Increase Pergolide when?


ferne fedeli
 

I would like to try increasing Magic's pergolide from 2mg to 3mg before the seasonal rise--hopefully to avoid a possible Laminitis episode like we had last fall.  I was thinking to increase the dose around the first of July.  Is that okay or should I start sooner?  I plan to retest late August or early September.
Ferne Fedeli
No. California
4/2010​


Diane Ogle
 

Hi Ferne,
    I've discovered through past year's testing and symptoms that mine start to rise by the first of June.  I've already upped them both by 0.25mg and am waiting results of their latest testing to see if I'll need to go higher this year.  As we know, each one is different and I've just learned to really watch my guys and to trust that.
Good luck,
Diane, Molly & Rowdy
No CA
Feb 2011


Kerry Isherwood
 

Well, this is an interesting coincidence:  i was just thinking of writing to ask this very question, whether you more experienced PPID'ers proactively choose to increase pergolide *before* the rise, or is it more generally advised to wait until signs occur to increase pergolide?  My mare also begins to historically fall apart in June and I'm getting anxious b/c this is my first "educated" year into the seasonal rise (mare was diagnosed last Oct, in the midst of a crisis). Here are her ACTHs (all at Cornell):

9/24/14.....ACTH  36.6 untreated, in full hyperglycemic/hyperinsulinemic crisis.  Start 1mg pergolide
10/25/14.....ACTH  26.2 on 1mg.
early Nov.....had severe insulin spike, PU/PD, etc; increased pergo by 0.5mg to 1.5mg/day
12/3/14.....ACTH  22.1 on 1.5mg/day
early '15.....insulin/glucose well-controlled on 1.5mg
5/17/15.....ACTH  22.1 on 1.5mg./day, still seems well-controlled, feels great under tack.

(kinda weird that her ACTH was exactly the same on last two results...I always considered her to be the most even tempered horse I've ever met, but that's getting a little freaky...)

Anyway, I'm not looking for THE right answer but more of experiences -- good and bad -- on how PPID'ers have dealt with the rise in past years, to proactively raise pergolide dose or wait to chase recurrence of symptoms and play catch up (cringe...)?

Any advice greatly appreaciated,
Kerry in NY


Chanda
 

Well, I'm certainly no expert, and I'm still learning my guy's "cycle", but I try to get ahead of it or at least stay on top, it seems to take longer to play catch up, than to be right there when it starts to change.

Chanda

MT 9/04


Nancy C
 

IMO there is definitely a need to know your horse on this one.  And it can take a few seasons to get it right.  And it can change as they age. (ie how MUCH does the dose go up?)

Beau always went into decline in August. Took me years to figure out what the devil was going on.  I now start bringing dose up in July with which my vet agrees.  I retest in August, then again in November. Thankfully my vet taught me how to pull the blood myself so it's less of an expense.

As Chanda says, you want to stay ahead of the issues if you can.

Nancy C in NH
ECIR Moderator 2003
FACT: Sensory nerves in the foot can be activated via tactile light pressure receptors and can affect vascular perfusion through the foot bringing more comfort to the horse. See RM Bowker, VMD, PhD, Nerves, Nerves, Nerves: Why Are They So Important To The Horse?  2013 NO Laminitis! Proceedings, Equine Cushing's and Insulin Resistance Group Inc.

 


periople8
 

I totally agree with having to know your horse from the look in his eye to the way he moves as the seasonal rise approaches, but here is an issue I have just experienced:  here in the Pacific Northwest spring and early summer are (usually) still cool, wet, cloudy but this year the sun came out early.  Plants are early, the barn swallows are early, the field was just cut for hay (a month early) and my pony goes lame/with pulses about 4 weeks earlier than last year.  Progression of the PPID or progression of the season?  After 3 days of rechecking his entire protocol (same trim, same hay he's had for the last 8months, same balanced supplementation, same pea gravel paddock) I started raising his pergolide dose and already he appears to be more comfortable.  Gah

I planned to stay ahead of the curve this year, but I think the curve moved.
We need one of our brilliant vets to invent a  ACTH monitor/pergolide dispenser like the insulin pump!

Bob
SW Washington 3/13


ferne fedeli
 

Hi Diane,
So you have already started your increase.  Interesting.  I was shooting for July 1st.  Maybe I will still plan on that for this year and see how it goes...
Ferne Fedeli
No. California
4/2010​

On Sat, May 30, 2015 at 10:53 AM, Diane Ogle dianrwdy@... [EquineCushings] <EquineCushings@...> wrote:
 

Hi Ferne,
    I've discovered through past year's testing and symptoms that mine start to rise by the first of June.  I've already upped them both by 0.25mg and am waiting results of their latest testing to see if I'll need to go higher this year.  As we know, each one is different and I've just learned to really watch my guys and to trust that.
Good luck,
Diane, Molly & Rowdy
No CA
Feb 2011



ferne fedeli
 

Well, Nancy, I hadn't really noticed much difference in my horse last year at the time of his tests, but then later on he got Laminitis.  Mild this time, but it really took me by surprise.  He had gone from 2010 with nary a problem.  Of course, as you say, he is getting older (me too!).  I will contact my vet and shoot for around the first of July to increase his dose.  I was planning to go from 2mg to 3mg.  Is that reasonable?  I could just go to 2.5mg, but was worried that wouldn't be enough.
Ferne Fedeli
No. California
4/2010​

On Sat, May 30, 2015 at 2:04 PM, threecatfarm@... [EquineCushings] <EquineCushings@...> wrote:
 

IMO there is definitely a need to know your horse on this one.  And it can take a few seasons to get it right.  And it can change as they age. (ie how MUCH does the dose go up?)

Beau always went into decline in August. Took me years to figure out what the devil was going on.  I now start bringing dose up in July with which my vet agrees.  I retest in August, then again in November. Thankfully my vet taught me how to pull the blood myself so it's less of an expense.

As Chanda says, you want to stay ahead of the issues if you can.

Nancy C in NH
ECIR Moderator 2003
FACT: Sensory nerves in the foot can be activated via tactile light pressure receptors and can affect vascular perfusion through the foot bringing more comfort to the horse. See RM Bowker, VMD, PhD, Nerves, Nerves, Nerves: Why Are They So Important To The Horse?  2013 NO Laminitis! Proceedings, Equine Cushing's and Insulin Resistance Group Inc.

Equine Cushing's and Insulin Resistance Group Inc.
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Kerry Isherwood
 

Very interesting reading these responses & ever so helpful for a "first-timer" going into the seasonal rise.

So...PPID horses *will* need a pergolide increase during the rise? Is that the standard thinking? (Not asking how much; just that an increase is *usually* indicated)

Then, conversely, a subsequent tapering as eACTH naturally declines (December?) and remaining on a "maintenence" pergolide dose thru spring, all-the-while ideally supported by ACTH testing to establish expected down-trending or static ACTH as well as future target dose data (aka finding your PPID's ACTH "magic number").

Painfully simplistic & deceptively easy, no doubt....but mostly correct?

Thanks everyone,
Kerry in NY
Sept 2014 -- an anxious seasonal rise first-timer


Nancy C
 

Hi Kerry

Not sure we can say all horses will need or should taper up and/or down.  There are many who stay on one dose all year.  Because fall is the worst time for so many, dose increases happen frequently at that time, but many stay on that one increased dose all year.

Late summer into early fall is a critical time for careful monitoring of symptoms for all horses, but especially for those who have suffered laminitis before or who like mine, never have controlled insulin.

These two archived messages are helpful

Seasonal Rise When to Test ACTH Message by Eleanor https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/132334

 

Increase Pergolide Message (Scale of Symptoms) by Patti https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/111988

Want to also speak to the importance of understanding trim.

IMO and IME, during seasonal rise there is a need to be very vigilant with trim. All aspects of DDT+E are important.  Understanding the correct trim, making sure it is physiologically tight and balanced is a huge factor in whether a horse whose insulin is not controlled can withstand an insulin surge from slightly higher PPID issues (acth, cortisol) in the fall.  Or during spring shots and other events the IR horse is likely to experience.

We've got lots of resources to begin to understand trim on ecirhorse.org, both in the proceedings and on the  Laminitis and Trim pages there.  Will also be a big part of the  NO Laminitis! Conference in November. 

Nancy C in NH
ECIR Moderator 2003

NO Laminitis! 2015 in Georgetown, TX November 6-8: Dr. Eleanor Kellon, Dr. Robert Bowker, Dr. Philip Johnson, Dr. Benjamin Buchanan, Kathleen Gustafson, Daisy Bicking and Lavinia Fiscletti. Registration opening soon. Click on nolaminitis.org for updates.


 




---In EquineCushings@..., <kerry.isherwood@...> wrote :


So...PPID horses *will* need a pergolide increase during the rise? Is that the standard thinking? (Not asking how much; just that an increase is *usually* indicated)