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Eva and Apollo (PPID, IR)
San Diego, CA
Joined 01/24/2018

Apollo's Case History

Hi Eva,

Great job on getting your CH filled out for Apollo!  That really gives us the details that we need to help you better!  I did look over your CH on Apollo and have some suggestions, but first let me answer your question. 

Keep in mind, that nothing may work long term and you (or the barn workers) may have to switch it up from time to time to get Apollo to eat the Prascend.  Some folks make their own soft cookies and we have a file with some recipes.
https://ecir.groups.io/g/main/files/Treats%20for%20Horses  Keep in mind that cookies that are cooked to the soft stage rather than crunchy will need to be refrigerated to avoid mold issues, so you might have to take just a week's worth at a time to the barn.  Here's a commercially made low sugar starch pill pocket:  https://beetebites.com/equipockets/   

Also there's a wealth of information in our pergolide file:  
https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide 
especially in the "Pergolide 101" file (5th one down):  
https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide/Pergolide%20101.pdf 
And on our website:  https://www.ecirhorse.org/pergolide.php 

And I bet other folks that board will chime in with ideas about how they manage this.  

In looking over your CH I see that you've observed IR symptoms (periodic lameness, cresty neck, bulging over eyes...) in Apollo since 2014, and he definitely tested positive for both PPID and IR in June 2018.  He's in a dry lot with no grazing, so that's really good!  I see some things in your CH that you can do to tighten up his diet, but it's also going to be really important to get his ACTH under control. 

In looking at your lab work, I noticed that the glucose on both specimens was slightly under the normal values.  This could indicate mishandling of the specimen, in which case both the ACTH and the insulin could have been negatively affected, since they are very susceptible to degradation if not handled correctly.  For future lab work we do recommend that you use Cornell as we have found that the results are much more consistent.  They have discounted shipping labels so no problem shipping from California.  $15 from any point of origin:  https://ahdc.vet.cornell.edu/docs/Shipping_Discount_Program_Information.pdf   Your vet also needs to have an account there, but if s/he doesn't already have one, it is easily done online.  All the details about proper handling of the specimens can be found on our website here:  https://www.ecirhorse.org/DDT+E-diagnosis.php 

To avoid the pergolide veil (depression, lack of appetite) that some but not all horses experience when first starting on the drug, we recommend weaning onto it slowly.  Start with 0.25mg for 3-4 days and increase by 0.25 mgs every 3-4 days until you are at the recommended "target dose", often 1 mg to start.  If you are going to use compounded pergolide you can order 0.25 mg, 0.5 mg and 0.75 mg capsules to get you through the weaning period.  If you use Prascend (brand name pergolide) to get the 0.25 mg dose, you can dissolve half a tab (0.5 mg) in a few cc's of water, give half and save the rest in the fridge for the next day.  Pergolide in water degrades quickly (more info in the pergolide 101 file I linked to above, and on our website here: https://www.ecirhorse.org/pergolide.php  ) so you don't want to make these up far in advance for the barn staff to use.  We recommend that you retest about 3 weeks after you have reached your full target dose to make sure the dose is controlling the ACTH. 

And then keep in mind that during the seasonal rise (fall) ALL horses have a natural rise in their ACTH, but PPID horses can have an exaggerated and prolonged rise in their ACTH which puts them at risk for laminitis.  Frequently an increase in pergolide is needed to keep the ACTH under control during the seasonal rise.  In the early stages of the disease it can sometimes be weaned back to the pre-rise dose, but as the disease progresses it often can not. Since PPID is a progressive disease, it usually takes increasing the dose over time to keep the ACTH under control.  More info about the seasonal rise here:  https://www.ecirhorse.org/seasonal-rise.php  In reading the timeline in Apollo's CH, I think you are going to see him feel much better when you start the pergolide!

I see in your CH that you are giving Apollo some supplements.  In general, there are often hidden, or no-no ingredients in supplements and you are usually better off supplementing ingredients individually.  EVERYTHING you give him should be under 10% sugar+starch.  Smart pack doesn't list guaranteed analyses of their products, so it's difficult to evaluate the sugar and start content of their products.  You could write to the company and ask for a guaranteed analysis of each product.

But here are some obvservations about some of the supps that you are using: 

The Smart Digest Ultra pellets have a alfalfa meal (often not tolerated by IR horses) and stabilized rice bran and vegetable oil--both have an upside down Omega 3:6 ratio.  We like to see the Omega 3:6 ratio at about 4:1, which is the same as grass.  In fact, most of the smart pack supplements contain rice bran and vegetable oil.

The Smart Flex Ultra contains glucosmine, which we generally don't recommend for IR horses.  More info here:  https://ecir.groups.io/g/main/files/5%20Core%20Diet/1.%20Avoid%20These%20Items.pdf 

The SmartOmega 3 & E Ultra can easily be replaced by stabilized ground flax seed and vitamin E gel caps. 

And HEIRO. What can I say.....sadly I fell into the HEIRO trap before I found this group.  It's been discussed many times here.  Here's a list of prior discussions:  https://ecir.groups.io/g/main/search?q=HEIRO 

This is my favorite one:  https://ecir.groups.io/g/main/message/141681 

Really the best way too feed Apollo is to have his hay analyzed and feed only what it take to balance the minerals and replace the "missing ingredients" (salt,Vitamin E, Omega FA's).  Here's a great post by Kathleen that explains why we balance:
https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/1.%20Diet%20Balancing%20-%20KFGs%20View%20From%20the%20Soapbox.pdf 

Look here for some innovative ways that people who board have found to buy/store and test hay:  
https://ecir.groups.io/g/main/files/5%20Core%20Diet/1.%20Hay%20Information/Finding%20and%20Storing%20Hay.pdf 

And if you find it totally impossible to balance to your hay analysis, there are some decent supplements that can come close to balancing your hay, tho no way to know for sure without an analysis and always second best to balancing to the hay.  Look in this file for a list of safe supplements:  https://ecir.groups.io/g/main/files/6%20Diet%20Balancing/Commercial%20Supplements%20SAFE/Acceptable%20Commercial%20Supplements%20for%20Ration%20Balancing.pdf 

OK, Eva, that gives you some reading to do, LOL!  Let us know is you have any more questions!
--
Maggie, Chancey and Spiral in VA
March 2011
ECIR Moderator/Primary Response

PS....the link to Apollo's CH in Eva's above post doesn't work.  But I fixed it, so it should work the next time she posts.  Here's a link:  https://ecir.groups.io/g/CaseHistory/files/Eva%20and%20Apollo 
--
Maggie, Chancey and Spiral in VA
March 2011
ECIR Moderator/Primary Response

On Wed, Feb 6, 2019 at 11:04 AM, Eva Stettner wrote:

I was wondering what folks use to hide the tablet in. I board Apollo and I have to leave his supplements for the barn workers to feed him every day. So I can't put it in a carrot or something that would go bad. A soft cookie might be best.

Hi Eva,
What has been working for me is to use 1/4 cup Stabul 1 feed pellets.  The pellets are the same size as the compounded pergolide capsules I used.  For Prascend, I have found it works best if you put the Prascend tablet in an empty capsule first, otherwise they get a taste of the pill and start to refuse anything that might have the pill in it.  The empty capsules are available on line, such as:
https://smile.amazon.com/Empty-Gelatin-Capsules-Size-1000/dp/B000ACUJRW/ref=sr_1_4_s_it?s=hpc&ie=UTF8&qid=1549558702&sr=1-4&keywords=empty%2Bcapsules&th=1
There is enough room for one and a half Prascend tabs in the size 0.
Before they get anything else in the morning, I give them a pan with the Stabul pellets and the capsule right in the middle, then make sure they eat it before going to the next horse.  This has been working very well, even on higher doses.
 
--
Paula with Cory (IR & PPID?) and Onyx (IR/PPID)

  and Remy (?)

Bucks County, PA, USA

ECIR Primary Response

NRCplus 2011  ECIR 2014 

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Cory

https://ecir.groups.io/g/CaseHistory/album?id=1624

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Onyx

 

I use soaked soyhulls and soaked Alfalfa pellets. I use a pill crusher bought at any drug store and crush Prascend to powder and mix with that in middle of it to make sure it gets consumed first. Give it in first feed of day when eager to eat BEFORE HAY. She always eats it and I’m sure she gets her 3mgs that way. I also feed her jaiagolan twice a day. 
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Pat and Savannah
Vancouver Island, British Columbia, Canada
January 2018 

Case History: https://ecir.groups.io/g/CaseHistory/files/Pat%20and%20Savannah
Photos: https://ecir.groups.io/g/CaseHistory/album?id=22028&p=pcreated,,,50,2,0,0

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Ellen
Pal & Savvy
N. Alabama
Aug 2013
Case History 

Hi Eva....I am currently rotating between 1 dried prune, a slice of fresh summer squash and the Beet-e-Bites pill pocket.....As soon as he gets tired of one...i have the caregiver rotate to the next one...and so on. Relevante won't touch zucchini or celery.
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Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω

I also put Prascend on an empty pill capsule, in a palatable handful of feed. I feel the most important thing is that you give it when the horse is hungry!
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Maxine and Indy (PPID)

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933

 

Hi Maggie,
Thank you for your reply! I've been reading through the links and haven't finished all yet. But I wanted to thank you for all the help you've given me so far.
I've been using Smartpaks for a few years and like the convenience and the customer service is great. The reason I use the SmartDigest Ultra is it has a colic surgery guarantee. So I see it as insurance for the most common surgery a horse will ever need. But as he's gotten older, he's now at least 20, I'm not sure I'd want him to go through that if he ever needed it. So I'll have to rethink that.
The HEIRO seemed to help his foot soreness and shedding, and when I added the SmartPituitary Senior (with chasteberry) a few months later, his shedding has picked up. He looks much better now than he did one year ago. I'll post pics soon. Now since I'm starting him on prascend and with the cost of that, I decided to drop the SmartPituitary and replace it with a Smart&Simple Chasteberry supplement that has twice as much (3000 mg daily) as the SmartPituitary (Apollo was getting 1500 mg of chasteberry daily with a custom dose) at almost half the price. Another thing I like about Smartpak is my horse eats them readily. and they have a money back guarantee if the supplement doesn't work for you. If I gave him pure chasteberry in a powder form, he would never eat that!
I can see the HEIRO is going to be redundant when he starts prascend because that should reduce his cortisol levels and inflammation and he won't be foot sore (I'm hoping). I didn't realize it has so much iron in it. Honestly, despite all the negative reviews, I did see an improvement with it or I wouldn't have kept using it this long!
I'm grateful for your time and experience, and I see I have much to learn. So I will continue reading the links!

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Eva and Apollo (PPID, IR)
San Diego, CA
Joined 01/24/2018

Apollo's Case History

Hi Paula,
Thank you for your post. I will try the pill in an empty capsule. That's brilliant! I'll look into Stabul 1. I'm not sure if Tractor Supply carries it here. It sounds like your horses like it!

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Eva and Apollo (PPID, IR)
San Diego, CA
Joined 01/24/2018

Apollo's Case History

 Pat, I live too far from the barn where I board Apollo to feed him every day. I leave his supplements in bags and he gets fed those every day at lunch. So I have to use a soft cookie or something that won't go bad in a baggie in the Southern CA heat.
Lynn, thanks for your suggestions. The Beet-e-Bites sound promising and I'll see if Apollo will eat a prune. I like the idea of rotating treats.
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Eva and Apollo (PPID, IR)
San Diego, CA
Joined 01/24/2018

Apollo's Case History

Hi Eva - Maggie made a great point about feeding the medication when the horse is hungry. It reminded me to add that i have the caregiver hand feed Relevante's capsule (he is on the compounded pergolide now) first thing in the morning before Stabul 1 with supplements and hay. I have found rotating to be very helpful too.
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Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω

On Thu, Feb 7, 2019 at 04:10 PM, Eva Stettner wrote:

I'm not sure if Tractor Supply carries it here. It sounds like your horses like it!

Hi Eva,
In case you can't get it locally, I order the Stabul 1 feed pellets directly from Anderson feed.  I use it only for the pergolide "treat", so 20 lbs lasts for a while.  The shipping is free, so that helps too.
 
--
Paula with Cory (IR & PPID?) and Onyx (IR/PPID)

  and Remy (?)

Bucks County, PA, USA

ECIR Primary Response

NRCplus 2011  ECIR 2014 

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Cory

https://ecir.groups.io/g/CaseHistory/album?id=1624

https://ecir.groups.io/g/CaseHistory/files/Paula%20and%20Onyx

 

My guys really like Stabul 1 also.  The big problem for us in this area of Northern California, is finding a TSC that will carry it.  One store agreed to carry and then was told by his upper management to not order any more as shipping was too expensive!!!  Such a pain!
--

Ferne Fedeli

No. California

Regional Members Database Coordinator

 - see who is near you

Add your contact information if you want to help out/meet ECIR members in your area.

Case History

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Cassie and Shevawn
03/2015   Gordon, TX
CH folder:  https://ecir.groups.io/g/CaseHistory/files/Shevawn%20and%20Cassie 
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=76832 

Hi Cassie, 

Yes, the Beet-e-Bites 30 count peppermint Equipockets are 28.95. That's what i pay...I feel your pain.
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Lynn
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album

Ω

Hi Eva, I use the recipe in the files which mixes ground flax and the "dust" from the bottom of the Timothy Balance Cubes bag, with water and flavoring added. The original recipe calls for rolling the "dough" flat, but I molded it into little "meatballs". Holding each one cupped in the palm of my hand, I inserted a Philips screwdriver to make a hole. These were baked on one side, then flipped, the oven turned off, and the balls stayed in the oven overnight as it cooled. My compounded pergolide capsules fit firmly into the dried ball. The horse loves peppermint and nods his head as he crunches it up. This solved his sudden decision that he didn't like peanuts in the shell anymore.
Prascend users could use a flat screwdriver the width of their tablet.
I keep some of the baked balls in an egg carton in the fridge, carrying the day's dose to the barn in a plastic container as the balls are too crumbly for a pocket. The rest go into the freezer until needed.
--

Thanks Bonnie! Did he really eat peanuts?

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Eva and Apollo (PPID, IR)
San Diego, CA
Joined 01/24/2018

Apollo's Case History

Yes, peanuts are (were) a favorite, right in their shell. I would crack off part of the shell, shake out the kernel and replace it with the capsule. At first I trimmed the piece of shell to be able to wedge it back to hold the pill. Later on I found a quarter teaspoon of peanut butter would glue both pill and shell in place.
The dog would be watching this and would beg for the leftover peanut kernel. Then more. "Species rivalry."
Probably when the thrill of the new peppermint flavored ball wears off, Lad will accept peanuts again. By the way, he still likes them as treats, just not at pill time. They like to mess with our minds....
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Yes, peanuts are (were) a favorite, right in their shell. I would crack off part of the shell, shake out the kernel and replace it with the capsule. At first I trimmed the piece of shell to be able to wedge it back to hold the pill. Later on I found a quarter teaspoon of peanut butter would glue both pill and shell in place.

Hi Bonnie,
This is great info! I didn't know horses like peanuts! And eat the shell! Everyone has given me great ideas. I got a bunch of things to try and the empty capsules. Waiting for prascend to come in the mail today.
Thanks everyone!


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Eva and Apollo (PPID, IR)
San Diego, CA
Joined 01/24/2018

Apollo's Case History