Re: Searching archives and interpreting ACTH results in fall


Lavinia Fiscaletti
 
Edited

Hi Kathy,

I sure do remember you and Magic. Welcome back, sorry you find yourself in need again.

A couple of questions for you: what were the results of the insulin/glucose tests? Where was the blood work sent?

Testing during the seasonal rise is fine to check the status of an already confirmed PPID horse. Testing for the first time can be a bit of a grey area. Grayson's results are hinting at early PPID but aren't undeniably positive as older horses in general tend to have ACTH levels that are somewhat higher than young horses show. Whether to start him on pergolide or not is a bit of a judgement call at this time as seasonal rise is peaking now, with ACTH also topping out and starting to drop over the next month for non-PPID horses. If you opt to start him, definitely titrate up the dose. A small dose of pergolide is not likely to hurt even if he isn't PPID, may help, and could be stopped after the rise period in order to retest without the seasonal influence in play. Because he has had no signs of laminitis, you could probably just make sure the diet is really tight and opt not to start the perg now then plan to retest him after the rise or in April for a more definitive answer. I know, clear as mud :(

Compounded pergolide is available with a script but now that the patented, equine version Prascend is on the market, many vets don't want to prescribe the compounded. Here's the list of compounding pharmacies that members have used successfully should you go that route:

https://ecir.groups.io/g/main/wiki/ECIR-Links

He's definitely IR but without a leptin test it's unclear whether this is baseline IR or only being driven by the seasonal rise. Being a TWH makes it more likely he's baseline IR and the seasonal influence has exacerbated that tendency even without PPID. You're already working on getting the weight down. Good on stopping the Senior feed. The TC ESC+starch numbers are only averages - not a guaranteed analysis for every batch. Whether it is a good match for your hay or not is unknown unless you have an anaylsis for the hay. If the alfalfa isn't bothering his feet, no problem to keep using it as long as you are taking it into account in the mineral balancing as it is adding significant calcium to his ration (6-7g per pound). G

Crest should soften fairly quickly, esp if it is a new symptom, once the diet is tight enough and he loses the extra pounds as that is an IR symptom. Make sure the muzzle is sealed - no grass - for turnout. Be careful not to cut his hay allotment back too quickly to lose the weight as that can backfire on you by having his system go into thinking "starvation". Feed him either 2% of his ideal weight or 1.5% of his current weight in soaked hay daily - whichever amount is larger. Adjust downward as he loses weight.

HTH.

--
Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team

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