There is no such thing as "not at immediate risk" with PPID/IR. That only exists in your mind as a denial/defense mechanism until you are willing or able to understand the true pathology of PPID
I am a veterinary professional. I embrace a conservative, "less is more" philosophy when treating my pets/horses as well as my clients.
My IR mare was -- what I thought -- very well controlled by my excellent, researched-based husbandry throughout her life and I was happily competing in sanctioned horse trials last year. We won enough events to qualify for our regional championships and i packed up my super fit 20yo mare for the 6-hr drive to the two-day champs in August. First day of show, mare was fantastic in dressage phase and I had high hopes! Second day of intense showing, my mare literally couldnt/wouldnt move and I had to scratch. Bloodwork showed that her insulin had spiked dangerously high from the stressors of the long haul & show pressures and from her then un-diagnosed PPID. I know now that she couldnt move bc she was sub-clinically laminitic
The rest of August was terrible -- her IR became so uncontrollable despite my educated efforts that she reached diabetes mellitus status. I was despondent bc outwardly my mare looked pretty good but her bloodwork showed she was at severe risk of founder. How could my super fit mare be winning horse trials one day and "about to founder" the next, esp when she looked ok?
IR/PPID horses "look ok" until they dont, and the dont phase is almost always laminitis. Theres no gradual, graceful easing into this disease: its a terminal disease that, fortunately, can be slowed tremendously well with pergolide. The cold hard fact is that PPID will be what kills my mare, whether its founder, insurmountable infection, parasites, etc. I accept that.
Fortunately, I found this group and Dr Kellon looked at my mare's case and theorized that despite normal eACTH levels she may still be a very early PPID. With all other medical treatments exhausted and no vets willing to help me, I tried pergolide -- and it worked: my mare's out-of-control insulin came down and is able to be controlled once again with strict diet and exercise. She is still, and always will be, at high risk for laminitis
Im a vet tech and own my own hospital, so I could draw blood anytime I wanted to check my mare's status. With these resources I was pretty confident I was beating the odds by controlling my mare's IR with frequent blood checks, educated & strict diet, and exercise -- she's an event horse: isnt that the epitome of fitness? 10+ hours a week of gallops, ring jumping, cross-country?
I am now humbled from last fall's scare and I now understand & respect the disease that is slowly killing my horse. There is only one known medical treatment that is proven to potentially slow its progression (pergolide). There is no cure for PPID, so to put it bluntly, any other "treatment" is merely implementing hospice measures, in my view.
Kerry Isherwood, LVT-VTS(ECC)
Licensed Veterinary Technician,
Emergency & Critical Care Specialist
Pinky Sept 2014
Tofurky Nov 2014