Time to increase prascend?


lj friedman
 

Jesses lab results were reported today. Seems like acth is increasing and vet wants to increase to 2.0 mg. prascend..   thoughts on this?   All are  Cornell labs


                    3/02/15         5/04/15         7/2015

acth          40.7                32.4                46.8

insulin      35.89              31.92              55.64

leptin         3.18                2.86                 4.26

glucose     97                   86                  110


Prascend  1.0 mg was started 01/02/15.  After the 5/04/15 labs, prascend was increased to 1.5 mg. I assume is makes sense to increase prascend to 2.0 mg at this time?  If yes, when would I want to re-test for acth?    Also vet wants to know what he can do to tighten up IR status.  Not sure what can be done as Jesse only gets timothy pellets and bp with his supps that are balanced and sent from Horsetech.. One shortcut I;ve been taking is with the r/s/r bp.  I rinse it, soak it, then  dump the water w/o an additional rinse. Could this be THE problem?  I know when I dump the water it could be a little clearer. .  lj friedman san diego nov 2014


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Kathy Brinkerhoff
 

Lj,

Lj posts:  "One shortcut I;ve been taking is with the r/s/r bp.  I rinse it, soak it, then  dump the water w/o an additional rinse. Could this be THE problem? "

If you put beet pulp Lj in the search box you will find numerous posts to you regarding the r/s/r of beet pulp preparation.  You understand the concept of why it is done.  It seems to this observer that whenever Jesse is doing well you start taking "short cuts" or ask about taking "short cuts" in his diet, etc.   You have done an excellent job with Jesse when you follow the recommendations of the Board and Dr. Kellon.........please, "stay the course" and don't veer off into short cut land which results in problems.

I haven't checked your CH, but is his diet of timothy pellets/HT custom and now going forward back to r/s/r beet pulp tight?  Has anything else in his diet changed?  What are his current treats?  Might someone be giving him treats that are not appropriate to his diet?  Is his exercise program still in place?  These are just questions for you to consider and if the info is in the CH I will find it so no need to respond in a post to me.  

I will defer to the mods to comment on his blood work results and prascend dosage.

Kathy Brinkerhoff

SE/WI  10/12



 








Kathy Brinkerhoff
 

Hi Lj,

I took a look at Jesse's CH and is this  info all up to date?

11/14 8 oz. of TC Omega Flax
01/15 15.5 pounds of Sunrise Timothy Pellets
04/15  2.4 #'s of r/s/r Beet Pulp

03/15 HT Custom    Are you still supplementing with this same custom from HT?

Exercise: 20 minutes round pen work.  5  days per week?


Thank you,

Kathy Brinkerhoff

SE/WI  10/12













 

Hi, Kathy.
If you don't live in the drought-striken west, you probably cannot appreciate how severe the California drought is and how strongly people object to rinsing of horse feed - whether hay or BP - in these circumstances. You can call it a shortcut, but under such conditions, it may be all that can reasonably be done with the resources at hand. IMO a better solution where drought is so severe is to use alternative feeds that don't require rinsing. I write this respectfully as a reminder that we are struggling with extraordinary  conditions out here. 

Cass for Satra and Cayuse
Sonoma County, Calif Oct 12

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

 It seems to this observer that whenever Jesse is doing well you start taking "short cuts" or ask about taking "short cuts" in his diet, etc.   You have done an excellent job with Jesse when you follow the recommendations of the Board and Dr. Kellon.........please, "stay the course" and don't veer off into short cut land which results in problems.


Kathy Brinkerhoff
 

Hi Cass,

Lj is feeding and  rinsing Jesse's  Beet Pulp by his choice.  He referred to skipping the last rinse as a "short cut " he was using and wondered if missing this last step was contributing to Jesse's recent blood work and his vet's comments to "control Jesse's IR" with no mention of his concerns for water conservation.  I am very aware of your extraordinary conditions in CA.  I have relatives who live in the SF area and I help owners who live in CA with their horses' diets.  If water conservation was Lj's concern, which I may have missed in his post,  than perhaps he should consider feeding less than 2.4# 's of BP....say 1/2#  or find another carrier that does not need rinsing for his supplement carrier.  In the past,  I have personally helped Lj with his diet for Jesse and we have discussed alternatives to beet pulp.  Lj prefers to feed beet pulp in this amount and has outlined his reasons in numerous posts on this Board and in emails to me.

I do apologize if my post seemed insensitive to the drought in CA as that certainly was not my intent.

Kathy Brinkerhoff

SE/WI  10/12




lj friedman
 

NO,  Jesse gets  aprox  18# of timothy pellets, 2.4# of bp and his horse tech flax basd supps.. Nothing else.,   Beginning this past Monday, he is now tack walked for 30 minutes, 6 days a week.  


Nancy C
 

lj

The best you can do to help get a handle on insulin is get the ACTH within  range.

Can't remember if you tested for iron overload, and it sounds like the CH is not up to date so won't take the time to go there right now.

Hafta run. Sorry.

Nancy C in NH
ECIR Moderator 2003
FACT: The VA Polytechnic Pony Study is the only study to look at IR and laminitis under natural conditions. Learn more at the 2015 NO Laminitis! Conference in Georgetown, Texas, November 6-8.
http://nolaminitis.org/index.php/program-schedule/guest-speakers






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

NO,  Jesse gets  aprox  18# of timothy pellets, 2.4# of bp and his horse tech flax basd supps.. Nothing else.,   Beginning this past Monday, he is now tack walked for 30 minutes, 6 days a week.  


lj friedman
 

One comment about the amount of bp I feed  2.4#.  First, this feeding is pretty much a 4th meal.. as he gets fed 3 x a day with timothy pellets. Also, I feel, that bp might have some colic preventative properties.. ( no science to back this up, just hearsay.  ) And he eats it slowly.  a bit slower than he eats his pellets.   lj friedman san diego nov 2014
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lj friedman
 

thanks for your reply ,. Jesse gets ZERO treats. and noone gives him any treats either.   And I will revert back to r/s/r bp and see if things change.. I take this shortcut bec it isnt a cake walk when I prep the r/s/r bp.. some of the bp leaks out, etc, and it is heavy to lift the bucket to dump. But I will correct starting today..  My barn uses well water so water is plenty available.. lj friedman san diego nov 2014

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Lavinia Fiscaletti
 

Hi Lj,

Agree with the vet that the pergolide (Prascend) dose should be increased as Jesse is already above high normal and the seasonal rise period hasn't officially hit yet (although PPID horses can have an extended rise period).

If this was one of my horses, I would titrate him to the 2mg dose then continue up to at least 2.5mg as his ACTH is going to continue to rise even with the increased meds because of the seasonal influence. Your goal is to continue to control the increase as much as possible. Test again in mid-Sept to reassess.

Insulin/glucose are likely being influenced by the rising ACTH levels so controlling the ACTH will also help with the IR.

Diet-wise: the timothy pellets don't have a guaranteed analysis for every batch - neither mineral nor  s/s - so they are one area where things could be tightened up. The second rinse of the r/s/r of bp is so that any sugars that are soaked out are then rinsed away. Skipping the second rinse lowers the value of the soaking as residual sugars may still be sticking to the bp. You don't see dissolved sugar - the cloudiness/darkness of the soak water is dirt and pigments released from the bp.

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

>>>>>>>>>>>>>>>>>>>>>>


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Lorna Cane
 


>  My barn uses well water so water is plenty available.

Sadly,that's no guarantee.Wells have been known to run dry in times of drought. They need to get their water from somewhere.



Lorna in Ontario,Canada
ECIR Moderator 2002


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lj friedman
 

I updated CH today.. thanks..


Lorna Cane
 


>I updated CH today.. thanks..

 Signature , and link ?


Lorna in Ontario,Canada
ECIR Moderator 2002


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ferne fedeli
 

We have had several wells in our area go dry, or else start pumping up mud, etc.  I'm keeping my fingers crossed, as ours has been just fine so far.  Trying to conserve as best we can.  Bought a timer for the faucet we use to fill the water container in the dry lot, as I was forever leaving it to overflow for a few minutes!!!  The timer really works well!
Ferne Fedeli
No. California
4/2010


>  My barn uses well water so water is plenty available.

Sadly,that's no guarantee.Wells have been known to run dry in times of drought. They need to get their water from somewhere.





Lorna Cane
 


Ok,in English this time:

>We have had several wells in our area go dry, or else start pumping up mud, etc.


Let's continue  further discussion of wells and water over on the Horsekeeping List.



Lorna in Ontario,Canada
ECIR Moderator 2002


*See What Works in Equine Nutrition*
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lj friedman
 

Thanks for your reply. I have been keeping tabs on the equi analysis's that are posted from Mtn Sunrise for their timothy pellets that I feed Jesse,. The last analysis was similar to what I used for balancing, and kathlleen stated that  a new horse tech custom mix was not indicated.  Mtn Sunrise told me they will be posting a new analysis shortly. When I get it, I will send it to Kathleen to see if I need to revise my Horsetech mix..  thanks. lj friedman san diego nov 2014

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lj friedman
 

This post from lavinia:
If this was one of my horses, I would titrate him to the 2mg dose then continue up to at least 2.5mg as his ACTH is going to continue to rise even with the increased meds because of the seasonal influence. Your goal is to continue to control the increase as much as possible. Test again in mid-Sept to reassess.

Whenever you start your sentences off with "if this was one of my horses… "I pretty much automatically do what you would do if it was your horse. You wrote AT LEAST for a dose of 2.5, which makes me think that you think I should move up to 3.0 mg? With that being said, if I'm going to switch to compounded pergolide to save some money and I am with the current plan of increasing to 2.5 mg of prascend, do you think it's appropriate that I should consider ordering 3.0 mg compounded pergolide and switch over to that particular strength capsule in the few weeks time when titration indicates he can go to 3.0 mg? Lj friednan san diego nov2014


Casey James <macivor19@...>
 

Starfire was diagnosed with PPID in Nov of last year so this is my first seasonal rise to figure out.  Should I try to keep the ACTH in mid range or should it be allowed to go a little higher since this is normal for many non PPID horses during the seasonal rise? 


casey oregon 2015


This post from lavinia:
If this was one of my horses, I would titrate him as his ACTH is going to continue to rise because of the seasonal influence. Your goal is to continue to control the increase as much as possible. Test again in mid-Sept to reassess.

.
 


lj friedman
 

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takarri@...
 

Hi   Casey,

 

Good on you for being proactive with Starfire. I would be looking at trying to keep the ACTH in the mid range (or lower)  rather than higher. The better the control the less risk of laminitis.

 

Pauline & Spur

Sth West Vic

Australia Aug 07

EC Primary Response

http://tinyurl.com/7qbdyas

---In EquineCushings@..., <macivor19@...> wrote :


Starfire was diagnosed with PPID in Nov of last year so this is my first seasonal rise to figure out.  Should I try to keep the ACTH in mid range or should it be allowed to go a little higher since this is normal for many non PPID horses during the seasonal rise?