Was Jennifer and Darcy, back again. Now Darcy Diagnosis: PPID


bectonliterary
 

Hi everyone,

I got some of Darcy's blood work results back today, and her ACTH number was 59.4 pg/ml. I have an insulin number (17.49 uIU/ml), but no glucose or leptin yet. Not sure why. But I have contacted him for those values.

The vet recommends pergolide @ 1 mg daily for one month followed by retesting the Endo ACTH at the end of that month.

Even though I knew a diagnosis of PPID was likely, I'm a little overwhelmed and upset. I'll be researching the files for how to proceed, but any additional advice is greatly appreciated.

I am also waiting for copies of the radiographs I had done on her front feet. According to him, he saw no evidence of long-term, low-grade hoof pain or any rotation. He suggested taking the toes back more, which I have already addressed.

She has been moving great and even showed a lot of spunk today.  I hope that continues as long as possible.

Thanks in advance,
Jennifer and Darcy in SC
2011


bectonliterary
 

I have updated Darcy's case history to include her current diet, schedule, exercise, and test results. Here's the link: ECHistory6

 



Also, I've alerted the barn owner that some changes will becoming for Darcy's medication needs. Now, I just have to figure out pergolide dosing for her needs and this tapering thing. Plus, how to get the meds down my picky eater's gullet. :D

Thanks!
Jennifer and Darcy in SC
2011


Maggie
 

Hi Jennifer,

Happy to hear that Darcy is feeling better.  Great job on updated Darcy's CH!  And thanks for the link to it.  If you could include that in your signature every time you post, it helps us to find it faster.  Thanks!  

I have a couple of suggestions and a couple of questions.  First of all, I am guessing that your vet did not order the glucose.  It's always the first thing that comes back when I do my labs and also does not say "pending" on the copy of your Cornell labwork.  When you contact him, ask him to call Cornell and have them add it.  They will still have your blood sample, so it shouldn't be an issue.  You should be getting the leptin back any day now.  It's always the last thing to come back, for me anyway.

When you start the pergolide, you want to wean Darcy on to it slowly to avoid the pergolide veil (depression, lack of appetite) that some, but not all horses experience when first starting the drug.  We recommend that you start with 0.25mg for 3-4 days and increase by 0.25mg every 3-4 days until you reach your target dose, often 1 mg to start.  Once at your target dose for 3 weeks then you will want to retest the ACTH to see if that dose is controlling the ACTH.  The goal is to get the ACTH down into the low to mid 20's.  More reading on the seasonal rise can be found here:  http://www.ecirhorse.org/index.php/cushing-s-disease/seasonal-rise  If you are using compounded pergolide, you can order 0.25mg tabs to wean on.  If you are using Prascend, they are scored to break in half, but not recommended to break into quarters.  In that case, you can break one in half, which is 0.5mg, and dissolve half in 10 cc of water.  Administer half of that (0.25mg) and save the other half in the frig for the next days dose.

Another really helpful thing to avoid the pergolide veil is a product called APF.  You can buy it at some local tack and feed stores, online, and also on their website: http://www.auburnlabs.com/html/eqProdGen.html  You may want to have some on hand before you start the pergolide.  I see in your CH that Darcy has periods of poor appetite.  I bet that has more to do with her PPID than boredom with her low sugar diet, and that once her ACTH is under control, you will probably see a resolution of that as well as the rain rot. 

I don't see a current hay analysis in your CH folder, so don't have that to go by, but I see that for your trace minerals you are supplementing 18mg of of Cu.  That seems an unusually low amount of Cu to me and I don't see any mention of Zn supplementation.  I could be totally off base, since my hay is always high in iron and I have to supplement lots of Cu and Zn to balance it.  But just curious how you are balancing.  IR and PPID horses benefit from a really tightly balanced diet, so if you post your hay analysis we can help you to evaluate that.

I see that Lavinia suggested that you post pictures of Darcy's feet in the PHOTOS section so she could have a look and see if you have an optimum trim in place.  Also see that you do your own trimming.  IMO, it's always great to have an extra set of eyes evaluating my trim, so it would be great if you could post both pictures of Darcy's feet, and those radio graphs that you are waiting for.  Here's a site that shows how to take good hoof photos:  http://www.all-natural-horse-care.com/good-hoof-photos.html   You can just start an album in the PHOTOS section of ECH6 to put the pics and xrays in.

I also see in your CH that you are doing round pen work and riding Darcy in the RP.  We highly recommend that you don't ride or do round pen work/lunging until half to 2/3 of the laminitic foot is grown out.  The reason for this is that those tight turns of RP work and the extra weight of a rider can damage the fragile new laminae as they grown in.  Hand walking in long straight lines with no tight turns is recommended until the damaged hoof grows out sufficiently.

If you have any trouble getting Darcy to eat her pergolide, just do a search of the archived messages.  TONS of posts on this in the past!  And also don't forget about the picky eaters checklist in the ECHorsekeeping files!

Maggie, Chancey and Spiral in VA
March 2011
EC moderator/Primary Response
https://groups.yahoo.com/neo/groups/ECHistory4/files/maggie%20in%20virginia/ 




Maggie
 

Well, Jennifer, I am replying to my own post to you, LOL!  You are probably wondering why I included "More reading on the seasonal rise can be found here:  http://www.ecirhorse.org/index.php/cushing-s-disease/seasonal-rise"  Complete brain fart!  We are NOT in the seasonal rise, but save that link!  You will want it when we get closer, late summer, early fall.  Sorry if I confused you!  


Maggie, Chancey and Spiral in VA



bectonliterary
 

Maggie,

Thank you so much for responding with all that information! I have asked the vet to add the glucose test and a prescription. I think he just wanted to sell me the Prascend, but I like the idea of the apple-flavored encapsulated powder from Thriving Pets. It seems like that might set us up for a higher probability of success in getting it down Darcy's throat. :D

I will also get my hands on the APF. I want to make the transition as easy as possible for Darcy (and the barn staff).

Also, thank you for the information on exercising her. I had looked around, but I never quite laid my eyes on any definitive suggestions. (I think I'm on info overload though, so I may have missed it.) My round penning has been gentle, and I'm not asking for turns. Mostly, I just had her walking in a large circle around me and then cutting across the middle. I will adjust my plans accordingly. I didn't realize how careful I needed to be with those feet. Thank you again!

I have been gradually adjusting my trim to meet the vet's suggestions from the radiographs. I didn't want to take back the toe too much at once, so they are still "in progress." Will those pictures be enough to help?

Also, I need to do another hay analysis. Is there a link to a resource for hay corers? I am going to need one.

Thanks,
Jennifer and Darcy in SC
October 2011
https://groups.yahoo.com/neo/groups/ECHistory6/files/Jennifer%20and%20Darcy/


Maggie
 

Hi Jennifer,

You are welcome!  I'm glad you found it helpful. 

I do think that pictures will be helpful.  I hate to speak for Lavinia, but I do think she can look and help you to see if you are moving in the right direction, and guide you as you go.  Just make sure to date everything so that she can see the progress that you've made since the xrays were taken.  You might also find it helpful to go and look at the albums in the ECH8 "photos" section.  "Too long toes" is a common problem and it may help you to look at the other xrays, photos and markups that are in those albums.

You may be able to borrow a hay corer from your local extention office or coop.  Here's the link to EquiAnalytical's hay probe:  http://equi-analytical.com/supplies/  If you buy one from them, they offer a free hay analysis, but it's the #601, which you don't want.  You want the #603 (trainer) package, but they will apply the price of the #601 ($28) to the cost of the #603 ($54).  Also ask them to send you some free forage sample kits.  They come with free shipping envelopes.

Thanks for adding your CH link to your signature!

Maggie, Chancey and Spiral in VA



bectonliterary
 

I got Darcy full blood work panel back. It's worse than 3 years ago. Aaaaaaaaaaaaaaaaaaaaaaaa!

Okay, that's out.

Glucose 97 mg/dl
Insulin 17.49 uIU/ml
Leptin 10.69 ng/ml
ACTH 10.69 pg/ml

The calculator says compensated IR, laminitis risk.

I admit her diet hasn't been perfect because I haven't been testing hay since the first time, and I let the BO add a handful of Safe Choice Special Care to entice her to eat. But isn't it possible that the high ACTH is causing some of the IR symptoms?

I have requested a prescription from the vet for pergolide, and I will order it as soon as I get the scrip in hand.

I have uploaded her report and radiographs to my CH. I will get pictures of her feet when I'm at the barn today.

I think that's all I can do at the moment. I kind of hate this in between stuff. I know there's more I can do, but I can't do it all at once.


Thanks,
Jennifer and Darcy in SC
October 2011
https://groups.yahoo.com/neo/groups/ECHistory6/files/Jennifer%20and%20Darcy/


bectonliterary
 

Now I'm replying to myself!

Actually, her numbers are just slightly better than the previous test. I think I'm too emotional for math. Still, something is clearly out of whack.

Thanks,
Jennifer and Darcy in SC
October 2011
https://groups.yahoo.com/neo/groups/ECHistory6/files/Jennifer%20and%20Darcy/

 


Lavinia Fiscaletti
 

Hi Jennifer,

I've made an album in the PHOTS section of ECHistory6 and moved Darcy's xrays and pictures there:

https://groups.yahoo.com/neo/groups/ECHistory6/photos/albums/441937740

You can add the feet pix to this when you get them. Pix take up a huge amount of room in the files section, as well as being difficult to view because of the way Yahoo sets things up.

Yes, it's possible that the ACTH is driving some of the higher I/G numbers. If the temps were colder (40's or lower) when the blood was pulled that could also be a factor. The decreased work load due to the foot soreness is also likely playing a part.

On the xrays, her toes are too far out in front, soles are thin, coffin bones are ground parallel (likely due to heels being under run and crushed) and there is a slight broken back axis to the bony column. It's all quite fixable, tho.

Just remember to breath  - you're doing a good job getting things organized and making the necessary changes to fix the problems.

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


bectonliterary
 

Thank you for making the photo album for me. I am a little overwhelmed at the moment.

I am already working on the changes you mentioned based on the radiographs. I have taken both toes back, but the right still needs to come back farther Next time I'm there, I'll finish the job and not be as timid about it. I've had my hoof mentor take a look and suggest changes, so I feel like I'm on the right track and will get pictures up asap.

I have some questions re pergolide.

1. I was initially excited about the apple flavored encapsulated pergolide powder from Thriving Pets. However, I've seen some posts regarding the dosage there that confused me. Should this source be avoided?

2. I board my mare, so I'm trying to make this easier on the staff. I pre mix Darcy's supplements in baggies. Can I just add the correct dosage of pergolide powder to that mix and seal the baggie to prevent more air exposure? Or would that compromise the drug?

Jennifer and Darcy in SC
October 2011
https://groups.yahoo.com/neo/groups/ECHistory6/files/Jennifer%20and%20Darcy/

 


bectonliterary
 

Hi everyone,

I just wanted to update you all on Darcy's progress. Thanks to your suggestions based on the radiographs of Darcy's feet, I adjusted her trim. Now, she is moving with considerably more zing in her step. I am thrilled with her progress with the trim adjustment alone.

This week, she started pergolide, which I ordered from Thriving Pets. The customer service there is excellent, and Chris helped me out a lot regarding the dosages. She has been on .325 mg of pergolide mesylate for 5 days, and today will be her first at .65 mg of pergolide mesylate. She has shown no lethargy or disinterest in food (beyond her normal transient disinterest).

The capsules have been easy to hide in unsalted peanut shells. And to make it easy for the barn staff, I bought her a pill caddy. I can portion her medication and put it in the peanut shells for the staff to hand feed her. Plus, it's so cold in the barn, I can leave them on her stall and they are still refrigerated. :D So far, this method seems to be working. I'll have to adjust in the summer, but hey...at least the pills are going in her.

Jennifer and Darcy in SC
October 2011
https://groups.yahoo.com/neo/groups/ECHistory6/files/Jennifer%20and%20Darcy/

 


Lavinia Fiscaletti
 

Hi Jennifer,

Thanks for the update. Now you can see why we harp so much about the smallest details of the trim - glad it has helped in such a visible way.

Good job on being creative and getting Darcy's meds into her :)

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