ACTH slightly elevated mid December - what can be done?

[Demerara_Stables]

Test results came back today:

Vet says we should do the TRH test during spring vaccines or we could do it sooner if I wanted. I said we can wait, but should we do it sooner?

Meanwhile, what’s the current science around feeding the maybe/slightly PPID horse? She’s currently on Strucomix Senior, grass hay with a small flake of alfalfa once daily, 24/7 turnout in Northern CA (some grass October-January, lush grass January-March, no grass July-October).

20yo Appendix mare, started showing signs of lethargy/exercise intolerance (meaning just lacking energy) 2 years ago. This year had some lacerations that took just too long to heal, high FEC, and then grew a yak of a coat this winter so I decided to test her.

[Jackie_amp_Starlette]

Please join the ECIR group. Lots of information and help there.

Dr. Keller says the ACTH test is always elevated end of June through January.

main@ECIR.groups.io | Home

[JB]

If you want more assurance, do the TRH Stim test sooner rather than later. It’s more reliable from late Fall to early Summer.

46 is in the equivocal zone this time of year, but it’s much closer to supportive of, than unlikely

2021-PPID-Recommendations-V11-wo-insert.pdf

The good thing about this time of year is that the shorter daylight hours are kinder to the PPID horse, so if your Spring vaccines are closer to March than to June, I’d say it’s reasonable to wait until then

[JB]

re: feeding - generally, aim for a diet of around 12% NSC, or less if you can. Test your hay if possible.

If she was 30, not 20, I’d say it almost doesn’t matter, but she’s got lots of years left, so working to keep her diet lower NSC is a better idea. I’m not concerned about it with my 33yo, because at this point he’s losing teeth, he’s a picky eater, so he gets to eat whatever he’ll eat and often the NSC is in the upper teens.

https://www.facebook.com/groups/12994389809 is a great group

@Jackie_amp_Starlette

Dr. Keller says the ACTH test is always elevated end of June through January.

I don’t understand that at all, are you SURE she said “through January”? Elevated in what context? See the chart I listed above, which is from the Equine Endocrinology Group which is the best of the best in studying this.

[Critter]

Worth doing the stim test…even at this time of year. My gelding had similar numbers and it was during the fall, so we might have ignored it. But, he was having a lot more exercise intolerance and some almost laminitic episodes when on grass. His stim test came back really elevated. We put him on 1/2 tab of prascend, and he is doing so much better this year! Was able to tolerate grass all summer and his weight looks great. Still growing a yak coat (which he never did)…but I can manage that.

[MorganMaresVT]

Having air fern Morgans, my default is always a low NSC, metabolic-friendly diet. That said, just want to point out that not all PPID horses are also insulin resistant, so if I were in your shoes I’d probably also want to have the bloodwork for insulin/glucose/leptin as more info to inform your diet and turnout decisions. Otherwise, not much to add to the good suggestions you’ve gotten.

ETA: @JB Sorry for the “reply to,” not meaning to call out your post specifically (though I agree with your thoughts )!

[Demerara_Stables]

Thanks everyone!

@MorganMaresVT I was just about to ask this - her insulin on the results above was normal (and I wasn’t instructed to fast her so it was just after her grain and during her eating hay). She’s never been overweight or had a cresty neck, so do I really need to be concerned with a low NSC feed? Is high NSC bad for PPID itself or just for IR horses?
Picture from June when we were just coming out of lush grass season, this is on 2-4 days a week of light work. Everyone else was fat at this point of the year.

And a recent picture, during fall where everyone loses weight when it gets cold, no matter how much I feed them

[Jackie_amp_Starlette]

End of December. This is from a bunch of info I sent a friend that I captured from the discussions they have under their documents. There is a lot more information that you will have to go the site to review (and I am aware that is not Dr. K but one of her followers, but she seems to be reviewing all that is said.)

[MorganMaresVT]

Uggh, sorry, was reading too fast and distracted while doing it. Apologies! So, insulin under 40 is probably outside the “danger zone” for drastic EMS-related diet changes, though the ERIC group recommends that anything above 10 is of concern. I’d take it seriously before it escalates into a more concerning level.

Having had horses who tested similarly to what you’re showing, we spent a year monitoring with twice-annual bloodwork. As the mares aged and were clearly in the PPID range but with moderately concerning insulin levels, my plan with my vet was low NSC diet (including tested hay), adding low dose Prascend, and monitoring with ACTH and insulin tested twice a year (you can coordinate with the vet around the right timing for the first re-check after adding Prascend).

[Demerara_Stables]

Man, I just missed that December 20 cut off, huh. 🤦🏻

[Jackie_amp_Starlette]

Honestly, I have no idea how they can pick an exact day for cutoff. I really believe each horse can be different. If I recall, there were even differences depending on where youi live in the world.

[Demerara_Stables]

That makes sense, my response was mostly tongue in cheek which of course is not come through well in text.

[JB]

@Demerara_Stables

I wasn’t instructed to fast her so it was just after her grain and during her eating hay

This is extra good then because you could have gotten a false positive after her grain meal I WOULD test her fairly regularly though, properly fasted (hay-only), just to keep tabs on whether that’s changing.

@Demerara_Stables

do I really need to be concerned with a low NSC feed? Is high NSC bad for PPID itself or just for IR horses?

I would at least aim for not much higher than 15% total, but less than that if you’re feeding more than maybe 5-6lb of grain a day.

[Demerara_Stables]

That makes sense, thanks for sharing your experience! I of course will check with the vet, but I assume we can do a fasted glucose/ insulin at the same time we are doing the TRH, correct? I was hoping to not have the vet out again but I think with the TRH I’ll have to. I usually pull stuff myself and drop it off.

[ladipus]

I would test now with the TRH stim -that way you can accurately know whether or not your horse truly is PPID …from what you described it very much sounds like that could be the case…I would also feed/manage your horse as if he’s PPID -meaning a low sugar/starch diet for feed and hay …if laminitis is at all a concern or ever has been in the past I would limit grazing on pasture -especially spring & fall when sugars are highest …might need to muzzle when turned out…if you’re looking for a commercial feed -something like Nuzu Stabul One, Hygain Zero , Cavalor Fiberforce , or even Tribute Seniority Low NSC …but ideally a forage based diet such as what the ECIR recommends -I feed mine a combo of soaked Timothy Balance Cubes/Vermont Blend Pro/Ground Flax/Vitamin E and a little Nuzu Stabul One

[ladipus]

ECIR specialist do not recommend fasting for insulin /glucose/acth
@Demerara_Stables

ECIR-Group-DDTE-Safe-Feeds.pdf

[ladipus]

@Demerara_Stables

Please take a look at the ECIR group /Guidelines …better to be ahead and manage now then wait until your in crisis and dealing with laminitis

Equine Cushings & Insulin Resistance Group

ECIR-Group-DDTE-Safe-Feeds.pdf

https://ecir.groups.io/g/main/messages

[Demerara_Stables]

Ya I think I’m going to do the TRH after the holidays.

I really like the cavalor feeds, but the fiber force definitely doesn’t have enough protein - she does well with more protein so I may need to look at another brand (or add more alfalfa?).

She’s never had any laminitis concerns, and she lives for grass so limiting pasture isn’t an option. I tried a muzzle once (when we had fewer horses and more grass)…and it did not go well.

Thankfully she’s always been in good weight so I’m not too concerned with the grass.

[JB]

@ladipus

ECIR specialist do not recommend fasting for insulin /glucose/acth

Fasting for this is forage-only, just no hard feed of any kind.

[Demerara_Stables]

That’s what I read, thanks!