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Re: Updated Case History, Suggestions Needed
Maggie
>>In the 3rd paragraph that was supposed to say he gets no hay unless soaked, not no hay....
Whew! When I read that my fingers started to twitch! Glad to hear that was a typo! :)
>>We have been fighting laminitis now since August so he does not currently have a fall insulin level.
Kendra, several things in your note jump out at me that suggest that Opie is PPID.
1) Fall laminitis is often the first sign of PPID due to the seasonal rise. For more information have a read on our website here: http://ecirhorse.org/index.php/cushing-s-disease/seasonal-rise Great place to send your vet as well.
2) Depression can also be a sign of PPID. More information here: http://ecirhorse.org/index.php/cushing-s-disease and here: http://ecirhorse.org/index.php/cushing-s-disease/physiology-of-ppid-cushing-s-disease
3) Opie is feeling better since starting on the Prascend,
4) Opie's age of 15
5) There is some thinking that the oxidative stress of IR over the long term, can lead to PPID. You know that Opie was IR when you purchased him and who knows how long before that. Here's a post by Dr Kellon on that matter: https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/178825 Pay special attention to this statement: "On one level, IR horses may seem at higher risk because they are at higher risk to develop laminitis early in the course of PPID."
Great to hear that Opie is feeling better on the Prascend! There is really no need to wait for 60 days of a trial period. We recommend testing after 2 to 4 weeks on the target dose to see if the ACTH is well controlled. Here's a post by Dr. Jaini that addresses that: https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/190147 And a bunch of information on pergolide: http://ecirhorse.org/index.php/cushing-s-disease/pergolide Embedded in that link is also a message from Patti on using a scale of symptoms to help determine if you are at your target dose: https://groups.yahoo.com/neo/groups/EquineCushings/conversations/topics/111988?threaded=1&l=1
I noticed in your CH on Opie that you have him on SmartVite Thrive. This product contains Vit C and B vitamins that are not recommended for IR horses. Also, added manganese, which you may or may not need to balance your hay, and not enough copper, zinc, biotin and methionine to even begin to do any good. The best thing you can do is to have your hay tested and balanced. Here's a link to "help with mineral balancing" https://groups.yahoo.com/neo/groups/EquineCushings/files/7%20Help%20with%20Mineral%20Balancing/ Please read the "nutritional needs for insulin resistance" by Dr Kellon, the last file in that folder. Also noticed that Opie has a "severe allergy to flies." I can just tell you from experience that Chancey used to have the WORST sweet itch (hypersensitivity to Culicoides aka midges) ever. He would scratch his belly raw and bleeding. After finding this group and starting first the emergency diet and then balancing his hay, he no longer has any signs of sweet itch!
You also state that "He is in a controlled IR and his spring insulin level was 24.3, also in the normal range." Here is a link to the IR calculator. http://www.freil.com/~mlf/IR/ir.html Plug in your numbers to see that an insulin of 24.3 puts Opie in the "severely IR" category. You didn't say what his glucose was, but just to give you an idea, I put it in as 80 and then again as 100 with the insulin of 24.3, and both times it comes back "severely IR". The labs normals are too high. The freil calculator is based on the IR pony field study, 7th file down in this "insulin resistance" folder: https://groups.yahoo.com/neo/groups/EquineCushings/files/Insulin%20Resistance/ I may be confused, but are you currently hand walking and trotting Opie? A laminitic horse should never be forced to move. You don't want to compromise the fragile new lamina connections. It would be very helpful if you could post some pictures of Opie's feet for one of our hoof gurus to have a look. Here's a site that shows how too take good hoof photos: http://www.all-natural-horse-care.com/good-hoof-photos.html
Maggie, Chancey and Spiral in VA
March 2011 EC Primary Response http://pets.groups.yahoo.com/group/ECHistory4/files/maggie%20in%20virginia/
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Re: Switching To Compounded Pergolide(and questions!)
Hi Stephanie
I have switched directly one from or to the other without issue. At the time I went from compound to Prascend the dose was lower. 8 mg Compound to 5 mg Prascend if I remember correctly. When going the other way, went one-for-one, and if increase was needed, then went on with titrating up. As I've said before 5 mg of Prascend did not control the ACTH. Nancy C in NH ECIR Moderator 2003 Learn the facts about IR, PPID, equine nutrition, exercise and the foot. www.ECIRhorse.org Check out the FACTS on Facebook https://www.facebook.com/ECIRGroup Support the ECIR Group Inc., the nonprofit arm of the ECIR Group Equine Cushing's and Insulin Resistance Group Inc.
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Re: gut problem
janieclougher@...
Oh, Ethlyn. I am so sorry for your loss. Fly free, dear Dakota. Jaini and crew BC 09 ECIR mod/support
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Re: when to re-test ACTH
janieclougher@...
Hi, Erin - Virtually all horses will have responded to the pergolide by 17 days (some much sooner) so you can re-test in 3 weeks to find out if the dose is controlling her ACTH. Meaning, you can re-test now; it's not too soon.
Glad she is feelng better! And yes, the new Neo makes many basic tasks on the list (like searching) difficult or impossible. Jaini and crew BC 09 EC mod/support - If I can get a new vet to come out in the next week or two, is that too soon to recheck her ACTH? Erin ME 2014 https://groups.yahoo.com/neo/groups/echistory8/files/Bella/
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Re: Updated Case History, Suggestions Needed
Kendra
In the 3rd paragraph that was supposed to say he gets no hay unless soaked, not no hay. I apologize. From: "jaggirl47@... [EquineCushings]" To: EquineCushings@... Sent: Sunday, November 2, 2014 6:44 PM Subject: [EquineCushings] Updated Case History, Suggestions Needed I just updated Opie's case history. He has been doing rehab for check ligament tears for the past 6 months and is still not able to be ridden. I am very strict on his diet and when he initially went into rehab we took away pretty much any extra item that might contain sugar. His diet is in his case history. The problem I am having is his crest continues to flair up, he now has mild laminitis in all 4 hooves (no rotation), and we have been having occasional abscesses for the past couple of months. We drew ACTH levels last year and they were well within the normal ranges. He is in a controlled IR and his spring insulin level was 24.3, also in the normal range. I have to put that in his case history because I completely forgot. We have been fighting laminitis now since August so he does not currently have a fall insulin level. We were trying to fight that prior to drawing a new lab so we can get an accurate level rather than an increase due to the laminitis. Soaking the hay hasn't made a difference and he is on beet pulp with vitamins and minerals, no grain whatsoever. He gets no hay. The vet feels like he may be showing pre-Cushing's so we have started on Prascend at 0.5mg total daily for 60 days for a trial. I did notice his personality, which has been rather depressed the past few weeks, has snapped back very close to his normal pony-tude after starting the Prascend. No change in the hooves or crest as of yet but he just started Monday and has had a total of 7 doses. The vet's plan is to redraw the ACTH and send to Cornell if the trial works. He has had no actual signs of Cushing's aside from what I just explained. Can Prascend work on IR horses that are non-responsive to diet measures even if they do not have Cushing's? Is there anything I may be missing to bring up at our next vet appointment? Oh, he is seeing the farrier every 3 weeks. He is barefoot and gets rasped every 3 weeks instead of a trim every 6 due to the way his hooves grow. He has a few confirmation issues we have to stay on top of unrelated to the IR. Here is his case history link. It is still bare but I will work to get pics loaded into it. Kendra and Opie Washington 7/2013
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Updated Case History, Suggestions Needed
Kendra
I just updated Opie's case history. He has been doing rehab for check ligament tears for the past 6 months and is still not able to be ridden. I am very strict on his diet and when he initially went into rehab we took away pretty much any extra item that might contain sugar. His diet is in his case history. The problem I am having is his crest continues to flair up, he now has mild laminitis in all 4 hooves (no rotation), and we have been having occasional abscesses for the past couple of months. We drew ACTH levels last year and they were well within the normal ranges. He is in a controlled IR and his spring insulin level was 24.3, also in the normal range. I have to put that in his case history because I completely forgot. We have been fighting laminitis now since August so he does not currently have a fall insulin level. We were trying to fight that prior to drawing a new lab so we can get an accurate level rather than an increase due to the laminitis. Soaking the hay hasn't made a difference and he is on beet pulp with vitamins and minerals, no grain whatsoever. He gets no hay. The vet feels like he may be showing pre-Cushing's so we have started on Prascend at 0.5mg total daily for 60 days for a trial. I did notice his personality, which has been rather depressed the past few weeks, has snapped back very close to his normal pony-tude after starting the Prascend. No change in the hooves or crest as of yet but he just started Monday and has had a total of 7 doses. The vet's plan is to redraw the ACTH and send to Cornell if the trial works. He has had no actual signs of Cushing's aside from what I just explained. Can Prascend work on IR horses that are non-responsive to diet measures even if they do not have Cushing's? Is there anything I may be missing to bring up at our next vet appointment? Oh, he is seeing the farrier every 3 weeks. He is barefoot and gets rasped every 3 weeks instead of a trim every 6 due to the way his hooves grow. He has a few confirmation issues we have to stay on top of unrelated to the IR. Here is his case history link. It is still bare but I will work to get pics loaded into it. https://groups.yahoo.com/neo/groups/echistory7/files/Kendra-Washington/ Kendra and Opie Washington 7/2013
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Re: Switching To Compounded Pergolide(and questions!)
Stephanie Stout
PS: I started him on APF and it is definitely helping. He is more alert and perky! So, thanks to everyone that mentioned it!
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Re: Switching To Compounded Pergolide(and questions!)
Stephanie Stout
Thank you all for replying. I am going to do my research and get some compounded ordered tomorrow. Would you guys switch slowly(half Prascend/half compounded) for a couple days or just switch full on(one day all Prascend, next day all compounded)? He's on 2.5mg of Prascend right now, and I'm thinking I might have to raise him up to 3mg in the next couple days to make sure this laminitis stops and get his levels down.
Thanks again. Stephanie & King Member since Oct 2014 Oregon
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FINDING THINGS WITH THE NEW NEO
We have a lot of new members. Learning Yahoo, especially NEO, takes a bit of work and everyone is having a problem. Hang in there. Keep at it. If you are trying to find a particular file or topic discussion, and having trouble, please speak up. You are not alone and by asking you will help others. There’s so much info here, the links below can help you negotiate the learning curve and find background to questions and issues: ** DDT+E - Diagnosis, Diet, Trim plus Exercise - What is it? Once at the above page, click on the list to the left for even more detail. ****START HERE folder. Similar to above but also has other great files. including how to start a Case History. ** What blood testing do I need for diagnosis? ** How to get help with Mineral Balancing ** How to search the FILES sections for documents with NEO. You must be a member to do this. Go to the FILES section via the web page At the top of your browser window, look for the SEARCH FILES WINDOW and enter your search word(s). Try Diagnosis, for example. All docs with diagnosis in them will appear. In this case DDT Diagnosis, diagnosing Insulin Resistance, IR Pony Field Study, Low Dose Dex test and more all came up. Click on the Topic heading to open the document. ** Archived Messages - How to Search this treasure trove of information and history in the NEW NEO format ** Current Case History filing cabinet accepting new member info Links to ALL Case History Sites (Scroll down to Links to ECIR History Sites.pdf) Like us on Facebook! *** Donate to the ECIR Group Inc. nonprofit! Owners, Moderators & Primary Response Teams of the Equine Cushing's and Insulin Resistance Yahoo group REMEMBER: If you get an error message when clicking on a link or tiny URL, check your BROWSER WINDOW and remove "pets." from the URL. We know this is an extra step when you are in high anxiety. Hang in there. It gets easier. If you are lost, speak up.
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Prascend Experiences and Reporting to the FDA
*** Prascend Experiences Anxiety is running high over the claim that 1 to 3 mg of Prascend (average size horse) will work as well as any dose of compounded pergolide. The value of this group lies heavily in members reporting their experiences. If you have any information to share about Prascend, either dosage related or side effects, good or bad, please send your story to one of the ECIR Group moderators: Lorna Cane <briars@...> Jaini Clougher <merlin5clougher@...> Nancy Collins <threecatfarm@...>. Eleanor Kellon VMD <drkellon@...> Your file will be uploaded to the Prascend Experiences File. If you prefer to not have your name used, the moderators will protect your identity. All members may read about fellow member experiences here *** Reporting Adverse Reactions and Ineffective Drugs or Supplements to the FDA Failure to respond to the recommended dose is an adverse event that should be reported to FDA as a therapeutic failure. Evidence of failure to respond can be comprised of observation of clinical signs (lack of change in symptoms) or through blood work. Information on how to contact the FDA may be found here. Reports become part of the permanent Adverse Drug Experience records. Owners, Moderators & Primary Response Teams of the Equine Cushing's and Insulin Resistance Yahoo group
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CONTRIBUTING YOUR INFORMATION - HELP US TO HELP YOU
ThePitchforkPrincess@...
This is a very large group of horse owners with the potential for having a large database of information. Well-documented scientific data (your case history) helps the ECIR Group gain the trust of science-based equine professionals and shows patterns that shape the protocols that helps so many PPID and IR horses and owners. Sharing your information is the best way to thank the ECIR Group's volunteers for their help. Please take the time to add or update your Case History.
HELP US TO HELP YOU: For faster and more relevant answers, please include a link to your case history, photos etc, in your messages – to properly answer any questions the volunteers need to see a case history for your horse.
POSTING YOUR HORSE'S INFORMATION: 1. NEW Case Histories should now be posted in ECHistory8.
2. Full instructions and templates can be found in the main files in the folder
3. Keep your case history safe! Avoid losing your information by following the simple instructions and tricks for posting and updating case histories in the document “Warning for Naming Folders”.
3. If you are updating an old Case History but there is no longer enough space on older history groups, feel free to move your information to ECHistory8.
<<< IMPORTANT >>> 4. Photos of any sort - this includes photos of text such as lab reports - should be posted in the PHOTOS SECTION of the ECHistory Group where your case history is posted. Links to ECIR Case History Sites
If you had or have to move your Case History, you don't need to move your photos. Just be sure a link to them is posted in both your case history and your message signature.
As you can appreciate, there are just too many places information can be. It is the responsibility of the uploader to note the urls and provide links whenever seeking advice from the volunteers. If you are unsure how to do this see the document "How to Make, Save and Post Signatures and Links".
5. Please check if you can add any information to the various Databases and Polls.
For Neo Yahoo users, buttons/links to these locations can be found just under the any of the group's cover photos.
For Classic Yahoo users these buttons/links are located in the top left-hand corner of the screen. Or you can click these links:
Thank you for your cooperation.
Owners, Moderators & Primary Response Team of the Equine Cushings List
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Re: Dakota / WAS gut problem
I am so sorry Ethlyn. May your have many,many happy memories to fill the hole in your heart.
Nancy C in NH ECIR Moderator 2003 Learn the facts about IR, PPID, equine nutrition, exercise and the foot. www.ECIRhorse.org Check out the FACTS on Facebook https://www.facebook.com/ECIRGroup Support the ECIR Group Inc., the nonprofit arm of the ECIR Group http://ecirhorse.org/index.php/equine-cushing-s-and-insulin-resistance-group-inc
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Re: Low numbers, sick horse
Not finding or recalling any cases where ACTH was "too low".
Hope to have Dr Kellon in on this. She and all of us will benefit from seeing your updated History. If Cato were here, I'd be getting he blood work your vet suggested to rule out other issues. Nancy C in NH ECIR Moderator 2003 Learn the facts about IR, PPID, equine nutrition, exercise and the foot. www.ECIRhorse.org Check out the FACTS on Facebook https://www.facebook.com/ECIRGroup Support the ECIR Group Inc., the nonprofit arm of the ECIR Group Equine Cushing's and Insulin Resistance Group Inc.
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Re: Low numbers, sick horse
---In EquineCushings@..., <hinecedark@...> wrote : So . . . while I struggle with getting Cato's case history updated, the general questions remain: I am assuming since all horse have ACTH, that it is necessary to them. Is that correct? Is it known "how much" is necessary? If the high end of the reference interval is "too high" in many cases, then is the low end "too low"? Is it possible to take it "too low" with pergolide? If a low level of ACTH is enough to tip the horse, non-IR at baseline, into IR, then is "too low" a worry at all? I realize these aren't the standard question/concerns, but they are mine for a reason. I can't believe I have the only horse ever to be this sensitive. If the group with the most experience with ECIR doesn't have answers, where do I look? Thank you, Melinda IN 2010
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Re: Switching To Compounded Pergolide(and questions!)
Hi Stephanie
How does compound compare to Prascend in the field is a big, big conversation. As always, we are need members to tell us their experiences. Reports have been:
https://groups.yahoo.com/neo/groups/EquineCushings/files/%201%20A%20a%20Prascend%20Experiences/
You may not be able to go dose for dose switching to compound. You need to be vigilant. There is no one pharmacy recommended by ECIR. The ECIR recommendation is to use a reputable pharmacy. In the LINKS section is a list of businesses that have been reported as serving member needs well. https://groups.yahoo.com/neo/groups/EquineCushings/links/all Scroll down to Pharmacies. I have recently swithced to Pet Health and been very happy. Recommendation is to buy caps 30 days at a time and store int eh door of the frige. As for getting the pergolide caps in them, a handful of Nuzu works well. I use a feed bag b/c I give several other pills and I know they all got to where they needed to go. HTH Nancy C in NH ECIR Moderator 2003 Learn the facts about IR, PPID, equine nutrition, exercise and the foot. www.ECIRhorse.org Check out the FACTS on Facebook https://www.facebook.com/ECIRGroup Support the ECIR Group Inc., the nonprofit arm of the ECIR Group http://ecirhorse.org/index.php/equine-cushing-s-and-insulin-resistance-group-inc ---In EquineCushings@..., <KWPNDRESSAGE@...> wrote : Is the dosage the same(ie: Is 2.5mg of Prascend is the same as 2.5mg of the compounded)?
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Re: Switching To Compounded Pergolide(and questions!)
ferne fedeli
This is Ferne Fedeli again. I realized that you also asked how to feed to picky eaters. I should be an expert on that, but am continually stumped!!! My Icelandic has eaten them in a prune just fine for months and then would not touch, so changed to a handful of the Stabul 1 pellets. After a few weeks refused those. My last thing was to give it in a slice of carrot that I hollowed out the middle a bit and stuck the capsule in. So far he has liked that, but probably shouldn't even give him that much carrot, as he has laminitis again... If someone else has some brilliant ideas, let us know!!! Ferne Fedeli No. California 4/2010
On Fri, Oct 31, 2014 at 10:39 AM, KWPNDRESSAGE@... [EquineCushings] <EquineCushings@...> wrote:
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Re: Switching To Compounded Pergolide(and questions!)
ferne fedeli
I don't have all the answers to your questions, but have been using Thriving Pets for my Pergolide for several years now. I always only buy 30 days worth at a time and keep it on the refrigerator door, as has been recommended. I have no complaints. Their service is quite quick. I use the postal service and usually get the capsules in about 3 days here in California. The dosage for the compounded should be the same as the Prascend. Ferne Fedeli No. California 4/2010
On Fri, Oct 31, 2014 at 10:39 AM, KWPNDRESSAGE@... [EquineCushings] <EquineCushings@...> wrote:
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Re: Dakota / WAS gut problem
aet001@...
Ethlyn, I'm so sorry for your loss. Fly free, Dakota, green grass and blue skies forever. Amy in PA '06ish (Herbie IR, Darby, lost beloveds on HIH site Echo, Dylan, Pebbles, Cherry, Misty who was C/IR)
---In EquineCushings@..., <windybriars@...> wrote : Hi Ethlyn, >(As a postscript, I sadly announce that Dakota, who brought me to this group, was euthanized this past Wednesday.
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Re: Low numbers, sick horse
palomino.1982@...
Hi Melinda~
No answers at the moment...but a quick question: What lab is used for analysis of ACTH, etc. ? Susan EC Primary Response SoCal 2007 ---In EquineCushings@..., <hinecedark@...> wrote : So . . . while I struggle with getting Cato's case history updated, the general questions remain: I am assuming since all horse have ACTH, that it is necessary to them. Is that correct? Is it known "how much" is necessary? If the high end of the reference interval is "too high" in many cases, then is the low end "too low"? Is it possible to take it "too low" with pergolide? If a low level of ACTH is enough to tip the horse, non-IR at baseline, into IR, then is "too low" a worry at all? I realize these aren't the standard question/concerns, but they are mine for a reason. I can't believe I have the only horse ever to be this sensitive. If the group with the most experience with ECIR doesn't have answers, where do I look? Thank you, Melinda IN 2010
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Re: Low numbers, sick horse
hinecedark@...
So . . . while I struggle with getting Cato's case history updated, the general questions remain: I am assuming since all horse have ACTH, that it is necessary to them. Is that correct? Is it known "how much" is necessary? If the high end of the reference interval is "too high" in many cases, then is the low end "too low"? Is it possible to take it "too low" with pergolide? If a low level of ACTH is enough to tip the horse, non-IR at baseline, into IR, then is "too low" a worry at all? I realize these aren't the standard question/concerns, but they are mine for a reason. I can't believe I have the only horse ever to be this sensitive. If the group with the most experience with ECIR doesn't have answers, where do I look? Thank you, Melinda IN 2010
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