Date
1 - 20 of 32
Vinnie and Invokana update 12/22
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Hi Dr Kellon, I wanted to send a quick update. I am still waiting on some labs but Vinnie's tryglicerides are up to 732.
CH is up to date as of Nov labs. (Will update with current labs once I have then all in.) He is on 225mg of Invokana. I think I will bump up his beet pulp back to 3.5 to 4lb. (I had dropped it down to 2.5 lb a little concerned about the iron and Vinnie is giving me trouble eating his extra zinc/copper pellets.) In light of the tryglicerides I thought it wise to bump that back up? Once I get a full picture of the labs I will update, but I thought the tryglicerides increase was important to mention right away. CBC and Chem were also done. Minor changes but the most concerning was the wbc being a little low. I still have to submit a urinalysis, I got a sterile catch but missed the window due to delayed ppw, so will get that sent next week. PU/PD still present. ~25 to 30 gallons consumed that I can track per day. I bumped up pergolide from 11.5 to 12.7 to see if that helped and after about 3 days I am seeing slight improvement. All in all he is doing well, we were walking about 25 to 40 mins per day. Some days he was just out for about hour to walk or play with Summer. I am a little concerned about the WBC. We will also redo CBC/Chem in a week to monitor for changes. Last but not least, We had a little trim set back this week, so our activity level has decreaed but hoping to get past that. The LF is a delicate balance. :) -- 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 |
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Was there a cholesterol on his chemistry screen? I'm less concerned about TG when liver enzymes are normal but do want to be a bit proactive there too. Definitely increase beet pulp. Is he still getting L-carnitine? Jiaogulan or Laminox? I would also give him a pound of flax a day, divided up. May make more changes depending on his insulin and glucose. Is he still getting just the lower ESC orchardgrass? Did he like Spirulina when he was getting it? It's great for immune support. When you don't have any evidence of infection, low end (How low?) white counts usually don't mean anything, especially in older horses.
-- Eleanor in PA www.drkellon.com |
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Hi Dr K, some liver changes. I have uploaded the doc here. https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Vinnie/Vinnie%20Bloodwork/272989-22.pdf
I dont see cholesterol, but i know my vet ordered a bile acid test this week as well which is pending. He is still getting 2 scoops laminox, tbsp spirulina syringed with some reservatrol, aakg, and pea um. He is getting l-carnitine 27.5 g and 100g pea protein. And yes the lower esc +starch hay. I had increased his timothy pellets to about 1o cups per day. He is eating all his feed too. 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 |
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At 15 lbs of hay per day, he is getting approximately 250 grams less sugar with this hay. If your vet agrees, I would try replacing that with maltodextrin spread out over the day - some in bucket feeds, some sprinkled on hay. If you order 30 lbs here https://bulkfoods.com/baking-ingredients/maltodextrin.html that would be a 54 day supply. You can recheck insulin and glucose in a week to make sure he is handling it.
I'm assuming the mild liver enzyme elevations are from the triglycerides. Increasing his ESC back to the amount he tolerated well before should help. That white/neutrophil count is too low to call it within normal but let's see what the next one shows. It could be as simple as a transient viral infection. -- Eleanor in PA www.drkellon.com |
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Thanks Dr Kellon.
-- 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 |
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Hi Dr Kellon,
What would be some other options to bring up the ESC, just so I have a couple options to present to my vet. As a side note, I had decreased his TC Sr by 2 cups per day when I decreased his beet pulp. Thanks 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 |
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Other options are another hay with higher ESC, or some plain oats. The pea protein was to supply more gluconeogenic precursors but that hasn't helped. The only other option is the fermentation product acetate which you get in abundance from beet pulp.
TC Senior is 10% fat which is very high and not a good choice for a horse that is already struggling to metabolize fats. I'd stop that entirely. He would tolerate TC Lite better If he needs a taste tempter, feed him 2 parts beet pulp and 1 part wheat bran. That also balances the calcium. If you get up to 2 lbs/day of wheat bran that would replace the maltodextrin. If you can't quite get up to 2 lbs wheat bran could add some corn syrup which is actually less than 20% simple sugar and remainder of the carbohydrates oligosaccharides which are fermented to acetate and lactate. -- Eleanor in PA www.drkellon.com |
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Thanks Dr Kellon. :)
I had also switched to flax oil, should I switch back to ground flax to add in the 1lb daily. I could use a mix of cocoomega and TC ground flax since I just got 30lb of that too on sale during the black Friday deals st smart pak. If I were to add oats, do they need to be crimped or just plain race horse oats? I am leaning towards looking for a higher esc!starch hay, but that will take some effort. In the meantime I like the wheat bran option because Vinnie loves it and the fact that it will balance the calcium is a huge benefit. Should I hold in any changes until we get the actual insulin numbers from last week's labs? Thanks again for all your help! 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 |
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Flax is another source of fermentable fiber/acetate so you can go back to the ground flax.
If you want to try the WB and BP first let's do that and hold off on oats. No need to wait on the insulin. It's his comfort level and liver enzymes I'm more focused on at the moment. -- Eleanor in PA www.drkellon.com |
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Sounds good. Thanks Dr Kellon.
-- 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 |
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Little update.
I started the WB and Flax at half the recommended dose last night and this afternoon feeding to make sure he is tolerating the change well gastrointestinally. I reduced the TC Sr by half as well, I will stop that once I prove he will eat the full amts of beet pulp w/o it. So far he loves it. I did note the presence of a small crest today. It was soft but it is a change. He is also seemingly battling an abcess in the LF starting today UGH). He was sore after the last reset, but perhaps this was an abcess brewing. I will poultice with numotizine in the heel bulb and coronary band until my farrier comes tomorrow to pull the sneaker. Forgot to add.. so editing, should I continue with pea protein at 100g? Yes, sometimes I feel like the universe is conspiring against Vinnie and me, but we got this!!!! Right??? -- 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 |
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Right. Keep the pea protein.
-- Eleanor in PA www.drkellon.com |
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Thank you
-- 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 |
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Dr Kellon, what is the likelihood that the 2cups am/pm of wheat bran setting off acute laminitis?
My question is because Vinnie was sore after last shoeing, increasingly worse. I think we have mechanical soreness due to a rocker added emulating appearance of laminitis in both fronts. No abcess appearance. Insulin was 61 on last labs acth was 17.1. Labs last Monday were taken "before" daily invokana and he had am feed of alfalfa, 3 cups timothy pellets and a cup of stabul 1. I feel like insulin is good under those circumstances. 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 |
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I can start a new thread, if need be but wanted to bump this to the top for attention.
Thanks in advance. -- 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 |
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Nancy,
Best way to find out is to stop feeding it for a few days. Are you weighing the wheat bran and feeding it with twice as much beet pulp, by weight? If so, the sugar and starch should only be around 11%. It is always better to start a new thread. -- Eleanor in PA www.drkellon.com |
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Yes, weighing on a gram scale and for the 2 cups WB I was giving 6 to 7 cups BP.
I added 453g WB yday in the afternoon BP of 8 cups, but did only 1 cup WB last night. I could stop for a couple days and go back to my original feeding regimen. We also corrected some of the shoeing yday so we may have residual soreness that mproves just because of those changes. -- 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 |
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Cut it back to 1/2 cup, hopefully enough to still make him eat all the BP.
-- Eleanor in PA www.drkellon.com |
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Ok will try that.
-- 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 |
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Here is my plan. After thinking about all these random events simultaneously coming together, I think I should go back to what I was feeding the week before the shoeing when he was sound, which does include the TC sr, and while not ideal it was 8 cups total per day mixed in his BP. I will still increase the BP to the 3.5 to 4lb per day to help the TG.
Once we get him sound again, we can start decreasing the TC sr and adding the WB back and if he gets sore again then we know that WB was the culprit. (He loves it, better than the TC Sr so I am hoping it can work). I will start a new post with updates. Hoping this is just a blip and we are back on track soon. Sound like an OK plan? 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 |
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