Test Results for ChaCha - My hardkeeper PHOTOS ADDED AT BOTTOM

[wingnut]

My vet emailed me late last night, knowing I'd be anxious for these results. I can't believe what they're "telling" us (reference levels or expected ranges are in parenthesis):

ACTH Baseline: 10.7 pg/mL (9-35)

Insulin: 6.91 (10-40)

T4 Baseline: <0.05 (.85-2.4)

T3 Baseline: <0.07 (0.3 - 0.8)

Lymes OspA: 233 Negative

Lymes OspC: 56 Negative

Lymes OspF: 50 Negative

According to my vet, these results show NO Cushings, NO IR and NO Lymes and possible HYPOthyroidism. The problem with that is that the normal treat for HYPthyroidism will make a horse LOSE weight and obviously, we cannot do that.

I'll be talking with her today to discuss next steps. I'd love to hear from any of you out there who have suggestions. I'm pretty much beside myself now because based on previous conversations with the vet, the next steps are very unclear and may reach a cost prohibitive point that we simply can't go to as much I would love to be able to.

 

[Field-of-Dreams]

Did he test for renal acidosis?

http://www.equisearch.com/uncategorized/a-rare-case-of-equine-renal-tubular-acidosis/

I'm pretty sure this is what our mare has, we've been giving her baking soda and Karo and she is eating pretty well now. AND putting the weight back on!

 

[chandab]

Did your vet do a glucose test as well? I want to say that the glucose insulin ration is important, even if insulin looks to be normal (I'm not sure though). Usually with a thin horse IR isn't the issue, but these minis always seem to throw us for a loop.

When my gelding was diagnosed with Cushing, it was NOT based on an ACTH test, as we weren't even looking at Cushings at his age; but it was based on his liver enzymes and other tests being totally out of whack. He's been on pergolide for about 8 months now, and looks pretty darn good. [At diagnosis in November, while we couldn't see it through his shaggy coat, we could feel he was a bag of bones. Here's a pic of him last month when I clipped him:



He has lost a little weight since this picture, as I tried to drop one item from his diet; it didn't work to drop it, so its coming with today's delivery.

 

[wingnut]

I think she did the glucose levels back in April. All her other results were normal as well.

 

[JAX]

Joy, would you mind if I copied your above message and send to a group that I belong to to see if they or the lead vet have any suggestions? They are actually a PPID/IR group but I have a feeling that I remember Dr Kellon talking about this.

 

[wingnut]

JAX: Please feel free. My vet is at a loss as to what to do next as she's never experienced such a thing in her practice before. Next steps for us at this point would be to take her to a place like New Bolton in PA or Marion DuPont Scott Equine Medicial center to have them try to determine whats going on. I'm contacting both places today just to see what kind of costs we might be looking at.

 

[targetsmom]

I would like to hear more about liver enzymes being out of whack and how that relates to Cushings. We had a mare with similar low body score issues and the only thing that tested out of whack was her liver enzymes. Unfortunately no one was able to help her. Her ACTH was normal although her DAM had Cushings.

 

[drmatthewtaylor]

I don't think these results imply Cushings or IR either, but I also don't think they rule those things out. Unless she's foundered, I wouldn't put those diseases or hypothyroidism at the top of my list (BTW, I doubt she has true hypothyroidism but rather is sick euthyroid. A condition wherein the thyroid acts abnormally because of another disease).

Could you please list all of the blood work done and when and the results.

Dr Taylor

 

[wingnut]

Field of Dreams: I don't think she has tested for that.

 

[JAX]

I have sent in a message and am hoping Dr Kellon will see and respond soon. Chances are she will be asking the same questions as Dr Taylor. Was the horse kept off all food before the blood draw? What time of day was blood draw? Was the horse at home or was she trailered to vets for the draw? ie would she have been stressed? How was the sample handled? Which lab did the testing?

Then again I could be wrong and none of those might matter in this case... Either way I will let you know if she responds before you get this figured out.

 

[wingnut]

Dr Taylor: My vet agrees with you that the thyroid results are likely low due to something else not as a result of true hypothyroidism.

I'm attaching the results from the tests done on April 11th in PDF format.

Cha Cha Lab Results 4-11-12.pdf

 

[wingnut]

The horse was allowed pasture/hay the day of the last blood draw for Cushings/IR etc. She had been about 20 hours from her last bucket of Triple Crown Low Starch. The blood was drawn late afternoon....5:00pm-ish, at home. No stress that we can determine. She's pretty much left to her own devices. No training, no forced stalling (which she does not like), no over handling (which she also does not like). Cornell did the lab work. How as the sample handled? The vet said that one of the test needed to be centrifuged (sp?) and frozen. Then she would ship it out with N??? packs to keep it frozen for the overnight transport (FED EX).

I'm attaching the results we received today as well.

Cha Cha Lab Results 6-19-12 (2).pdf

 

[wingnut]

In an effort to "check off all the boxes" I'm having our equine dentist come back out and check her again JUST in case something has developed since he was here in early March. One thing of note that got the interest of the Dr. at the Marion DuPont Scott center that I spoke with was the fact that she has ALWAYS dribbled feed when she eats. Despite excellent care from our equine dentist. The Dr. at the MDS center said they would definitely check out her mouth extensively. Other options are re-running blood work, running additional bloodwork, ultrasound her belly and possibly doing a thoracic (sp?) xray/radiograph, looking for masses/growths.

I'm getting ready to make a similar call to New Bolton to get an idea of where they would start and what the costs might begin at.

P.S. I've been promising pictures too...will have some this afternoon. The heat here as jumped considerably and I need to clip her, so i will have before and after pics.

 

[drmatthewtaylor]

I sympathize with wanting to know costs, but your question is coming too early. It would be impossible to know the cost without actually seeing the sick animal. Other than the Office Fee, every other cost could be run past you as the Dr. feels its needed. But how much lab and imaging work needs done is anyone's guess. Maybe the problem will be able to be diagnosed on exam alone. Any 'quote' the Clinic would give you would be a guess at best and then you'll be comparing apples to oranges in terms of what one Clinic might include vs. the other.

Bottom line is the previous work up didn't yield a diagnosis, more needs to be done and if your Vet is suggesting referral then I would respect that opinion.

Previous blood work looked normal, but likely needs repeated.

Dr. Taylor

 

[wingnut]

Thanks Dr. Taylor. Your input is valid and much appreciated.

 

[chandab]

I would like to hear more about liver enzymes being out of whack and how that relates to Cushings. We had a mare with similar low body score issues and the only thing that tested out of whack was her liver enzymes. Unfortunately no one was able to help her. Her ACTH was normal although her DAM had Cushings.

I honestly don't know, but when we did the blood tests (late Nov 2011), 2 out of 3 of his liver enzymes came back off the charts high (third was at extreme top end of normal), extremely high glucose, (I don't know insulin), and electrolytes off. Immediately we dropped sweet feed (was using it to get him to eat), and when the vet said tests pointed to Cushings, we put him on pergolide; new tests in April after 5 months on pergolide and lower sugar/starch feed, all his liver enzymes were back to normal, glucose normal, (still not sure on insulin), and electolytes only slightly off. [Never used ACTH to test for Cushings, as we weren't looking for Cushings at the time.]

 

[HGFarm]

Poor guy, you are doing everything you can. Hope you can find the answer and get him stabilized pretty much.

 

[wingnut]

Here are the photos I promised:

Pre-clip

Post Clip:

A view of her back ridge and hip points...I don't think those are ribs showing as much as a bad clip job:

 

[valshingle]

I'm sure you covered this in an earlier post, but have you done a Panacur Powerpack on her? I had a big horse that kept getting thinner and thinner. She had been wormed regularly, but the vet suggested the powerpack and it worked.

 

[wingnut]

I did a power pack 5 day dose on everyone sometime last fall/winter...don't have my notes with me.