main@ECIR.groups.io | Vinnie update - Jan 2023- Ertugliflozin day 2

Home Messages Hashtags Subgroups

Date Date 1 - 20 of 35

Vinnie update - Jan 2023- Ertugliflozin day 2

Nancy & Vinnie & Summer #287041 Hi all, Just a quick update on Vinnie. Ertugliflozin arrived and we are on day 2. I will be pulling labs on probably 10 days to see how the tryglicerides and insulin are doing. We are still working through some stuff with Vinnie's feet. We think we have a mechanical issues potentially combined with collections. So far poulticing hasn't produced anything, but today we had some swelling in the pastern and fetlock in the RF so it could be getting ready exit the coronary band. We have tried a few different things to help the mechanical issue especially in the RF which seems to be the worse of the two at the moment. We are making headway on this so that is a positive, and we have rads hopefully this weekend which should give us a better understanding on the best way to help Mr. V. We have stopped the WB because this was a new variable that we couldn't be certain was part of any cause of foot soreness. The LF has improved faster than the RF but turns are still challenging for both. With the rains he is locked in a 12x12 stall with deep shavings and exercise stopped until we get a handle on the cause of the hoof pain. All in all he is bright and his appetite improved yesterday again so I think the pain he was in is coming under control. Thanks Nan.. stay tuned :) -- 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
More All Messages By This Member
Jennifer Murphy #287050 Nancy, maybe I missed it, but is there a reason you're transitioning from Invokana to Steglatro? -- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0
More All Messages By This Member
Nancy & Vinnie & Summer #287058 Hi Jennifer, Vinnie's tryglicerides remain elevated and continue to rise in spite of many changes to diet to accommodate on canagliflozin, and he is starting to have mild liver enzymes changes. We are trying ertugliflozin to see if this SGLT2 works better for him related to tryglicerides. In the study done by Dr Sundra (shared by Dr Kellon recently) the 51 horses and ponies in that study had milder elevations of tryglicerides, so we are hoping the same applies to Vinnie :) 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
More All Messages By This Member
Nancy & Vinnie & Summer #287059 Jennifer here is the study if you missed the original post : https://beva.onlinelibrary.wiley.com/doi/full/10.1111/eve.13738 Thx 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
More All Messages By This Member
Jennifer Murphy #287069 My vet and I have actually been discussing that study over the past few days. We're trying to determine why Flea is suddenly extremely laminitic with no diet or hay changes. His triglycerides haven't been a concern, but after reading that study she's wondering if he's "upregulated the SGLT1 receptors like the paper describes". She explained it to me when she was here drawing blood this morning, and we were talking about possibly switching him to the ertugliflozin. I'd like to see if the increase in the Invokana helps at all. I know you've changed Vinnie's dosage in the past - did you feel that was controlling his IR at all? -- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0
More All Messages By This Member
Nancy & Vinnie & Summer #287071 Hi Jennifer, Yes it is definitely controlling his insulin, but the dosage he needs on Invokana to control insulin, causes the high tryglicerides that don't seem to stablize. -- 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
More All Messages By This Member
Nancy & Vinnie & Summer #287077 I added a photo of the first urine strip after 4 days (today is the fourth and administered right before free catch) of 15mg ertugliflozin. I think the strips look good. Side note the little blue spot on the top of the "blood" j think dripped down from "PH" when j picked up the strip there wasn't that blue spot. ) Also we have a half inch tract in the middle of the toe at the coronary band where something is going to exit, that corresponds to an area of dried blood at the toe when we brought his toes back to correct load and reduce hoof wall load two days ago. I am hoping we dont have more sinking or rotation. I am poulticing again to hopefully get this thing moving. If the weather permits tomorrow we get some rads and hopefully decide the next steps. Fingers crossed we are getting ahead of this stuff!! Thx 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
More All Messages By This Member
Nancy & Vinnie & Summer #287210 Edited Just a quick update. Vinnie is still very foot sore. We are in day 7 of ertugliflozin, but I would be surprised if insulin is a factor. My vet and I worked on Vinnie's feet together to continue to resolve load issues. He had lost sole depth, but is derotated nicely. I am happy with the positive changes my vet and I have made. Now hopefully getting the hoof walls unloaded and the foot supported things will start to improve. I will say I am feeling a little defeated by this calamity, so many continued lessons learned....but Vinnie isn't ready to.give up yet CH will be updated when I have a sec to breathe. I am holding on new labs until he is a little more comfortable. Last insulin ( on canagliflozin) was 54. -- 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
More All Messages By This Member
Jennifer Murphy #287212 I'm sorry Vinnie is so sore, Nancy. I know what you mean by feeling defeated, too. I'm pulling for you and Vinne. <3 -- Jennifer in NH 2020 CH - https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Flea Photo album - https://ecir.groups.io/g/CaseHistory/album?id=251041&p=Name,,,20,1,0,0
More All Messages By This Member
Nancy C #287213 Nancy and Jennifer -- and anyone struggling right now: Make sure you are hugging your equines often. It helps. -- Nancy C in NH ECIR Moderator 2003 ECIR Group Inc. President 2021-2022 ECIR Group NEW Case History site open to Early Adopters. HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993
More All Messages By This Member
Bobbie Day #287216 Oh gosh Nancy Vinnie is strong and so are you, but I know how hard this journey has been. I know your doing your very best (like always) and so does he. Im thinking of you my friend ❤️ -- Bobbie and Maggie Desi (over the rainbow bridge 7/21) Utah, Nov 2018 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
More All Messages By This Member
Nancy & Vinnie & Summer #287254 Edited We ended up getting some labs pulled yesterday to rule out metabolics. We don't have insulin yet but after 7 days on 15mg ertugliflozin, Vinnies tryglicerides have now elevated to 1147. So this is not good news. Meeting with my vet tomorrow to regroup on his feet and hopefully we will have insulin by then, and regroup on these labs. -- 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
More All Messages By This Member
Joy V #287258 Fingers crossed you're able to get Vinnie's triglycerides down Nancy. -- Joy and Willie (EC/IR) Nevada County, CA - 2019 ECIR Group Moderator Case history: Willie's Case History Willie's photo album: Willie's Photos
More All Messages By This Member
Eleanor Kellon, VMD #287261 See what your vet says but I would be inclined to take him off and put him on metformin, order some Body Builder and do not restart until you get that. Also ask your vet to run a full blood chemistry. Any weight or muscle loss? Please list his full diet and amount - or point me to a post that has it correctly. -- 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."
More All Messages By This Member
Nancy & Vinnie & Summer #287262 Edited Hi Dr Kellon I received Body Builder, I didn't start yet because his feet are so sore still, and this supp had 150mg sugar. Without having a solid root cause we decided to hold off until the labs are complete in. Will definitely discuss with my vet and going back to metformin which I do have on hand. At the time of these labs diet is as follows: 15lb grass hay 7 eac+starch 5lb alfalfa 3lb dry weight beet pulp 10 cups TC sr (mixed in the BP) 4 cups stabul 1 6 cups timothy pellets 8oz ground flax. 100g pea protein 25g l-carnitine Prior to this diet the week before he was on nearly 4.2lb beet pulp with the 16% wheat bran mixed in. We went back to TC sr to see if that would help the TG because they had also gone up on the BP WB mix. He has lost about 50lb down from 953 on the tape. Appetite has been up and down, not as good with the BP mix once I stopped the wheat bran, so we had a little ramp down period and then he has been consuming maybe 80% of the mix. His feet were a little bit better yesterday. I am sure pain has a little to do with the weight loss too. He has been bright in spite of pain. He has had body temp changes, warmer than usual at times but not febrile. Thanks Nancy -- 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
More All Messages By This Member
Nancy & Vinnie & Summer #287264 Edited I should note Metformin wasn't controlling his insulin in the past, which started our journey down this road.. He had been on it three times in his history of metabolic laminitis, as recent as 12/ 2019. -- 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
More All Messages By This Member
Nancy & Vinnie & Summer #287270 Link to latest cbc/Chem panel from last week in December. These were taken after adding WB and 4.2 lb beet pulp to see if that helped the TG, which it did not. https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Vinnie/Vinnie%20Bloodwork/283956-22.pdf Link to diet labs meds spreadsheet that I keep for my vet. There are trends here that I am hoping will help us figure out the best way to use the SGLT2 meds at an interval and dose that control insulin and manage TG. https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Vinnie/Vinnie%20Bloodwork/D%27Cruz%20Vinnie%202023-1-12-%20Lab%20Tests%20and%20Meds.PDF -- 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
More All Messages By This Member
Eleanor Kellon, VMD #287271 150 mg is nothing. There are 22,700 mg in a pound of 5% ESC hay. Triglycerides rise as a result of an energy crisis. In this case, lost glucose. This was proven to be the case when he was at Davis. Vinnie's response is extreme, which either means his capacity to synthesize glucose (from amino acids or glycerol) is poor or his capacity to utilize the TG is poor - or both. Why would you think TC Sr would be better than BP? It is high fat, lower protein. The ESC + starch of a 16%WB with BP mix is about 5%. The goal with the diet is to provide generous levels of fermentable fiber to substitute for glucose (hay, beet pulp, flax, Stabul 1) and extra protein as a gluconeogenic source - currently pea protein and was wheat bran. When the pea protein is gone I would suggest you try 50 grams of L-cysteine and 50 grams of L-glycine https://www.bulksupplements.com/products/l-cysteine-hcl-powder?variant=32133419991151 , https://www.bulksupplements.com/products/glycine-pure-powder?_pos=1&_sid=27f2c74a0&_ss=r . Both are purely gluconeogenic. I know metformin hasn't controlled his insulin but it has some effect on neuropathic pain. I would use it until you see if his liver enzymes are OK. -- 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."
More All Messages By This Member
Nancy & Vinnie & Summer #287274 Edited Hi Dr K, sorry if I confused things. We were still giving BP just reduced from 4.2lb to 3lb when I added the TC Sr back. The reason why I changed back to TC sr, is because that seemed to be working a better for the months prior to changing to WB. Check out my diet labs spreadsheet I have no problem trying the WB again. I will definitely order the aminos and add in the Body Builder. I am just a little intimidated by all of these compounding events trying to figure the best path forward. I always appreciate your guidance and value it immensely. 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
More All Messages By This Member
Eleanor Kellon, VMD #287275 I would be a little concerned about the hematology results - the low white cells, abnormal white cells and elevated fibrinogen. An infection could be playing a role here. Has he been screened for EIA and Lyme? I'm not sure where you see he was worse on wheat bran. The 732 TG level on 12/14 was after a meal and without getting Invokana, both of which would lower TG. The reading on WB on 12/26 wasn't better at 792 but probably not significantly different either considering the test conditions on 12/14. You discontinued the WB on 12/28 so the 1147 level on 1/12 was after 15 days on the TC Senior. Where you wrote NFR activators did you mean Nrf2 activators? These stimulate antioxidant production but also have effects on fat metabolism that varies by tissue type and strain of mice. Effects totally unknown in horses. You started those on 12/23. I think I'd discontinue. -- 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."
More All Messages By This Member

1 - 20 of 35

Previous Topic Next Topic

Home Hashtags Subgroups About Features Pricing Updates Terms Help Twitter