Ziggy's test results - UPDATED WITH X RAYS

[Jane&Ziggy]

The vet called me yesterday and told me that Ziggy's tests (for EMS and Cushing's) were both right at the boundary of normal and not, at the bottom of the reportable range. He didn't give me the figures - I wish he had and will call back next week to get them.

He suggested that we have the TRH test next, to see what else is going on, and then, if that one is also inconclusive, the glucose test. I've looked these up and I see the tests are legit, but it costs me nearly £100 every time he comes out to do a test, before the lab fees, and I feel a bit wary about repeated visits.

There are so many people here who know a lot about this - @carthorse , @Jessey and many more. Could anyone give me any guidance on these tests and what is best for me to do? If you need the detail of the results, just say, and I'll repost on Monday when I've spoken to the vets' office.

 

[Jessey]

Personally I'd do the TRH stim test and if that's inconclusive I'd wait and retest at the peak of the seasonal rise. The glucose test risks triggering lami and I wouldn't risk that in one who's already had it.

Jess was borderline on resting acth but we opted for a drug trial to see if she improved (it has no effect on those who don't have it) and she did but I wish I'd done the TRH stim test so I could be 100% sure it wasn't coincidence. The only way to do that now would be to take her off the drugs and retest.

 

[Jane&Ziggy]

See, I knew someone would know what to do!

@Jessey can you tell me what the TRH stim test is finding out? I did read the stuff on Google but got full brain syndrome.

 

[Jessey]

@Jessey can you tell me what the TRH stim test is finding out? I did read the stuff on Google but got full brain syndrome.

It's basically assessing the pituitary glands ability to react to TRH (a hormone), they take a baseline blood test, then give TRH, then do another blood test for the same thing to see if the reaction is a normal one. Resting (baseline) ACTH is less accurate because it is normal for it to be raised by stress (Inc external stress like vet visits and internal like pain) and it can vary throughout the day, but because they give a known amount of TRH and its just the variance they look at it is more accurate.

 

[carthorse]

There's no way I'd do the glucose test on a horse that's already had laminitis. Given that these tests are going to cost you a fair bit of money & you're testing because he's symptomatic I'd ask the vet if you could instead try a prascend trial to see how he responds to that & also manage him as though he has EMS/IR, though obviously without the exercise element until he's sound enough to cope with it. If he responds well to the prascend then you have your answer, or as a vet in my practice used to say "if it looks like a duck, waddles like a duck & quacks like a duck the chances are that it's a duck!" - a useful philosophy when we were dealing with Jim since taking bloods was dangerous to everyone, but also one that saved me money to spend on his other vet bills!

 

[Jane&Ziggy]

That's very interesting @carthorse and could be worth a try if the vet will play ball.

I realise I am being thick, but other than him not getting laminitis, how would I know that prascend is working?

 

[carthorse]

It depends on what symptoms he's showing really. If his coat has got heavier that may improve, the crestiness may go/reduce along with any other unusual fat deposits, he may have more energy - basically look at the symptoms for PPID, consider which ones he may be showing & then monitor to see if he improves. Even if the only symptom he's showing is laminitis then it's worth the prascend to control that since it's arguably the biggest problem with PPID, but remember that you also need to get his foot balance sorted since your vet thinks some of this flare up is mechanical. It sounds clichéd but you know Ziggy & I think you'll know if it's having an effect.

 

[Jessey]

Retesting bloods would show a decrease in his number too if its working, generally.

Have you got his Xrays yet? I love looking at a good xray

 

[Jane&Ziggy]

I've just received copies of the X rays and his blood results and here they are - all views gratefully received! I've also included his lab results in case anyone understands them

The first 2 x rays are his left (better) foot, the second 2 are is right (worse) foot.

 

[carthorse]

To me, and I could be wrong, that reads as though he's positive for PPID & insulin dysregulation so I don't understand why your vet isn't suggesting Prascend. Once you can get the feet under control you can start exercise which will improve his insulin sensitivity, though as a stop gap you could try metformin to see if that helps. But nothing is going to work until he's treated for the PPID.

Both x-rays look like he'd be better with the toe taken back much further, and the heel dropped, to try and realign the hoof capsule to the pedal bone. On the plus side you look to have reasonable sole depth & that always helps a lot. I'm not good at looking at the rear views but they don't seem a pair so I'm guessing something needs doing there too.

 

[Jane&Ziggy]

Thank you @carthorse, trimmer is coming tomorrow. I will ask vet about the lab results.

 

[Jessey]

I would agree, the left number is the reading and the right the cut off for normal, so he's above normal for both. Jess was confirmed when her ACTH result was 29.8 and the cut off was <29, that coupled with symptoms was considered conclusive enough to trial drugs. Her resting insulin was 12 and cut off was <20 so normal. Given Liphook's comment at the bottom they obviously consider it to be positive for ppid.

Obviously your vet is the only one qualified to read xrays but to me there's rotation (so very valid to have got xrays) as the bone at the front isn't parallel to the hoof wall, I'd agree there's a lot of toe to come back and perhaps a little improvement to be made on medio lateral balance but its tiny. And side bone development on both but that's not uncommon on a horse in their teens. Any lami is never great but it isn't an xray that makes me wince, hopefully very manageable for your trimmer to get him comfortable with these to help

 

[lauren123]

Hi @Jane&Ziggy . I thought I would add my two cents since both @Jessey and @carthorse have both been amazing support. I had the TRH stim test done for sox as he was borderline also. Basically they take blood, inject it , time 10 minutes and then retake the blood. Soxs first time. Bearing in mind that he was borderline when we did this test (TRH) the cut off was something like 110 for the TEST. Sox came back as 210!! It was only when we did this test that it showed up. He get bloods at first done every 4 months i believe ( Same test TRH) and his last reading ( only been done one this year i think) the normal test was well under the marker and the one that should be under 110 was 66. I believe. Ok he is now one 1 and a half tablets, he was on 1. Due to retest him again next month with his jabs Also because sox already had had lami it wasn't the one that can bring on lami

 

[Jane&Ziggy]

Thanks @lauren123 , very helpful!

I would agree, the left number is the reading and the right the cut off for normal, so he's above normal for both. Jess was confirmed when her ACTH result was 29.8 and the cut off was <29, that coupled with symptoms was considered conclusive enough to trial drugs. Her resting insulin was 12 and cut off was <20 so normal. Given Liphook's comment at the bottom they obviously consider it to be positive for ppid.

Obviously your vet is the only one qualified to read xrays but to me there's rotation (so very valid to have got xrays) as the bone at the front isn't parallel to the hoof wall, I'd agree there's a lot of toe to come back and perhaps a little improvement to be made on medio lateral balance but its tiny. And side bone development on both but that's not uncommon on a horse in their teens. Any lami is never great but it isn't an xray that makes me wince, hopefully very manageable for your trimmer to get him comfortable with these to help

I agree with you about the X rays and it was exactly what I expected to see given what my trimmer had told me. He's coming today and has them for reference so should be able to make good progress.

 

[carthorse]

I hope today went well & that he's more comfortable now. What were your trimmer's views on the x-rays?

 

[Jane&Ziggy]

He said it was good to see them, that they showed what he expected and that the thickness of Ziggy's soles was useful when trimming back as hard as he had to. His feet are much shorter now, I'll post a pic. He also said something about how rotation of the caudal foot (I think that is what he said) is not cause for panic because it's generally able to be trimmed out.

Here are his feet just post trim. The right one, the more severely affected, is still flatter and more slipper like than we want but he took off as much as he could. Ziggy was much more comfortable after.

 

[joellie]

I would agree with others that his test results show him to be positive for cushings ,. if it was me I would be asking the vet about starting him on prascend.

 

[carthorse]

If you can afford it I'd be tempted to get x-rays now that he's trimmed as then you'll know how close to ideal this trim is and whether more needs taking off the heel or toe. It's why it would have been perfect if you could have got the two together, but I appreciate that isn't always possible. Did you get anywhere asking if he could trim him more often? I can't help but think that's going to be something that he needs for a while. It's good to know Ziggy is more comfortable