Test not collected properly caused abn high reading?


Jane Hester
 

Been thinking how my horse with minimal PPID symptoms could have result of 995 on ACTH lab results. When the vet drew the blood, he forgot to take it with him. I happened to see in on top of tall cabinet about 2 hours later—so was in warm barn (80 degrees ish) all that time. Called vet as soon as I saw it and after 30 min or so, they asked if I could bring it to clinic. Got it there in 30 min and gave to receptionist. She took it back but don’t know what happened after that. Not sure if it was shaken. Could this be reason for unusually high reading? Thank you for your help!
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Jane Hester in NC 2021


Kirsten Rasmussen
 

Hi Jane,

If the sample was degraded the ACTH would be lower, not higher.  Similarly, the insulin and glucose would be lower, too.   But your glucose looks appropriate.  That said, I'm surprised the glucose in a blood sample left out for 2.5 hours wasn't metabolized at least a bit.  It's always possible a sample got mixed up though if the vet had multiple blood pulls that day so if the results really don't fit your horse, then a retest can be done.  We have seen other high readings like yours though, it's not that unusual.

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

Thanks! Not surprised if he does have Cushings but read where blood should
be shaken and kept cool after pulled. So if would be lower in heat, guess that’s not it. Would a horse typically show more symptoms with such a high score?🤔
Jane Hester in NC 2021


Kirsten Rasmussen
 

Not necessarily.  Not all the ACTH is active, and it seems to vary by horse, so some horses have really high ACTH but not a lot of signs, and vice versa.  There are other hormones involved that we don't measure and they can be more active than the ACTH, or not.  Each horse is highly individual.

Yes, it should be refrigerated or put on ice after being pulled, centrifuged within 4 hours, then refrigerated or frozen for shipping.  Having glucose measured every time will usually provide clues if the sample was mishandled because it is the most sensitive.  But a glucose of 97 is perfectly normal so your bloodwork looks reliable. 

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


Jane Hester
 

Thank you! Just hope to get that number down fast! Talked to vet just now—he recommended going straight to full tablet since number is so high. Gave 1/2 tab yesterday and today—will start whole tab tomorrow. He is eating well—just seems a more lethargic than usual. I’m pretty worried about my boy!
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Jane Hester in NC 2021


 

Hi, Jane. 

The safest way to introduce pergolide is slowly. In general, we suggest starting at ¼ mg for 3 days, then ½ mg for 3 days, and continue until you reach your target dose. A common side effect of pergolide is lethargy AND loss of appetite. So if your horse stops eating hay and wanders away, it’s time to slow down the introduction. There’s a File explaining the process.  Many of us have found that APF helps with these side effects that are called the “pergolide veil”. 

https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide/Pergolide%20101.pdf

One more thing. Handling blood samples for our metabolic horses is fussy and detailed. Mishandled blood samples cost money AND supply bad information. If glucose was “normal” after sitting at 80 degrees for 2 hours, I wouldn’t trust that lab result. If you can manage, repeat labs in a month for ACTH, glucose and insulin would be smart. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
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Candice Piraino
 

HI Jane,

I can actually tell you a quick personal story of my own! My very own riding gelding never had shown any signs of being PPID ( well before I found ECIR and went down lots of rabbit holes and then started to realize all the little red flags I had missed!) AND had been seen by numerous vets who never mentioned PPID. Well low and behold at a later date he was footsore, had rads completed and had shown some degree of rotation. I then found ECIR and asked an attending vet to test for PPID. The vet was absolutely shocked by his numbers and so was I!!! His numbers were so high off the charts, they never computed! The only pushing of testing was from me wanting to know more and dig deeper.

So I just wanted to share my little story of how it can be different for all horses, and some horses don't "look" PPID or show symptoms and then test VERY high!

If you are concerned about the validity of the test, you might ask your vet to redraw on their own dime since it was their own mistake maybe? They might be reasonable about it, and you might feel reassured about the test results. It couldn't hurt to ask, right?

Glad you here!
--

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer @www.arkhavenfarm.com

 


Jane Hester
 

Makes me feel better to know I am not alone. Will have insulin and ACTH retested on next scheduled vet visit Nov 5. Is supposed to get fall shots and deworming on that visit—but thinking I shouldn’t do shots/deworming until is ACTH levels normalize and insulin/glucose re-tested. Especially since he is footsore on hard/gravel. If he is still footsore on Nov 5, will ask for X-rays to assess rotation. Any thought on worming/shots with ACTH so high? Going straight to 1 full Prascend tablet today per vet to get number down faster—wonder if 1 tablet will be enough? Thanks for your help. I’m pretty worried about my boy!
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Jane Hester in NC 2021


Jane Hester
 

Vet wasn’t concerned about handling issue but will retest all on Nov 5 visit. Just started Prascend so need to wait a bit. He is on forage only anti-inflammatory diet for long time—only thing I lack is testing his grass hay at this barn. I’m at boarding barn so source varies. I’ve had other grass hay tested in area and tested good. So much to think about—head is spinning!
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Jane Hester in NC 2021


Kirsten Rasmussen
 

His ACTH will be lower on Nov 5 after 3 weeks on 1 mg pergolide, and also because we are now past the peak of the seasonal rise so it's coming down naturally now.  If his insulin was sky high at the last test, too, I would definitely hold off.  But it was not that high with the last bloodwork so I think the risk of vaccines and dewormer triggering laminitis is low.  However, you can definitely hold off until you get his new lab results back, so do what you feel most comfortable doing.  Will your vet leave the vaccine and dewormer with you to give later?  Just make sure you pull blood before anything else is done, including administering any sedatives if needed, and have ice or a fridge to put it in (ice is handy because you can send it with the vet on ice).

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