Pergolide doseages


Cheryl Oickle
 


-- intermittent improvement noted these days. 4 good this week of note. . A question re pergolide...she is 800 lb started on 0.5 mg for 6 days. No evidence of a pergolide veil.  Increased to 1 mg and in three days became very irritable and aggressive with everyone.  She bit me badly.  Her dose was hence decreased back to 0.5 mg with return to normal behaviour in spite of pain and sore feet within 2 and a half days.  Her acth level although specimen was thawed upon arrival was only 3 point above normal ( the spec was spun and frozen appropriately before shipping). I am getting mixed messages r egarding what may be a satisfactory dose ....one ve5 says 0.5 mg a waste of time and another says 1 mg.  Too much based on her levels and behaviour
Cheryl and Jewel
Oct 2018

https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel


Lorna Cane
 

Hi Cheryl,

Can you add her test results, and any other updates to the CH, so we can see the details ?

--

Lorna in Eastern Ontario, Canada
ECIR Moderator 2002
https://ecir.groups.io/g/main/files/PPID%20and%20IR%20Success%20Stories/Success%20Story%20%233%20-%20Lorna%20and%20Ollies%20Story.pdf

 


 

Hi, Cheryl - you must be tearing your hair out!  Could you just clarify for us:  how was her foot pain after 6 days of 0.5 mg pergolide?  And how was her foot pain after increasing to 1 mg pergolide?  And, to be clear, did her foot pain increase 2 1/2 days after going back to 0.5 mg pergolide, or do you mean she was just as foot-sore as ever, but her mood improved?

  Pergolide is dosed to effect, not by body weight. Its task is to replace the dopamine that would normally be produced by dopamine-producing nerve cells in the hypothalamus, so how much pergolide is needed depends on how many of those nerve cells have been lost. However, like any drug that affects neurotransmitters, there can be mood changes.  Mood changes can also be caused by pain, either constant, increasing, or decreasing.  The satisfactory dose is the one that controls the ACTH (which should be in the low to mid-normal range, ie about 20 pg/mL or less). 
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
BC 09
ECIR mod/support  https://bit.ly/2MlAtPd  

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711


 

This from Cheryl:  

"Her pergolide dose of 0.5 mg seemed to improved her foot pain approximately 3 weeks into the doseage.  The increase to the 1 mg only lasted 4 days due to the  change in her behaviour at day 7-11 of introducing the drug. I am at day 22 of the drug at 0.5 mg and her pain waxes and wanes  I am  having difficulty getting the actual levels of her blood work from the September draw.  All I know is that the "normal" range is 0-10 and her marker was at 13 but the specimen was thawed upon arrival to the lab.  This is in whatever Canadian Units they use.  I am not too techy so having trouble updating my Case History.  Cheryl"

And, from the case history (I didn't scroll down far enough - sorry!) :

"Very reluctant to move in September but ?? Oct 1 variable amounts of pain between rt and left front. Seems to move from foot to foot. No effect from analgesic. Started on pergolide at 0.5 mg Oct 5 no pergolide veil noted. Increased to 1.0 mg Oct 21… became very agitated and aggressive 3/7 later. Dose decreased and settled in 3 days. Maintained on 0.5 mg at present 2018 10 27 "

So, just to make sure we are all on the same page:

Jewel had laminitis in June of 2010 at age 9.  She had white line disease in October of 2017, farrier did a resection. She had another bout of laminitis in June of 2018 (age 17), which seemed to resolve in about a month, and now her current bout which started in September of this year, and is not resolving, with continued foot pain.

She was on 0.5 mg of pergolide for 3 weeks, starting on October 5; foot pain seemed to reduce about 3 weeks into the dose. That doesn't quite make sense, since the dose was increased 16 days after starting. The dose was increased up to 1 mg on October 21; on or about October 25th, her dose was reduced to 0.5 mg again, and her demeanor returned to normal.

Chaste tree berry was started July 15th, and discontinued October 10th.

Her most recent ACTH was 13.0 pmol/L  (normal 2-10 pmol/L) , in September, before she started the pergolide.

She is getting hay; not tested, and not soaked.

I have some ideas, but please do let me know if the above synopsis is incorrect, or I am missing something! :)

 Her ACTH of 13.0 pmol/L in September puts her squarely in the "grey" area. She might have Cushing's (PPID); or she might not. There is certainly a high index of suspicion, given that she had foot issues two Octobers in a row.

I don't know if you are able to get the hay tested, or if you can soak it?  

Here is what I would do, if Jewel were mine. First, start a journal. Assign a number from 1 to 10 for each of : foot comfort, demeanor (attitude), size of udder, size and firmness of crest. Make a quick note every day of what those things look like.

Second, soak the hay, if at all possible.

Third, start her back up on the Chaste Tree Berry. It won't control ACTH (but I do wonder if it was having some effect, since she was on it when the blood was taken in September).  CTB can help with a lot of clinical signs of Cushing's, and it also has a slight opioid effect, which might make her feel better.

Fourth, order some Ginseng from Rainey Ginseng: https://raineyginseng.com/  Get the powdered stuff, and feed at a rate of about 20-30 grams per day (I don't know what that is in teaspoons, sorry - if anyone has done a weight to volume measurement, please let me know!)

Once the ginseng has arrived, and she has been on it for 2 or 3 days, increase the pergolide to 0.75 mg daily. To do this, you will have to dissolve half a tablet in a measured amount of water (like 4 cc, for example); Draw up half the mixed solution into each of two syringes (dosing syringes from the drug store are ideal). Give half one day, and put the other half in the fridge for the next day. Repeat. After 4 doses of that, go up to 1 mg again, and see what happens. Don't forget to keep notes in the journal.

So, going back to Diagnosis, Diet, Trim and Exercise (which is a non-starter at the moment):  We have a tentative diagnosis of Cushing's (PPID), or at least a high index of suspicion. We don't know what the insulin or glucose looks like. It seems prudent to use Prascend (pergolide) and chaste tree berry at this time. Use an adaptogen (the North American ginseng) for increases in pergolide dose.

We will have to keep mare issues in the backs of our minds.

Diet: if we don't know for sure that the hay is below 10% ESC and starch, it is best to soak it. One hour in cold water, or 30 minutes in hot water, water drained where the horses can't get at it.
         Since she is at a boarding barn, double-check that she isn't getting illicit treats or feed.

Trim: Once you get the hoof pictures up, let us know. This could be a big missing piece of the puzzle.

Regarding case history (and thank you for getting that done!), you should be able to edit the Word version you have on your computer, and then upload it into your case history folder. Once that is done, you can delete the old case history.

Hang in there, and keep up the good work!

 
 
 
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
BC 09
ECIR mod/support  https://bit.ly/2MlAtPd  

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711


Cheryl Oickle
 

Just one correction her hay IS tested and less than 10% ESC  actually 7.1 and starch is 1.2 %.  Sorry if I wasn’t clear on that.   The prascend dose? Thoughts should it stay at 0.5 or should I try again to increase to 1.0 mg
--
Cheryl and Jewel
Oct 2018

https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel


Cheryl Oickle
 

Sorry need to read the pergolide suggestion in the response too quick to respond.   I hav a trimmer coming out nov 14 or 15 and will acquire hoof pics with a high grade camera at that time for posting and evaluation.   Specializes in issues as this
--
Cheryl and Jewel
Oct 2018

https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel


Eleanor Kellon, VMD
 

To try to sort through the PPID issue, I would suggest tapering off pergolide in December and doing a TRH stimulation in February.  If positive, you have an early PPID. If negative, you have an IR horse that is sensitive to the seasonal rise effects so know you at least need pergolide seasonally.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

p.s. Improvement 3 weeks into the low dose pergolide with this timing could easily have been from ACTH levels dropping anyway rather than a drug effect.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Eleanor, we are a little stuck on this in Canada. I know one vet in Quebec that will import the TRH, but apparently one has to pay for the whole flat (over $1,000), so if there aren't a whole bunch of horses needing a TRH stim test, it is unlikely that a practice will bring it in.  Dang!
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
BC 09
ECIR mod/support  https://bit.ly/2MlAtPd  

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711


Eleanor Kellon, VMD
 

TRH:  Thanks,  Jaini.  I didn't know that.  Anyone know the status in EU and AU?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001