Re: Pigeon fever treatment

Leigh Jacobs

As a CVT, I have seen several cases that have needed much stronger medication.  Cetiofur containing medications have been the choice of my veterinarian, especially with elderly, immune compromised horses.  Educate yourself on this particular med as well as others such as rifampin in combination with other broad spectrum anti bacterial meds.  And first and foremost, do not discontinue use of the medication until told to do so.  Twice now, we have had people stop using the cetiofur before they should have and ended up having to add rifampin to the treatment course.   These drugs are not cheap.  Medication alone can run up to $1k, therefore once you start, you don't stop.  Dr. Kellon will have to answer the question about how it has an effect in Cushings/IR horses.  I know that I would be very nervous with my EMS horse. I do my best to keep flies down in their stalls and acreage preventing exposure by cleaning twice daily.  And spray the fly spray twice daily, use fly traps etc. If I could get the stable owner to treat all horses with a feed fly control product, I would.
In response to the ACTH draw, I spoke with my doc about this.  He prefers to check in March (during the bump up) and during the fall rise.  We are in Arizona and this may differ with other areas.  I test 4 times a year, because I can.  I do a full panel in the fall, and every few months pull blood for ACTH.  I want to know that the compounded pergolide is doing its job and keeping Ace in the low normals and as a result, will adjust his medication as needed based on results.
Just my 2 cents worth.
Leigh, Ace and Shadow
Tucson, AZ

On Monday, January 30, 2017 11:52 AM, "Jill, Khari & Jetty in Idaho via Groups.Io" <kharimom2001@...> wrote:

First off, apologies for not updating my case history before posting this but it will not save for some reason.  I keep getting a message box that says I need to use "ODF format" but when I choose that, it still does not save.  I will get some help on that when more tech savvy son comes.  
For now, I have a treatment concern regarding my IR and likely PPID gelding. He has for years developed an edematous sheath when not exercising regularly.  I have assumed it was associated with his age (nearly 20 now) and metabolic status.  Last October, he presented with unilateral pitting ventral edema that included the sheath and one hind leg.  He was diagnosed with Pigeon fever and put on SMZ/TMZ for 6 weeks.  The abdominal and leg edema went away and the sheath decreased significantly but not to normal.  During his treatment course, I read in the files that sulfa drugs are not recommended for PPID horses so I after the 6 weeks, I hoped that the rest of the swelling would go away with exercise.  He has never acted "sick" during this time.  Unfortunately our weather here took a record-setting turn for the worse and we have been under a permanent layer of snow and ice since Christmas so no one is getting any exercise.  The horses are moving very little on their own due to the unrelenting icy conditions.  

His sheath has been slowly getting more swollen and today I noticed a patch of the ventral edema again.  The vet wants to start him back on the TMZ. I told the vet at the initial diagnosis in October that Khari had an ACTH of 49 over a year ago but has not been on pergolide because the (different) vet who drew the blood thought it was not so far out of range and was probably due to the extreme stress created during the blood drawing process. (yelling & rope yanking by the vet, Khari rearing & running - followed by him standing for draw but quivering all over while I held him). Also, he would not prescribe compounded pergolide and my finances were at the breaking point. Anyway, the new vet who diagnosed the Pigeon fever (at a highly regarded equine hospital here) believes the only way to diagnosis PPID is with the Dex suppression test which I don't want. Also, he didn't think we should do any metabolic testing while Khari was ill with the Pigeon fever.

So. Questions.
 #1:   Does anyone have any experience with treating Pigeon fever with something other than SMZ?  
#2:  Could all of this edema still be connected with either his IR status or PPID?  Or something else?
#3:  Is it too early in the year to have an ACTH drawn?  Assuming I can find yet another vet who will do the ACTH and not abuse my horse?  The current vet is a good horse handler and had no problems drawing blood for the CBC  - but is adamant that an ACTH alone is not an accurate diagnostic tool.
Thank you!
Jill, Khari & Jetty in Idaho
NRC Grad 2010

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