Vinnie and Invokana update 4/2022


Nancy & Vinnie & Summer
 

Hi Dr Kellon,

Got labs in and not as pleased as I would have hoped..but he is doing well soundness wise.

April:
Insulin 101.01
Acth 25.8
Tryglicerides 307
Glucose 121

Meds:
4.2mg compounded pergolide 
150mg invokana daily

FEB
Insulin 76.5
Acth 17.1
Tryglicerides 141
Glucose 112

Meds:
4.2mg compounded pergolide 
150mg invokana every other day

I will add the update the pdf and add to my folder that has all the feeds, but totals he has been actually eating is as follows:

19lb hay eats this consistently daily free fed in nets.

Mash:
2.5lb stabul 1
5lb TC balanced cubes
1.5lb dry weight beet pulp
8 cups tc senior 
6cups cavalor

I mix this in a big tub spread over two feedings. He sometimes eats all of it and sometimes will eat half or 3/4. 

On the days prior to the labs he was eating almost all his feeds. 

Labs were taken at 10am with Temps at about 65.

I am concerned about his ACTH on spite of increasing his dose of pergolide it hasn't yet stabilized. So whIle in normal ranges I feel a jump from 17.1 to 25.8 seems alot in 2 months? We have always thought his initial November laminitis in 2018 was because of early cushings, but at that time his acth was super low, I think 9 if I recall correctly.

Also he normally would have shed by now and has not, plus is drinking and urinating more than his normal from the past.. (he was never a good drinker) I am filling three 5 gallon buckets twice per day, plus he has a 25 gallon refillable tub that I can't track. And go through about 6 bales of shavings a week. 

Would you increase pergolide to get that number back in the teens and see what it does to Insulin? Or do you think I also need to increase Invokana? With the TG at 307 I am happy we are managing him but I want that insulin down and I don't want the TG up :)

Here is the latest video of our work. We just introduced a little bit of trot and are walking 20 to 30 mins 5 to 6 days a week.

https://youtu.be/eLT3C4sAA7I

Thanks Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Nancy & Vinnie & Summer
 


Sherry Morse
 

I know you're excited to see him moving so well Nancy and it makes me SO HAPPY to see him walking so well and trotting after everything you've been through with him.  He looks great even with the questionable numbers!




Eleanor Kellon, VMD
 

He may need a higher dose of Invokana but I would try to get his ACTH back down first. Will he eat more beet pulp if you cut back on something else? I would titrate the pergolide up until his drinking normalizes. Even allowing for more urinating and drinking from the Invokana, that's clearly abnormal.  Are you testing his urine?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 

Hi Dr K,

Thank you, I can play with a little more beet pulp but the 1.5 to 2 cups dry seems to be his magic number.  He starts to get picky about eating the more beet pulp I add.  

I will start to titrate up his pergolide. And post results as I see the different results.

Thanks so much! Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Nancy & Vinnie & Summer
 

I have tried to.get consistent urine samples on him, but he is one of those horses that decided as soon as he saw me he would stop peeing,  I think i scared him with the capture decive once (smart arabians...).  So I decided to reset and stop trying for a little bit.  He is just now starting to allow me being in his royal presence when he pees, so I am trying to think of a strategy that I can capture without scaring or offending him :) 
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Bobbie Day
 

Oh my gosh Nancy he looks AMAZING!
I know I repeat myself time and again but I wish new members would go back and see how far Vinnie has come. He has such a will, and he still amazes me.
It always makes my day seeing him.
Thank you for the updates ❤️


--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821


Nancy & Vinnie & Summer
 

Thanks Bobbie and Martha!! And I am sure you know, but will say it again, Vinnie wouldn't be here if I didn't have this group and Dr Kellon. 

And i have to give a massive shout out to  my vet who gives me such broad latitude and trust to try things recommended here. and she taught me how to pull for labs so that we could do that as frequently as needed. And of course my amazing farrier;  the p3 bone loss and the ringbone and the damage to the laminae from the sinking on the left front requires a delicate balance of breakover and caudal support and look at Vinnie go!!! 🥰🥰

It takes a village!!!

--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Nancy & Vinnie & Summer
 


Nancy & Vinnie & Summer
 

Update. I managed to get a urine sample today.  Glucose reading is at darkest brown which is good. No other anomalies noted.

I am up to 5.4mg Compounded Pergolide and seeing positive things.  Seems to have better turns over the LF medial side which as always been tough for him due to (ringbone, bone loss and sinking), so that is an improvement. Already seeing improvement with water consumption.  Only refilled two of the 5 gallon buckets yday.  And he started to drop some guard hairs. I am thinking I will continue to titrate up at least another 1.2mg to see how things change.

I also contemplated doing a TRH stim to see what that looks like in context to his ACTH # But we don't have a baseline TRH  so would that matter?

Thanks Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

Yes, the TRH stim could be helpful even without a baseline TRH test but since you have such obvious clinical signs I think you're OK going by that on dosage changes.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 

Just a quick update with some observations.  We are at 5.4mg Compounded. Day 2 of the increase dose we hit a littlw veil and decreased appetite, so I upped his APF.

We are at day 4 of the 5.4 mg and his appetite is fantastic. He is a little more sore in the LF but hard to say of it is foot or ringbone.  We have also been walking about 25 mins and of he offers a little trot I let him for a short period..less than 1 minute. ( my instinct says it is ringbone..but there are lots of factors and I don't want to overlook things.

Water consumption has slowed which is good. We have had some warmer days too. His pee spots are a little more manageable too.

Shedding a little bit too. He does have some scurfy spots on either side of his tail but I don't think this is worms. I think it could just be all related to cushings.

He tapes at about 985 tonight. He was holding at about 969 so the increase of weight is about the max I want him at.

I have managed to add one more cup of sw beet pulp to each feeding.

I'm tempted to go up another 1.2 mg of pergolide, but I am not sure if i should hold for now and maybe retest in 3 weeks and then decide if a bump is needed?

I also thought that if is acth went up by about ~50% in two months maybe the 50% increase of pergolide may be warranted?

What do you think? 
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

I would wait for blood work to increase pergolide. You could try magnetic wraps like these https://www.sstack.com/dura-tech-magnetic-ankle-wraps-5-magnets/p/08738/ for his pasterns. The magnets really help some horses.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 


Frances C
 

Dr. K. Do you think that these magnetic pastern wraps (or far infrared wraps) would be of any comfort to a DSLD mare?
--
- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382


Eleanor Kellon, VMD
 

Frances,

Not pastern wraps but maybe fetlock.However, DSLD horses typically have lesions along the length of the ligament and tendons.  Not the far infrared.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 

Dr K, should I wait 3 weeks for the labs or try to do them sooner? To see how the insulin js doing?

Thanks Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

As long as you don't see anything alarming, I'd wait the 3 weeks.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 

Hi Dr K,

I got a little worried because Vinnie got a little less forward in the walk and stared acting a little more footy in the RF (ever so slightly) so erring on the side of caution 2 days ago I bumped up invokana day 1 to 225 and day 2 to 200. It made a big difference. He is back to walking super forward and even made a difference in the LF.

I am contemplating my next move? Keep him on 175-225mg til next labs or back down to 150mg now that he is feeling more comfortable and monitor?

Thanks Nan
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

If there is one thing we have learned about Invokana it's that there will be an effective dose for each horse and going below it you will lose the benefit. Vinnie is a prime example of that. Try keeping him at 200 but if he backslides go up to 225. This is probably because of his weight gain.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001