Re: Veterinary Help With Cushings


Hi Judy,

I just wanted to add a few words of support. My Arabian mare's PPID condition was confirmed by the dex suppression test as recommended by a board certified equine internal medicine specialist! Fortunately she didn't have any side effects. I later learned from the group about ACTH testing and have done this ever since.

Read and learn as much as you can about these diseases. You'll have to be your own horse's advocate. No vet, no matter how well meaning or devoted, has unlimited time or effort to devote to becoming the font of knowledge for every diseases known to mankind. This group sees more horses in a month that many vets might in a year or longer. Some just don't have the experience or the up to date knowledge provided by the group.

At the eight vet practice at which I work everyone could recognize a traditional PPID presentation. One of the three large animal vets sees most of the PPID/IR horses and prescribes Prascend. I doubt that any of them know about the Pergolide veil, titrating the dose and/or adding APF. Thankfully one of them  recognizes the research I do and signs my compounded Pergolide prescriptions. He knows that my horse is tested several times a year and asks me about the proper testing procedure for his patients.

There are all different kinds of vets out there. Some think they know everything and won't listen to you. Others admit they don't know as much but are willing to learn. Use the information from this group to empower yourself in dealing with a vet to find one you can work with for Rudy.

Good luck to you both.

Jennifer and Mill in TN
Jan 2011

Re: Veterinary Help With Cushings


Hi Judy,

So many of us have been where you are--overwhelmed and confused.  Know this--the DDT/E philosophy works!  All four aspects must be in place for the best results.  I have a couple of thoughts.

One, Diagnosis.  Since your vet did the DST to diagnose PPID, you don't really know for sure if IR is an issue for Rudy as well, but it looks highly suspicious for a couple of reasons.  A high ACTH can drive the insulin up causing IR as well.  Consequently, all PPID horses should be treated as though they are also IR until proven otherwise.  Like Mandy said, "avoid laminitis at all cost"!!  It will not hurt Rudy, even if he is not IR at baseline, to at least temporarily start the emergency diet, until you can get your vet on board with the recommended lab work, (ACTH, insulin, glucose and leptin on a NON-fasting horse).  Leptin resistance goes hand in hand with insulin resistance.  Leptin is the hormone that says "stop eating".  Your comment that Rudy has a voracious appetite and has gained weight, makes him very suspect to be insulin and leptin resistant, especially given that his PPID symptoms have been going on for "the past several years."

Here is the link to Cornell's website.  It's the lab that we recommend you send your blood work.  The bundled ACTH, insulin and leptin is $62 + $8 to add a glucose.  Ask your vet if he/she will do these particular tests for you.  They are explained in detail on our website, which Mandy gave you the link to.  He may (will) charge you more than what the actual cost is, but those 4 tests are what you need to know if you are dealing with only PPID or also IR at baseline as well.

 I also see that your vet is giving you a 60 day supply of powdered pergolide.  Please know a couple of things.  The compounded powdered pergolide IN CAPSULES is what we recommend, but the powdered pergolide in a jar will help you with your initial weaning on to the drug.  Make sure you stir the powder up each time you dose as the medicine and the carrier can settle and separate, and stirring will help you get more accurate dosing.  The reason that we recommend the capsules is that each time you open the jar of powder the drug is exposed to humidity and light and that has a degrading effect on the medicine.  The capsules help preserve the integrity of the drug within.  Still, we recommend that you order only 30 days at a time and keep it in the door of the frig.  Here is one place that you can fill a prescription that your vet writes you for pergolide:

You want to wean Rudy on to pergolide slowly to avoid the initial side effects that some but not all horses experience when starting onto the drug.  We call it the "pergolide veil" and the symptoms are depression and lack of appetite.  I know, it probably seems that Rudy could not possibly have a lack of appetite!  But it can be a sobering side effect if it does happen.  So you will want to start him with 0.25 mg/day for 3 or 4 days and increase the dose by 0.25mg every 3 or 4 days until he is at the target dose.  After at the target dose for 2 weeks we recommend retesting the ACTH to see if it is being controlled with the target dose.  There are also some other subtle symptoms that may help you and your vet decide if you are at the target dose.   Please read this scale of symptoms post from Patti:  Another thing that can really help with the pergolide veil is a product called APF, available at some local tack and feed stores, online, and through their website:

Please take the time to join ECH8 and fill out the case history form on Rudy.  Mandy has sent you a link, and an invitation as well.  It really does give us the details we need to help you better.

Maggie, Chancey and Spiral in VA
March 2011
EC Primary Response

Help with mare with Cushings and pain from arthritis


I need to get something into my Mare who has had cushings for about 6 years and now she has arthritis and is in pain She is walking stiff this is the worst she had been and winter is coming I have been giving her devils claw with yucca just found out you cannot give this to cushings horses.

Please if anybody knows of something I can give her to relieve the pain that she is allowed please let me know.

She is also on pergolide 1.25mg a day.

The devils claw and yucca were helping a little, I cant get her to eat but I have tried everything she is at a private home but they will not do the paste she gives them to much trouble for them to do it everyday.

Please if anybody knows of something safe for cushings horse I can give let me know, I am so confused about what to give her, she has never foundered but I read that a lot o this stuff will made her founder.

Please help me,

Thank you,


Re: Veterinary Help With Cushings


Hi Marian,


I would be most interested in reading the detailed protocol and all the findings of Dr Jennifer Davis you mentioned in your post:


“Dr. Jennifer Davis just in 2012 compared 21 additional formulations of compounded pergolide (as follow up to her 2009 study on aqueous pergolide on file) and once again, found huge inconsistency. One formulation from Wedgewood actually had NO measurable pergolide for the 180 days of study evaluation. Only 4 met the +/- 10% of stated 1mg label concentration from the compounder on Day 0 of the analysis.”


Since a prime purpose of this forum is for sharing data and facts about PPID, would you please provide this information to the group?  When and where was it published?



I’ve searched ivis, google, google scholar, PubMed, etc and can find no mention of this study, although the abstract for her original 2009 study is easily found on PubMed:


J Am Vet Med Assoc. 2009 Feb 1;234(3):385-9. doi: 10.2460/javma.234.3.385.

Effects of compounding and storage conditions on stability of pergolide mesylate.

Davis JL1, Kirk LM, Davidson GS, Papich MG.


For anyone interested, a more expanded version of this 2009 study can be found here, scroll down to the second last study at the end of the document:

The Effects of Compounding and Storage Conditions on the Stability of Pergolide Mesylate.

-Jennifer L Davis. PAGES 30-31 IMMUNOLOGY SECTION.




SW Ontario,  March 2005

Re: APF Dosage & Ok to give with Bute?

Deb Funderburk <hawkhilldeb@...>

Hi Stephanie-- I have been giving Cory 4 ml a day for months. I call it Magic Juice since he loves it so much and it smells so good. I ran out a few days ago and he seems less perky, so I know it is helping him. Thanks for the reminder to order it today. (Cory is around 750 pounds.) I would probably give him more if it weren't so expensive, but he seems to do well on the 4 ml. I don't know about the Bute since, thankfully, Cory seems to be able to do without it now.

I am interested in the gabapentin that King is taking. Can you discuss that a little, since my vet mentioned it last visit as a possibility to help with Cory's heel pain?

Deb and Cory in NC
July 2012

Re: Veterinary Help With Cushings


Nancy...and Marian,

>>>I sure hope Teri sees your post because it appears you haven’t followed those background discussions either. 

I sure did!   (I am the one who's pony is taking 32 mgs compounded pergolide caps (16 am - 16 pm) a day.)

Just for the record vet started Stormy on 1/2 mg Prascend in Dec. 2011.  (And no, we did not titrate up because he didn't know that we should) Thanks to finding this group and having a very open minded, willing to learn vet...he switched Stormy to 4 mgs compounded pergolide in Nov. 2012.   
And to repeat vet freely admits that if it weren't for the info from this group, Stormy would have been 6 ft. under a long time ago!  Unfortunately, like too many vets, he was not that well educated on Cushings or IR.  (He was also full of BI bologna!) 
My story is like so many others. I was getting bad advice from him and two other vets. Like...Safe Choice IS 'safe'!  Try Purina Sr....'not enough molasses to hurt her'.  When it didn't help her gain wt., I was told to try Enrich 32.  Sigh.... Then I pumped her full of NSAIDs to try to help the laminitis pain!  (As directed by the vets) Stormy was going downhill fast!  She spent the winter, and most of the spring, flat out on the ground.  She literally did not get back on her feet till I found this group!   I am not trying to bash vet is great....just lacked knowledge on PPID/IR. Like you Nancy,  I am extremely thankful he was open to the advice/collective knowledge of this group.

My head is spinning.
You go Nancy ...and Linda!!!!  

Teri and Stormy
Indy 4-2012

APF Dosage & Ok to give with Bute?

Stephanie Stout

Hi All, 

Does anyone have an APF dosage chart or any thoughts on dosages? I just ordered APF for my newly diagnosed Cushings & IR horse that is feeling really icky/loosing weight(with significant rotation). I'm still working on perfecting his Prascend dosage for what works for him. How much APF would you start him on? And, is it okay to give it with Bute? I'm weaning him off the Bute, but he's on 1gram every 30-36 hours right now. He's also on a painkiller(Gabapentin) right now until I can get everything under control as he can't do without it. 

Thanks so much.

Stephanie & King

Oct 2014


Re: Veterinary Help With Cushings


Linda, I am still trying to digest the information that has been presented and to see how it applies to my horse and how I might implement it. I am overwhelmed to get so much interest and support. :)



Re: Veterinary Help With Cushings


Yep, another here who's vet isn't very helpful with Cushing's, but thankfully she will write script for compounded pergolide, and this group is wonderful for information (sometimes to the point of overload, but Jasper is doing well thanks to that overload).


MT 9/04

Re: Veterinary Help With Cushings

Stephanie Stout

Judy - I just wanted to add that I'm going through a similar situation, so hang in there. I'm having heck of a time getting vets( that have very little experience with Cushings/IR) to help me out, so I have been doing most everything on my own(with the advice from this group, the websites, etc) since the vets are being quite challenging. So, hang in there and start reading :) 

Member since Oct 2014

Re: High WNV Activity-Give Shot?


I gave Fionn one back in May and he was fine.  I gave it alone, not combined with other shots and gave him a day off from work.    He’s PPID and IR and 18.  There is too much risk here in KY, so I don’t feel like I have a choice.  Every horse is different, of course, and only you can decide.

Re: Drs Little & Gockowski

Lorna Cane

Thank you for saying this,Judy :

>I knew Dex Suppression was not good from research I did.  But never dreamed the famous vet in our area would test that way!!!  I thought he was an expert!  I doubt he has time to learn about treating Cushings since he only has three Cushings horses in his large practice.  My regular vet knew even less, just treated one horse for it 15 years ago!!!

I wish I had a Loonie (dollar) for every one of our members (we are almost 12,000 strong now) who has expressed similar experiences/expectations here,over the past 13 years.

I hope Marian is reading.

Lorna in Ontario,Canada


Re: Veterinary Help With Cushings


Judy -

Please, don't pick and choose!  Go back to Mandy's post that was written to you from an owner's perspective, and her many, many years volunteering on this list - this is not just chat info but cutting edge information on how to manage a horse with cushings.  It is what has kept my boy, 21, with 10 years of cushings on a sound and happy road.

Your comments about the two vets in your area are exactly what Dr Little needs to understand exists in OUR universe.  Not her non-clincal universe. 

I thank you for making that point for us.

Please.  Reread what Mandy has to say.

EC Primary Response
West Coast
May 2004

Re: Drs Little & Gockowski

Lorna Cane

Thanks for your post, Kerry. Your tone made me smile, wryly.

This caught my eye.

>I've used many compounded Rxs through the years and have a handful of 

proven pharmacies that I trust to formulate meds so I am completely 

comfortable using compounded pergolide. 

In our Files is a post from the pharmacy many of us in Canada

 use,concerning quality control.Seems to me we should be careful not to 

lump all pharmacies in the same pile wrt  efficacy,as Marian continues to do.

Here's the post, in case NEO screws up the link:

"In November,2010, Island Pharmacy ( then known as Shawnigan Lake People's Pharmacy ), B.C., sent 15 capsules from 2 lots of Pergolide Mesylate powder, to the lab for analysis, covering the powder that had been used over the last 6 months.

They also sent both new and old capsules (capsulated for 3 months)

The lab results said they were stable and compounded 1mg Pergolide Mesylate capsules with a measured 0.949mg/cap which is where the USP guidelines says it should be for compounded medication.

Please contact Kathryn Davies <shawnigangirl@...> if you would like copies of the results."

Lorna in Ontario,Canada
ECIR Moderator 2002
*See What Works in Equine Nutrition*

Support the ECIR Group while you shop. It's easy.

Re: Veterinary Help With Cushings


Elva, you are the reason I joined this list.  :)  I knew Dex Suppression was not good from research I did.  But never dreamed the famous vet in our area would test that way!!!  I thought he was an expert!  I doubt he has time to learn about treating Cushings since he only has three Cushings horses in his large practice.  My regular vet knew even less, just treated one horse for it 15 years ago!!!

I appreciate everyone's comments and advice.  I can pick and choose what seems most helpful in Rudy and my situation.  He is only 15 and I would like to continue riding him.


Re: Drs Little & Gockowski

Kerry Isherwood

Drs. Little & Gockowski--

Thanks for the levity afforded by your ivory tower espousals--it sure breaks the tedium of dealing with actual problems like laminitis, euthanasia, and heartbreak.  A good chuckle is always good for the soul...wait--what is that saying--"Laughter is the best medicine"?--but only if you're licensed to prescribe it in your state, right?

As a veterinary professional with a recently diagnosed PPID horse, I obtain Prascend *at cost* from our distributor and can afford the initial 1mg/day dose, but if my mare's dose increases I am going to buy compounded--Prascend's cost even at wholesale prices borders on ridiculous.  I've used many compounded Rxs through the years and have a handful of proven pharmacies that I trust to formulate meds so I am completely comfortable using compounded pergolide.  I bluntly told my BI rep this.  You gotta do what you gotta do, you know?  Well, maybe you don't--the view is rosy from the ivory tower high above the rest of us.

Again, thanks for the chuckle--now back to reality,


Kerry Isherwood, LVT-VTS(ECC)
Licensed Veterinary Technician, Vet. Tech. Specialist (Emergency & Critical Care)
Brewster, NY
Sept 2014

Re: Med dosing with quidding


I have used a pitted prune at Dr. Kellon's suggestion, Can your mare deal with that?

I place a small plastic dishpan under my pony's chin while feeding the pill. That way the pill can be seen if it drops from his mouth.

Bonnie Ivey, Ontario 12/08

Re: Veterinary Help With Cushings

Nancy C

Sorry Marion but I have one more comment...

If you or Dr Gockowski would be willing to share Dr Davis's 2012 pergolide study, Id be happy to put it in the files.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
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Help horse foundering again


Hi everyone I have a 14 year old QH who foundered last year from what we suspected of being over fed grain. I had someone taking care of them for a weekend and she way over fed her. She came back from it fine no rotation. Now it is almost a year to the day and she has been on a strict no grain or grass diet with safe tested hay. Today I noticed the stance and she was unwilling to walk. Called the vet out and sure enough it is founder again. She has had no change to her diet this time it is bad the worse she has ever been. We are padding her feet and giving her bute I am trying to get my farrier out since she is due for a trim. She wants to wait to xray until after she is trimmed. I am just so upset I don't understand I was doing everything right. I am worried if this keeps happening I am go to lose her. Has anyone ever delt with this before and maybe can give me some advice. I should mention she has very little sole depth. I did have her pull blood for a lymes test since ticks are all over here and it is a big problem. He legs are swelled up as well.

Brittany and Dream WI

Re: Veterinary Help With Cushings


I do not have a place to dry lot Rudy.  He has never shown any foot tenderness or laminiticsymptoms.  I have tried to watch his weight, putting him in the corral overnight when grass is rank and when he is getting free choice hay in the winter.  For the past several years he has grown a four inch long winter coat that does not shed readily.  He has had a voracious appetite and gained weight.  All my saddles quit fitting till I got a Skito pad to fill in his topline.  Lately, he has lacked his usual energy.

I never dreamed that the premier equine vet in the area would give the dex suppression test!  But I left him there for it, knowing that he was not founderprone.  He got 4.4 on both blood draws.

The vet is sending me his test results plus a 60 day supply of powdered pergolide for $116.00!  I am to give a mg a day.


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