Date   

Re: Most recent PPID and EMS/IR lab results

Kirsten Rasmussen
 
Edited

Hi Karen,

Given Apollo's high insulin despite all that you are doing diet-wise, and the fairly high post-stim ACTH number, I too would increase pergolide.  My horse is similar to Nancy's Vinnie.  Onset of very difficult to control IR in 2017 and normal baseline ACTH.  Eventually we got an abnormal ACTH result and started pergolide, but in hindsight I feel I should have started it 2-3 years earlier based on the sequence of events and physical signs of PPID.

I'm glad he's feeling good despite the high insulin.  If that changes, I would make sure your vet is prepared to write a Px for 30mg/kg 2x/day Metformin so you can treat him right away.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Re: Prascend and Central Nervous System issues

Bobbie Day
 

Karen
i do find this interesting as Desi did this a time or two, but only when I was administering a shot or medication. I just attributed it to something in her past, she only did it a handful of times. But a mare we lost several years ago that I now know had classical signs of PPID, which regardless of the many, many vet visits we had was missed, she had bad neurological problems. She would run into things etc. I can’t help but think it was because her PPID since the pituitary gland is involved, but I would be interested in Dr.K’s opinion.

--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821


Re: Banamine/Gabapentin/Pentoxifylline

Sherry Morse
 

On hay that insulin number is perfectly normal so he is definitely not IR.  I would get him on some decent hay at the amount he actually needs to be eating, get that hay tested so it can be balanced appropriately and get him trimmed and he should be well on his way to feeling as good as he can considering all the other issues he has going on.  




Re: Banamine/Gabapentin/Pentoxifylline

Alysoun Mahoney
 

Thank you so much for this input, Sherry.

Charlie's bloodwork was done after access to the regular low-quality hay his vet allowed, but no grain that morning. 

You've given me a lot of homework -- but a glimmer of hope!
--
Alysoun M in PA 2022
https://ecir.groups.io/g/CaseHistory/files/Alysoun%20and%20Charlie
https://ecir.groups.io/g/CaseHistory/album?id=275965 


Re: Prascend and Central Nervous System issues

kalloway@...
 

I don’t know if you would call it a fit but it was almost like one to me. The was trembling or shaking uncontrollably.
--
Karen
Victoria Australia
March 2021


Re: Banamine/Gabapentin/Pentoxifylline

Sherry Morse
 

Hi Alysoun,

Was Charlie's bloodwork done fasting or with hay in front of him? If done fasting his insulin is slightly elevated, if not he's not IR.  Generally speaking if a horse has an insulin number over 80 they're in the danger zone for laminitis.  Charlie is FAR from that even if the test was done fasting.  That brings us back to the laminitis being mechanical and not related to his weight (which looks fine) or being on grass.  Following an "IR Protocol" isn't necessarily a bad idea for any horse as how most horses are fed does them no favors but there's no reason at this point to think that Charlie couldn't be on grass. 

Whether Charlie is IR or not Purina Enrich Balancer is not a good idea and neither is '5 flakes of low quality grass hay'.  You want to test your hay and balance to the hay test results for any horse.  Feeding low quality hay is an old school solution and Dr. Gustafson devoted a section of her talk at the last NO Laminitis conference to why this is an outdated idea and doesn't actually do any good for an IR horse, or any horse.

If Charlie is 1200lbs and that's his ideal weight he should be eating 24lbs of food a day (hay plus any concentrates) I would guess his '5 flakes of low quality hay' and the pound of Enrich are a total of maybe 11- 16lbs so he's not eating enough to support his body right now and probably not getting the vitamins and minerals he needs to promote good hoof growth.  So a diet overhaul would be where I would start now.

As Charlie's trim is addressed you'll most likely need several other pairs of boots - there are several groups on Facebook for used boots so if you're a member of the platform you'll want to check those out.  Once he's had one good trim whatever he's been wearing for the last 2 weeks is very likely not going to fit anymore.

Indefinitely means never again and that's what we usually advise for IR horses that have had laminitis due to IR.  Again, I don't think that's Charlie's issue and even if it was if you were willing to put a completely sealed muzzle on him he could go out on grass (just not eat it).  As far as 'stabilized' - based on his bloodwork results he is stabilized. His trim does need to be addressed and I would limit his activity - even in boots - until it is.  


.


locked Re: Urgent Advice Required (Part II)

Sherry Morse
 

Hi Rebecca,

As we're still not quite in the seasonal rise for the northern hemisphere you could redo a TRH stim test on her now to get a better idea if she is early PPID.  I see in your case history she was on Prascend last winter - has that been continued or did you stop using it?  

For Emme I would be less concerned about early PPID than getting her to a good weight and checking if the diet and weight loss were enough to get her insulin to a better number.  If not, then I would be looking at medication for assistance unless a TRH Stim test came back with an elevated post-stim result.




Re: Prascend and Central Nervous System issues

Sherry Morse
 

What was she doing besides trembling? 




Re: Banamine/Gabapentin/Pentoxifylline

Alysoun Mahoney
 
Edited

Okay, I think I have set up my folder and case history file now, and uploaded Charlie's bloodwork too. At this stage my hope is that this group can help me understand what lifestyle protocol I should plan for Charlie for the coming weeks/months/years.

Charlie's bloodwork is all normal -- he does not have IR or PPID.  However the vet said when she sent the bloodwork "I think his laminitis is still related to his weight and sugar consumption with having been on grass." This is what confuses me -- is she saying he is overweight? Neither she nor any other vet who has examined him has ever previously suggested that he was overweight, though he is stocky for a TB. In fact, two of this vet's colleagues specifically told me he was a good weight. And am I to follow an IR protocol even though he doesn't have IR? I sent these questions to the vet too, but have not yet received a response.

When he was diagnosed on Jun 7, the vet said to put him on stall rest, feed him a pound of Purina Enrich Ration Balancer and 5 flakes low quality grass hay per day. He started on banamine/gabapentin/pentoxifylline that day too, have gradually tapered down, and plan stop tomorrow.

On June 10 they recommended SoftRide boots, and I spent $300 to get those by overnight delivery. He has been wearing those since June 11. 

This week the vet sent the blood work results with advice to "keep him in the barn area and off the grass indefinitely until we know he is stabilized." I'm not sure what "indefinitely" and "stabilized" mean. Also asked the vet to clarify these points, and await a response.
--

Alysoun M in PA 2022
https://ecir.groups.io/g/CaseHistory/files/Alysoun%20and%20Charlie

https://ecir.groups.io/g/CaseHistory/album?id=275965 


locked Re: Urgent Advice Required (Part II)

Rebecca.speed@...
 

Hi helpful group, 

Hoping for some clarification if I may ask. I’ve posted Emme’s lab results here previously which showed her ACTH & TRH results as normal and it was suggested that she isn’t a PPID case and we are dealing with uncontrollabed IR but having read more info coming in via this group I am concerned the results are a false reading and I’m inhibiting her recovery by not using Prascend. Any advice would be much appreciated. 


Thank you.
--
Rebecca , Surrey UK 2021
Case History Folder https://ecir.groups.io/g/CaseHistory/files/Rebecca%20&%20Emme%20from%20UK
Photo Album https://ecir.groups.io/g/CaseHistory/album?id=271481


Re: Prascend and Central Nervous System issues

kalloway@...
 

Her increased dose is 2mg per day
--
Karen
Victoria Australia
March 2021


Prascend and Central Nervous System issues

kalloway@...
 

Hello,

5 days ago I increased Faith’s Prascend dose and have seen and improvement in her weight shifting. However today at her feet trimming she had an episode where she was trembling and had a central nervous system reaction. It was certainly a worrying episode. In looking for reasons I have discovered that prascend can have a central nervous system reactions.

Has anybody experienced this. Should I back off her dose? Is there any other recommendations as to how I should approach this latest development?

Thanks

--
Karen
Victoria Australia
March 2021


Re: Most recent PPID and EMS/IR lab results

Nancy & Vinnie & Summer
 

Hi Karen
I am speaking purely from my personal experience with my horse Vinnie. His first laminitis was November 2018 ans his acth at that time was super low, if I recall 9  on the Cornell reference range.  But we had always suspected that this lamintis was driven by PPID in spite of his numbers on the bloodwork.  Fast forward to 2021 with some acute on chronic episodes of laminitis, we finally received a positive result for PPID based on a  baseline result of acth.  I wish we had the hindsight of a TRH stimulation, but what I can say is that this year we have increased from 1.8 nlmg compounded pergolide in December 2021 to a current dose of 6.6 mg compounded pergolide now.  I am finding with Vinnie that I need to consider his clinical symptoms more than looking at the acth number.  We still plan on doing  TRH stim, to use that as a marker of information, but I am finding that what his body tells me may be a better diagnostic than just the bloodwork alone.

Vinnie is also EMS and metformin didn't control him after a period of time on it, so we are using canagliflozin, but that is definitely not a first line of defense for control of insulin.

I hope your vet will work with you in metformin, but I agree with the others bases on the post stim number that could be a contributing factor go the elevated insulin based on my long arduous adventure with Vinnie.

Hope that helps, Nan
--
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: Banamine/Gabapentin/Pentoxifylline

 
Edited

Alysoun,
You  could either snap a photo of the report and post is as a jpeg or save it on your computer as a jpeg file and post that with your photos.
--
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: Most recent PPID and EMS/IR lab results

Sherry Morse
 

Karen,

You'll want to read the message Dr. Kellon posted earlier today about this: TRH Response Tests When On Pergolide (groups.io).  Are you part of the study?  At this point we can't tell you if Apollo's IR elevation is due to his PPID or not but as his insulin is still quite high trying to get it down needs to be a priority.  The way we do that is:

DIET (you're already addressing that and he's losing weight which is good, but his insulin is still elevated)
EXERCISE (you can start walking him if he's comfortable but you do need to keep an eye on him and keep working on getting his trim in order)

If insulin is still elevated with diet changes and weight loss we look at ACTH if a horse is PPID as well as IR as elevated ACTH may be driving up insulin - this is why we're suggesting increasing the dose of Prascend to see if it helps with the insulin level.

You can also try Metformin to lower the insulin but you need a script for that so need to work with your vet on that.




On Thursday, June 23, 2022, 09:04:22 PM EDT, a.k.a.petpalace2@... <a.k.a.petpalace2@...> wrote:


I thought target range for ACTH levels when using pergolide was teens/low twenties which Apollo's is.  Was I mistaken?  He is also one of those horses who had a normal endogenous ACTH level but tested positive with TRH stim test.  Isn't Dr. Kellon doing her study on these horses to help determine how to manage them?  So what I need to do is increase his Prascend dose to try and lower his insulin level even though his ACTH is not elevated? Won't increasing his Prascend lower is ACTH level too?  It was only 11.2 pg/mL when last checked.  If I increase his Prascend dose, how long do I wait to retest his insulin level?  Do I also recheck his glucose?  Does leptin level help differentiate between IR vs PPID as cause of high insulin?  If my vet would agree to metformin, would I still increase his Prascend?  
--
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: Banamine/Gabapentin/Pentoxifylline

Lorna Cane
 

Hi Alysoun,

I've copied this from the Welcome message that Trisha sent you a bit ago.If you can find it that would be good. Lots of info about getting around the group.

"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.-"

I hope this makes more sense now?


Lorna in Eastern Ontario
2002

Check out FAQ : https://www.ecirhorse.org/FAQ.php


Re: Banamine/Gabapentin/Pentoxifylline

Sherry Morse
 

Hi Alysoun,

You created a folder in the photos section of the Case History subsite but you have yet to create a folder for your case history.  That is done in the Files section of the CH group (https://ecir.groups.io/g/CaseHistory/files). Once you create a folder in the files section that's where you would put your case history PDF and any hay tests, bloodwork or other PDF or .doc documents.  Photos and x-rays (jpgs) go in the photos section.

If Charlie is not PPID or IR any further discussions about his treatment would go on the Hoof or Housekeeping subgroups but seeing his actual bloodwork results can help us help you determine his status.




Re: Banamine/Gabapentin/Pentoxifylline

Alysoun Mahoney
 

I did create a case history and posted a number of photos there over the last several days (see link below). However, I don’t see a link to add file types other than photos.
--
Alysoun M in PA 2022
https://ecir.groups.io/g/CaseHistory/album?id=275965 


Re: Banamine/Gabapentin/Pentoxifylline

Lorna Cane
 

Hi Alysoun,

If you go to Wiki,you will see Getting Started,and below that Get Started on your Case History. Details are also in the Welcome package you received when you first posted.
I'm sorry I can't include the links here for you.Tablet being moody.
But the instructions above will allow you to include all the details we need to give the best help,including lab. test results.
You could include the results here in a message, so volunteers can think about them,until you have time to get started on the case history.
By the way, the case history doesn't have to be totally completed before you to post a link here to it. Include what you can as soon as possible,and add details as you have time.
The devil is in the details.

--
Lorna in Eastern Ontario
2002

Check out FAQ : https://www.ecirhorse.org/FAQ.php


Re: Banamine/Gabapentin/Pentoxifylline

Alysoun Mahoney
 

Yes I do but am not sure where to post them. The case history folder seems to be for photos only (vs documents)
--
Alysoun M in PA 2022
https://ecir.groups.io/g/CaseHistory/album?id=275965 

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