Re: Baby is worsening
Thank you for putting your information in a Case History. Please be sure to re-read the information sent by Martha earlier today. https://ecir.groups.io/g/main/message/265527 It's a lot to take in.
What jumps out at me is that Baby's ACTH is above the normal range at the time of the year when it should be at the lowest and that her insulin is high enough to be within the range that can cause hoof pain and laminitis. Some horses are very sensitive to uncontrolled PPID which we measure through ACTH. My own PPID horse was diagnosed in May at the high end of the normal reference range. She was dead lame and her insulin had spiked.
An increase in pergolide dose may help Baby. Prascend is an expensive unpleasant-tasting medication. With difficulties getting Baby to take Prascend, your vet is justified in prescribing compounded powdered pergolide in a capsule with flavoring that is almost sure to be easier to feed in a pill pocket or a handful of safe feed. ECIR files contain information about compounded pergolide, including a list of compounding pharmacies. https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20%20PPID/Cushings%20Disease%20Treatments/Pergolide/1.%20Compounded%20Pergolide Pergolide must be given every day to be effective. Skipping doses will result in uncontrolled PPID, worsening Baby's pain. I suggest you find pergolide in a potent form that you can easily feed every single day.
The best way to remove hoof pain is to remove the triggers for laminitis. Suspect #1 is uncontrolled PPID as indicated by the ACTH. Suspect #2 is hay that is not safe for a horse with Equine Metabolic Syndrome and/or PPID. Please post a copy of your hay analysis in your Case History Folder. Details in the analysis are important. If you have a pdf file, post it in the case history folder. If you have an image file (like a photo from your phone), post it Baby's Photo Album. It's not a dig against the reputable grower that the hay isn't quite suitable for a laminitic horse. You're in an emergency. As Dr Kellon said, soaking the hay is your best bet right now.
If you have hoof Xrays from your veterinarian, be sure to post them to the Photo Album for Dr Kellon and ECIR moderators who can read and interpret them.
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
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