What bloodwork for unthrifty horse? Update 9/25

[Libby2563]

I’ve been giving him sucralfate again for a few weeks now. Scoping is on the table. I wouldn’t be at all surprised if he has gastric ulcers again since he did last year, but I don’t think it’s the entire problem. Thanks for the reminder that ultrasound is a possibility for the hindgut!

I’m frustrated that I have to play Dr Google DVM. Last spring I consulted the local internal medicine guru who’s supposedly excellent at gut health, and instead of addressing that concern she decided his neck hurt and sent us down a very expensive rabbit hole that led to zero diagnosable neck issues, but…wait for it…ulcers. Yes, the concern I had raised with her 4 months earlier. Sigh.

[IPEsq]

I’m late to this but I’d probably test glucose again (I’ve never had a low glucose result, so I’m not totally buying the blood storage explanation). Add baseline insulin. And thyroid. And test for PPID…I’ve known another younger horse who had it with maybe a slightly rounder lower belly but no other signs other than he got an eye ulcer that just would not heal.

Depending on where insulin comes back you may want to do the Karo syrup test for ID.

[Libby2563]

Update: I finally got a vet to test ACTH and it came back positive! We missed the window for TRH stim but resting ACTH was 95.8 with a seasonal reference range of 2-30 (Cornell). Sheesh. Glad I posted here and listened to you guys / my gut instead of the two vets that told me he’s too young and doesn’t have symptoms.

I’ve been advised to start with 1/2 a Prascend per day. Does that sound right? My 28-year-old has been on compounded pergolide and seems to be holding steady so I’m tempted to start with that. Thoughts?

[JB]

Well boo, but also yay that it’s something known and manageable for hopefully a very long time.

Yes, 1/2 dose is a great idea. 1-2 weeks, if things go well then add the other half either as the whole pill at once, or at another feeding if you want to still creep your way into a whole pill at a time. I did half for a week, then a whole, and mine was fine, but not all are, so it’s a bit of a game you have to start playing.

Since you have compounded already, that makes it much easier to give 1/2mg doses, especially if it’s a fresh batch.

@Libby2563

two vets that told me he’s too young and doesn’t have symptoms.

This is the most ridiculous thing for a vet to say that 15 is too young 20% of PPID horses are 15 or older, so it’s not a tiny percentage. And, weight loss and unthriftiness are pretty classic earlier symptoms. Not the ONLY thing they can be a symptom of for sure, but they ARE typical

Anyway, I’m glad you have proof now and a plan

[ladipus]

15 is definitely not too young … have a now 21 yr old TB who was diagnosed with Cushings /PPID at 15 …and it’s absolutely not true that all Cushings horses are fat with cresty necks …if it’s not controlled they absolutely can be thin and lose topline and just not look well in general…so I would insist on doing bloodwork-acth with a TRH stim to rule it out …I’d also check for Lyme as well as a chemistry -specifically creatine & BUN …kidney disease often presents with weight loss as only initial symptom

[Jump314]

@JB, why do you assume the vet wants the horse on 1 pill per day? Maybe they want to try just 1/2 pill to see how well that works.

You also say

@JB

20% of PPID horses are 15 or older

I don’t think this is what you mean. Maybe you mean that 20% of older horses have PPID?

[OzarksRider]

@IPEsq

I’m late to this but I’d probably test glucose again (I’ve never had a low glucose result, so I’m not totally buying the blood storage explanation).

Improper collection and storage of the blood specimen can cause both false high and false low glucose results. Red blood cells metabolize glucose, so if the plasma isn’t separated from the red blood cells in a timely manner the glucose result will be falsely decreased. The result will also be falsely decreased if the specimen isn’t stored properly (refrigeration or freezing) for too long before testing. On the other hand, if the specimen is hemolyzed (red blood cells ruptured), the glucose result will be falsely elevated due to glucose released from the hemolyzed cells.