Date   

Re: compounded pergolide

PapBallou@...
 

How di this vet come to think the group recommends compounded pergolide?  We have stated the differences between the two forms, and recommended that if compounded is used, it is used within specific, tight guidelines.

As far as the 'cloud', Dr Kellon posted what the Equine Endocrinology group, started by the company that manufactures prascend, has to say about the 'veil'.

The uselessness of a support group - well, there wouldn't be one that is 12+ years old, with about 12K members if cushings was just so straight forward...and BI wouldn't be investing in many, many seminars if there wasn't a huge void in the total understanding of cushings by so many vets.  It's this cushings and all its ramifications is simple that would have my two horses already in the ground.

Linda and Pap Ballou
Western NV
May 2004


---In EquineCushings@..., <lj_friedman@...> wrote :

My vet emailed me this. I'm not looking to start a riot on the web,, just want to make sure that by getting pergolide at Pethealth Pharmacy instead of prascend. I am doing what is best for the horse. I would regret causing problems to save money.. but everyone wants to save. 
From the vet:

I am glad you guys decided to further pursue the Cushing's. However, first of all I do not understand why a Cushing's support group is needed. This is very straightforward test and treat. As far as the pergolide cloud goes I have close to 100 horses on medication and I've had one with an issue when starting the medication, it's not something to really worry about. Second of all I would never use a group that recommends compounded medications they are very ill advised an uneducated. There are very few instances we even use compounded drugs in general on horses and it's definitely not to just save money. There is many studies that show compounded drugs are not efficacious, specially in regards to Pergolide. So, I will not fill a script for compounded  Pergolide. If you want me to approve the medication then you can get it on my online pharmacy which you were set up for, for Prascend. Thanks

Sent from my iPhone

 I 'm told that aprox 30% of horses get the veil/cloud.  And yes, I know this is the vets own pharmacy

Lj Friedman san diego nov 2014


Re: compounded pergolide

lj friedman
 

My vet emailed me this. I'm not looking to start a riot on the web,, just want to make sure that by getting pergolide at Pethealth Pharmacy instead of prascend. I am doing what is best for the horse. I would regret causing problems to save money.. but everyone wants to save. 
From the vet:

I am glad you guys decided to further pursue the Cushing's. However, first of all I do not understand why a Cushing's support group is needed. This is very straightforward test and treat. As far as the pergolide cloud goes I have close to 100 horses on medication and I've had one with an issue when starting the medication, it's not something to really worry about. Second of all I would never use a group that recommends compounded medications they are very ill advised an uneducated. There are very few instances we even use compounded drugs in general on horses and it's definitely not to just save money. There is many studies that show compounded drugs are not efficacious, specially in regards to Pergolide. So, I will not fill a script for compounded  Pergolide. If you want me to approve the medication then you can get it on my online pharmacy which you were set up for, for Prascend. Thanks

Sent from my iPhone

 I 'm told that aprox 30% of horses get the veil/cloud.  And yes, I know this is the vets own pharmacy

Lj Friedman san diego nov 2014


Re: Please help. New to all of this.

Tiffany Woodward
 

Lavinia,

I have added a few pictures of Maggie's right front in my album.  I'm sorry they are not the best quality, but hopefully they'll give you an idea of what that foot looks like after the farrier worked on her last Monday.  I have not been able to get pictures of the left foot, since she's still unwilling to bear weight on the right for more than a few seconds.  And I have not been able to catch her laying down long enough to get pictures either.

She definitely improved after a trim last Monday.  We cut the pads in her Soft Rides down even more as well.  Tuesday, Wednesday, and Thursday were really good days.  She was moving around just a little better, rocking back less, and even seemed just a little more comfortable on the right foot with the crack.  Friday-Sunday she's been a little less comfortable...not as bad as she was before the trim, but not as good as she was right after.  We had a sudden cold snap Thursday night into Friday, but I'm not sure I can really say that's related to her level of discomfort.  It's warmer today, and she's still pretty sore.  Although maybe a little better than Friday/Saturday?  It's hard to say.

Tiffany Woodward in NC
Nov. 2014
https://groups.yahoo.com/neo/groups/echistory8/files/TiffanyWoodward%20and%20Maggie/

  https://groups.yahoo.com/neo/groups/echistory8/photos/albums/540173897

 


Re: Cushings??

Lavinia Fiscaletti
 

Hi Rachel,

Welcome to the list. We are going to need a bit more info from you regarding your girl so ask that you please fill out a case history for her on our sister list ECHistory8. You'll need to join but I'll send you an invite so that it will be easy. Here is the link to the site:

https://groups.yahoo.com/neo/groups/echistory8/info

Dr. Kellon has already addressed part of your question regarding the bald patches. We follow a protocol here that we call DDT/E, which is just shorthand for Diagnosis, Diet, Trim and Exercise. Our website is a good place to look for all the basic information regarding Cushings (PPID) and Insulin Resistance (IR). Great place to send your vet too:

http://www.ecirhorse.org/

PPID and IR are two separate things but can have many overlapping symptoms. A horse can be either PPID, OR IR, OR neither OR both. PPID, a disease, is treated with medication with pergolide being the gold standard. IR is metabolic type rather than a disease and is managed with diet. Many PPID horses will become IR over time so watching their diet is a sensible way to head off additional trouble down the line.

DIAGNOSIS: This is thru bloodwork. We trecommend having ACTH, Insulin, Glucose and Leptin tests done on a blood sample taken from a NON-Fasting horse. Also recommend that the samples bee sent to Cornell as that lab has been found to have the most reliable and consistent results. What tests are you having done and where was the blood work sent? Please ask your vet for an actual copy of the reults when they are received so that you can pass that info on to us. We'll need the actual results, units of measure and the lab's normal ranges. What is prompting you to consider your mare may be PPID?

DIET: Is forage based, low sugar/starch/fat with minerals balanced to the forage analysis. Until you know for sure what is going on using the emergency diet is a smart move. That she seems to have responded well already makes IR a very real possibility. We recommend having your hay tested at Equi-Analytical using the Trainer #603 package. Once you receive the results, there are people here that can help you build a custom supplement to work with the forage you have so that you are correctly filling all the dietary needs.

http://www.ecirhorse.org/

TRIM: An important part of the program but one that is often times overlooked. Toes backed and heels low so that the hoof capsule is tightly hugging and supporting the internal structures. Encourage you to post pics of your mare's feet in the Photos section of ECHistory8, that way we can assess her trim and help to make sure it is optimal for her. Here is a link to how to take good pics:

http://www.all-natural-horse-care.com/good-hoof-photos.html

If she is in any way sore footed, we recommend using boots and pads for comfort.

EXERCISE: Best thing for an IR horse but never force a sore horse to move. Need to be especially careful if there is any NSAID use as this can allow them to do too much too soon and do more damage to themselves.

Ask any questions as they come up - we're here to help. There are quite a few Canadian members here so you aren't alone and they will chime is too. We also have a file specifically for sourcing things in Canada.  We know we throw a lot of info at you in the beginning but it will become easier as you go along - promise :)  Also understand that this is made more difficult because you aren't  a seasoned horse owner so you are getting hit with a double whammy. Just remember to breathe and take things one day at a time.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team


Re: Mixing pain medications

kansteen5545@...
 

Hi Dr. Kellon
Your answer was the information I was looking for - what actually happens at a cellular level. Thank you.
Karen
Scarborough,ME
May/2014

---- "drkellon@... [EquineCushings]" wrote:

"laminitis caused by endocrine disorders, IR, is not primarily an inflammatory process like it is in other causes of laminitis."
= = = = = = = =

In laminitis triggered by plant or bacterial toxins, there is inflammation which activates the MMP enzymes, breaking down the basement membrane of the laminae and causing an influx of which blood cells. In IR induced laminitis, there is no enzyme activation or white cell influx. The exact details are not worked out yet but a key element appears to be elevation of endothelin which is a very potent vasoconstrictor.


Winter Laminitis

Nancy C
 

We've recently had questions about winter lamintis both here and on Facebook and wanted to share  links for more info.

First is Dr Kellon's blog post about what makes winter laminitis different:

http://equine.uckele.com/Resources-Articles/cat/drkellon/post/WinterLaminitis/

 


Member have  seen pain that comes after seasonal rise beginning with temps  even in the 40s starting back in 2003 or so.  Here's an early post

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/topics/70188

 

Links to files on adaptogens

  https://groups.yahoo.com/neo/groups/EquineCushings/search/files?query=adaptogen

 

A question on FB came up about ALCAR, so including that link here too

'https://groups.yahoo.com/neo/groups/EquineCushings/search/files?query=ALCAR

 

Nancy C in NH
ECIR Moderator 2003

Support the ECIR Group nonprofit and gain valuable info to help your horses through recordings of the 2013 NO Laminitis! Conference available for $50 or $75 donation.

 

Table of Contents

 


Re: Mixing pain medications

Eleanor Kellon, VMD
 

"laminitis caused by endocrine disorders, IR, is not primarily an inflammatory process like it is in other causes of laminitis."

= = = = = = = =

In laminitis triggered by plant or bacterial toxins, there is inflammation which activates the MMP enzymes, breaking down the basement membrane of the laminae and causing an influx of which blood cells. In IR induced laminitis, there is no enzyme activation or white cell influx.  The exact details are not worked out yet but a key element appears to be elevation of endothelin which is a very potent vasoconstrictor.

Once tissue damage occurs, there is a natural inflammatory response as part of the clean up process but it is not the root cause so NSAID drugs have limited use.

The links Nanc posted give more details.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


Re: Mixing pain medications

Nancy C
 

Hi Karen

Not Dr Kellon, but here are two previous discussions that may get you started:

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/189869

 



https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/173596

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/155586

 




Good thread here
https://groups.yahoo.com/neo/groups/EquineCushings/conversations/topics/160714

 



This post is particularly good in discussing the issue of nsaids in general.


https://groups.yahoo.com/neo/groups/EquineCushings/conversations/topics/58964


 

The most effective way of getting control of pain is through identifying and removing the laminitis trigger, supporting the horse through correct diagnosis and control of PPID, control of IR via diet, and the correct trim, usually way more frequently than most owner, farriers and trimmers are used to.

Also recommend reading the proceedings from 2013 NO Laminitis Conference, specifically, Dr Kellon on Endothelin and Dr Bowker on Nerves, Suspensory and Vascular Cushion.

Table of Contents

 



Nancy C in NH
ECIR Moderator 2003

---In EquineCushings@..., <kansteen5545@...> wrote :

Hi Dr. Kellon -
Could you expand on this?
Karen
Scarborough,ME
May/2014
>
"laminitis caused by endocrine disorders, IR, is not primarily an inflammatory process like it is in other causes of laminitis."


Re: Mixing pain medications

kansteen5545@...
 

Hi Dr. Kellon -
Could you expand on this?
Karen
Scarborough,ME
May/2014
"laminitis caused by endocrine disorders, IR, is not primarily an inflammatory process like it is in other causes of laminitis."
Eleanor in PA
www.drkellon.com http://www.drkellon.com





Mixing pain medications

Eleanor Kellon, VMD
 

We regularly get comments from members who have been told to mix phenylbutazone with other pain medications in the same class such as Banamine (flunixin meglumine) or firocoxib (Previcox, Equioxx).


This trend started because of poor response to even peak dose phenylbutazone in many horses with laminitis.  However, the reason for that is that laminitis caused by endocrine disorders, IR, is not primarily an inflammatory process like it is in other causes of laminitis.


Perhaps even more important is that mixing these drugs puts the horse at very high risk of serious side effects from intestinal and kidney damage:


http://www.ncbi.nlm.nih.gov/pubmed/24354928


Effectiveness of administration of phenylbutazone alone or concurrent administration of phenylbutazone and flunixin meglumine to alleviate lameness in horses.


Effects of phenylbutazone alone or in combination with flunixin meglumine on blood protein concentrations in horses.


Eleanor in PA

www.drkellon.com

EC Co-owner

Feb 2001



Re: Cushings??

Eleanor Kellon, VMD
 

You will soon get a welcoming and orienting response from our super support staff that will help you organize your horse's information into a form that allows us to easily give you feedback on this group's collective experience.

In the meantime, I would suggest you involve your veterinarian into getting a biopsy of these hair loss areas.  Hair loss is not a symptom of Cushing's in horses although areas of flaking and skin thickening with increased pigmentation in spots such as around the elbows could be.

The key to successfully dealing with this or any other health issue is to get an accurate diagnosis first.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


Re: sources of ODTB in So Cal.

Lindsey Mac Neil
 

I could not figure out how to respond privately, but I did not get an invite to the other group or I don't know how to find it. I'm not sure...

Thanks,
Lindsey


Cushings??

Rachel Petzold <r.petzold@...>
 

Hi!My mare is at risk of Cushing's so I've started her on the emergency diet and I finally have a proper farier and am getting blood work back soon. She is doing so well now!Today I was out to see her and I noticed bald patches on her. They are loonie size and bald, as if hair had never been there. She had one before and it popped up as a bald spot, then turned really flaky, then the hair grew back. I thought nothing of it but now she has a flaky patch, and a new bald patch. Is this Cushing's related???? Or something totally different?? I'm a fairly new horse owner and I'm already overwhelmed with my first horse having Cushing's, so any help is appreciated, I know its not the classic Cushing's hair coat but could it still be related??Thank you!!!
RachelAlbertaNov 2014


New file uploaded to EquineCushings

EquineCushings@...
 

Hello,


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Re: Please help. New to all of this.

Tiffany Woodward
 

Maggie,

Maggie is definitely a little better post-trim.  She's moving around a little easier, rocking back a lot less, and even moving a little better on that right front (with the sole crack).  I was hoping to catch her laying down so I could get some hoof photos but no such luck. 

I'll try clearing the cache to see what happens.

Tiffany Woodward in NC
November 2014
https://groups.yahoo.com/neo/groups/echistory8/files/TiffanyWoodward%20and%20Maggie/

  https://groups.yahoo.com/neo/groups/echistory8/photos/albums/540173897

 


Re: Which ACTH test?

Stephanie Stout
 

Thank you very much Lavinia! I'm planning on doing the tests next week. Have a great Thanksgiving!

Stephanie 
Oregon
Oct 2014


Re: Prascend

Eleanor Kellon, VMD
 

The Equine Endocrinology Group recommends: 
"Some horses show a transient reduction in appetite. It is therefore recommended that Prascend be introduced gradually by giving partial doses for the first four days or by administering half the dose morning and evening" -  http://sites.tufts.edu/equineendogroup/files/2013/11/EEG-recommendations_-downloadable-final.pdf
 
Would like to mention here that the recommendations of this group, which was put together and funded by the manufacturers of Prascend, are often not rooted in science or even extensive personal experience.

Because of the rapid metabolism of pergolide in horses, splitting a dose into two daily segments may well result in the dose only being half as effective.  In other words, 0.5 mg twice a day is not the same as 1 mg once a day.  We have certainly had members whose experience supports that.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001



Re: Taurine

Nancy C
 

Peggy

Would love to know which article you were reading.  A lot of us use Methionine in out custom supplements, a precursor to taurine according to Dr Kellon in this article. 


Resources - The Many Functions of L-Methionine in the Equine Diet - Uckele Health & Nutrition

 

Most of the discussion about taurine on ECIR yahoo has been about it's calming qualities.

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/39741

Might you have a link to the article you read?

Thanks!

Nancy C in NH
ECIR Moderator 2003

FACT: Insulin resistance (IR) is the failure of insulin sensitive cells to respond to “normal” levels of insulin.  See E. M. Kellon, VMD, Diagnosis of Insulin Resistance and PPID, 2013 NO Laminitis! Proceedings, Equine Cushing's and Insulin Resistance Group Inc.

 





Re: Which ACTH test?

Lavinia Fiscaletti
 

Hi Stephanie,

Yes, the bundled ACTH+Insulin is correct. You only need to specify endogenous if you are testing the ACTH alone as there are several tests for that.

Add the serum glucose onto your testing - it is on a separate part of the testing forms and is very inexpensive but when testing insulin running the glucose as well makes the resulting information more complete. No need to run Leptin each time.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team



Re: leg wraps

Lavinia Fiscaletti
 

Hi Linda,

This is meant for horses who experience cold-induced hoof pain. Due to previous damage, they are highly sensitive to drops in temps and respond by getting extremely footsore even when diets are tight and ACTH is well controlled.

Anytime the temps drop in to the 40's (and lower) these compromised horses will start to have cold-induced pain so that's when the wraps need to be applied to help them avoid the vaso-constriction and blood shunting that naturally occurs.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team


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