Date   

Re: Pergolide dosages given for active ingredient or the mesylate form (as in Prascend)

Karen Ward
 

Exactly what I needed, Candice.  Thank you!  I don't know who could do this, but it would be helpful if this info were included in the file(s) on pergolide, especially where it talks about getting it from a compounding pharmacy.  Do you know who I should approach with this request?


Update and new blood work for Riosa reveal severely increased insulin

hdavis
 

Hello,

I have been attempting to get Rio back into some work (online) since our issues this spring which are still not resolved but have been improving. She did have some muscle issues which could have been due to hot weather but had some episodes which appeared to be mild cases of muscle tying up (no blood work to confirm as couldn't get it done). We revised salt intake and reduced exercise until her movement and body suggested we could start handwalking and doing online exercise.  

We also switched to compounded pergolide over the summer for the equivalent to 2 mgs of Prascend but due to not having a vet that was able to make a farm visit have not tested via alternative testing and couldn't do ACTH in this last blood draw as we were having issues already with the blood draw and too many pokes agitating her.  I have a local tech who pulls blood for me now which is great but still sometimes Rio gets upset if poked too many times. This go around we tested glucose, insulin, triglycerides, vitamin e (was low last time) and selenium.  

I have the results back for all except vitamin e and selenium. Results are brutal to say the least so help would be appreciated.  Exercise has to continue to me moderate as she cannot be exercised for high intensity for long durations yet. 

Insulin - 584 pmol/l - highest it has ever been when testing
glucose - 5.8mmol/l
tricglycerides - 1.0 mmol/l

previous tests were much lower.  She continues to be ribby and look like she is lacking muscle and has now gotten a pot belly somewhat.  She is not on free choice hay anymore although not on 20lbs a day either and more like 25-26 lbs.  She does have an increased crest but her other fat deposits haven't increased drastically just her crest.  

As I did not test her ACTH or do the domperidone test to look at her levels for PPID except for acth in early summer, I left her compouned pergolide the same dose.  I am kicking myself in the butt that I didn't at least test for ACTH or do a slight increase this fall as could the fall rise be partially why our insulin is so elevated?  

She is still on 1 of the 300 mg Invokana pills per day as well.  Should I increase the compounded pergolide now but I'm sure we are way to late for that. Thoughts, help, ideas would be appreciated.

She is not showing foot lameness so do I still keep trying to do at the least the exercise we have been doing?  TIA.


--
Heather
August 5, 2017, Brandon, Manitoba, Canada

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

https://ecir.groups.io/g/CaseHistory/album?id=8819 


Storm

Case History


 




Re: New diagnosis pending

Lavinia Fiscaletti
 

Hi Kelly,

You don't need to wait for the Leptin result to fill out a case history as you can always go back in and add information as it becomes available. Did you have his glucose tested?

If his insulin is elevated in the least bit then he is EMS/IR - esp. as he is already on a low sugar + starch diet. Not being enthusiastic about a low-sugar diet is like changing a kid's diet from hot dogs and cotton candy to one of broiled fish and broccoli - they're still hungry but certainly not thrilled about the taste change initially.

Seeing trim picks will be helpful, esp. if you can take them immediately after the feet are trimmed.

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Re: not a new topic, just to clarify

Eleanor Kellon, VMD
 

No. You don't have to fast for any of the tests. The reason for the 4 hour wait is that insulin response to the first feeding of the day is exaggerated.  He won't be fasting with that hole in the  muzzle.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Advice and clarification needed please

 

Anette, has anyone mentioned that trucking to an ACTH testing will not give reliable results?  No one knows exactly why but that’s what’s been observed so we discourage that.  If the vet can’t come to your horse, we suggest drawing the blood at home yourself or finding a vet tech who can come to your house to draw it.  After drawing the blood, it needs special handling care to not degrade the sample.  Trucking generally leads to elevated results and inadequate care leads to lower results.
--
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


 
 


Advice and clarification needed please

Anette
 

Hello, Superman is going in today to have his ACTH checked and an extensive CBC done. Vet tech called this morning to say that Cornell said they have to use protirelin,wait and then draw blood again. I don't understand why Cornell is saying this ,Dr. said he hasn't had them do this before either. Vet doesn't have protirelin on hand and has to order it. Does Superman need this test? Earlier this year I wanted the TRH test done because he shows symptoms of PPID but the test numbers said he didn't have it. In NC. vets can't have protirelin ,I was informed that they could get it from human hospitals but at that point decided to just start him on 1/4 a pill of Pergolide. 
--
Anette and Superman (Jaywalker in heaven)
Boomer, NC
Sep.9 2018
https://ecir.groups.io/g/CaseHistory/files/Anette%20and%20Jaywalker
https://ecir.groups.io/g/CaseHistory/album?id=265991


Re: not a new topic, just to clarify

Starshine Ranch
 

So for ACTH we don't have to fast them but for the Insulin part of the test we do?
--
Linda in CA  2020  Midnight and Ostara
https://ecir.groups.io/g/CaseHistory/files/Linda%20Midnight%20OStara


Re: New diagnosis pending

 

Hi Kelly,
Welcome!  I’m not wishing to add to your concerns but ACTH is not very stable and needs specific handling to give an accurate result.  If you were surprised by the results, this is something to consider.  Degradation occurs occasionally when the vet sends the sample to one lab for analysis and that lab then sends it on to another lab which is able to analyze ACTH levels.  Glucose is also quite unstable so you can get some perspective on the situation from that analysis as well.
From your experience caring for Red, you may well be aware of this.  If not, you can add this to your list of possibilities.

--

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: Possible Answer For Relevante's Foot Soreness...But.....?

Lynn
 

Thanks Maxine. I learned those detective "skills" from all of you! I'm ordering the Soft Rides for the front feet this morning and then will keep him in those for the next few weeks, no riding, just hand walking. By that point my vet will be here and I can have him evaluate him, take radiographs and pull blood for ACTH.  It appears this will be a process of elimination.  Hopefully he shows improvement by then and his numbers are still good.
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω


Re: New diagnosis pending

JoinTheHunt
 

Thanks for the welcome, Maxine! I think I corrected the link, it is showing blue for me. 

We are still waiting on leptin numbers and probably won't have those till the end of the week, maybe not even until next Monday. We did get ACTH and insulin back and the results are frustrating, to say the least. I will update case history when I get the full lab report which won't be until we get leptin back, but his ACTH is low. So low that my vet stated that Artie absolutely does not have Cushing's. However his insulin is also only barely elevated and she is not confident in diagnosing him with EMS either. His comfort is improving so I will leave him on the low sugar diet until we have more information, but he is not a fan and isn't eating very well, although he is bright and alert and begging from everyone within sight of his stall. 

The hay he is on right now has been tested. I have a neighbor across with the road with an IR horse and was able to buy a small supply from her source for the short term until I can get mine tested and see if we have anything suitable for him to eat. His farrier is coming today and hopefully I can get some good pics of his trim to upload. He is 2 weeks overdue right now because he was too uncomfortable to stand for her during his scheduled appt. 
--
Kelly in SE Wisconsin 2017

https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20Artie

 


Re: not a new topic, just to clarify

Eleanor Kellon, VMD
 

If you could back up his hay to 6:30 that would be better.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Cortisol level and PPID

Trisha DePietro
 

Join the August 2021 Subgroup Marie. I forgot to include the specific subgroup you should join. 
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Cortisol level and PPID

Trisha DePietro
 

Hi Marie. Dr. Kellon recommends that you go to this site:   https://cir2016.groups.io/g/main  and join that subgroup to get answers to your questions....Hope this helps. 
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Looking for Devil’s Claw in Canada

Connie Proceviat
 

Hi Suzanne,

Greenhawk sells pure Devils Claw. 

--
Connie Proceviat
2013 Manitoba, Canada
Case History: https://ecir.groups.io/g/CaseHistory/files/Connie%20and%20Falki
Falki Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=254861


Re: Pergolide dosages given for active ingredient or the mesylate form (as in Prascend)

Candice Piraino
 

HI Karen,

You can find more information here at this link which should help you and your vet:

https://ecir.groups.io/g/main/message/245748

--

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer @www.arkhavenfarm.com

 


Re: Mild laminitis or abscess?

Candice Piraino
 

HI Jessica,

Since this is your first post, we like to send all member a welcome email to make sure you all have all your information in one place and a good way to get started. Please let us know if we can help you in any way while you upload your case history.

You would need some radiographs of her feet to determine if there is any rotation going on with the help of a vet. A vet appt might be in order, especially since Fall Laminitis is a sign of PPID. Sub clinical laminitis goes unnoticed by many owners, unfortunately, and then a horse isn't diagnosed until a catastrophic event. Prevention is key and always better for the horse and owner in the long run.Dr. Kellon has already given you an answer though I see :)

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

--

Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer @www.arkhavenfarm.com

 


Re: Cortisol level and PPID

Marie
 

Weeks are IR and PPID course of Eleanor Kellon.
--
Marie Volsicka
Mid Europe
2021


Re: Cortisol level and PPID

Marie
 

In first sentence should be cortisol levels are often NOT elevated. I ´m sorry. So horse with PPID can have elevated cortisol, but they haven ´t to have elevated cortisol. Am I right?
--
Marie Volsicka
Mid Europe
2021


Re: Possible Answer For Relevante's Foot Soreness...But.....?

Maxine McArthur
 

Ah, in that case maybe the bruise scenario is more likely then. You do good detective work!
I remember the issue you had with increasing his pergolide and behaviour, in particular because I have noticed a possible similar correlation when I raise Indy's dose beyond a certain level--but I'm not sure in her case, because mares are so darn changeable anyway every few weeks that it could have been ordinary sex hormone-related loopiness. 
If you keep him in boots for a while, and exercise him in them, and his soreness improves, I guess you'll have your answer. 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Re: Possible Answer For Relevante's Foot Soreness...But.....?

Lynn
 

Hi Maxine,
Up until the last couple of weeks, I've been paying the barn owner's daughter to hand walk him for 45 minutes two times during the week. Then, because there was such a bumper crop of hay this year, some of it got stored in the arena, so she began walking him outside [no boots]. I told her to keep him on the grass/soft surfaces but that likely didn't happen 100 percent of the time. The driveway is very long, uneven, and rocky because it is not paved. And yes, Lavinia told me that as well about the pinkish tinge because it also appeared on the previous trim and I took a photo and sent it to her. His diet has not changed. His hay is balanced and currently being soaked. I did see him chomp on some leaves that blew into his paddock earlier this summer when it was so hot but if that were it, the soreness would have shown up much sooner I would think. I've never increased his pergolide dosage during the rise because the first year I did that he went bonkers in a scary way and it didn't stop until his dose was lowered to what he is currently on.  There are long threads here about that and the consensus was as long as his ACTH remained controlled, leave his dose where it was - we've done that every year without an issue. His last ACTH test at the end of June was 19.4 pg/mL. The lowest it's ever been. It's good she was able to determine it wasn't the shoulder or anywhere else in the leg, but don't know what to think about the feet. I am going to text my vet tomorrow and let him know what's going on ...I also have two videos I can send him. UGH!
--
Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

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