Date   

Re: Adding Cyproheptadine to Pergolide prescription

Lorna Cane
 

Thank you Dr. Kellon,


> We have roughly twice as many horses on Prascend in the low dose  


categories (22% vs 10%) but 215 out of the total 268 horses are on 


compounded drugs.  Also, some of the high doses horses are on 


compounded after switching from Prascend (or Permax) because the cost 


was prohibitive otherwise.




And thanks to everyone who has contributed, and who continues to contribute, to our Database. 

It is such valuable information, and allows us to be the best advocates for our horses.



Lorna in Ontario,Canada
ECIR Moderator 2002
*See What Works in Equine Nutrition*
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https://www.facebook.com/ECIRGroup

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Re: Adding Cyproheptadine to Pergolide prescription

Eleanor Kellon, VMD
 


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

I went on line and it indicated that Cyproheptadine (Periactin) doesn't seem to be anywhere near as effective compared to Pergolide. But I didn't see anything in regards to the combination.

= = = = = = = = = =

You didn't see anything because there is nothing there!  The suggestion came from the BI sponsored Endocrinology Group but with no formal data at all to support it.


The objection to dosages over 5 mg also comes from BI, but again with no data.  They make two general claims.


One is that horses on over 5 mg/day have more side effects but we have 51 (out of 268) horses, 19%, in the pergolide database, most for several years, with no higher reports of side effects or suspicious health problems.


The other claim is that horses that need high doses must be on low potency compounded drug.  We have roughly twice as many horses on Prascend in the low dose  categories (22% vs 10%) but 215 out of the total 268 horses are on compounded drugs.  Also, some of the high doses horses are on compounded after switching from Prascend (or Permax) because the cost was prohibitive otherwise.


If you read Prascend's New Animal Drug Application presented to the FDA


http://www.fda.gov/downloads/AnimalV.../UCM280354.pdf


There is only formal safety data (i.e. including a control group) for dosages up to 2 mg. The adverse event reporting, which included 113 horses with no controls, only their baseline history, also only evaluated up to a 2 mg dose despite the fact that 41.6% of horses remained with abnormal lab values after 90 days on 1 mg/day and overall success rate at 180 days including horses on both 1 and 2 mg/day was 68.6%.


The suggested upper "safe" dose of 5 mg/day (it was 3 mg/day when Prascend was first introduced in the USA) is based entirely upon that being highest reported dose found in the published literature (literally just a handful of horses)- NOT on formal safety studies. It would be more accurate to state that safety of dosages above 5 (or 3) mg has not been studied.


As for the cypro, it is an old treatment with limited usefulness that was discarded long ago in favor of pergolide.  Again, there is nothing to support the idea that the combination would be more effective than pergolide alone.


Eleanor in PA

www.drkellon.com

EC Co-owner

Feb 2001



Re: leptin interpretation -- how high can you go?

Eleanor Kellon, VMD
 

Dr. Cartmill was the first to make the correlation between high leptin and IR in horses.  His dissertation is here:

http://etd.lsu.edu/docs/available/etd-04152004-095658/unrestricted/Cartmill_dis.pdf

I'm not ruling out a role for gabapentin in this yet.

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


Re: leptin interpretation -- how high can you go?

Kerry Isherwood
 

Thank you so much, ladies, for your swift assurances that my gelding is indeed not the outlier of leptin resistance that I fretted over. He is, in fact, in good company it seems! :)

I find it very interesting that my 20yo mare--the quintessential IR model whose fat pads have their own fat pads--had a leptin of only 4.19 at her highest, while my svelte gelding, who has many times been mistaken for a Thoroughbred, is in perfect body condition w/o a trace of any visible fat on him, yet has a leptin of >8.

Just when you think you know horses.... ;)

Thank you,
Kerry in NY
Sept 2014


Re: leptin interpretation -- how high can you go?

Claudia Goodman
 

My Morgan mare's Leptin level was 8.8 back in February. I have been able to keep her insulin levels down right around mid-range (non-fasting) and she has been doing well. I will retest her Leptin in a few months to monitor change.

Claudia & Silhouette 2014 California

https://groups.yahoo.com/neo/groups/echistory8/files/Claudia%20%26%20Silhouette/




Re: International Volunteers Day

Laura Cull
 

I only joined a couple of months ago but I am deeply grateful for this group and the dedicated volunteers. EC is a devastating diagnosis to come to terms with. Without this group I don't know how I would have sorted through all the information and misinformation to figure out how to best take care of my beloved horse.
Thank you so much for all your dedication.

Laura & Hope
Oct 2014
Kelowna, BC, Canada


Re: International Volunteers Day

bigwhitevan2002
 




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

>>>>>>>>>>I just want to emphasize that each and every person on this group is important.,<<<<<<<<<<
 

So true Dr. K , but I'm not letting you put down your 'super hero  cape ' that easy,  I am convinced you never sleep...

Thank you for being the veterinary voice of reason, knowledge, and scientific basis,  when the tides of doubt are assailing my ( our) ears as so spoken by a majority of the main stream Veterinarians ,

My hat is off to you and all the dedicated people on this list,  who have helped me in the past 10 years in managing several different horses and ponies...

here's  to another 10 more....( I cannot believe I just said that  LOL, but  getting off this list would be so , so....uncomplicated and  boring.)

With much gratitude to all,

Julie in Oregon,
 with Pony, Richie , Kayla, Durango (rip) KoKo ( rip) and many more who have been assisted in the proper protocols due to the selfless dedication of all....




EC Co-owner
Feb 2001


Re: leptin interpretation -- how high can you go?

Lavinia Fiscaletti
 

Hi Kerry,

Know of one member whose mini came back with a leptin of 15.66 so yours is not that bad in comparison.

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




Re: leptin interpretation -- how high can you go?

chf1752@...
 

Bella's leptin was 10.89 back in 2011. Insulin 79.66, glucose 88 and ACTH 24. All done at Cornell. Fat and blubbery like a walrus, over 200lbs overweight. She was ~20 years old at the time. She's a large pony, most likely a Welsh Cob/Arab cross. 

3 years later and massive diet and lifestyle modifications have gotten that 200lbs off her, but she does have those residual fat pads. Any time she's stressed, they puff up again. 

Her most recent glucose came back at 70, and I'm waiting on her insulin results. 

Erin
ME
2014
https://groups.yahoo.com/neo/groups/echistory8/files/Bella/



Re: leptin interpretation -- how high can you go?

Leigh Jacobs
 

Hi Kerry,
My 20+yo Shadow's leptin is >9 ng/ml.  Based on some reading of human research papers, I am correlating it to his huge, nondiminshing appetite.  He is a TWH, so called easy keeper and has not had out of normal insulin or glucose values.  He is not PPID.  However, based on what I have read from Cornell and this group, I am treating him as an IR horse, increasing his fiber, decreasing his concentrates, and trying to get him turned out every day, or ridden.  He is a jumpy/nervous horse, but I have always attributed it to his young years in the show ring.  Makes me wonder if the people in leptin studies have issues as well???
Leigh, Ace and Shadow
Tucson, AZ
2011





On Wednesday, December 10, 2014 11:54 AM, "kerry.isherwood@... [EquineCushings]" wrote:


 
So my gelding's leptin came back 8.32 ng/mL (norm 1-4).  He's the 7yo Saddlebred with inexplicable nervous behavior that has been on gabapentin since April, 2014.  He recently came up with two high insulins, the latest being 47 uIU/mL.  Initially the thought was that perhaps gabapentin was driving the insulin up but with a leptin like that....yeesh!  Has anyone ever seen a leptin that high?  Cornell only indicates that >7 ng/ml is "high".  You guys have more experience than anyone else I know with leptin, so should I believe a leptin this high or throw it out and re-submit a new sample? 

In denial of EMS for horse #2,

Kerry in NY
Sept 2014




Adding Cyproheptadine to Pergolide prescription

Jen Mcgeehan
 

Aloha from Hawaii!

It has been a long time since I came to this site for help...So glad to have your input on a new situation with my 32-year old Palomino - Smoke Signal Dun.

He has been on Pergolide, currently 5mg, for about 3 years. Suffered a coffin bone rotation in 2011 and diagnosed with IR and Cushings. We successfully brought him back to good health, through this site's excellent advise, and we still ride our pastures. In 2013 his ACTH level was 29.6. Just had another blood test done and it is at 51. I know this time of year the count can rise, but am sure it is way too high. He is currently on 5mg of Pergolide from Thriving Pets. The vet won't write a prescription for any higher of a dose even though I shared with her that horses can go as high as 10 or 12 mg, if needed. She wants to add Cyrpoheptadine with the Pergolide. Any studies to share in regards to the success of this? I went on line and it indicated that Cyproheptadine (Periactin) doesn't seem to be anywhere near as effective compared to Pergolide. But I didn't see anything in regards to the combination. Would appreciate your help/input here. (His IR numbers are fine...) Merry Christmas!!!


Re: Soaking odtb cubes

ferne fedeli
 

We soak 4 lbs. of cubes for my partner's Appy in the am and use roughly 3/4 of a 2 gallon bucket of water.  At night, he gets 5 lbs. of cubes and a full 2 gallons of water.  It depends on how "soupy" you want it, of course.  As a supplement carrier am and pm for all 3 equines, I put 1 gallon of warm/hot water over about 1 lb. of cubes.  What I don't use for the supps, goes over the top of the Appy's other cubes.  It is definitely a little more soupy.  The cubes also soften up very quickly in the hot water, although it probably takes 10 minutes or more for me to do the other chores and get around to dishing out the carrier cubes and supps...
Ferne Fedeli
No. California
4/2010

On Mon, Dec 8, 2014 at 10:36 PM, Lj lj_friedman@... [EquineCushings] <EquineCushings@...> wrote:
 

I need to prepare the cubes for a 10 minute soaking. Can someone tell me how much water to pour over 4 to 5 pounds of cubes ? I need to have the water set aside each time for the barnmanager where it's easy for him to pour over the needed amount of water If anyone is soaking approximately four or 5 pounds of hay cubes, let me know how much water you soak with and I will do the same. Thanks. Lj friedman San Diego November 2014

Sent from my iPhone



Re: off topic

ferne fedeli
 

I have an Icelandic Horse 20 yo that is Cushings and IR and a 9 yo donkey that I assume is IR (never tested).
Ferne Fedeli
No. California
4/2010

On Sun, Dec 7, 2014 at 9:11 AM, Lj lj_friedman@... [EquineCushings] <EquineCushings@...> wrote:
 

I'm wondering of the members on the group, approximately how many of us have Cushing's horses and how many of us have IR horses? LJ Friedman San Diego November 2014

Sent from my iPhone



leptin interpretation -- how high can you go?

Kerry Isherwood
 

So my gelding's leptin came back 8.32 ng/mL (norm 1-4).  He's the 7yo Saddlebred with inexplicable nervous behavior that has been on gabapentin since April, 2014.  He recently came up with two high insulins, the latest being 47 uIU/mL.  Initially the thought was that perhaps gabapentin was driving the insulin up but with a leptin like that....yeesh!  Has anyone ever seen a leptin that high?  Cornell only indicates that >7 ng/ml is "high".  You guys have more experience than anyone else I know with leptin, so should I believe a leptin this high or throw it out and re-submit a new sample? 

In denial of EMS for horse #2,

Kerry in NY
Sept 2014



Re: International Volunteers Day

Eleanor Kellon, VMD
 

I just want to emphasize that each and every person on this group is important.

There is no way we could do what we do with only one person manning the group.  Not only would that one person starve to death from 24/7 work as an unpaid volunteer, they would not be able to keep pace with the need and certainly wouldn't have any time to organize or move things forward.

There have also been priceless pieces of information coming from members. The practice of soaking hay to lower sugars came from a member of this group who was trying soaking to lower iron and noted it reliably reduced sugar.  An agronomist in the group at the time suggested this was a "duh" moment since rained on hay had lower sugar but the bottom line was that soaking to reduce sugar had never been suggested before our member reported it. Studies on the effect of soaking continue to this day.

The fall rise in ACTH that is such an integral factor in how we manage PPID horses was first suspected and documented by the veterinarian of one of our owners - before it ever appeared in an article.

I had long suspected a role for iron in IR because of what is known to occur in humans and other species, but the proof was only possible because members got involved and tested their horses.

This group was a really exciting place in the early days of IR when the veterinary  community at large dismissed it.  Now that IR is mainstream, it's not so high energy but the sheer volume of the information here can provide new insights on an ongoing basis.

YOUR INFORMATION IS CRITICAL in moving understanding forward in a way that small formal studies cannot.  We cannot usurp formal studies, but we sure can direct them to confirm what we see.  Fill out a case history.  Check out the polls and databases.  We need you.

A university associated vet recently said owner observations were "suspect at best".  Our view point is exactly the opposite.  No one is more qualified to report their animal's condition than an involved owner.  Speak up.

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


Re: Complete diet: NOW:Proper PPID protocol

lj friedman
 

Thanks for the reply. I am very aware I how to titrate the pergolide. I have already purchased the APF and will ask your specific instructions when I start treatment. And when pergolide is started I will be using a local vet with cushings experience and cornell access . It just so happens that an equine vet the boards at my barn has a cushings horse , she is out of town now but I will consult with her as well. Lj Friedman San Diego November 2014

Sent from my iPhone


Re: throwing this out there

Diana Marquardt
 

Can't get on Yahoo try rod Johnson at horse tech he said he would help me good luck



On December 10, 2014, at 7:17 AM, "bigwhitevan2002@... [EquineCushings]" <EquineCushings@...> wrote:


 

Rather than go down the list of hay gurus ( as i  started and was respectfully asked to look further as first person I inquired of was super busy at this time) I am tossing out a request for anyone who has a bit of time to help me balance out my hay and get my horses back on a tighter mineral profile.

 I have been going the CAL Trace route, but due to another special needs horse as well as my PPIDers I would like help, well not help I am asking if someone can do the math etc to get my hay balanced out,


who ever is available please let me know when , where , and who to send funding too


I know this is a busy time of year for most..


Thanks 

Julie 

Oregon 06

with Pony, Kayla, Richard, and Shy. 


throwing this out there

bigwhitevan2002
 

Rather than go down the list of hay gurus ( as i  started and was respectfully asked to look further as first person I inquired of was super busy at this time) I am tossing out a request for anyone who has a bit of time to help me balance out my hay and get my horses back on a tighter mineral profile.

 I have been going the CAL Trace route, but due to another special needs horse as well as my PPIDers I would like help, well not help I am asking if someone can do the math etc to get my hay balanced out,


who ever is available please let me know when , where , and who to send funding too


I know this is a busy time of year for most..


Thanks 

Julie 

Oregon 06

with Pony, Kayla, Richard, and Shy. 


Re: DEHY Cubes

Lorna Cane
 

Hi Ruth,

>Orange tag on the bottom says Premium Timothy cubes.  I appears my assumption was correct.

Especially for new members,I was trying to clarify whether you were talking about Timothy cubes, or Timothy Balance cubes - I forget whether you're in Canada or not,but here they are called Complete cubes.
 The Timothy Balance cubes are the ones most of us use because we're looking for the added minerals,etc.
I have bought the straight Timothy cubes from OD,too, but for a different purpose.
Lorna in Ontario,Canada

ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

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

http://www.iGive.com/EquineCushingsandInsulinResistanceGroupInc







DEHY Cubes

Ruth Vale
 

>> have a 3/4 bag of Ontario DEHY timothy forage cubes that my morgan
refuses to touch.
>Bag says "Ontario DEHY Premium Quality Forage cubes. My mistake, I assumed Timothy.

Orange tag on the bottom says Premium Timothy cubes.  I appears my assumption was correct.
In any case, my guy won't touch them.  Even when mixed in with stuff he does like.  I have discovered he likes peanuts, though, so we have the beginnings of a treat library.

Sorry I don't have the links - I'm locked out of Yahoo at the moment.  It forgot my user id and my password after more than a decade of membership and I don't  have the stamina to argue with the idiot.  Argh!

Ruth and Bounce
September 2013