Starting Pergolide without blood test


janieclougher@...
 

Hi, Debora - There have been a small number of misdiagnosed horses who were started on pergolide, but did not need it.  We have no firm data (beyond the anecdotal), but it would appear that most have no effects, and  some have more of a pergolide veil than one would suspect.  Since there has been a marked improvement since starting pergolide, I would say that the owner can quite safely stay on pergolide for now.  If there will never be any testing done, it becomes a little harder to know what dose of pergolide will work for this horse; however, many people successfully manage their horse's PPID, dosing by clinical signs. Given the horse's positive response to pergolide right now, at the beginning of the seasonal rise, your client could reasonably expect to increase the pergolide over the winter, and should be alert to any signs that show the necessity for an increase: goopy eyes, bigger/harder crest, more footsoreness, dirty sheath (ie, more sheath secretions), increased urination and drinking.  This, of course, assumes that the IR diet is tight and in place.

What can and *will* do damage is riding so soon after frank laminitis.  It takes 9  to 12 months for a full hoof growth cycle (I know you know this - this is for others reading)  One should not ride a horse who has had frank laminitis until there is a 1/2 to 3/4 growth cycle. That is 6 to 9 months, depending on the horse. Really frightful founders should not be ridden for a full year.  There is a ton of gentle ground work that can be done (no tight circles, no hard ground, use hoof boots);  but definitely no riding. Even when the trim is superb, those laminar attachments are fragile, and will tear loose until there is adequate growth and tight attachment.

IR and PPID horses can be managed effectively without multiple vet visits and bloodwork, but it is a big commitment in observation and management.  In a perfect world, we would all get bloodwork done 3 times a year or more.  I totally get it that not everyone can do this.  However, I would strongly urge not to ride this horse until after Christmas, at the very earliest.


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

I have a client horse, 17 yr old Andalusian has tested IR some years ago.  No case history as no vet visits, blood work or diagnosis.  ......

Laminitis attack was Memorial Day weekend...I had trimmed the horse a few days before so luckily he was well balanced with correct heels/toe position.  He has been barefoot 10+ years that I can verify.

We are about 10 weeks in to the various treatments including Jherb, aakg, tumeric blends and other herbal support.  At 8 weeks he was still struggling so we elected to try him on 1mg pergolide.  His improvement has been remarkable since starting the pergolide to the point that I was able to ride him yesterday, in boots and pads, but ride him out on trail none the less. 

My question is, if by chance he is not PPID, what would be the negative effects of dosing him with 1mg Pergolide per day? 
Debora Lay
LayzD Equine Services
Hamilton, MT
cant remember when I joined this group
NRC+ 1112



Lorna Cane
 


>cant remember when I joined this group

Hi Debora,

Feb, 2012 .

I'm interested in the answer to your pergolide question,too,so not much help there.


Lorna in Ontario,Canada
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PapBallou@...
 

 Since there has been a marked improvement since starting pergolide, I would say that the owner can quite safely stay on pergolide for now.  If there will never be any testing done, it becomes a little harder to know what dose of pergolide will work for this horse;



Neo is eating posts!  This may go through twice.

I'd like to know how in the heck you were able to get pergolide from a vet who is clueless about these things!  Pretty amazing.

Linda
EC Primary Response
West Coast
May 2004


janieclougher@...
 

....However, I would strongly urge not to ride this horse until after Christmas, at the very earliest......




Shoot!  Where did my signature go?  Sorry, team!


Jaini (BVSc),Merlin,Maggie,Gypsy
BC09
ECIR  mod/support

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layzd@...
 

Thank you for the reply.   He did have a dirty sheath, very oily, greasy smegma, to the point it was on the inside of his legs.  He also had huge fat pad bulges over his eyes where it would normally dip in.  The eyes are almost flat and the smegma is less.  I could not remember if these were IR or PPID symptoms, or both.  He had some eye discharge, but not goopy like the mini's I manage with PPID.

He has lost quite a bit of weight, and you can now see the ribs slightly.  He still has some fat pad at the tail head and behind the shoulder.  His neck was never hard, crested yes, but he is a crested breed but it was always soft and flexible, and his coat shed nicely.  So having some symptoms and not others was confusing to me. 

Riding was at a walk, straight line down the trail, in boots and pads and the trail was soft dirt, for about an hour.  The week before that I took him to an arena with new composite footing and he worked at liberty well with no boots.  I firmly believe in exercise and movement to increase blood flow and therefore increase growth.  I would not tell someone else to ride a previously laminitic horse, but I feel I myself am qualified to determine how much exercise and how to apply that exercise and at what point.  I have been rehabbing foundered and laminitic horses for some years now.  I will be cautious with his work, as I usually am, and monitor his progress carefully.  I do appreciate the comments and will err on the side of caution with him as I do not want a relapse. 

The ground he lives on is dirt lot, which is great for his diet, but not so good for working his feet.  It is a couple of acres, so he has the opportunity for good movement on his own, but he has always been somewhat lazy so I am sure he does not move around that much.

Thank you so much for the quick reply, as we have struggled with the question of involving a vet or not.  The last two times a vet was brought in on a suspected PPID case did not go well here.  One wanted to do the Dex test, which I convinced the owner not to do, and the other horse ended up back in shoes despite my protest.  It is very hard for the owners to know the facts and those damn "dr" titles seem to scare them into treatments they might not choose otherwise.

Debora


Eleanor Kellon, VMD
 


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

Thank you so much for the quick reply, as we have struggled with the question of involving a vet or not. 

= = = = = = = = = = =

    There is no question to struggle with here.  You have to involve a vet.  You are practicing medicine without a license and dispensing a prescription only medication. That's a crime in every state.

The best thing you can do for this owner is to have her join this group and request referrals for a veterinarian familiar with these disorders.  She should give an e-mail where she can receive private replies. Professionals should not be discussed on list by name.

I have to agree with those who have said a recently laminitic horse should not be ridden or forced to move until the connections have regrown.  What you call laziness may very well be related to pain.  First do no  harm should be the guiding principle of any type of caregiver.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


PapBallou@...
 

This is EXACTLY the behavior and 'philosophy' that has had many state vet associations going after non-veterinarians who don't know of nor respect the line between lawful practice of medicine and what they can and can't do under the law.

As a trimmer, I am flabbergasted you are willing to admit in a public forum that this is what you do and don't see the egregiousness of it..

Linda
EC Primary Response
West Coast
May 2004


layzd@...
 

Linda, What am I supposed to do?  Let him continue to struggle?  Let the local vet run a test that will make it worse?  I felt like we were stuck between a rock and a hard place, and the owner made all the decisions.  When someone asks for help, I do what I can.  Yes, sometimes I make mistakes, and maybe I did with this horse.  But not all of us have all the resources and opportunities to enact a perfect treatment plan.  I will be more cautious in the future. 

Debora


PapBallou@...
 

One thing, don't be so foolish as to post in a public forum what you are doing.  While everyone here may understand your conundrum, no one here is going to support this.

Second, if the vet is so bad, go to the state board, before they come for you.  YOU will have no leg to stand on.

Sadly, there are groups of hoof care professionals that are making a name for themselves for not recognizing the line of practicing medicine.  This ends up hurting all of us who plug away each day who understand this very, very important aspect of care, animal or human.

Linda
EC Primary Response
West Coast
May 2004







layzd@...
 

Point taken. 

Debora
Feb 2012


Eleanor Kellon, VMD
 


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

Linda, What am I supposed to do?  Let him continue to struggle? 

= = = = = = = =

Your best option is to empower the owner, not to insert yourself in the owner-veterinarian relationship. Your job is to trim. Period. You can certainly share things you have learned on other fronts and encourage the owner to do more research but you can't take over functions that are not yours.  You can tell the owner the facts as you understand them but must then refer the owner to sources of information that will lead to them making their own decision.  It's their horse.  You also must respect the owner's decision.  Again, it's their horse.  If an owner makes a decision you don't agree with, you can state your opinion but probably shouldn't abandon them - just wait until you are proven correct by the horse's response.  That's where your value will come out.

You are not a veterinarian.  No matter how much you read you will not have the basic knowledge of physiology and biochemistry that makes you capable of diagnosing and prescribing.  Yes, there are also veterinarians with interests that are in other fields and not following endrocrinopathic laminitis that do not recognize some things but they can be brought on board by an educated owner.  It's their job to do so though, not yours. 

My point here is that if you are putting pressure on clients you are just as bad as the vets you criticize.  The owner has to make this decision based on information given from both sides, from outside sources. Support the owner in their journey to find information but let them make the decision.  It's their right.

Eleanor in PA
www.drkellon.com
EC-owner
Feb 2001


layzd@...
 

Thank you Dr. Kellon.  Good point all, and well taken. 

Debora


PapBallou@...
 


I am sorry if I did not elaborate on the relationship.  My job is more than to trim the hooves.  I am responsible for this horses daily care, exercise, training and in the future, sale or rehoming.  The owner is not here.  I have a care/custody/control agreement.  The owner has made all the decisions.  

I am ending this here  The ultimate question/point is that pergolide, from an unknown source, IOWs not a bonafide RX for this particular animal obtained from a licensed vet, was given, and publicly flaunted by referring to the vet with demeaning names.  I don't have the authority to treat any of my horses for PPID except for Pap and the mini within the guidelines my vet and I have agreed on. 

Anything else is practicing medicine.

Linda
EC Primary Response
West Coast
May 2004



janieclougher@...
 

"Riding was at a walk, straight line down the trail, in boots and pads and the trail was soft dirt, for about an hour.  The week before that I took him to an arena with new composite footing and he worked at liberty well with no boots.  I firmly believe in exercise and movement to increase blood flow and therefore increase growth.  I would not tell someone else to ride a previously laminitic horse, but I feel I myself am qualified to determine how much exercise and how to apply that exercise and at what point.  I have been rehabbing foundered and laminitic horses for some years now.  I will be cautious with his work, as I usually am, and monitor his progress carefully.  I do appreciate the comments and will err on the side of caution with him as I do not want a relapse. "

"Recently when he started showing such improvement, I took him to the arena with the great footing and for the first half hour let him move at liberty, which he did very well.  I did notice slight hesitations in tight turns to the right, the more affected front hoof.  For the second half hour, from the ground, I asked for some movement putting him thru his liberty exercises, which he did quite willingly and what almost seemed to be happily.  At this point I was mostly asking for direction, not speed.  He walked or trotted as he choose.  I merely pointed in the direction or around which obstacle I wanted him to go.  The last half hour I got on with a bareback (double padded) pad and let him move at liberty.  At no time while I was on him did I request speed or direction. "


I am sorry, Debora, but I must most vehemently disagree with these activities in a recently laminitic horse.  By recently, I mean a laminitic attack within the last 6 months, that actually ended after the triggers were removed - ie, the triggers were discovered (PPID, IR, Lyme disease and/or other) and removed, so that healing could begin. So, no riding within 6 months after cessation of a laminitis episode.  Brief and gentle ground work is certainly indicated, preferably in boots if necessary, but no turns, or at least very gently turns, and never more than 20 minutes a day, at the walk, at the beginning, increasing gradually over a period of many weeks.  Yes, movement is very important; but it is equally important to allow the horse to dictate the movement in the dirt paddock or dirt paddock track system. Actually asking the horse to do any liberty work or  ground work is totally different. Totally. Often the best plan is to allow free movement outside in boots.

I am qualified to make these assertions because I am a veterinarian (although not the idiot kind - very few of us are) who has spent a lot of time researching the pathogenesis and mechanics of laminitis.

Coles notes version:  Once active laminitis has ceased,triggers removed,  and healing has begun, free movement, often with boots, is best.

Gentle in-hand walking can commence 4 to 6 weeks after the episode. No turns.  Boots or very soft ground a must. Gradually increase duration.

No riding until at least 1/2 hoof growth cycle, and preferably 2/3 hoof growth cycle; minimum 6 months.



Jaini (BSc, BVSc),Merlin,Maggie,Gypsy and now Eddy
BC09
ECIR  mod/support

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Lorna Cane
 



Thanks,as usual,for your clear,well thought-out message,Jaini.

I especially like this part,for people like me,who are better with a concrete marker to help make decisions. It gives us something to look for,as opposed to remembering how long it has been:

>No riding until at least 1/2 hoof growth cycle, and preferably 2/3 hoof growth cycle; minimum 6 months.


Lorna in Ontario,Canada
ECIR Moderator 2002
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Ellen
 

> "Hi ,

    Just wanted to share my experience with two different vets and a farrier. My regular vet and my farrier recommended that I begin riding a month after  my mare suffered laminitsis, which resulted in a 6 degree rotation in one front foot and a 7 degree rotation in the other front foot. The fancy specialist ( in other words, obscenely expensive) told me to start riding after 10 days and to severely limit her hay. I listened to my regular vet and farrier and ignored the fancy vet. My mare has a stretched white line in both front feet, whether or not it was a result from the laminitsis or putting  her back to work too soon is something that I will never know.

Again. I wish I had known about this group and would have allowed my mare a full 6 month recovery  rather than be guided by  the vet or farrier. I just added my two cents to show how confusing it is to decide  the best course of action for our beloved horses.

Ellen

Long Island

March  2013

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