New Symptoms/New Bloodwork results

[ladipus]

Hello…I decided to re test my 11yr old Dutch Wb mare Schimpie last week because she has been very low energy to ride and just blah in general lately…also sort of irritable too at times…so far this is what has come back : Metabolic panel sent to Cornell (non fasted)
Glucose -96 mg/dl ( 71-122)
lipemia - 7
leptin still pending
Insuin - 27.62ulU/mL (10-40)
T4 - 1.44ug/dL (1-3)
acth - 77.4pg/mL (2-30)
lyme - all negative
epm - still pending
Vitamin E level still pending
According to the G:I ratio this still puts her in the IR /At Risk category

Looks like last time I tested her was April 2021…numbers weren’t much different - Glucose -98, Insulin-37, Acth pre stim 14.4/ post 55.3, Lyme negative…and also not much difference from the initial onset of actute laminitis 6/2020 triggered by steroids - Cortisol 3.89 (2-6) , Insulin 63.15, acth 34.6, Lyme negative

Anyhow she had been doing very well for quite some time(sound , happy , in regular ridden work anywhere from 3-5 days /week …I’ve just been noticing lately her energy level is super low and she’s just not herself when being ridden …like it’s a struggle to get her in front of my leg …she’s got zero gas in the tank …even with all this bad weather and being stalled for several days now …no energy what so ever.

…I’m a bit puzzled because her diet is pretty good -or so I thought recommended by the ECIR group ever since her bout of laminitis 2 yrs ago…she gets a small amount of Ontario Dehy Timothy Balance Cubes/Vermont Blend/Flax/Vitamin E capsules with a handful of usually Nuzu Stabul One (unless chewy is out of it …in which case she gets a handful of Hygain Zero)this is to cover her supplements which are Uckele Laminox, Phytoquench Pellets, Spirulina, GUT and Insulin Wise , Tractguard, and Sucralfate…i recently added APF Pro in hopes of it helping her energy…I normally feed her a tested low sugar Timothy hay but my supplier has run out and hasn’t been able to find any for a few months now …since then we have been soaking our local hay guys Timothy /orchard mix, and also found an alfalfa/orchard mix that surprisingly tested low sugar -so I give her a little of that as well …that is really the only difference in her diet -which I understand possibly a big difference…however her bloodwork results to me don’t seem that much different from previous…yet her energy and demeanor have declined again. Her weight and body condition is pretty good all things considered. Vet said the higher insulin& glucose could absolutely be the reason for her low energy.

My vet has recommended to try Metformin and Thyro L

I was thinking maybe she’s not getting “enough “ from her diet to support her energy…like maybe she needs more from a performance standpoint….could soaking the hay be leaching out important vitamins /minerals and now she’s lacking ??I was considering going back to Triple Crowns Ration Balancer or possibly trying something else like feeding only Hygain Zero -although that might be too many calories…or switching to something like Mad Barn Amino Trace Plus, Uckeles U Balance Foundation or Sport horse grass …California Trace Plus -although that’s not much difference from Vermont Blend

Any advice or suggestions appreciated

[starsandsun]

I’ve gone round and round with issues like this as well. Wanted to mention Metaborol rather than Thyro L. A friend has her mare on Velagliflozin (?) and it dropped her insulin levels like a rock so if it’s a real concern, there is a medical ‘cure’.

I think you are describing a horse that is uncomfortable or in pain, somewhere. When you speak about weight and body condition, has it been declining? What was she on steroids for last year? Is the hay stalkier than what she used to get?

If I were you, I’d be curious about markers for pain. I’d be very attentive to heart rate for a few days … take it multiple times per day and see if there is any increases outside normal bounds. As in, is it higher and then she passes manure and her heart drops?

You might also try to do a pain trial, and give her 500# of banamine and then wait a few hours to ride and see how it goes.

This comes from Dr. Sue Dyson’s research, so thought I would add in case it’s helpful to you:

24 Pain-Associated Behaviors

Face

Ears rotated back behind vertical or flat

Eyelids closed or semiclosed

Sclera (whites of the eye) exposed

Intense stare

Opening mouth repeatedly

Tongue exposed and/or moving in and out of the mouth

Bit pulling through the mouth, to the left or right

Body

Repeated head position changes

Head tilt

Head in front of the vertical

Head behind the vertical

Head moving constantly from side to side and/or head tossing

Tail clamped or held to one side or large tail swishing movements

Gait

Rushed gait/irregular rhythm

Sluggish gait/irregular rhythm

Hind limbs not following in the front limbs’ tracks

Repeated wrong lead and/or change of lead in front or behind in canter

Spontaneous gait changes

Stumbling and/or repeated toe-dragging

Sudden change in direction of movement

Spooking

Reluctance to move freely/stopping spontaneously

Rearing

Bucking with or without kicking out backward

[Jealoushe]

I had a friend with a horse like this and gave the horse the red blood cell supplement and the horse felt so much better it’s rider could no longer ride it because it was such a lazy kick ride before haha Might be worth a shot?

[JB]

@ladipus

acth - 77.4pg/mL (2-30)

between this and her symptoms, I’m curious why she’s not being treated for PPID and see if she improves after 30-60 days or so?

[ladipus]

Jb …I wondered the same as well …my vet told me that normal/non Cushings horses can have up to 3 times the normal range …however the ECIR group says otherwise and says I should show these new studies to my vet :

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ECIR also says an ACTH of 77 in a young horse is indicative of early PPID at the peak of the seasonal rise. That number would be more normal for an elderly horse, not an 11 year old. Our understanding of what is normal this time of year is evolving and the 3x rule doesn’t hold anymore with new research. The Liphook charts that Sherry shared the link to show a max of about 55 (normal) at the peak of the rise. If you want to leave her untreated this fall and redo the TRH Stim in the late winter or spring to confirm the early PPID, that’s fine as we are coming out the other end of the rise and Schimpy’s insulin is not overly elevated. But next by July you should have her started on pergolide and then retest her baseline ACTH to make sure it’s staying low.

They are also suggesting that it Looks like she needs a bump on her Prascend dosage at the very least right now. Her insulin is nowhere near high enough to warrant Metformin and unless she needs to lose weight there’s no need to put her on Thyro-L.

I’m feeling overwhelmed with the conflicting information between my vet and the ECIR group

[ladipus]

I would be up for trying that except that added iron -which is in Red cell isn’t good for IR/Metabolic horses.

[ladipus]

I’ve heard of that drug and have been curious about it as well…Problem is my vet hasn’t so I would need to convince him to try it …I’m also considering switching to Metabarol because the Insulin Wise hasn’t don’t much for her.

I saw that study in regards to pain …her feet are well shod/good angles, no heat or pulses , no shifting weight , picks up both leads easily , counter canters beautifully, does flying changes, , normal length of stride /tracking up, ears forward /pleasant expression…occasionally swishes tail when saddling /girthing -but she’s on ulcer prevention supplements and gets Sucralfate, has saddle fit checked frequently, has chiro /acupuncture, and had Pro Stride on hocks /stifles last December…gets the Adequan series ,legend for shows, gets examined by top sport horse vets twice /year …only thing noticeable is her energy level /lack of going forward …like I have to work really hard to get her in front of my leg …she’s always been quiet /push ride …but this is more than usual lately , cranky at times with grooming /tacking up …and occasionally spooky -which isn’t like her at all. Her weight is good …2 yrs ago June 2020 she needed to lose her winter weight -nothing excessive …she was put on steroids due to bad allergies from sweet itch /insect bite sensitivity to the point she was ripping her skin open …antihistamines and supplements weren’t helping …that is when she came down with acute laminitis…so me mentioning her weight /body condition is in comparison to 2 yrs ago when she needed to lose some weight .

[NaturallyHappy]

I used Metabarol but switched to Resvantage when my two quit eating Metabarol. It worked much better for both of mine w respect to lowering insulin. One that always hovered between 50 and 60, no matter what, dropped to 20!!!

[ladipus]

Dr Ellanor Kellon from the ECIR group commented on my post on their forum and said :

“ How much work is she doing? I wouldn’t put her on pergolide, Metformin or Thyro-L. Her diet may be too low in available carbs to replenish her glycogen. Try giving her 1.5 lbs of high quality oats (aka racehorse oats) or oat groats immediately after exercise - no other time.

A negative TRH stim test trumps a seasonal ACTH elevation every time. You can repeat that test later though. They can change from negative to positive. It wouldn’t be high on my list at her age.“

[JB]

@ladipus

A negative TRH stim test trumps a seasonal ACTH elevation every time.

Good point.

[ladipus]

Got some more bloodwork results …epm negative! Leptin is 20 the range is (10-20) vitamin e still pending

For reference here’s some pictures of her …which my vet said her weight looked good …she taped at 1,200lbs she’s approximately 16.1 maybe 16.2 H

[ladipus]

Bumping

[ladipus]

Some side body conformation photos …and photos of her poor mouth /jaw …even just a few days on Metformin caused these horrible blisters

I’m upset because this happened to her the first time we tried Metformin 2yrs ago during the acute laminitis and the local vet still suggested it again

Local vet now says stop Metformin and just give Thyro L …but 2 wks ago said she didn’t need it and her weight was fine

I shared the results with my sport horse vet who does her Pro Stride injections and other more involved vet work and she suggests starting her on Prascend

ECIR group -Dr Kellon said not to give her any medication…while some of the volunteers on that group suggested Prascend and nothing else
Dr Kellon also suggested trying giving Oats after exercise to help with her energy

[NaturallyHappy]

Wow! We used Metformin for one of the horses mentioned above. His lip blistered terribly (like yours) but nothing under the jaw. We also used it for an older horse who was on steroids briefly. We smeared his mouth w Vaseline to help w the blistering-he never had problems under his jaw, either. I wonder if something else is going on.

[ladipus]

Crazy isn’t it …no this is exactly what happened when she was put on Metformin 2yrs ago …like to a T …was only on it 5 days this time …2yrs ago she was on it 10 days …perhaps this is a bad allergic reaction to it ??

[TWH_Girl]

I’m certainly not going to make recommendations for what to medicate your horse with, but she doesn’t appear overweight or have any other Cushings symptoms except for the elevated acth.

I need to do TSH test on my guy for Cushings
…but he’s a TWH, 20, and he’s got fat pads, a cresty neck, and he’s sluggish & unable to drop weight. We did start Thyro L about 6 weeks ago and he’s finally losing weight and has a lot more energy. He’s been feeling really good. Not necessarily saying that’s your answer but what about a more specialized internal medicine consult? Purina Super Sport would possibly be helpful but sounds like she’s already on quite a few things so not sure if you want to add more.

[ladipus]

I have an appointment set up at New Bolten with Internal Medicine and Sport Medicine in a couple weeks

[starsandsun]

Their team is great. If you’re working with Dr. Brown, she is awesome.

[ladipus]

Yes …my appointment is with Dr Brown and Dr Johnson!

[SpicyPRE]

I recently read interesting results with metabolic horses by adding marine-based omegas - phytoplankton.