island pharmacy and stored in fridge door and given via syringe in mouth. 

Perhaps her recent weight gain is from reduction of pergolide as well although only been about 5 days that she has dropped down to the new dose.  

August 5, 2017, Brandon, Manitoba, Canada

Riosa 
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm