Corrine and Kerry, I'm not piling on. Heaven knows it's taken me years to get things straight in my head, much less get DDT&E dialed in. I know how hard this is to hear when you're already dealing with a host of horse problems and chores. PPID is a moving target.
Dr Kellon said it the best (and this is a crude paraphrase of her actual words that got it through my thick head): If PPID is uncontrolled, all the dietary interventions in the world will not fix your horse's insulin resistance.
I'm working on this very problem right now (again!). Diet is tight with tested low S+S hay and balanced minerals. Management is tight in a dry lot. Trim is tight. But my mare's insulin tests at a level that is twice as high as any earlier result. So because my horse has PPID that is usually poorly controlled, the first order of business is to limit the variables and make sure ACTH is within an acceptable range all day long. When the symptoms won't go away, I know of no way to do that without testing or involving your vet in experimentally adjusting the dose of pergolide (which some are very reluctant to do).
After weeks of temperatures in the 90's and 100's, I more fully appreciate the logistical difficulties of handling spun down plasma for accurate ACTH testing. Keeping a sample at 39 degrees is a practical impossibility for a hard-working vet like mine who leaves the office at 7:30 AM and gets back after 6PM (or 8PM or 9PM). Which is why I bought my own simple centrifuge on Amazon to help out. I know that's extravagant, but around here, $165 for a centrifuge is $100 less than a farm call, shipping and lab testing done with mishandled blood. With an ice bath available at the time of the blood draw, we can spin down the blood here, draw off the plasma, store it in my freezer, and my vet can pick it back up later in the day on the way back to the office/lab.
I wish both you and your horses all the best.
Cass for Satra
Sonoma County, Calif. Oct. '12
---In EquineCushings@..., <threecatfarm@...> wrote :
Every time this comes up I am still left with the same question.
Did her insulin come down because she had better controlled ACTH or because she got off the Cubes. I don't think that has been separated out.