Time Sensitive - Upcoming Vet Appt 8/4 for Minis Archie and Candy Man


Laurie
 

Hi -

I've just updated Archie's case history and added Candy Man's to my folder. I hope I've done it correctly!

The vet will be out again on Thurs to draw blood for Insulin and do TRH Response on both ponies.

Would someone please take a look at their histories and let me know if there's anything else the vet should pull blood for or if any of their medications should be changed? Candy seems to be doing much better on the increased dose of Metformin; Archie's dose was just increased last night.

Do they actually have PPID? The Stim tests done Sept 2021 were abnormal, but the ones done March 2022 were normal. They didn't start the Prascend until after the lab draw in March 2022. Could the test done Sept 2021 have been abnormal due to the seasonal rise? The vet said she thought maybe the compounded TRH medication might have been bad in March 2022 but wanted to start them on Prascend anyway.

I would really appreciate it if someone could provide further information for me.

Thank you so much!

Laurie, Archie and Candy Man
July 2018 - Texas

Case Histories
:  
CaseHistory@ECIR.groups.io | Files
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=62869



Sherry Morse
 

Hi Laurie,

The TRH test is not reliable from July until January so trying to run it now will not yield reliable results. If you want accurate testing to see if Metformin is working you need to test 7-10 days after starting the medication. Metformin is dosed at 30mg/kg twice a day. I can't look at the CH right now to see if that's where you started both horses or not. 
--

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response

PA 2014

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

 


Laurie
 

Sherry, thank you for this information. My vet had consulted with a colleague at a different office about my boys and was told that after August the TRH results may be invalid. 

Unfortunately, it seems both ponies have been underdosed since starting the Metformin in June. I believe they are on the correct amount now for their weights.
I'll contact my vet and reschedule the insulin draws for next week. I feel terrible that so much time has been lost and they've been in pain. Would you recommend any other tests be done besides the insulin?

When you have time to look at their case histories, would you please let me know if you think any of their other medications or supplements should be changed or stopped? Do you think they should be on the Prascend since their TRH was normal in March? I have been really confused about this and my vet said she felt they would get some benefit from it, but it hasn't reduced their insulin levels at all.

It may be my imagination, but I *think* Archie seems less sore on the increased dose and Candy doesn't seem sore at all. 

Laurie, Archie and Candy Man
July 2018 - Texas

Case Histories
:  
CaseHistory@ECIR.groups.io | Files
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=62869



Sherry Morse
 

Hi Laurie,

You can get glucose and ACTH (just baseline) checked. Although we are in the early stages of the rise now you still want to see a PPID equine with ACTH levels in the low 20s now as that indicates that the amount of medication they're on currently is doing the job and they don't need an increase.

Looking at the diets I would cut out the Standlee pellets since you are using tested hay and you can source the Timothy Balance Cubes.

For Candy Man as far as ACTH testing you have a TRH stim test done at the height of the rise in 2021 that was normal for that time of year at baseline and his tests earlier this year I'm confused as to why you had a baseline done on March 9th and a stim test done on March 28th.  Based on the first test result and on the post-TRH number he's not PPID although his pre-number on the 28th was higher than it'd been on the 9th.  At this point I'd leave him on the Prascend through the rise just to be safe, then stop it in December and retest in March (using the TRH Stim again) to see what his results are.  If he again tests as not PPID I would not start him on Prascend again. 

Did your vet prescribe Thyro-L thinking it will help insulin?  It can help jump start weight loss but it will not bring insulin down.  

Archie I again would cut the Standlee pellets and I have the same question on the Thyro-L but his ACTH test in 2018 showed he was already over the accepted range for ACTH although not by much.  Again the September TRH test can't be really interpreted but his pre-test result was higher than normal for a non-PPID horse which would indicate to me that he's probably early PPID.

For both ponies I'd focus on getting their insulin controlled.  If you could post current body pictures of both that would be helpful as well.




Lesley Bludworth
 

Sherry,
the protocol is to test base line ATCH in the spring and then best to do a do a TRH test when?


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Sherry Morse via groups.io <sherry_morse@...>
Sent: Tuesday, August 2, 2022 6:48 AM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] Time Sensitive - Upcoming Vet Appt 8/4 for Minis Archie and Candy Man
 
Hi Laurie,

You can get glucose and ACTH (just baseline) checked. Although we are in the early stages of the rise now you still want to see a PPID equine with ACTH levels in the low 20s now as that indicates that the amount of medication they're on currently is doing the job and they don't need an increase.

Looking at the diets I would cut out the Standlee pellets since you are using tested hay and you can source the Timothy Balance Cubes.

For Candy Man as far as ACTH testing you have a TRH stim test done at the height of the rise in 2021 that was normal for that time of year at baseline and his tests earlier this year I'm confused as to why you had a baseline done on March 9th and a stim test done on March 28th.  Based on the first test result and on the post-TRH number he's not PPID although his pre-number on the 28th was higher than it'd been on the 9th.  At this point I'd leave him on the Prascend through the rise just to be safe, then stop it in December and retest in March (using the TRH Stim again) to see what his results are.  If he again tests as not PPID I would not start him on Prascend again. 

Did your vet prescribe Thyro-L thinking it will help insulin?  It can help jump start weight loss but it will not bring insulin down.  

Archie I again would cut the Standlee pellets and I have the same question on the Thyro-L but his ACTH test in 2018 showed he was already over the accepted range for ACTH although not by much.  Again the September TRH test can't be really interpreted but his pre-test result was higher than normal for a non-PPID horse which would indicate to me that he's probably early PPID.

For both ponies I'd focus on getting their insulin controlled.  If you could post current body pictures of both that would be helpful as well.




--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History


Eleanor Kellon, VMD
 

Laurie,

Have you tested the last load of hay for nitrate? Protein is suspiciously high for a mature hay. Were they on Prascend when the March TRH was done? If not, they don't need it.

--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Hi Lesley,
You can measure ACTH (adreno cortico tropic hormone) any time, depending on what you want to know.  In the middle of the rise in late September, you will learn how high it will get during the rise.  Outside the rise (late Dec- early June), you will learn what the baseline is.  Knowing what the baseline is tells you whether or not you need pergolide started or increased.  An exaggerated rise as determined by testing in Sept will guide you in how much you need to adjust pergolide for the fall next year.  Some early cases will not show an elevated ACTH outside of the rise but instead an exaggerated elevation in Sept.  Those horses might only need fall pergolide at this point in their disease.  

I just tested my horses’ ACTH a few weeks ago and they were all in the high teens to low twenties.  I will not test again in Sept because pergolide which is increased during the rise will not act reliably to further decrease ACTH.  I will test again in the early spring to see if they need any increases.

TRH stim test will not give interpretable results during the rise so it needs to be done outside the rise, if at all.  If your baseline ACTH is elevated and you start your horse on pergolide, there really isn’t a reason I can think of to do a TRH stim test.

Hope this helps a bit.
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


Laurie
 

Hi Dr. Kellon -

Unfortunately, I did not have the last load of hay tested for nitrates. The hay is from Arizona, and I believe they cut hay year-round there; don't know if that makes a difference. But I can get another sample and send it off if you think I need to.

They were not on Prascend in March when the TRH was done, but my vet had me start them on it that same day after the blood was drawn. I discussed it with my vet, and she felt they would get some benefit from it, but it did not lower their insulin levels at all. I am so relieved to hear you say they don't need it!! Do they need to be tapered off of it, or can I abruptly stop giving it?

Laurie, Archie and Candy Man
July 2018 - Texas

Case Histories
:  
https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Archie%20-%20Candy%20Man
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=62869



Eleanor Kellon, VMD
 

Yes, I think you should test for nitrate since it can enhance hoof pain.

You can do a quick taper, half current dose for a week then off. There is currently no evidence pergolide will help horses that do not have PPID.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Laurie
 

Hi Sherry -

Thank you, I will discuss adding glucose and ACTH when my vet comes to do the insulin levels.

I am planning on stopping the Standlee Timothy pellets as soon as the ponies start eating the TC Balancer cubes a little better. I am splitting one small handful of the Standlee pellets between the two of them, so they are probably getting about 10-15 pieces each. They are just so picky; I have to really start slowly with transitioning any changes.

What is the normal range for a pre-TRH test result during the seasonal rise? I don't have an answer as to why my vet did the tests when she did, other than she had an anxious owner on her hands!

I believe that she had me start giving the Thyro-L to help with weight loss and not for the high insulins. Should I be tapering them off of it now? They have been on it for over four months. I will post photos as soon as I figure out how to make a second folder for Candy Man, but I would say they are between a 4 and a 5 on the body condition scale. They are a little thin and their ribs show slightly. Archie has lost all the muscling and condition he had before the laminitis flare up. Candy has had more regular exercise, so he is not as out of condition, but the heat we are having here makes working (driving) him difficult.

Lowering their insulin levels is definitely my priority.

Laurie, Archie and Candy Man
July 2018 - Texas

Case Histories
:  
https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Archie%20-%20Candy%20Man
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=62869



Laurie
 

Dr. Kellon -

I will submit another sample for nitrate. What should I do if the results are elevated?

Laurie, Archie and Candy Man
July 2018 - Texas

Case Histories
:  
https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Archie%20-%20Candy%20Man
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=62869



Kirsten Rasmussen
 

Hi Laurie,

If nitrates are elevated, soaking the hay does help lower them.  You can also mix it with another low nitrate hay.

A BCS between 4 and 5 is good.  I would try to maintain that and taper off the Thyro-L.

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


Sherry Morse
 

Hi Laurie,

The 'pre-TRH' test is just a baseline ACTH and the range during the rise is usually adjusted by whichever lab is doing the testing.  It's the post-TRH reading that is problematic during the rise.  

If the ponies are thin I would taper them off the Thyro-L as any thyroid issues usually resolve once IR is controlled.   You need to decrease the dose by about a 1/2 tsp every 2 weeks (https://ecir.groups.io/g/main/message/265797)

To create a new photo album go to the photos section of the CH group (https://ecir.groups.io/g/CaseHistory/photos) and click on the "New Album" button.  Once you've created the album open it and then you can upload pictures to the album.





Laurie
 

Hi Sherry -

I started reducing their Prascend dose last night from 1/4 tablet to 1/8 tab per Dr. Kellon's recommendation above to taper them off it completely as their blood work doesn't seem to support them having PPID. Should I go ahead and get another ACTH done next week along with the insulin and glucose levels? Or wait to do it until March 2023?

Archie is only on 1/4 tsp Thyro-L every AM and Candy gets 1/2 tsp every AM. How much should I reduce theirs by and over what length of time?
Would cutting it in half be too much?

I added a new, current photo of Archie to his album and created one for Candy Man, then put a current photo of him in it. I added his link to my signature, but for some reason it's not a blue, clickable link. Is there a way to change it?

Thanks,

Laurie, Archie and Candy Man
July 2018 - Texas

Case Histories
:  https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Archie%20-%20Candy%20Man

Photo Album for Archie:  https://ecir.groups.io/g/CaseHistory/album?id=62869
Photo Album for Candy Man: https://ecir.groups.io/g/CaseHistory/album?id=277334


Laurie
 

Kirsten -

Thank you so much for that info.

I've added current photos of both ponies to show their body condition. When I created Candy's album and added the link to my signature, the link does not paste as a blue, clickable one. Any way to change it into one?

Thanks,

Laurie, Archie and Candy Man
July 2018 - Texas

Case Histories
:  https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Archie%20-%20Candy%20Man

Photo Album for Archie:  https://ecir.groups.io/g/CaseHistory/album?id=62869
Photo Album for Candy Man: https://ecir.groups.io/g/CaseHistory/album?id=277334


Kirsten Rasmussen
 

You just have to go back to edit your signature, put the cursor at the end of the link, then hit Return/Enter.  It will turn blue.  Then Save the change.

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


Kirsten Rasmussen
 

Both of those boys look fantastic!

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


Sherry Morse
 

Hi Laurie,

Don't waste the money on testing ACTH next week - you need to wait 3 weeks after changing a dosage to see if it's had an effect one way or another.  I would wait on testing that until next March and at that point you'll need to decide if you just want to do a baseline test or a TRH Stim test.

I'll defer to Dr. Kellon on the Thyro-L but I would think you could cut in half for a week and then stop Archie and stop Candy in 2 weeks. 

Agree with Kirsten that they both look good right now!




Laurie
 

Thank you Kirsten, looks like that worked. And thank you for the compliment about the boys!
--
Laurie, Archie and Candy Man
July 2018 - Texas

Case Histories
:  https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Archie%20-%20Candy%20Man

Photo Album for Archie:  https://ecir.groups.io/g/CaseHistory/album?id=62869
Photo Album for Candy Man: https://ecir.groups.io/g/CaseHistory/album?id=277334


Laurie
 

Hi Sherry -

Thank you again, we will hold off on doing the ACTH next week.

I understand that the horses are to have hay in front of them continuously for at least four hours prior to and up to the lab draw for the insulin and glucose. 
What about the timing for giving them the Metformin? I normally tie them up, administer it, and then wait 30-45 minutes before giving them their breakfast or dinner hay and Timothy Balancer cubes. Should I go ahead and give the Metformin to them the morning of the draw (vet is scheduled to be here around 9 am, but could arrive later) and let them get started on their hay and cubes? I was originally instructed to give it 30-60 minutes before feeding, but I plan to give them a little extra hay the evening before, so they don't run out by morning.

Laurie, Archie and Candy Man
July 2018 - Texas

Case Histories
:  https://ecir.groups.io/g/CaseHistory/files/Laurie%20and%20Archie%20-%20Candy%20Man

Photo Album for Archie:  https://ecir.groups.io/g/CaseHistory/album?id=62869
Photo Album for Candy Man: https://ecir.groups.io/g/CaseHistory/album?id=277334