Help--off-the-charts levels for Kasha's bloodwork


grayarabiankasha <kvshopping@...>
 

Kasha's ACTH is now 284 (normal range is 9-35); his insulin is 126.46
(normal 10-40). There was a misunderstanding, so I didn't get the
glucose level, but I can do that; however, it hardly matters at this
point. My vet said Kasha probably has the metabolic disorder in
addition to the Cushings. Kasha is on 2.5 mg pergolide--am I right in
assuming I should be upping it? How much should I do? He's 27, and all
we want now is to let him live as long as he can as comfortably as he
can. He still enjoys his life, so in light of the tests, what can I do
make it better?


grayarabiankasha <kvshopping@...>
 

P.S. to my post: Kasha is on ODTB cubes, a couple handfuls of TC Safe
Starch Forage, R/S/R BP with 2 oz flax, 1200 IU vitamin E, 2 T salt, a
handful of Blue Seal Carb Guard & 1/2 cup flakes from the cubes mixed
in for taste. I put 2.5 mg powdered pergolyde on top. That's his whole
diet, and it has been that way for about 4 months. He gets NO treats; I
did try to give him a Skodes brownie once a day for a few days, but he
appeared to be more sore in his feet, so I stopped that (just in case
that was the reason). He wears Soft Ride boots all the time.
Kathy & Kasha


llkeach50
 

--- In EquineCushings@..., "grayarabiankasha"
<kvshopping@...> wrote:

Kasha's ACTH is now 284 (normal range is 9-35); his insulin is 126.46
(normal 10-40). There was a misunderstanding, so I didn't get the
glucose level, but I can do that; however, it hardly matters at this
point. My vet said Kasha probably has the metabolic disorder in
addition to the Cushings. Kasha is on 2.5 mg pergolide--am I right in
assuming I should be upping it? How much should I do? He's 27, and
all
we want now is to let him live as long as he can as comfortably as he
can. He still enjoys his life, so in light of the tests, what can I
do
make it better?
******Kathy,
I just had to chim in here when I read your description of Kasha as it
could have been my Scooter you were describing! Scooter's last ACTH
was 115 and his Insulin was 99, and that was on 4.5 mg. pergolide a
day. So we increased the dose to 5.25 and the new ACTH results will be
in on Monday.
He is 28 and he also is in Soft Ride boots all the time. His diet is
almost identical to Kasha's. He gets mostly ODBT cubes, along with some
Alfalfa/timothy cubes as filler, a bit of Poulin Carb Safe and R/S/R
beet pulp, flax, vit. E and salt.
Dr. Kellon did balance this diet for me and gave me a mineral mix to
add as he gets only 9# of the ODBT cubes a day. He also enjoys life
and is not ready to call it quits.
How are Kasha's feet? Trim good, any rotation? Are his feet sore?
That pergolide dose definately needs to be increased; Scooter is eating
well even on 5.25 mg a day. I did use APF to transition him up to the
higher dose. He never went off feed.
So hang in there, you have lots of room to increase the pergolide, no
worries!

Linda and Scooter


5 Pine Ranch
 

Was Kasha at all excited at the time the bloodwork was drawn? What
time of day was the bloodwork taken and how long after the last dose of
pergolide. Is he getting pergolide once a day or split twice a day?

Amberlee


grayarabiankasha <kvshopping@...>
 

it could have been my Scooter you were describing!
Linda, Kasha currently has laminitis and his hooves are sinking as of
the last xrays (they are posted in the files). He is sore, of course. I
do use APF, so I will continue using it with the increase of pergolyde.
Please let me know what Scooter's new results are. Hopefully Dr Kellon
will give me some guidelines on how much to increase his perg--thanks
for your response--
Kathy & Kasha


grayarabiankasha <kvshopping@...>
 

Was Kasha at all excited at the time the bloodwork was drawn?
Amberlee, Kasha's blood was drawn very quickly (the vet was slick!) so
I don't think the stress had time to reach his blood; howeer, the draw
was at 2 p.m. while his perg dose (once daily) was at around 5 p.m. the
night before. Do you think it would have an effect on the results? I
had asked about this possibility, but the answers I got led me to
believe the results wouldn't be majorly skewed. What do you think?
Kathy & Kasha


Sandra Su
 

At 11:48 PM +0000 6/20/08, Kathy wrote:
Kasha's blood was drawn very quickly (the vet was slick!) so I don't think the stress had time to reach his blood;
Besides, if the ACTH is really, really high, how much of that is stress, even if the horse is nervous? How much higher does ACTH go when a horse is stressed than it would be if the same horse wasn't stressed? Anyone know?
I'm thinking if the ACTH is really high, even if the horse is stressed, that maybe it'd be lower if there was no stress, but it'd still be higher than normal. Maybe stress would put it right over the edge of the reference range in a normal horse, but would it be enough to drive it sky high?

his perg dose (once daily) was at around 5 p.m. the night before. Do you think it would have an effect on the results?
Search old messages about the new discoveries Dr. Kellon reported on how different the half-life of pergolide in horses is than it is in people. It made me decide to split Penny's dose so she gets pergolide twice a day, which is more effective.
If you test that many hours after the last dose of pergolide, it might have affected the results, from what I understand. But rather than me reinterpreting what Dr. K said, why not search the old messages and get it straight from the source?
--

Sandy Su
ssu@...


grayarabiankasha <kvshopping@...>
 

I am aware about the new info re: pergolyde's half-life and also about
not making hasty decisions because of one study. That said, my options
for twice daily perg doses are very limited anyway, as I board my
horses, and the people who clean and feed are hired help who speak
limited English. It does seem clear that regardless of the additional
factors that could have made the ACTH soar, I do need to up the dose.
My financial resources are stretched as far as they can go, so I cannot
keep testing after each increase--anyone have a suggestion on how high
I should go with the pergolyde in light of the sky high ACTH results? I
don't want to poison my horse, but I do want to fight the disease as
well as I can. Thanks for all help---
Kathy & Kasha


 

My financial resources are stretched as far as they can go, so I cannot
keep testing after each increase--anyone have a suggestion on how high
I should go with the pergolyde in light of the sky high ACTH results? I
don't want to poison my horse, but I do want to fight the disease as
well as I can. Thanks for all help---
Kathy & Kasha
Hi Kathy ~

You would be safe increasing in 0.5 mg increments and assessing his clinical signs as a
guide. Doing it this way, I would give 4-7 days between increments.
We sometimes under rate clinical signs and become obsessed with numbers. In medicine,
we often say "treat the patient, not the numbers". Not that the lab results aren't important
guides, but sometimes they can over rule our common sense.

So, take some paper and write down (really write it down, as a week from now it will be
fuzzy, and be as objective as you can) - Kasha's overall appearance, how much back sag
he has, if his eyes are clear or goopy, his coat condition.
Rate his attitude on a scale from 0 to 10 (0 depressed, lethargic - 10 happy, curious), his
activity (0 lying down all the time - 10 galloping with tail flagged) and your assessment of
his hoof pain (0 can't put weight on foot for trimming - 10 sound on gravel at trot, maybe
a 5 for sound at trot in boots), sweating (0 for anhydrosis - 10 for excessive sweating).
Put a word description next to each score - so you can pinpoint just what you meant when
you re-score him in a few days or a week. Take a picture or two to go with, put the pages
away in his notebook and increase his pergolide 1/2 mg.
Do this again in 4-7 days and compare it to the first assessment; then decide if you feel
his pergolide should go up another 1/2 mg or if he's shown improvement and you'll hold
steady.

If you overshoot by 1/2 mg, you won't hurt your horse. But if you do a couple of increases
and don't see any positive change, it should cue you to review the other basics - diet,
teeth, parasites, ulcer pain, foot pain, someone sneaking him sugar, etc.

I know this sounds like a lot of work, but so is dragging the vet out and paying for another
test when you don't have the money for it. And if you've never used 0-10 assessment
scales, it will feel awkward at first (which is why its helpful to include a descriptive word or
two). It's also good to do your reassessment before looking at the first one - lessens our
natural tendency to "cheat".

This isn't a bad thing for any of us to do with any of our horses. I just "made up" the above
scale as I was typing here - you can set up an appropriate 0-10 scale for anything you
want to track by clinical signs (crest size, appetite, bug bite bother factor).

Patti K
Vail AZ


grayarabiankasha <kvshopping@...>
 

So, take some paper and write down ... Kasha's overall appearance,
how much back sag he has, if his eyes are clear or goopy, his coat
condition. . .

This is a good idea, Patti. It will not be easy to differentiate,
however, the specifics as he is pretty sore from the laminitis and
hoof sinking, but I will definitely give it a try. I needed guidance
with the increases, so thanks so much for your help. BTW, today was
the first day he did not want his beet pulp. He left some of it from
last night, and today he was not even interested in it. I'm going to
assume it is the heat (we are in a surreal heat wave here in the Los
Angeles area--upper nineties in my area!) and not freak out right
now. I'm glad it happened now instead of during the perg increases
that I plan to do--it would have really confused me...

Thanks again--I will report what happens--

Kathy & Kasha


Sandra Su
 

At 9:31 PM +0000 6/21/08, Kathy wrote:
It does seem clear that regardless of the additional factors that could have made the ACTH soar, I do need to up the dose. My financial resources are stretched as far as they can go, so I cannot keep testing after each increase--anyone have a suggestion on how high I should go with the pergolyde in light of the sky high ACTH results?
I think you're asking a question that's impossible to answer. Each horse is different, and some horses seem to respond fine to small doses of pergolide and others need more to keep the ACTH down.
That said, I've heard here of horses on as high as 5 mg a day. Maybe this will give you an idea: On 4/18/08 Penny's ACTH tested as 103 pg/mL (ref. range 9-35). We upped her dose from 1 mg, which she had been getting at the time of that test, to 1.5 mg and tested 4 weeks after increasing the dose. On 5/28/08, we tested again, and Penny's ACTH was 15.9 pg/mL. So, for Penny, an increase of 0.5 mg and giving pergolide twice a day instead of once a day did the trick.
However, this may not be the case with your horse. You should consult your vet for a guess, if he or she is willing to do the guessing. My vet upped the dose by 0.5 mg and then said we'd test 4 weeks later to be sure that was enough of an increase. It was -- for Penny.
--

Sandy Su
ssu@...


grayarabiankasha <kvshopping@...>
 

Each horse is different, and some horses seem to respond fine to
--- In EquineCushings@..., Sandra Su <ssu@...> wrote:
I think you're asking a question that's impossible to answer.
small doses of pergolide and others need more to keep the ACTH ...
Thanks for your input, Sandra. Before Kasha's flare-up, he was
getting 1 mg. I upped it to 2.5 (over the course of months), and you
saw the results I posted. I'll observe him as I increase, but
increase I must.

What is really interesting is that Kasha has kept all his muscles,
and his back doesn't sag or belly protrude. He does have some fat
pads, but he does not look like a 27-year-old horse and especially
not like a 27-year-old Cushings horse. It seems odd considering his
horrifying ACTH and insulin levels. Could it be that the daily jaunts
in hilly Rolling Hills has imbedded his muscles like those a dancer
develops? Or the fact that he was a stallion for 7 years before being
gelded? It would be interesting to know. Perhaps I'm over-reacting--
are there a lot of horses out there who look completely healthy but
have severe Cushings symptoms? Oh, well--getting off-topic a bit.
Thanks agin for your help---
Kathy & Kasha