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Author Topic: Metabolic Disorder Issues and Test Results  (Read 1363 times)

Mona

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Metabolic Disorder Issues and Test Results
« on: August 18, 2014, 09:19:41 am »

I had some blood work run on a mare there to check for metabolic disorders of any sort.  I had a Cushings Panel run which included T4, ACTH, Cortisol and Glucose.  I also had a separate T3 run.  The vet called and the results really are not making sense to him. 

The results showed:

T3 was normal at 1.05 with normal range being 0.9 - 2.4
T4 was LOW with her result being < 13 and with 13-40 being normal
ACTH was OUT OF THIS WORLD at 472, with normal being 2-10
Cortisol was normal (he never gave me the numbers, just said it was normal)
Glucose was normal as well, with a reading of 5.4 and with the normal range being 3.7-6.9

I did not have insulin run because I was checking more for Cushings and it was a "group" test they run for that.  I did have the T3 run separately as the horse has had prior thyroid issues.

So...my question is....my vet is STUMPED on why the ACTH levels are sky high.  Normally, with ACTH levels that high, the Cortisol should also be way high, and they were normal.  And he said even seasonal highs should not be anywhere near that much off the charts! 

Any ideas???  Thanks in advance.

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abbypeaches

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Re: Metabolic Disorder Issues and Test Results
« Reply #1 on: August 18, 2014, 09:55:04 am »

Most likely your horse has Cushing's disease.  Go to www.ecirhorse.org to get further help. Dr. Eleanor Kellon,DVM advises on there and the rest of the group is extremely helpful. It made a world of difference for my horse. If you have any trouble accessing the group, contact the moderator listed and she will help you.
  Keep us posted on your progress.
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Mona

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Re: Metabolic Disorder Issues and Test Results
« Reply #2 on: August 18, 2014, 10:13:36 am »

Thank you Marilyn.   :)

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loneelk

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Re: Metabolic Disorder Issues and Test Results
« Reply #3 on: August 18, 2014, 12:21:22 pm »

Can't think of a comparison w/ horses, but I know that my doc has pointed out to me on my own blood work a tendency that the lab used by our local hospital (the only local place to get blood drawn for labs) has two indicators that are routinely just wrong.  Abnormally high, to the point that the doc said that if her patients' levels for those two indicators were really that high, something would be seriously medically wrong with all of us. 
Maybe a new draw and send it to a different lab?  Altho I know how expensive it is to have blood work done, so maybe that's not an option.
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Mona

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Re: Metabolic Disorder Issues and Test Results
« Reply #4 on: August 18, 2014, 12:26:44 pm »

I just paid about $300 for this work, so no, not about to have it redone unless it is a mistake of theirs and they are going to go good to have it redone.  The vet called the place that did the test, but the person that did the testing is gone away on holidays...figures!  So now hge is waiting to hear back from someone else there to see what they can offer on why the ACTH would be out the roof and the Cortisol normal.
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kckc

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Re: Metabolic Disorder Issues and Test Results
« Reply #5 on: August 18, 2014, 12:27:22 pm »

what made you decide to have the mare's bw done?
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Mona

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Re: Metabolic Disorder Issues and Test Results
« Reply #6 on: August 18, 2014, 12:29:42 pm »

Because I suspect Cushings by different signs I've seen in her and the reading I've done on it.
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Morson, Ontario.  Canada

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Mona

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Re: Metabolic Disorder Issues and Test Results
« Reply #7 on: August 18, 2014, 12:41:12 pm »

I guess I could elaborate a little more.  This is my mini mare.  She was born and raised here until she was 12 years old.  She was on Thyro-L for a couple years when I owned her, due to low thyroid. (she got HUGE and a neck goiter)  I sold her as a companion to a local gal for her mini gelding.  She took it upon herself to take her off the meds.  I got her back at the end of November last year. She was in fairly good (body score) condition.  BUT, she has been packing on the weight and when she shed out and I was brushing her out this Spring, I noticed fat pockets in a place I had never seen before.  I came in and googled it and the only thing that showed up for fat pockets there was Cushings.  After reading a fair bit on it, I noticed that she has shown a fair number of symptoms over the years.  Her low thyroid, her extreme weight drop (I gave owner hell because she had let her get so thin and I was VERY upset to see that), then I noticed this winter she drank a LOT of water for one little horse, and I now how much is normal due to keeping mini stallions in a pen by themselves over the 16 years I raised minis.  Now she is fat again with those fat deposits.  I have decided that due to the extreme expense with constant blood work to keep med levels regulated etc., that I will not treat her for Cushings.  Although she's not "old", she is 18 now and I will do what I can to keep her comfortable and live her life as normally as possible, but I also know that leaving Cushings untreated will eventually lead to founder issues.  We have decided that once it gets to that point, that we will have her euthanized.  So anyway, she just seems to have several symptoms throughout the years up to now, that are seeming like they could be Cushings signs.
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loneelk

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Re: Metabolic Disorder Issues and Test Results
« Reply #8 on: August 18, 2014, 01:09:58 pm »

Being more familiar than I want to be w/ these sorts of issues, I'll just say "I'm sorry this happened to your little mare".  Will be interesting to hear what the lab person says about the values.
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Mona

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Re: Metabolic Disorder Issues and Test Results
« Reply #9 on: August 18, 2014, 06:03:18 pm »

Well, the vet called me back awhile ago.  He spoke to the head ??? at the testing lab, and was told that my mare, with ACTH levels that high is definitely cushingoid and even though the cortisol levels do not relate, there can be cases like this.  They are FAAAAAAAAAAAAR too high to be attributed to seasonal high levels.   :-[
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PAWalker

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Re: Metabolic Disorder Issues and Test Results
« Reply #10 on: August 18, 2014, 06:19:09 pm »

To answer your original question, I would e-mail a copy of your test results directly to Dr. Eleanor Kellon.

I have never dealt directly with cushings but Duke was tested for it in 2007.

I THOUGHT the purpose of the ACTH test is to read the cortisol LEVELS in the body.  The Dex Suppression test is the other method but nobody likes to use that, as it is known to bring on founder in some horses.

I could be wrong, so my best answer is to send everything you posted (re the test results) to Dr. Kellon and see if she will reply back.

It is probably a given the pony has some sort of metabolic issue since IR, EMS, nor Cushings ever go away - they just stay "held in control" by whatever means works on the horse or pony that the owner has to keep giving them for the rest of their lives.
Judy
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Mona

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Re: Metabolic Disorder Issues and Test Results
« Reply #11 on: August 18, 2014, 06:32:54 pm »

Thanks Judy.  I have emailed her.
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Winona

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Re: Metabolic Disorder Issues and Test Results
« Reply #12 on: August 18, 2014, 07:32:23 pm »

Mona, I understand the cost of treating for Cushings. But, my vet put my old horse on a dose of pergolide that helped his symptoms so we did not do regular blood work. I found low cost compounded pergolide on-line. But, sorry she is going through this and understand your decision.
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Mona

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Re: Metabolic Disorder Issues and Test Results
« Reply #13 on: August 18, 2014, 08:06:52 pm »

Winona, thanks, and funny you should say that.  After speaking with my vet again this afternoon when he called me back about the high ACTH levels, we did discuss that.  I discussed with the vet (locum from out of province) that came here to draw the blood for the testing, my decision to not go the route of all the testing, and apparently, he shared it with the vet (owner of the clinic) that called me. When he called, he did say he totally understands and supports my decision, and that he would be OK with my treating her with Pergolide (or a compounded source) and not following up with blood work all the time, and instead just trying to gauge it on her body condition and reaction to the dosage she was on. THAT I am more than happy and agreeable to do.  I din't think (before this afternoon) that that would be an option.  So yes, I will get my little mare onto something.  THANK YOU!   :)
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OldnOrnery

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Re: Metabolic Disorder Issues and Test Results
« Reply #14 on: August 18, 2014, 10:53:33 pm »

Mona, you can do a decent job of gauging the dose of pergolide from physical symptoms. Many, many owners of Cushings horses test only once a year because of the expense. I believe Canadians send to Guelph. The ECIR Yahoo Group has acres of information to help you as a Canadian. https://groups.yahoo.com/neo/groups/EquineCushings/info

With pergolide, you need to taper the dose up slowly until symptoms are controlled. Some (not all) equines suffer side effects from increasing pergolide too quickly. It has a name: the pergolide veil. Horses with "the veil" lose appetite, act as if they are zoned out, mope around with no energy.  My mare doesn't suffer at all, but others can barely tolerate ¼ mg increases. So starts low and increase slowly (increasing after 3 weeks) until symptoms are under control.

There are herbal treatments for the veil. Canadian ginseng has made a real difference in my mare's quality of life. It's a leveler. I'm not a big fan of herbal treatments. Call me a skeptic. But having seen the effects on my Cushings mare, I'm a fan on Canadian ginseng and of jiaogulan.

The symptoms you'll watch are: excessive drinking and urination; running eyes; pot belly posture with loss of top line and muscle; foot tenderness (sign of laminitis, whether acute or low grade); ravenous appetite. Long, non-shedding hair coat is a sign that the horse had had PPID for a while, several years. Body condition varies from emaciation from insulin resistance (where the cells are starving) to obesity (from uncontrolled appetite).

Your vet can prescribe you a combination of dosages: ¼ mg to use for increases + the dose that seems to work. Dosage varies enormously depending on the horse. Unfortunately, your mini will need pergolide for the rest of her life and will need to increase dosage over time. My mare is now on 6 ½ mg/day, all in one dose. It will take you a long time to get there with a mini. Make sure that you get compounded pergolide in capsules, store it tightly closed in the refrigerator door and receive prescription refills monthly. NO liquid pergolide. Pergolide is sensitive to dampness and temperature, so you need to store it in a controlled environment. It's dosed once a day.

The way Cushings works is that the "master control" hormone, the pituitary, over-secretes ACTH. The results are body-wide, not just cortisol. Insulin is one of the hormones affected by excessive cortisol, which is why Cushings horses can become insulin resistant. Eventually the neurons that respond to the hormone dopamine are destroyed. It's a complicated disorder, but just take in what you need to, a bit at a time.

Cushings is NOT a death sentence, but it needs management. Here's my 22 yo Cushings mare. Plenty of life left in this old girl.
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