Prascend


janieclougher@...
 

Hi, Janna - Evitex (chaste tree berry or Vitex agnus-castus extract) will certainly help with some of the symptoms of PPID, especially shedding issues.  However, it does not appear to control the production of ACTH and some other hormones involved.  Most horses that are started on Evitex end up being put on pergolide to control PPID.  Pergolide is still the only medication that can help replace the action of the neurotransmitter dopamine. Anecdotal evidence is showing that control of PPID in earlier stages helps slow or even stop the excessive growth in the pituitary that is responsible for the high output of hormones occurring in PPID.

There is a good explanation here: 

http://ecirhorse.org/index.php/cushing-s-disease/physiology-of-ppid-cushing-s-disease

 



Jaini (BVSc),Merlin,Maggie,Gypsy
BC 09
ECIR mod/support
https://groups.yahoo.com/neo/groups/ECHistory/files/Jaini%20Clougher%2C%20Smithers%20BC/

 




---In EquineCushings@..., <tjburdett2@...> wrote :

I see you have started your mare on Evitex.  What is your thoughts of the product
--

Janna Burdett


Janna Burdett <tjburdett2@...>
 

I see you have started your mare on Evitex.  What is your thoughts of the product

On Thu, Dec 4, 2014 at 11:53 PM, muriel318@... [EquineCushings] <EquineCushings@...> wrote:
 

I have a 23 year old female lipazzaner.  She was diagnosed with Cushings this past spring.  Vet prescribed prascend 1/2 tablet once a day.  She never went off her feed but she had terrible side effects.  Lethagic, depression,

SEVERE muscular/skeleton pain (yes, the package insert did mention that about 4 horses out of 122 had muscular skeletal pain).  She could barely move.  Kept her on the medication for 20 some days and the side effects just got worse as time went on.  Tried to explain what happened to the vet but was told they had never heard of such a thing and said to keep her on it!  I didn't because she was miserable.  3 days after she was off this drug, she was her old self.  The only problem she had at this time was that she had not shed out all her winter coat.  Started her on a product called Full Stride by Pureform for cushing horses that has high amounts of chromium etc.  She shed out the rest of winter coat and looked beautiful.  Fall came and she got laminitis for the first time.  My fault for not understanding hormone issues and sugar increasing in the grass in fall.  Anyway, had the same vet group come but a different vet.  Was reprimanded for taking her off prescend. Did not believe side effects she had earler in spring.  They insisted I try it again but start at 1/4 tablet a day graduallly increasing it to the 1/2 tablet.  "Emma" just kept getting worse.  To make a long story short, she started swaying from one front foot to the other tapping the tip of her hoof on the ground.  All day long she swayed and tapped.  She could not turn in her stall.  Was told to increase Prescend to 1/2 tablet.  Had been on 1/4 tablet for over 4 weeks, 3 days after increasing, she would not move.  Stood in the same spot in her stall going on 4 days.  Could hardly walk, could not turn and was practically falling on us.  Was talking to vet this entire time.  Was ready to put her down but because of the spring experience with prascend decided to wean her off and see what happened.  10 days later, she could walk and turn again and stopped the toe tapping and swaying!!  I contacted a more holistic vet and have her on cyproheptadine and evitex, previcox, full stride, a probiotic (KLPP), ocotea oil, traumeel.  This ordeal started Sept. 20th.  Today, 12/04/14, I let her out in a larger paddock for the first time.  She trotted a little and moved better than ever!  Please be aware that any drug can have side effects. Horses, just like people are unique. What might work for one may not work for another.  This experience was very upsetting because of the failure of the vets to recognize my horse could not tolerate this drug and needed something else.  I will contact the company because this was not a pergolide veil that was going to pass.  I just wanted to get this out there in case someone else has a similar experience.  Do not put your horse down until you take them off and see if they will get better with a different plan.  Thanks.  




--
Janna Burdett
770-971-4327 (home)
404-863-5652 (cell)


muriel covington
 

Thanks for your support.   Will follow your advise about diet/supplements and make necessary changes.  I am not using the same vets that prescribed Pergolide as they could not help me with the side effects she was having - severe muscular/skeletal pain to the point we were ready to put her down.  (Attempted to use Prascend on 2 secparate occasions several months apart and even in a "non- founder" state had same out come). The vet that is seeing Emma now is more open to trying things like adaptagens etc. (holistic/traditional).  He was just out today and wants me to maintain Emma on the cyproheptadine and Evitex, previcox, ocotea oil, traumeel, Full stride, KLPP (probiotic) because she is doing so good.  He drew a thyroid test because that had never been done.  His advise sounds like he is already thinking the same way you are - that we will get another ACTH and insulin level in a couple of months and go from there.  Emma now able to go out (with grazing muzzle) for an hour in an area the vet approved (virtually no grass present). 

 

Muriel & Emma

Elgin, IL (Dec. 2014)

 

 


Nancy C
 

Hi Muriel

IF you go to Cornell's endocrinology department, you'll see there are two TRH assays, one with two sample, one with three. Your vet may have been following their recs which say teh third draw is unnecessary, vs EEG (Tufts) recs.

I can see your thinking regarding the 65 ACTH in the fall but the 118 you had pre-TRH administration is high, as Lavinia has said.

The MSM @ 4 grams and Glucosamine 5 grams in the full stride maybe helping but it's not a huge amount.  The cyproheptadine has really no research showing it works.  Evitex works for a while on symptoms. My money is on the previcox your vet is prescribing.

So back to square one, a horse who may need pergolide but cannot seem to tolerate it.  We've had a couple of horses who have had very bad reactions to Prascend and when switched to 0.25 mg of compound, were able to titrate on successfully. The change in one horse in particular was profound.

Based on my own experiences and those of more than a few others, horses on a low Sugar and Starch diet (if IR) with minerals blanced, adequate vit E and selenium, salt, omega 3 and 6 via flax seems to do better transitioning on to the drug when they need it.  IOW, no veil.  Using adaptogens can also help. 

Since we are out of seasonal rise, and assuming she is doing well, if she were here, I'd be working to support via diet recs used here.  Once well out of winter - ie, May - I'd retest ACTH.  Is she showed clear PPID, I'd try compound pergolide with adaptogen (APF - Auburn Labs)

If she is truly on of the four in 100+ who cannot tolerate this drug as outlined in the Prascend label, you may have no choices.  I'd be trying this one more time though, because to have Cushing's go unchecked is not pretty and we've seen so many great outcomes with the DDT+E recs from this group.  Been here a long time and I may be not remembering well, but I cannot remember one horse who, if followed the DDT+E protocol first outlined by Maggie for you, could not adjust to the pergolide and be more healthy as a result. I hope Dr Kellon corrects me if I am wrong.

I know this is a hard place to be Muriel.  Hope it works out for Emma.

Nancy C in NH
ECIR Moderator 2003
Hear Drs Kellon and Bowker and more, in eight hours of great info and informative Q&A from 2013 NO Laminitis! Conference.

http://ecirhorse.org/index.php/no-laminitis-conference





My husband and I are assuming there is nothing more to be done then but to enjoy her for as long as we can and realize that the Evitex and cyptohepdatine she is currently on may only work for awhile.  Appreciate the info.I have found from this site.

 

Sincerely,

Muriel & Emma

Elgin, IL 


muriel covington
 

Thanks for your reply.  Reason I started thinking about the initial test - Looked up the protocol for TRH testing from tufts university vet clinic trials and that is how they said the test should be done.  Fasting, then 10 minutes and then 30 minutes after the injection.  You are correct, her initial ACTH was high I was just trying to understand her severe reactions to pergolide.  Someone on this site mentioned "maybe she doesn't have Cushings"  so I started looking into how test is to be done and there were a lot of commnets about false test results.  My husband and I are assuming there is nothing more to be done then but to enjoy her for as long as we can and realize that the Evitex and cyptohepdatine she is currently on may only work for awhile.  Appreciate the info.I have found from this site.

 

Sincerely,

Muriel & Emma

Elgin, IL 


Lavinia Fiscaletti
 

Hi Muriel,

Horses should NOT be fasted for any of these tests. Fasting is a holdover form human testing protocols. It will result in falsely low insulin/glucose readings and can affect ACTH results as well. Are the insulin results you have from fasting tests? If so, Emma's insulin/glucose levels are actually higher than the tests are telling you, which would go along with the fat pads she had.

The initial ACTH you had of 118pg/ml was already a definitive positive for PPID even without the TRH results. Please see my previous post to you on this:

https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/190648

TRH testing is an older protocol and does not give consistent results. It has recently been re-endorsed by the EEG, only to be used from Dec thru June and only needing 2 test samples. Per Dr.Kellon, "Would like to mention here that the recommendations of this group [EEG], which was put together and funded by the manufacturers of Prascend, are often not rooted in science or even extensive personal experience".

Once you have a diagnosis, there is no need to repeat TRH testing. A simple, single ACTH draw is used to monitor control. Please have a read on outr website for more on the various testing options:

http://www.ecirhorse.org/index.php/ddt-overview/ddt-diagnosis


Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team

 

 

 

 




muriel covington
 

I have a hard copy of Emma's ACTH test from 5/21/2014

I know she was not fasting for this test.  From what I have recently read, the horse is suppose to be fasting

then blood drawn before injection then again at 10 minute and 30 minute intervals.

The hard copy of the test results I have says:

 

ACTH: TRH RESPONSE 2

 

PRE-TRH ACTH   118 pg/ml                          REF:   9 - 35

 

POST-TRH ACTH    964 pg/ml                       REF:   0 - 110

 

No time is mentioned when the POST draw was done so I don't know if this is 10 minutes or 30 minutes following the injection.  Seems to me that all 3 results should be included and labeled but I am not familar with how this test should be reported.  I have a hard copy of the fall results and it was done fasting.  The ACTH was 65 at that time and there was a note saying ACTH is normally high in the fall so this COULD be normal.  She was not injected the time of the fall draw. 

 

Was wondering if you are familar with this test and know how it should be reported.  Should 3 values be given ?    PRE           10 minutes POST                   30 minutes POST

 

Thought I would ask group.  I am not using the vet group that did the May testing anymore - long story.  Just trying to get facts so I can contact the Equine hospital I am now using and explain to them why I think this test may have been done incorrectly.  Thanks,

 

Muriel & Emma

Elgin, IL  12/07/2014

 

 

 

 

 


 



---In EquineCushings@..., <threecatfarm@...> wrote :

Hi Muriel

Have you asked your vet to email or snail mail you hard copies of the tests from the lab(s)? That might tell you a lot more about your testing.


kansteen5545@...
 

Hi Muriel -
That's one of the neat things about a group. Lots of different minds which have had varying experiences. I'm glad it was the TRH stim test your mare had.
Karen
Scarborough,ME
May/2014
---- "muriel covington muriel318@yahoo.com [EquineCushings]" wrote:

Karen, Thanks for making me think about the test that was performed to diagnosis Emma.  It couldn't have been the dexamethosone suppresion test as the vet did not come out 2 days in a row to perform it.


Nancy C
 

Hi Muriel

Have you asked your vet to email or snail mail you hard copies of the tests from the lab(s)? That might tell you a lot more about your testing.

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


Lorna Cane
 

Muriel,

> I do not know how to attach my history to this email but it is in the folder of histories in the ecir 8 site. 

Here is the link to your history for Emma.Copy/paste it to your signature when you post:
ECHistory8

 

I'm not able to comment on the blood draws.


Lorna in Ontario,Canada
ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

Support the ECIR Group while you shop. It's easy.  

http://www.iGive.com/EquineCushingsandInsulinResistanceGroupInc




muriel covington
 

Karen, Thanks for making me think about the test that was performed to diagnosis Emma.  It couldn't have been the dexamethosone suppresion test as the vet did not come out 2 days in a row to perform it.  I read about the TRH stim test and found out how it is suppose to be done.  Said horse was to fast and have blood drawn before, 10 minutes and 30 minutes after the injectoin.  I know blood was drawn before (however, Emma had not been fasting), then some time after (I think 10 minutes).  I do not remember three blood draws - only 2 and the blood test results only showed a pre and post result - no times mentioned and only 2 test results not 3.  Question I have is shouldn't there be three  results for this test?  If anyone knows, could you please answer.   Wondering if Emma really has cushing.  Had a fasting ACTH drawn in the fall (which I am told is normally high) and it was 65 normal not over 35.  I do not know how to attach my history to this email but it is in the folder of histories in the ecir 8 site.  Thanks so much!
Muriel and Emma
Elgin, IL
joined Dec. 5, 2014


Lorna Cane
 

Hi Muriel.

> Sorry if I sound defensive about this but I have been going around and around about what happened to Emma ....



You can be sure that many,many of us understand the frustration/worry that comes with the territory.Although I don't know anyone who has experienced what you have,we have all experienced the not knowing,not being able to find the cause,not be listened to/heard,and so fifth.


I know you must be tearing your hair out with some of our questions,but I think it was Karen who put it so well,talking about how sometimes the trigger isn't what we thought it was at all.

Sometimes.


This may not be true in your case,but if you can put up with the 'picking away' at this mystery,repeating questions you have already answered a million times,and etc.,I am hoping that there will be an AHA! moment.


To help us help you and Emma, add your location and when you joined the group to your signature every time you post.

Well done getting your case history done.Add the link to that history to your signature,too.


Hang in,keep breathing,and know that you are shoulder-to-shoulder with horse  owners who know how unspeakably stressful it is to be where you are.

And would be thrilled to help you find out what's going on!




Lorna in Ontario,Canada
ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

Support the ECIR Group while you shop. It's easy.  

http://www.iGive.com/EquineCushingsandInsulinResistanceGroupInc




muriel covington
 

Appreciate your concern.  Sorry if I sound defensive about this but I have been going around and around about what happened to Emma on Pergolide every since this spring's initial attempt to use it.  Everyone kept brushing off the side effects like they were no big deal and telling me to use it anyway.  Not like we didn't try it again.    No one has heard of this happening and I was repeatedly told the normal side effect was being "off their feed".  Interestingly the package insert does mention a few horses having behavior issues, muscular/skeltal pain etc.  Emma wouldn't have survived if I would have kept her on it as I would have had to put her down - that is how bad it was.  My area vets now "get it" but it was a struggle getting them to understand what was happening - until they saw her after I stopped the pergolide and they wittnessed the difference. 

I am concerned about how I can manage this problem as time goes on.  Hopefully the suggestions from this website/group will help and I will have the privilege of enjoying Emma several more years.  With my husband's help, I finally figured how to fill out history form etc.

Thanks.

Sincerely, Muriel    


kansteen5545@...
 

Thanks Nancy -
I was HOPING it wasn't Dexamethasone!
Karen
Scarborough, ME
May/2014
---- "threecatfarm@cyberpine.net [EquineCushings]" < wrote:


Karen - the vet likely injected thyrotropin releasing hormone (TRH) to test the ACTH response. The TRH stim test is described in the Diagnosis proceedings from the 2013 NO Laminitis Conf


kansteen5545@...
 

Hi Muriel -
It's not that I don't believe you - I only had that thought - and thought I'd put it out there. In my own experiences I have seen one thing turn out to be something else entirely. I hope you can get everything straightened out with your mare - I know how worrisome horse problems can be.
Karen
Scarborough,ME
May/2014



---- "muriel318@yahoo.com [EquineCushings]" <EquineCushings@yahoogroups.com> wrote:

Appreciate your comments but this swaying did not happen on the onset of founder or shortly thereafter. Not until she had been on pergolide for awhile. Emma would typically rest one front hoof (take the weight off it and slightly "cock" it when the founder first started and lay down and rest). This swaying back and forth was different and she would aggresively tap (bang) the very front of the toe of her hoof on the ground - back and forth all day long sway "bang the front of her hoof, then sway the other way and bang the very tip of that toe. She was not resting her hooves. This was an aggrevated movement. She was severly stiff was stumbling and nearly falling and 3 days after stopping pergolide, she stopped swaying and tappinjg, could again walk forward and turning improved over the next few days. Last apring, I tried pergolide when she was not in a "founder" state. Similar problems occured. She had behaviour changes but WOULD eat. Seemed depressed but the worse thing was that she became severly stiff and could not move out. Was on the drug over 20 days 1/2 tablet during that time. This fall tried pergolide over 6 weeks. You can choose not to believe me about all this but it was not a coincidence. Sincerely, Muriel


Lavinia Fiscaletti
 


Hi Muriel,

Here is the link to the case history folder:

https://groups.yahoo.com/neo/groups/echistory8/files/%201-INSTRUCTIONS%20AND%20CH%20TEMPLATE/

You are doing fine with your posting. Yahoo does make it difficult and we appreciate your efforts.

We believe what you say was happening to Emma. With her ACTH being 118pg/ml, which is more than 3 times the high normal amount, during the spring when ACTH levelas are at their natural lowest levels she is definitely PPID. The lower test result in Oct, when she was on .25mg pergolide every other day, was due to the effects of the pergolide. That this tiny dose was partially controlling her ACTH during the time of year when ACTH rises tells you she is extremely sensitive to the effects of the medication. Lippizans are known to metabolize meds much more slowly than other breeds. Generally, pergolide is cleared from a horse's system in 6-8 hours. Because she was likely clearing the drug much more slowly, she was - thru NO FAULT of yours - accumulating the drug in her system, resulting in an overdose.

Encourage you to post pics of her trim, shoes in the ECH8 PHOTOS section. That way, we can help make sure her trim is optimal for healing. Your comment that the shoes and trim were aimed at "relieving stress from the tendons" is a red flag that the heels have been left too high, or have been wedged up. This is based on an old-school and erroneous belief that the DDFT perpetuates rotation. This type of set-up will orient her coffin bone to point toward the ground and have a spear-like effect on the sole. The pulses you are seeing are an indication that the trim is not optimal and/or that the trigger(s) for her laminitis haven't been removed completely.

What is Emma's weight? From your description, it is likely she is on a 57mg dose of Previcox, which is the proper dose for a 1300lb horse. Overdosing is common when using Previcox as it is difficult to correctly divide the canine pills into the appropriate equine dose. Overdosing firocoxib, and extended use of it beyond the 2 week manufacturer recommended limit, greatly raises the likelihood of side effects and I would be esp wary with Emma as she has already shown how sensitive she is to medications.

The dry lot is certainly helping in the IR department. Your leptin and insulin levels are quite good. Fat pads are an IR and/or obesity symptom. Excessive drinking/peeing, laminitis/founder, enlarged teats/udder can be either/both IR and PPID. The coat changes are generally PPID, although mineral imbalances and parasitism can also affect the coat. Evitex (standardized CTB extract) will usually help normalize coat issues even when meds that properly control the ACTH (and therefore the PPID) do not. Making sure deworming protocols are optimal and dietary imbalances are addressed will also support her entire system in dealing with the challenges IR and PPID put on them.

Hang in there, well help you get this sorted out. Emma is quite lucky to have landed in your care.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team


muriel covington
 

I joined but don't seem to able to find instructions on how to fill out a case history.  Sorry.

 

Muriel


Nancy C
 

Hi Muriel

We're not "not believing you".  Just trying to pull the confounding factors apart to give you the best help possible.  We believe you saw what you saw.  "Why" is what we need to understand so that you can hopefully do the best for Emma.

I'm hoping Dr Kellon will weigh in here but Muriel we really need you to fill out a case history.  You are doing a good job responding to these messages.  I have sent you an invitation to another group which is a "filling cabinet" of sorts.  You need to join there like you did here, download  and fill out the Case History form.  that way we will know better what you know and will be able to refer back to it as we go forward.  It really, really helps us help you.

Look for an email from ECHistory8.  Click on that and follow the instructions.  Let us know if you have problems.


Karen - the vet likely injected thyrotropin releasing hormone (TRH)  to test the ACTH response.  The TRH stim test is described in the Diagnosis proceedings from the 2013 NO Laminitis Conf

2013 NO Laminitis Conference Proceedings & Recordings

 

Nancy C in NH
ECIR Moderator 2003
Hear Drs Kellon and Bowker and more, in eight hours of great info and informative Q&A from 2013 NO Laminitis! Conference.

2013 NO Laminitis Conference Proceedings & Recordings

 


muriel covington
 

Appreciate your comments but this swaying did not happen on the onset of founder or shortly thereafter.  Not until she had been on pergolide for awhile.  Emma would typically rest one front hoof (take the weight off it and slightly "cock" it when the founder first started and lay down and rest).  This swaying back and forth was different and she would aggresively tap (bang) the very front of the toe of her hoof on the ground - back and forth all day long sway "bang the front of her hoof, then sway the other way and bang the very tip of that toe. She was not resting her hooves.  This was an aggrevated movement.  She was severly stiff was stumbling and nearly falling and 3 days after stopping pergolide, she stopped swaying and tappinjg, could again walk forward and turning improved over the next few days.  Last apring, I tried pergolide when she was not in a "founder" state.  Similar problems occured.  She had behaviour changes but WOULD eat.  Seemed depressed but the worse thing was that she became severly stiff and could not move out.  Was on the drug over 20 days 1/2 tablet during that time.  This fall tried pergolide over 6 weeks.  You can choose not to believe me about all this but it was not a coincidence. Sincerely,  Muriel


kansteen5545@...
 

Hi Muriel -
The symptoms you are describing - shifting weight from one foot to another and then eventually not wanting to move is characteristic of a horse that is foundering. They do this to relieve the weight as best they can from their feet, as the lamina are tearing apart. It's not a neurological event. Can Pergolide cause a horse to founder? (Question for someone in the group) If not - I'm wondering if the dosing happened at the same time the horse was foundering - APPEARING that it was the Pergolide that was causing the problems.
Also - could you find out what it was that your vet injected before the test?
Karen
Scarborough,ME
May2014


---- "muriel318@yahoo.com [EquineCushings]" wrote:

This drug did something to her central nervous system. She swayed from one front foot to the other alternately tapping the toe of her hoof on the ground all day long. I am positive this made laminitis and rotation worse - all this moving about. She became stiff and sore all over to the point of not being able to turn and barely able to walk forward. Eventually, I tried increasing the pergolide to 1/2 tablet (1/4 tab X 4 weeks) and then (few days later) she stood in the same place in her stall, could not move. If you pushed her to move her over she would stumble and almost fall on us. She could not turn around.