IR Horse - Should Blood Work Get Better?? (9/15 Blood Work Post #7)
I just got the most recent blood work back on my recently-diagnosed IR horse back and the values still look out of whack. I haven't spoken with my vet yet, so will get some answers once that happens, but thought I'd ask my questions here too.
Horse had two episodes of laminitis back in July -- blood work after the first episode was taken mid-day (so he had morning feed, but no grain really since I discontinued the night before when he looked sore). Relevant results:
While waiting for those results, he had the 2nd laminitis episode. He was on stall rest (deeply bedded) with only hay and no grain after the 1st time, and then (~7/16) we started soaking all hay and duct-taping foam on his feet. He was receiving banamine and ace then too.
Repeated blood work on 7/19 early in the morning before feeding (had hay only the night before). Results:
X-rays at that time showed very mild rotation. Other than the two separate laminitis episodes as noted, he has showed no more discomfort in his feet -- pulse normal and never really had discernible heat. Kept him in Soft-Ride boots until my shoer and vet met here to put shoes with pour-in pads on. Feet continue to say they are happy (no pulse, no signs of discomfort or heat).
Based on input of an internal med specialist and my regular vet, we put him on Thyro-L (3 tsp/day) and previcox (like Equioxx). Repeated blood work after 2 weeks on meds -- early morning prior to feeding again-- and this is what we have:
So I'm looking at this thinking it hasn't gotten any better?! Has it just not been enough time on the diet and meds, or does this mean we aren't limiting his sugar intake enough, or ??
I did get my hay tested and it is too high -- 16% NSC -- so we continue to soak while I seek low-NSC hay. He is also on Quiessence - the double dose for now. He is not obese, but certainly is overweight due to inactivity (he was laid up for another issue when all this came on). Has the telltale fat pads on crest and butt, which I feel have receded somewhat over these past couple weeks.
Any input welcome - thanks!
Last edited by horsepoor; Sep. 18, 2010 at 01:34 PM.
Reason: New Blood Work 9/15 (Post #7)
Well it has gotten better. Are you asking if it should continue to get better from here? I got my horse's down from 115 to below 30 in a little over a month. We never had any signs of laminitis, so we're still in the preventative stage. He did lose a hundred pounds on the weight tape too but that took almost 5 months. I don't think we did Glucose. I know we didn't initially, but we may have the next time. Either way, I don't have a comparison on that.
Everything happens for a reason. Sometimes the reason is you're stupid and you made a bad decision.
It certainly sounds to me like you are doing everything right with regards to your horse and should be commended! Your blood work is definitely much better and will hopefully continue to stabilize. Daily exercise for at least 30 minutes is going to be really important in helping to keep glucose/insulin in check.
Well, that at least is good to hear. Since the first blood was drawn while in the midst of laminitis, I tend to just look at the last two, and those don't seem to show much improvement. But I am also impatient!
No exercise yet, due to the laminitis -- he just gets a small amount of walking for now. X-rays again this week, so that may influence the plan going forward.
I covet your horses insulin levels. I have a horse whose insulin runs 140 on hay that is 5% NSC, when she's sound and when she's sore. There is a hepatic form of IR in thin horses that is very difficult to control, but your horse is not there. This looks good. Chill. Walk your horse. They may always be on the high side or normal. The only time it was as low as 40 is end of summer when she's galloping 5X a week and fit enough to enter a low level event. Consider that it means 'this horse is always predisposed' and that will not change. But clinical improvement is our goal and it seems you are getting there. Good job.
As usual, I have the blood work results but vet won't call me on it until next week. So I have the weekend to wonder about it. So if anyone has any thoughts on it, I welcome them! I'm once again worried as things seem to be worse than the last time (see first post).
This is what we got this week:
Glucose, Plasma 135 mg/dl (range 60-120)
Insulin 36.1 uIU/ML (range 10.0-30.0) - Note: Sample slightly hemolyzed. Result may be falsely decreased by 5-10%.
He's been doing great, I thought -- happy feet, getting a little small paddock turnout, walking a small amount. Weight seems to be getting better. On 4 tsp daily of ThyroL.
But the one thing that did happen is this week he had a reaction to something unknown and had fat legs for a few days. No temp, just filling in the legs that has now resolved after wrapping/banamine for a few days. Vet didn't think that would affect the blood test results, but I'm wondering if it could have?
How useful is all this blood testing, anyway? Should I keep doing it on a monthly basis, or hold off for a while?
I haven't found low-NSC hay yet (well, I did, but it turned out to also be a weedy mess, with nightshade in every flake of the first bale I opened, so not feeding that). If soaking my 16% NSC hay sufficient, or do I really need to find something lower?
I don't have too much advice, but what are you feeding besides the hay and Quiessence? Any concentrates?
My mare was borderline IR when I had her tested a year and a half ago. Her labs were all high normal. She looked like an IR horse, cresty neck and fat pads. I started a strict exercise program, put her on dry lot turnout, and also put her on Smart IR from SmartPak (tried Quiessence first, but she wouldn't eat it). I didn't test hay because I board and they have several different batches/sources. I can say that the SmartIR seemed to make a noticable difference. She had already lost quite a bit of weight but still had the cresty neck. After the Smart IR, that seemed to go away almost entirely within a month. And BTW, I only have her on 1/2 a scoop a day, or 1/2 the recommended dose.
As long as his labs are within the normal range, even on the high end of normal, I wouldn't worry too much as long as he's not symptomatic. Insulin and glucose levels are constantly fluctuating. You seem to have a good handle on things. Personally I wouldn't test so often if he seems okay. Maybe only once or twice a year?
No concentrates. Just a small amount (<1/2 cup of pellets, or about 1/4 lb. dry) of soaked non-molasses beet pulp to get him to eat the thyro-l and quiessence.
I think the vet is doing the blood work more frequently to see how he responds to the thyro-l dosing, but I'm not sure. Will see what he says -- if we aren't changing anything in response to results, it doesn't make sense to keep running the blood. But I'm sure it helps to build my honorary wing at the vet hospital...($$$).