Re: Just Got the Diagnosis, Need Help Figuring It All Out

Lavinia Fiscaletti

Hi Jennifer(?),

Welcome to the list. With the blood work you have your little guy is definitely PPID (Cushings) and he is also IR. These are two different conditions that have some overlapping symptoms. IR is managed with diet while PPID is managed with medication - the Prascend you were given. We do not recommend starting on a full 1mg of the Prascend at once - you should taper onto the drug. If you start all at once your guy is likely to experience  some side effects that are called the "pergolide veil", which means he may lose his appetite, appear somewhat spacey and seem generally not like himself. This is temporary but tapering onto the drug will usually avoid these issues. An adaptogen called APF, manufactured by Auburn Labs, can help with the veil if he develops it in spite of tapering onto the medication.

Tapering onto Prascend is a bit difficult in the beginning as the caplets are only scored to be divided into 1/2. We recommend starting at .25mg for 4 days, then .5mg for 4 days, then .75mg for 4 days, then 1mg. To do this, divide a caplet in half then dissolve one of the halves in a small syringe with 6mls of water. Give him 1/2 of the syringe the first day then refrigerate the rest. Give the remainder the second day. Repeat. Next give him 1/2 of a caplet for 4 days - in a small amount of food is fine. Just be sure he eats it. For .75mg use the syringe again - feed 1/2 a caplet, dissolve the remaining 1/2 caplet and administer only half the syringe. Repeat 3 more times. Then go to the full 1mg dose.

We need some more information from you to be able to help you better. Please join our sister list ECHistory8 and fill out a case history form for your boy. This will get all the information about him stored in one place for future reference when you ask questions. Here is the link to the history site:

The list philosophy is DDT/E, which is just shorthand for Diagnosis, Diet, Trim and Exercise. They are the foundations for getting and keeping your pony healthy for the rest of his life. You can have a read on our website for more in-depth information and if you pass the website address onto your vets they can peruse it for the most up-to-date studies and protocols:

DIAGNOSIS: This is thru blood work, which you already have. Good job on insisting your vet draw the additional samples for ACTH and insulin. Please put all the results from any and all tests that have been done in your case history along with the units of measure and the lab's normal ranges. You DO NOT want to use fasting blood work as that will give you falsely low results on the insulin and glucose and can affect the ACTH as well. Retesting should be scheduled 2-3 weeks after you reach the targeted 1mg daily dose as that is enough time to for the medication to have reached full effect. Yes , it is possible the liver enzymes are being influenced by the PPID.

DIET: Should be low sugar/starch/fat and forage based, with the forage analyzed and minerals supplemented based on the assay. We can help you with that. No pasture, apples, carrots, sweet treats, red salt blocks. For now, you should start him on the emergency diet you were sent when you joined. The minerals are available at your local drugstore. This is a temporary diet that removes the most common diet ingredients that exacerbate IR. Need to stop the senior feed as it has too much sugar/starch for an IR equine. Some rinsed/soaked/rinsed beet pulp is a safe feed to use to add supplements to. Depending on where you are located, you may have Ontario Dehy Balanced Timothy cubes available to you. These are a completely safe feed for an IR horse so could be used as his entire diet. All you need to add is iodized salt, vit E gelcaps with oil in them and ground flax.

TRIM: Toes backed and heels lowered so that the hoof capsule tightly hugs and supports the internal structures. This is an important puzzle piece and one that is many times overlooked. We encourage you to post pictures of your guy's feet in the Photos section of ECHistory8 so we can take alook and make sure his tyrim is optimal.

EXERCISE: The best IR buster there is but never force a sire animal to move. It doesn't sound like he is having lameness issues - is that correct? If so, great! Laminitis is to be avoided at all costs.

We ask that you please sign your posts with your name, general geographic area and year of joining as this helps us to help you better. Once you have the case history filled out you can add the link to it to your signature as well.

Ask any questions as they come up, we're here to help. You aren't alone in this and many members have been in the same position of that frustrating lack of local help.

Lavinia, Dante, George Too and Peanut

Jan 05, RI

EC Support Team

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