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What test for Cody, 2nd try


Sherry with Dusty, Blue and Cody
 

Hi All,

I have updated Cody's case history, I think I got everything.  I need to schedule bloodwork.  Last January he came back "normal" on the regular acth so I asked for the TRH stim and got a positive diagnosis for PPID.  Do I need to schedule another TRH stim for him as that is how he was confirmed and is there anything else I should check?
--
Sherry, Feb 2018, Gates, NC
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Cody  

https://ecir.groups.io/g/DustyHoof/album?id=38179 

https://ecir.groups.io/g/BlueHoof/album?id=38486

https://ecir.groups.io/g/CaseHistory/album?id=38227
 


Maxine McArthur
 

Hi Sherry
One of the more experienced moderators may have more to say, but we usually suggest doing the baseline (endogenous) ACTH for a horse that is diagnosed and medicated, as you are monitoring how he is responding to the medication, not trying to work out if he has the disease or not. 

Your case history mentions that he has lost a bit of weight lately, which is often (although not always) a sign that the ACTH level is creeping up. If his bloodwork indicates he needs more pergolide, you may find that increasing the meds helps him put the weight on again. If the bloodwork is normal, you could consider increasing his beet pulp perhaps? Has there been any change in his hay lately that might be linked to the FFW? What is in the calf manna that he's been having since 23 Dec? 

Nice work on getting your folders organised, btw!
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Sherry Morse
 

Hi Sherry,

I agree with the advince Maxine has given, but will add that it seems like FFW started not long after you put Blueon Calf Manna which has a few things that could be an issue with a PPID horse (specifically the soybean meal and alfalfa).  I would suggest stopping the Calf Manna and if you feel he needs more weight increasing his hay and/or beet pulp.  You may also want to consider having your hay balanced for him to make sure you're not missing any minerals that he needs.




Sherry with Dusty, Blue and Cody
 

Hi Maxine,

Thank you.  Forgive my ignorance, is the endogenous the same as the "regular" ACTH?  The one that came back "normal" when I first had him tested?  I may have gotten my dates mixed up, I started him on the calf manna after he started with the ffw.  It has pre and pro biotics and it actually helped the first few days he was on it, but isn't helping now.  I normally have him on Coolstance in the winter to keep his weight up but haven't been able to get any lately.  I can definitely increase his beet pulp.  No change in hay.  
--
Sherry, Feb 2018, Gates, NC
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Cody  

https://ecir.groups.io/g/DustyHoof/album?id=38179 

https://ecir.groups.io/g/BlueHoof/album?id=38486

https://ecir.groups.io/g/CaseHistory/album?id=38227
 


Sherry with Dusty, Blue and Cody
 

Hi Sherry,

I can take him off the calf manna.  Hay balancing isn't feasible for us due to storage issues and the varying supplies in our area.  Any other suggestions are welcome.  
--
Sherry, Feb 2018, Gates, NC
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Cody  

https://ecir.groups.io/g/DustyHoof/album?id=38179 

https://ecir.groups.io/g/BlueHoof/album?id=38486

https://ecir.groups.io/g/CaseHistory/album?id=38227
 


Maxine McArthur
 

On Sat, Jan 30, 2021 at 05:36 AM, Sherry with Dusty, Blue and Cody wrote:
is the endogenous the same as the "regular" ACTH?  The one that came back "normal" when I first had him tested
That’s right, Sherry. Sorry for the confusion. 
 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Sherry Morse
 

Hi Sherry,

Hmmm, well there went my 'calf manna maybe was a cause of the FFW' theory; but you may want to see if things change if he's off of it. 




Sherry with Dusty, Blue and Cody
 

When I called the vet to schedule I was told he would have to have the TRH Stim test again as that was how he was diagnosed as his  ACTH test came back in the normal range.  Do I insist on the regular ACTH test?
--
Sherry, Feb 2018, Gates, NC
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Cody  

https://ecir.groups.io/g/DustyHoof/album?id=38179 

https://ecir.groups.io/g/BlueHoof/album?id=38486

https://ecir.groups.io/g/CaseHistory/album?id=38227
 


 

Hi Sherry,

I looked through Cody’s case history and see that he is on pergolide.  I don’t see the pre TRH test results in your ch but I gather it is normal?  As the post TRH test is positive, either he is in early stages of PPID or his PPID cannot be measured with ACTH testing.  If you re-test endogenously (pre TRH), a positive test will tell your he is less borderline and needs more pergolide.  With a negative test, he still might need more if the ACTH test doesn’t accurately reflect the status of the disease.

With the Post TRH, there are no standards for comparing a horse on pergolide so there is no meaningful information to be had.  It is recommended to take the horse off pergolide for three weeks and then test.  That would not tell you how well controlled his PPID is controlled by the pergolide you were giving him.

If he were mine, and I have a pony that always returns the same test value, even on pergolide, I would do regular endogenous testing to make sure nothing has changed but knowing that it might not be a good measure of his PPID control.  If you do the stim test, you’ll still get the endogenous test results but it will cost more money.
--
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


 
 


Karen Anderson
 

Hi Sherry:   

My vet just did the TRH stim test today on  20 year old Fhinland, who has been diagnosed with PPID for over a year now.  I asked her why we were still doing the TRH stim test and she reminded me that Fhin's ACTH  has consistently been in the teens or low 20s. She said, "So we need to do the stim test to see if what we are doing is working!"   I had to agree!!

Karen Anderson

Virus-free. www.avast.com

--
Karen and Fhinland in Maryland

Case Study:   https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Fhinland


Sherry Morse
 

Hi Karen,

It would be really helpful for us if you could update your CH with these test results as your current record don't show any test results in the teens or low 20s for Fhin.  If you're just listing the post TRH stim test results please indicate that.

Did you happen to see this message from Dr. Kellon in reply to your question regarding the TRH test on a horse that's already positive at baseline?  https://ecir.groups.io/g/main/message/260669




Sherry with Dusty, Blue and Cody
 

Hi Martha,

His first test came back at 32.9 ACTH and his post TRH was 527.   So is it best to leave him on pergolide and get reg ACTH or take him off for 3 weeks and do TRH?  Or do I take him off for 3 weeks for either test?  I'm sorry, I'm having serious brain fog.  And should I do the whole ACTH, Insulin, Leptin, Glucose, and T4 again?
--
Sherry, Feb 2018, Gates, NC
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Cody  

https://ecir.groups.io/g/DustyHoof/album?id=38179 

https://ecir.groups.io/g/BlueHoof/album?id=38486

https://ecir.groups.io/g/CaseHistory/album?id=38227
 


Sherry with Dusty, Blue and Cody
 

Can I forego the Glucose and T4?
--
Sherry, Feb 2018, Gates, NC
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Cody  

https://ecir.groups.io/g/DustyHoof/album?id=38179 

https://ecir.groups.io/g/BlueHoof/album?id=38486

https://ecir.groups.io/g/CaseHistory/album?id=38227
 


 

Hi Sherry,
I think there may have been some serious brain fog making the rounds.  Here, we might call it cabin fever.
Weaning off pergolide before testing won’t really tell you anything.  Your initial test is diagnostic for PPID, even pre TRH.  The post TRH result confirms it.  There is no reason to repeat that.  Dr. Kellon posted recently that there is no research to guide us in what to expect when giving TRH stimulation to a horse already on PPID.  I would suggest doing only the endogenous ACTH test and not the TRH stimulation.  With respect to the other testing, I would do insulin and glucose, skipping the leptin and T4, unless you have a particular interest in following those.  You can share Dr. Kellon’s post with your vet if you think it would help in avoiding the unnecessary added cost of the TRH stim test.

The free fecal water you describe in your case history is more age related than PPID, I think.  The condition has attracted considerable attention recently as I read about it quite often.  I have an occasional issue with it with one of mine.  I thought soaking his hay might help but it didn’t.  Mine seems to do best on Timothy balance cubes with added hay.  Pre/pro biotics are thought to be helpful.  

--

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