Date   

Re: High ACTH

Tanna
 

Andrea, if you don't mind my asking, what signs do you associate most with PPID?

As far as is my understanding, changes in hair coat associated with early PPID can be extremely subtle; long guard hairs under the chin and on the lower legs (like slight feathers where a horse wouldn't have had them in prior years) and the curly coat most associated with the "look" of a horse with Cushings is now more often associated with advanced disease. 


--
Tanna 

April 2019, (Yahoo Group member 2008)
Langley, BC, Canada

Tula's Case History 


Chasteberry and marish behavior

Mari <mjsav2000@...>
 

Good morning and Merry Christmas.  I have looked up chasteberry in the previous threads but wanted to double check.  For IR mares that have undesirable behavior (rank, saddle averse, cold backed, moody) and flank pain due to persistent follicles/ovarian cysts or irregular cycles, I saw recommendation of chasteberry - specifically the one from Uckele (5x) - the dose on label is 3-6 g daily.

Questions:  is this supplement given year round or symptomatic (example, when flank pain is seen)?
My mare is IR but not PPID and no issues with long hair  or shedding, is it ok to still give it?  
Is it ok to continue with Mare magic (raspberry leaves), Smart Calm supplements?
What are side effects that you guys have seen in mares?
Any precautions for humans handling the supplement?

Any other protocols for moody mares?  

Thank you.
--
Mari, CA, joined 2019
Briosa's case history: 
https://ecir.groups.io/g/CaseHistory/files/Mari%20and%20Briosa
Photos/radiographs: https://ecir.groups.io/g/CaseHistory/album?id=235962


Re: High ACTH

Lorna Cane
 

Hi Andrea,

Was the sample frozen before it was centrifuged,then?

I'm sure Dr. Kellon will get back to you. I, too, will be interested in what she knows.

--

Lorna Cane
Ontario, Canada
2002


 


Re: High ACTH

Andrea Richter
 

Thanks for the input, I appreciate your shared experiences and the links to the studies, but was kind of hoping to get Dr Kellon’s opinion.

I am going to retest prior to starting pergolide. 

According to the laminitis site, there are reasons for false positives: 

“Also freezing the blood sample before it has been separated by centrifuge can cause falsely high ACTH concentrations (Andy Durham - Liphook Equine Hospital).”

And 

 “A horse MUST be showing or have a history of clinical signs for a diagnosis of PPID. “

 

The AAEP states: “The best indication of PPID is the clinical sign of hirsuitism in the aged horse. The sensitivity of this clinical sign is better at predicting an abnormal pituitary than any diagnostic test available.” 

My horse has no symptoms. I only tested because of his age and the test was free. 

Thank you  


--
Andrea
January 2018, Winnipeg MB
Uma’s Case History https://ecir.groups.io/g/CaseHistory/files/Andrea%20and%20Uma


Re: High ACTH

LJ Friedman
 

does a curly coat,sweating, increased urination, usually show up as ppid, before laminitis strikes? 
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 


Re: High ACTH

Nancy C
 

Hi Andrea

While comparing test results to necropsy is ideal, as a practical mater, needing it to diagnose would leave  a lot of horses in dire shape waiting for necropsy. Dr Kellon describes the use of necropsy results however to help determine the levels used to diagnose the live horse.  https://ecir.groups.io/g/main/message/218675

Here are a few posts that reference the long term use by hundreds of members on this group. Dr Kellon references the only thing remotely like a long term use study was through BI, manufacturer of Prascend. IMO it is unlikely  they have followed horses as long as ECIR has followed  many through long and happy lives on the pergolide. I admit I am not up to date on BI's most recent papers so could be educated there.

https://ecir.groups.io/g/main/message/243338

https://ecir.groups.io/g/main/message/198544

https://ecir.groups.io/g/main/message/184359

https://www.ecirhorse.org/pergolide.php

The first recognized sign of PPID is most likely to be laminitis. Upon reflection of all the details, ECIR often sees signs of PPID unrecognized prior to laminitis.  For example my 20 y/o QH had minimal loss of muscle around his top line, often suspected of being a dietary issue.  He tested positive for PPID in July.  For these horses we want to control hgih insulin which come with those EMS at baseline or can develop with long term uncontrolled PPID.

There are reports here of horses with very high ACTH that defies control, but they are still PPID and require medication.

https://ecir.groups.io/g/main/topic/32037033#236718

While waiting for Dr Kellon, you may find ECIR's film Diagnosis worth the time invested.

https://www.ecirhorse.org/video.php

Hope this helps.
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA


Re: High ACTH

Sherry Morse
 

Hi Andrea,

Dr. Kellon will probably be better able to answer your questions but this is a 2013 study which found many owners under reported their horses having PPID: Prevalence, risk factors and clinical signs predictive for equine pituitary pars intermedia dysfunction in aged horses. - PubMed - NCBI and concluded that aged horses that tested positive for ACTH should be treated. 

A 2017 study (p 18 here: https://sites.tufts.edu/equineendogroup/files/2017/01/2017-Equine-Endocrinology-Summit-D-Russell-Havemeyer-Foundation.pdf) looked at ACTH levels in aged horses confirmed not to have PPID by autopsy and concluded a resting plasma ACTH concentration < 50 pg/ml would be considered normal in aged horses. 

You can of course not treat, but that means that the growth of the pituitary gland will continue unchecked.  Personally I know of three horses who were left untreated and all ended up being put down due to complications that could be correlated to lack of treatment.  
 






Baker's yeast as a cheap probiotic?

Cindy Giovanetti
 

I can't help but notice that an ingredient in all the expensive probiotics is saccharomyces cerevisiae, which is baker's yeast.  I'm guessing that we can't just give our horses a bit of inexpensive baker's yeast as a poor-man's substitute or that trick would be all over the internet already, right?  I'm guessing it has to do with whether the little critters are "alive" or "dead," right?
--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125


Re: High ACTH

Lorna Cane
 

Hi Andrea,

I began him on compounded pergolide,from Island Pharmacy,on Vancouver Island. Contact info is in our Files, International Sources.
If memory serves I began on 1mg right away. I never did have any veil issues with any of my boys.

I can say that it is dead wrong to say that PPID can only be confirmed by autopsy.I wouldn't believe anything else said by that author.

The rest of the answers I'll leave to Dr. Kellon,when she responds about dose. I just have assumptions,but no facts.


--

Lorna Cane
Ontario, Canada
2002


 


Re: High ACTH

Andrea Richter
 

Lorna, How did you proceed with your Morgan pony? Did you retest? Start on pergolide day ?

i wonder how many healthy older horse’s test or would test high ACTH and live out their lives without issue and not medicated. Are there any studies on this?

I’ve read in the past that PPID can only be confirmed via autopsy. Is this correct?

Are there any studies on the long term effects of  pergolide ?

Also, can Dr Kellon please tell me what dosage I should start him on and what dosage I should ween him up to. 

thank you 
--
Andrea
January 2018, Winnipeg MB
Uma’s Case History https://ecir.groups.io/g/CaseHistory/files/Andrea%20and%20Uma


Re: High ACTH

Lorna Cane
 

Hi Andrea,

About the requirement of symptoms, years ago there was a mixup here wrt blood draws. My Morgan pony was tested   for PPID, instead of just insulin and glucose, in error, whilst bloods for others were being drawn.
His ACTH came back very high, out of range, Cornell. I was gobsmacked because to my eye ( and I had 6 others who were symptomatic, so....) he was asymptomatic.
I certainly could have missed something, but it would have had to be pretty subtle.
I'm sure my case is not that rare.

--

Lorna Cane
Ontario, Canada
2002


 


Re: High ACTH

Tanna
 

Just double checking... your test results were given in pmol/L?

271 pmol/L is over 1200 pg/mL.

This is what my lab was using for ranges given in pmol/L. 

Normal Horses:  2.0-7.7 pmol/L (9-35 pg/mL)

An endogenous ACTH measured between November and July of >7.7 pmol/L (35 pg/mL) is consistent with Cushing's disease (PPID).

Between August and October, an endogenous ACTH concentration of > 22 pmol/L (100 pg/mL) is consistent with equine Cushing's disease.

I personally believe there is some room for variances in ACTH throughout a given day and when influenced by factors of stress, pain or illness, but not to the extent that your horse shows with that test. 

Perhaps you could test him again now that we are nearly outside of the rise to see if you have a result still outside of range? 


--
Tanna 

April 2019, (Yahoo Group member 2008)
Langley, BC, Canada

Tula's Case History 


Re: Supplements with maltodextrin and molasses - trying to deal with ulcers and IR

Mari <mjsav2000@...>
 

Thank you.  I had the farrier come back and work on the toes, he replaced the shoes and exchanged pads for thinner ones.  The mare is moving better but I am going to try a different farrier for the next cycle.  I've had equine veterinarian, radiographs - and the current farrier just cannot correct issues the way they need to be.

Really appreciate your input!
--
Mari, CA, joined 2019
Briosa's case history: 
https://ecir.groups.io/g/CaseHistory/files/Mari%20and%20Briosa
Photos/radiographs: https://ecir.groups.io/g/CaseHistory/album?id=235962


Riosa and ongoing issues - sent u an email Dr. Kellon

hdavis
 

Hello,

just a note that I sent you an email Dr Kellon in regards to Riosa and some questions I have.  Thanks!!
--
Heather
August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History
https://ecir.groups.io/g/CaseHistory/files/Heather%20and%20Riosa

 Photos

https://ecir.groups.io/g/CaseHistory/album?id=8819&p=pcreated,,,20,2,0,0  .


Storm

Case History



photos

 
 

 




Re: Intro of New Old Member

 

Hi Cindy,

Technically the rise should be over once the days begin to lengthen.  Some horses don’t follow this reliably but an extended fall rise is more likely in a horse with PPID.  So I would think you’d be safe to test anytime now.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Re: weighing hay

ferne fedeli
 

Why don't you just fill the hay net and then weigh it???  I know the weights of my Nibble Nets and I just fill them and weigh and feed.  Seems much easier to me.
--

Ferne Fedeli     2007

No. California
Case History

Regional Members Database Coordinator

 - see who is near you

Add your contact information if you want to help out/meet ECIR members in your area.

 


Re: Intro of New Old Member

Sherry Morse
 

Hi Cindy,

I just got the notification that your CH is done so I took a quick look at it.  There are a couple of things that jump out at me as far as Syndiego's diet - if he's PPID and IR the Tribute grain and the alfalfa cubes may be enough to push him over the edge into a laminitic episode. Getting his blood work done and figuring out what his current glucose, insulin, leptin and ACTH levels are as soon as possible would be a good thing.  As noted in the welcome letter we recommend using Cornell for the bloodwork and their turnaround time is usually pretty quick.  

In the meantime I would suggest changing out the alfalfa cubes for OBTC and consider stopping the Tribute grain entirely.  If he's currently 50lbs overweight you want to cut his total feed intake down to 18.5 pounds (2% of his ideal weight).  You may think he needs more grain because he's losing topline, but that's usually a sign of PPID not being controlled. 


Re: Intro of New Old Member

 

Hi, Cindy. Thanks for getting the CH up so quickly. You can create a Photo folder in the CH group to upload good photos of Syndiego. Dr Kellon and others here are really helpful in getting a handle on BCS. The instructions are here: https://ecir.groups.io/g/main/wiki/home#Photos-and-Hoof-Evaluation-Help  You can organize your photos of body condition using this approach: https://ecir.groups.io/g/main/wiki/Hoof-Related-Photo-Instructions#Naming-Body-Shots  
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse Case History Folder                Cayuse Photos
Diamond Case History Folder              Diamond Photos 


Re: Intro of New Old Member

Cindy Lawbaugh
 

Thank you.   I uploaded Syndiego's case history.

One of the things I struggle with is his BCS score.   I think he's a 6.   In my opinion he is overweight, however his ribs are visible and easily felt, so he doesn't seem to fit the definition to the letter.
He's not been regularly ridden in several years, and so  may be just be a loss of muscle and a poor top line?   Hard to describe

Cindy
N.Illinois
Dec 2019
Sydiego Case History Folder https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Syndiego


Re: Compounded flavored pergolide powder question

 

Tina, in addition to Lorna's suggestion that you want CP encapsulated, not as a loose powder, be sure your vet writes the prescription correctly, so the compounded medication matches the amount of pergolide your horse has been getting in Prascend. There is specific language to accomplish that, as explained here: https://ecir.groups.io/g/main/message/226568  "x mg of pergolide as pergolide mesylate"  

Lots of important details are covered in Files, including Pergolide 101. https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide/Pergolide%20101.pdf You want to refill your prescription every 30 days. You want to store the capsules carefully in a cool, dry place. Flavoring can be added to encapsulated CP (I get molasses-flavored CP). Flavoring increases the size of the capsule. 

If you need information to give your vet, studies supporting this approach are listed here: 
https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide/1.%20Compounded%20Pergolide/Pergolide%20stability%20studies.pdf 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse Case History Folder                Cayuse Photos
Diamond Case History Folder              Diamond Photos