Date   

invokana/Etruglifloxin and Triglycerides Study

Eleanor Kellon, VMD
 

We are getting down to a deadline for submission of an article on this for a special request by the publication Veterinary Sciences. I really need anyone who originally agreed to submit information for this article but have not done so yet to step up and give me your information.If you are having trouble with the report form, just let us know and we will help you with that. This is very important for horses with refractory laminitis and high insuliin. You can make a difference with your informationl
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Zahr Update: Insulin and glucose results

Eleanor Kellon, VMD
 
Edited

You're not confused. You have it exactly right. I don't know what pharmacy you are dealing with but they should know the difference between x mg of pergolide base and x mg of pergolide mesylate. The problem here is that they are geared by the USP to do mg of pergolide mesylate, not mg of pergolide. However, your veterinarian's prescription should make that perfectly clear.

There is no reason to alternate days of Prascend with CP. It's the same drug. Just make sure the concentration is the same.

If your pharmacist is struck in some kind of whatever misunderstanding then ask your vet to make the prescription for the correct amount of pergolide mesylate,  rather than pergolide. It's ridiculous that this should be an issue.

The capsules will not break down in cool water like Prascend does. You will have to open them and add to water in the syringe.

Zahr is an Arabian, a breed prone to EMS, but his history strongly suggests in his case it is the PPID causing the issues. I agree with focusing on his ACTH.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Zahr Update: Insulin and glucose results

Nancy & Vinnie & Summer
 

Mikaela,  I ran into the same with my CP rx when I switched. Fortunately the pharmacist was super helpful.  I had an RX tbat was 6.6 cp, and I had my vet write 6.6 mg cp from mesylate and that is interpreted as 5mg c pergolide, when in reality I wanted 6.6 c pergolide, which is actually 8.5cp from mesylate. I was able get the correction made pretty quickly and got my RX within the week. Super duper fast! And they had to compound new formulas for me for both Vinnie and Summer. You are not alone :)
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Re: New to Group

Maxine McArthur
 

Hello Kate from a fellow Aussie 
Trish and the welcome message have pretty much covered everything the group recommends, so give the links a good read and let us know if you have more questions. 

Is she getting any grass at the moment? That can delay recovery. Hoof testers are not reliable indicators of laminitis, and pulses (or the absence of pulses) is not a reliable indicator either. There may be abscesses brewing or damage to the laminae that needs to recover. It takes 6-9 months for a healthy hoof to grow down, so while her insulin levels may drop quickly with the metformin, she may take longer to become sound. Have you tried hoof boots or padding on her feet to see if it helps her comfort? 

One more thing—make sure she is getting the full dose of metformin (30mg per kg of her body weight) twice daily. You’ll need an accurate estimate of her weight (there’s a link in the Wiki on how to do that). This is really important as lower doses often do not help. 

If she’s doing well on the teff and beet pulp, I wouldn’t risk the lucerne while she’s still footy. 

Let us know when you have a case history and photos/xrays uploaded.

--
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: Zahr Update: Insulin and glucose results

Mikaela Tapuska
 

Hello again, 

After a whole process of what felt like pulling teeth, Zahr finally has his prescription for compounded pergolide (hooray!).

Although I did ask the vet to write the prescription as "X mg pergolide as pergolide mesylate" (and she did), the pharmacist said she'd need a new prescription from the vet if I wanted the 4mg of CP equivalent of 3mg prascend. So perhaps I misunderstood how that was supposed to be written? Since he is on 3mg prascend currently, I thought 3mg pergolide as pergolide mesylate would be converted from that to 3.9 (4) mg, but it does not sound like that is the case... (was it supposed to be written as 4mg pergolide as pergolide mesylate instead?)

The pharmacist told me that clinically there shouldn't be a difference between 3mg prascend and 3mg CP, which I argued I am not comfortable with for Zahr since he is so sensitive (and based on what this group has shared, I know to be inaccurate). But waiting for reworded paperwork from the vet to get a special order of 4mg CP, if the new prescription were sent in today, would get it here by the end of next week and pushes us back into August for the 3 week mark to test and wouldn't be useful at that point. I wound up ordering a 30 day supply of 3mg CP and will supplement him with an additional 0.5mg prascend daily, so that will work out to be about 2.8mg total after conversion (which I am not thrilled about, but I think this is the best I can do to get him tested in time). I'll work in the meantime to get the prescription sent in differently so that I can order the correct amount for next time.  

A couple more questions for the group:
1. Since we are changing medications, would it be ideal to alternate days between prascend and the CP for the first week so that is is introduced gradually?
2. How do other group members feed CP? Zahr currently gets his prascend syringed in the mornings because he won't eat it in his feed and he figured out pill pockets in one day. Will the capsules break down as effectively as the pink pills in cool water? 
3. When I get Zahr's ACTH tested, should I re-check insulin as well? I was thinking check to make sure that ACTH is controlled first, then re-check insulin after, because if the ACTH is still high I presume that will throw off his insulin numbers.

At this point I'm not sure precisely what day Zahr will be starting on the CP, but I think I'm going to go ahead and book his blood test for the last week of July since it can't be done any later. It may not hit the ideal 3 week mark, but I anticipate having to bump him up an additional 0.5mg on top of what he will already be getting at the point with prascend once the seasonal rise is in full effect. I'd prefer to get the numbers in while they are still semi-accurate rather than wait any longer.

Apologies for my own confusion and probably asking some of the same questions over again. Trying to get this prescription has been extremely frustrating with a lot of hurry up and wait, but at least we are on the right track now. Thank you again as always for the help and guidance!

--
Mikaela Tapuska in Calgary AB, 2021

Case History: https://ecir.groups.io/g/CaseHistory/files/Mikaela%20and%20Zahr

Photo Album : https://ecir.groups.io/g/CaseHistory/album?id=274255


Re: What did I do wrong this time

Eleanor Kellon, VMD
 

I'm sure Lavinia will comment too but IMO those feet are way too underrun to be suitable for riding. Shoes can't fix this. The horse needs a rehab trim, described here https://hoofrehab.com/DistalDescent.htm . We need full hoof photos as described in the Wiki to comment in detail. I seriously doubt the brief shade-grown grass had anything to do with this but we don't have any insulin numbers in your history.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


What did I do wrong this time

Kandace Krause
 

New photos in photo album.
K was reset on 2022 07 03, ridden one hour and finished sound on 2022 07 04, and was lame 2022 07 05.  This morning nearside fore is warm up to top of fetlock.

Changes in feed prior to lameness was allowed to eat shade grown grass after exercise for a 5 minute max, maybe 4 times.  grazed on shade grown grass 10 minutes timed, early mornings 3 times.  This is over the last month.

Changes in feed since lameness, delete soaked timothy alfalfa cubes from bucket feed (4 oz daily) no grass.

Can the reaction to shoeing be delayed by one day and ride?
Could the small amount of grass have just come to a head yesterday?
--
Kandace K
Rocky Mountains, Alberta, Oct 2020
https://ecir.groups.io/g/CaseHistory/files/Kandace%20J%20and%20K
https://ecir.groups.io/g/CaseHistory/album?id=259062


Re: Hooves look terrible ?? Need asssistance with hoof trimming with hoof mark-ups

a.k.a.petpalace2@...
 

Hi Nancy,
Thanks so much for your kind words of encouragement and additional information.  I may have just joined this group recently but I've been struggling with Apollo's hoof related health issues for more than a year.  I know I will get some flack for saying this but sometimes I'm tempted to just give up.  No matter what I do, nothing ever seems to be enough.  I do care about Apollo very much but it's emotionally, financially and physically exhausting at times trying to meet his many, seemly endless needs. I honestly didn't think it would be this hard for this long and if I had known, I'm not sure if I would have started because it seems no matter what you do, in terms of health, you've still dealing with an equine time bomb.  Unfortunately all this stress is affecting my health.  Had my post-op check-up today and although I'm doing well, my doctor says healing is a bit slow and that's probably because of my high stress level. Not sure how, but obviously I'm going to have to learn to deal with everything much better.  I'm actually not entirely comfortable posting these personal comments on this site as I'm normally a very private person and one of reasons I didn't joint ecir.groups.io earlier, but I'm doing so in case it helps someone else who's feeling discouraged, overwhelmed and exhausted.  
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


Re: Update on Isaac

Trisha DePietro
 

Hi Rene. Are you trying to get him to eat the prascend mixed into the supplements and the carrier? If yes, you will always have trouble with this process until you separate out the Prascend.  Here is the process I used to see what was working and what was not working.  I used this groups suggestions and went through the picky eaters checklist.....I ended up taking out all the supplements and just offered the carrier for 2-3 days- just to see what would happen....she always ate the carrier...then I added back, one at a time, the vitamins and minerals over the next several days- very slowly and very small increments until up to the full dose of what she needed. Once I got her good with that, I added the Prascend, secretly hidden in a gel cap, mixed it in so food was covering it slightly and she stopped eating her food- no matter how I disguised it, it just didn't matter. So, I found a product from Horsetech that is used as a food flavoring, ordered the peppermint ( its safe for IR horses)...and I started to just syringe the peppermint. I syringed small amounts about 2-3 cc's 2-3 times a day....just to see what her reaction would be and if I could get her to appreciate the new flavor. When she really started to show an interest in the syringe, ie licking it etc. then I dissolved a 1/4 tab of prascend into it and gradually increased to her full dose which is 2 tabs. I am so afraid to type this for fear of her refusing her next dose, but its' working. I am so much happier and she is getting her full dose everyday without a hitch. I also syringe my other horse too and she also loves the peppermint flavor. Life is better now and I don't have spices and teas and samples and partially used food all over the place anymore.  The 6 cc's is tolerable to syringe, without it being too much to dribble out..( had to experiment with that too). Hope this helps...
--
Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder


Re: Hooves look terrible ?? Need asssistance with hoof trimming with hoof mark-ups

a.k.a.petpalace2@...
 

Okay.  I didn't realize I needed pictures of back feet too.  Will do ASAP.  Is it same 4 views as fronts?  Will concavity and heel views also be needed?  I apologize for so many questions beforehand. I imagine it must be very tedious having to answer us "newbees" questions so many times.  
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


Re: Nominating Dr Kellon and Re: How to say "thank-you". Please help.

Kelly Kathleen Daughtry
 

I voted as well. I couldn't tell from the website if we would be notified. Anyone know? Just curious. 
--
Kelly & Micah, Clayton NC

April 2016

Case History: https://ecir.groups.io/g/CaseHistory/files/Kelly%20and%20%20Micah 

Photos: https://ecir.groups.io/g/CaseHistory/album?id=264981

 

          


Re: Feeding elderly horse with Cushings

Eleanor Kellon, VMD
 

I would switch him to a diet of 100% soaked  Triple Crown Naturals Timothy Balance Cubes and if your dealer doesn't have them and won't order them contact Ontario Dehy for availability directly from them in your area.  Start with 1.5 pounds of cubes per 100 lbs of body weight and soak with enough water to make them soft. Do not discard any extra water. I would increase his pergolide by another 1 mg, at least.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: New blood results for Riosa, feedback please

Eleanor Kellon, VMD
 

Her numbers look acceptable, Heather. How is she doing? Still on estradiol?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Need help quickly

LJ Friedman
 

dont give up.. I had same issue years ago when Jesse had laminitis..  3 weeks later he was cantering in the arena???  are u using easycare boots etc??  you can make emergency boots with styrofoam and duct tape.  your horse wont remember these painful times once you get him better..    but u need to do what is suggested here..  local vets dont know much..  
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Re: Nominating Dr Kellon and Re: How to say "thank-you". Please help.

Nancy C
 

Hi Dede

Nice to see you! 

Nominations for this award may continue to be submitted through July and August.  Three vets will be chosen each month as finalists with the "grind prize winner" chosen and honored at the AAEP conference in TX later in the year.

Details:
https://aaep.org/horse-owners/good-works-horses

Thanks for voting!  Share with others pretty please!

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Nominating Dr Kellon and Re: How to say "thank-you". Please help.

hueybre
 

Nancy, thank you so much for posting this wonderful way to pay tribute to Dr Kellon. She is truly an amazing veterinarian who so generously shares her time and expertise so that our horses can enjoy longer and healthier lives. Needless to say I did vote. Can you imagine how many votes Dr Kellon would receive if all the horses who reaped the benefits of  Dr Kellon's wisdom and generosity were able to cast their vote? Do you when the nomination process will be closed?  
--
Dede
in VA 2000 or 2001


Re: New labs in - advice on increasing Pergolide & arthritic pain relief

Eleanor Kellon, VMD
 

Yes, I would go to 3 mg and prescription as you said. Many people decide to go with long term NSAIDs in older horses, and if there are no options it's not a bad thing,
even if it does cause kidney and/or colonic disease. Before going there, I would suggest a rectal exam to check the pelvis for fractures and the SI joints for displacement.  Do you have access to an acupuncturist? Acupuncture and/or trigger point injections with Sarapin would be my first choice.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Re: Feeding elderly horse with Cushings

Sherry Morse
 

Hi Jean,

We really need a case history to help you out.  If you did not change anything after getting that test result there's no reason to think that a test now will show a positive change in his insulin level unfortunately.  You may want to recheck his ACTH now in case you need to make another adjustment before we hit the full rise. 

Please note that Triple Crown Senior is not a suitable feed for an IR horse with an insulin over 200. Has your hay been tested?  If not, are you soaking it?  Is there a reason you're not using beet pulp (rinsed/soaked/rinsed) or Stabul 1 as a carrier for any supplements Snowman is on?  How much does he weigh?  How much should he weigh?  You can replace the grain with beet pulp, Stabul 1 and/or Triple Balance Timothy Balance Cubes (fed at a 3:4 ratio to hay) which should help bring his insulin down.  If it's still elevated even with a diet change you'll need to look at medication to get it down but you do not want to continue with it being over 200 which is well over the danger zone for laminitis.




Re: Update on Isaac

Sherry Morse
 

Hi Rene,

Re: oil - I would suggest you try something else as Olive oil is obviously not a winner for Isaac.

As far as the FFW - you can do a search of the archives or please do start a new topic.




Re: Dosage of Pergolide? Help understanding test results after being on pergolide

Sherry Morse
 

Hi Sharon,

You are getting capsules.  The original person who asked this question sounded as if they were using a powder not in a capsule.  If that's the case every time the container is open the powder is being exposed to air and it is probably going to degrade faster than if it were in a capsule.  



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