Re: Updated Case History, Suggestions Needed
>>In the 3rd paragraph that was supposed to say he gets no hay unless soaked, not no hay....
Whew! When I read that my fingers started to twitch! Glad to hear that was a typo! :)
>>We have been fighting laminitis now since August so he does not currently have a fall insulin level.
Kendra, several things in your note jump out at me that suggest that Opie is PPID.
1) Fall laminitis is often the first sign of PPID due to the seasonal rise. For more information have a read on our website here: http://ecirhorse.org/index.php/cushing-s-disease/seasonal-rise Great place to send your vet as well.
2) Depression can also be a sign of PPID. More information here: http://ecirhorse.org/index.php/cushing-s-disease and here: http://ecirhorse.org/index.php/cushing-s-disease/physiology-of-ppid-cushing-s-disease
3) Opie is feeling better since starting on the Prascend,
4) Opie's age of 15
5) There is some thinking that the oxidative stress of IR over the long term, can lead to PPID. You know that Opie was IR when you purchased him and who knows how long before that. Here's a post by Dr Kellon on that matter: https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/178825 Pay special attention to this statement: "On one level, IR horses may seem at higher risk because they are at higher risk to develop laminitis early in the course of PPID."
Great to hear that Opie is feeling better on the Prascend! There is really no need to wait for 60 days of a trial period. We recommend testing after 2 to 4 weeks on the target dose to see if the ACTH is well controlled. Here's a post by Dr. Jaini that addresses that: https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/190147 And a bunch of information on pergolide: http://ecirhorse.org/index.php/cushing-s-disease/pergolide Embedded in that link is also a message from Patti on using a scale of symptoms to help determine if you are at your target dose: https://groups.yahoo.com/neo/groups/EquineCushings/conversations/topics/111988?threaded=1&l=1
I noticed in your CH on Opie that you have him on SmartVite Thrive. This product contains Vit C and B vitamins that are not recommended for IR horses. Also, added manganese, which you may or may not need to balance your hay, and not enough copper, zinc, biotin and methionine to even begin to do any good. The best thing you can do is to have your hay tested and balanced. Here's a link to "help with mineral balancing" https://groups.yahoo.com/neo/groups/EquineCushings/files/7%20Help%20with%20Mineral%20Balancing/ Please read the "nutritional needs for insulin resistance" by Dr Kellon, the last file in that folder. Also noticed that Opie has a "severe allergy to flies." I can just tell you from experience that Chancey used to have the WORST sweet itch (hypersensitivity to Culicoides aka midges) ever. He would scratch his belly raw and bleeding. After finding this group and starting first the emergency diet and then balancing his hay, he no longer has any signs of sweet itch!
You also state that "He is in a controlled IR and his spring insulin level was 24.3, also in the normal range." Here is a link to the IR calculator. http://www.freil.com/~mlf/IR/ir.html Plug in your numbers to see that an insulin of 24.3 puts Opie in the "severely IR" category. You didn't say what his glucose was, but just to give you an idea, I put it in as 80 and then again as 100 with the insulin of 24.3, and both times it comes back "severely IR". The labs normals are too high. The freil calculator is based on the IR pony field study, 7th file down in this "insulin resistance" folder: https://groups.yahoo.com/neo/groups/EquineCushings/files/Insulin%20Resistance/
I may be confused, but are you currently hand walking and trotting Opie? A laminitic horse should never be forced to move. You don't want to compromise the fragile new lamina connections. It would be very helpful if you could post some pictures of Opie's feet for one of our hoof gurus to have a look. Here's a site that shows how too take good hoof photos: http://www.all-natural-horse-care.com/good-hoof-photos.html
Maggie, Chancey and Spiral in VA
EC Primary Response