Switch from Pergolide to Cabergoline – Update and Questions


Angelika Busi
 

Although we are still at the very beginning of the cabergoline route, I would like to give an update and have questions on how best to continue.

1st cabergoline injection (0.5 ml) was given on June 19; about 24 hours after her last 21 mg pergolide dose;
2nd injection of 1 ml followed on July 3,
the 3rd one of 1 ml was on July 16. 

Qiqi’s ACTH on June 16 (still on 21 mg of pergolide) was 70.5 pg/mL
Her ACTH result on July 15, 5 days after her 3rd cabergoline injection was 90.6 pg/mL (all Cornell). I pushed it forward to avoid testing in the early stages of the seasonal rise.
Interestingly, her ACTH a year ago, from July 25, 2019, was 126 pg/mL, although at that time she was only on 11 mg pergolide. We have been chasing the numbers for more than a year. 

The injection sites were alternated each time. She had a reaction the last time, when it was given in her right pectorals. The next morning the injection site was swollen (but not hard or warm) and the swelling increased by the evening. The following morning it looked worse, was warm, hard and the swelling was starting to move downwards. I gave her a dose of bute, although she was not sensitive to touch.
At the first sign of the swelling, I started cold hosing, red light therapy and hand walking her am and pm and the swelling was gone 6 days later. 

APF was administered each time several days before and after the injections.  Although Qiqi had never shown a “vail” on pergolide, she ate less for a few days after the injections, although she put her nose immediately into any food offered to her. The mare doesn’t have any weight issues and I am not worried about a few days of pickiness. She also had a bit looser stool (not diarrhea) during these few days. There was no sign of dullness or depression at any time, although she was not happy on days with high temperatures and humidity. 

After the first 1 ml injection she started shedding. During this summer, I already had clipped her repeatedly because she still had so much coat.
Her main symptom, the udder swelling, seems to go down a bit after the injection, but is all back by the time of the next one and was never down as much as I had hoped for. 

My plan was to retest her ACTH again after 4 injections with 1 ml, as suggested by Dr. Kellon 10 days after the 4th dose and again on day 14 before the next injection to also check if the interval is sufficient. 

Despite recalling that it was the experience of other members too that initially their horses ACTH was higher after only a few injections and that the body needs time to adjust, it makes me nervous that the seasonal rise is coming up and she is possibly already experiencing it. 

Should I proceed with my plan as laid out above or would it be better to already increase the dose to 1.5 ml? Or should I stay on 1 ml and shorten the interval to 10 days?
Please advise. Thank you. 

Angelika and Qiqi & Apollo

https://ecir.groups.io/g/CaseHistory/files/Angelika%20and%20Qiqi%20-%20Apollo/Quqi

https://ecir.groups.io/g/CaseHistory/files/Angelika%20and%20Qiqi%20-%20Apollo/Apollo

NE Illinois

September 15

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