Re: Was Jennifer and Darcy, back again. Now Darcy Diagnosis: PPID
Happy to hear that Darcy is feeling better. Great job on updated Darcy's CH! And thanks for the link to it. If you could include that in your signature every time you post, it helps us to find it faster. Thanks!
I have a couple of suggestions and a couple of questions. First of all, I am guessing that your vet did not order the glucose. It's always the first thing that comes back when I do my labs and also does not say "pending" on the copy of your Cornell labwork. When you contact him, ask him to call Cornell and have them add it. They will still have your blood sample, so it shouldn't be an issue. You should be getting the leptin back any day now. It's always the last thing to come back, for me anyway.
When you start the pergolide, you want to wean Darcy on to it slowly to avoid the pergolide veil (depression, lack of appetite) that some, but not all horses experience when first starting the drug. We recommend that you start with 0.25mg for 3-4 days and increase by 0.25mg every 3-4 days until you reach your target dose, often 1 mg to start. Once at your target dose for 3 weeks then you will want to retest the ACTH to see if that dose is controlling the ACTH. The goal is to get the ACTH down into the low to mid 20's. More reading on the seasonal rise can be found here: http://www.ecirhorse.org/index.php/cushing-s-disease/seasonal-rise If you are using compounded pergolide, you can order 0.25mg tabs to wean on. If you are using Prascend, they are scored to break in half, but not recommended to break into quarters. In that case, you can break one in half, which is 0.5mg, and dissolve half in 10 cc of water. Administer half of that (0.25mg) and save the other half in the frig for the next days dose.
Another really helpful thing to avoid the pergolide veil is a product called APF. You can buy it at some local tack and feed stores, online, and also on their website: http://www.auburnlabs.com/html/eqProdGen.html You may want to have some on hand before you start the pergolide. I see in your CH that Darcy has periods of poor appetite. I bet that has more to do with her PPID than boredom with her low sugar diet, and that once her ACTH is under control, you will probably see a resolution of that as well as the rain rot.
I don't see a current hay analysis in your CH folder, so don't have that to go by, but I see that for your trace minerals you are supplementing 18mg of of Cu. That seems an unusually low amount of Cu to me and I don't see any mention of Zn supplementation. I could be totally off base, since my hay is always high in iron and I have to supplement lots of Cu and Zn to balance it. But just curious how you are balancing. IR and PPID horses benefit from a really tightly balanced diet, so if you post your hay analysis we can help you to evaluate that.
I see that Lavinia suggested that you post pictures of Darcy's feet in the PHOTOS section so she could have a look and see if you have an optimum trim in place. Also see that you do your own trimming. IMO, it's always great to have an extra set of eyes evaluating my trim, so it would be great if you could post both pictures of Darcy's feet, and those radio graphs that you are waiting for. Here's a site that shows how to take good hoof photos: http://www.all-natural-horse-care.com/good-hoof-photos.html You can just start an album in the PHOTOS section of ECH6 to put the pics and xrays in.
I also see in your CH that you are doing round pen work and riding Darcy in the RP. We highly recommend that you don't ride or do round pen work/lunging until half to 2/3 of the laminitic foot is grown out. The reason for this is that those tight turns of RP work and the extra weight of a rider can damage the fragile new laminae as they grown in. Hand walking in long straight lines with no tight turns is recommended until the damaged hoof grows out sufficiently.
If you have any trouble getting Darcy to eat her pergolide, just do a search of the archived messages. TONS of posts on this in the past! And also don't forget about the picky eaters checklist in the ECHorsekeeping files!
Maggie, Chancey and Spiral in VA
EC moderator/Primary Response