I'm sorry, I must disagree with this information and enter this discussion.
The best thing you can do right now is send your local vets to this website.
Your question ‘’can anyone recommend a vet’’ may not be needed. We’ll coach you!"
There are plenty of good vets who CAN and would WANT to help you. I would visit the AAEP website and search "Get-a-DVM” for help in locating AAEP members. This will help you locate a MO Equine vet who is a member of American Association of Equine Practitioners and then contact them for inquiry on their interest or expertise in PPID. Or even call the AAEP Office for Member listings-859-233-0147. I count over a 100 in MO in my Member Directory. Most vets would welcome the discussion and many vets are now well-versed in PPID, EMS, and management of what is now called insulin dysregulation/ID. This has been a topic of many veterinary CE conferences in recent years and many vets are now developing specialized interest in this field. Keep in mind, the info on endocrinology has changed rapidly over the past years with emerging research, and this has often been difficult for vets to exclusively focus on in practice.
Additional resources can be found on the Equine Endocrinology Group website (sites.tufts.edu/equineendogroup). These specific EEG members located at Universities can also assist you in locating someone well-versed in endocrinology.
Even though I am *NOT* an employee of BI any longer, the phrase "the compounded pergolide works well" is not factual in many cases. Sometimes it works, sometimes it doesn't--and it is NOT the same as FDA-approved drug. There is no guarantee of potency, stability, or efficacy with compounded medication, and if you have a dosing error or other adverse safety issue--you're on your own. Not the same. Compounded pergolide has helped many a horse in the past, but it should not ever be compared on the same plane as an approved drug, which undergoes consistent potency and quality testing batch to batch. Ask your compounder for such data on stability and potency, and you will likely 1) not receive an answer 2) receive data they generated internally (not evaluated by an outside source). Dr. Jennifer Davis just in 2012 compared 21 additional formulations of compounded pergolide (as follow up to her 2009 study on aqueous pergolide on file) and once again, found huge inconsistency. One formulation from Wedgewood actually had NO measurable pergolide for the 180 days of study evaluation. Only 4 met the +/- 10% of stated 1mg label concentration from the compounder on Day 0 of the analysis. Yes, it's generally cheaper, but it should be. Compounded pergolide is a crapshoot. Depends on the quality of the compounder, the active pharmaceutical ingredient/API (legally, compounders have to now formulate products from approved Prascend, but we all know many don’t and use illicit API), the batch to batch mixing, etc. It is not the same as Prascend, which must be manufactured under strict quality control batch to batch with ongoing stability testing through the product’s market lifecycle.
To the persons recently who posted about giving 32-36 of compounded pergolide—given that the average recommended dose range of pergolide is 1-5 mg/day…do you think perhaps trying an FDA approved drug might be a good strategy? Giving 36 mg a day goes against ANY recommendation from world-renowned experts in PPID. And, if you don’t see a response until you reach that level, could it be that there is little to no drug in your compounded product? Perhaps trying a drug with known potency might be a logical answer, and may even be cheaper than what you are paying at that level of dosing.
I do agree with the comment on Dex Suppression. This IS an outdated test, although it has done a decent job of diagnosing advanced PPID. It is no longer being recommended due to inferior sensitivity and the perception it will cause laminitis. Please refer to the EEG link above on Tier 1 and Tier 2 tests now recommended.
Lastly, I would have your vet contact Boehringer Ingelheim Veterinary Technical Services for questions. (No, I don't work for BI anymore). They can assist with resources, PPID case management, and lastly, if needed, helping to perhaps locate additional veterinarians in MO. They are there to assist vets and the clients they serve. For real. Your vet has their number.
Veterinary/DVM involvement is an integral component of progressive horse care. Sometimes equine vets cannot be readily found in rural areas or vets with certain expertise, and seeking online advice is understandable. But resources DO exist to help you. Denying your horse the input of a licensed medical professional is not a good strategy moving forward--nor would it be so in human health care. This site should serve as a helpful forum and resource to support total horse health, not "replace" professional veterinary care or promote veterinary medical advice disseminated from laypersons.
Marian Little, DVM