Searching archives and interpreting ACTH results in fall
Hi, I'm not new to the group but have been without an EC/IR horse for 9 years now. But now my 19 year old is exhibiting some issues so we tested insulin, glucose and ACTH.
Trying to catch up on things since a lot of new information has come out since I was following the group so closely. Some of the oldies on here remember Magic, my work to get ODTB cubes to TX, testing some feeds, etc.
We are in the middle of our son's wedding planning and a trip of our own to follow and have limited time to search, read and catch up or post this new case history so I'll get to the point of my question and get to the case history in a couple weeks.
I found the Liphook graph of ACTH values through the months of the year by searching on the archives. I was surprised that isn't on the ECIR website, just info about the seasonal rise, which I knew already.
With that site, http://www.thelaminitissite.org/ppid-faq/acth-interpretation, was the more recent 2016 study and graph by Durham. It is showing by week 37 (our test date was Sept 14) normal range could be in the upper 40's.
I know testing in fall is discouraged but we needed to find out what was going on. Grayson tested at 58.7 (the lab showed normal range 9-35). So he is above that upper 40 number on the graph. I'm just wondering how off of normal this is. Is he early stages but definitely PPID? Vet wants us to start on Prascend. I'm assuming Pergolide is no longer available like from Ian Hudgings? He is prescribing 1 mg/day. Do we need to start at a lower dose and work up to the 1 mg? That was the old knowledge that I had from 10 years ago. If so at what do we start and how quickly do we work up? Leaving my horse in the care of others is a little unnerving in that I can't see side effects as they begin if I'm out of town, so am also wondering how quickly we need to start this. Like ASAP or sure wait a couple weeks.
Until I can fill out a case history here is what we are dealing with.
For about 3 weeks now he has had a little swelling in the tip of the sheath and his crest has gotten hard. He was getting way too much hay as the 2" hole hay net allows way too fast of consumption and we have now rationed down to the 1.5% body weight amount (he was consuming 25 lbs a day and now we are at 15-17 lbs a day). Vet body scored him 7.5.
He is off the Purina Equine Sr that he had been on when we moved from the boarding facility, but still on when tested. His G:I ratio came out to 1.46 coming off the Sr feed (1 lb a day), unlimited hay and grass. No laminitis at this point.
We went from no grass to rain season and lots of grass so he is off the pasture and stuck in a stall and run for now. Have ordered a grazing muzzle so he can go out and move around and 1" hole hay nets to slow his hay eating so he doesn't go long periods without.
His current diet in addition to the 15 lbs Timothy hay is 8 ounces twice a day of TC Balancer with 9.2%ESC & 1.8%starch. He has been on a daily amount of less than a pound of alfalfa cubes which has helped prevent his impaction colics that he used to get. But the easy to soak large pellets from Dumor have molasses added so we are back to long soaking alfalfa cubes or pellets. I really don't want to remove this bit of soaked alfalfa cubes if possible. He also gets salt, Vit E and joint supplement which I can get amounts into the case history in a couple weeks. Just throwing this out there because I know I will be asked.
Oh and his sheath swelling has gone down today - yay!
So sum it up, questions are
1. can we trust the ACTH value to show PPID when done in September?
2. whether we need to work up to the 1 mg Prascend and how much for how many days?
3. can I wait a couple weeks to start it so I can observe him for side effects or get going asap?
4. is Pergolide still available somehow?
5. how quickly will a crest soften once we have worked on the diet? That was a symptom Magic did not have. He had the sunken eyes (which went away on treatment), sheath swelling (especially if he got ahold of leaves), long hair coat (never went away). From what I remember every horse is different and I have to learn what the symptoms are on this horse and what they mean for him as far as IR and C's.
19 yr old TWH gelding Grayson
Restarting 2018, but with group since 2005?