Prascend in the water bucket?


joyh2obury@...
 

Hi all, 
I'm a new member.  Still working on completing the case history for my new equine partner, a 15 year-old QH Mare I affectionately refer to as my "Mid-Life Crisis".

I purchased Emmy in November, 2018, she was already on 1 mg of Prascend since July and had been dx'd with PPID.  (Yes I knew all about her condition before I purchased her. No I'm not insane.)

It's been a struggle to get her to take her Prascend like a good girl.  She's super smart, independent and confident.  She can smell Prascend a mile away no matter how I try to sneak it in.  Dissolving, syringing, hiding in treats, mixing in food, etc, she might ingest it once, but never again.  Even turning her nose up at her food completely if she suspects it's in there.  Same with syringing into her mouth, the only thing I accomplished was making her refuse all syringes in her mouth, including paste-wormer.  With each failed attempt her mistrust of me grew, which strained our relationship.

Finally, I dissolved the pill in her water bucket in about 2 gallons of water. She usually gets it down in a couple hours without even noticing.  The vet doesn't like that idea and thinks the medication loses its potency and she's not getting the full strength.  And yet with all the things we have to do to get Prascend into our horses, I'd be surprised if anyone is getting the full potency of the drug into their animal,   Emmy's begun shedding, which has not happened in a couple years according to her previous owner, so she must be getting some benefit.

Two questions.  Has anyone tried dissolving the tablets in the water bucket and what are your thoughts about it?  Has anyone tried the Medi-Melt pergolide tablets from https://www.wedgewoodpetrx.com/pet-and-horse-owners/medi-melts.html  I'd hate to invest in yet another method and find it rejected like the dozens of others.

Thanks for your help.

Joy


Paula Hancock
 

On Fri, Feb 8, 2019 at 07:29 AM, <h2obury@...> wrote:
Two questions.  Has anyone tried dissolving the tablets in the water bucket and what are your thoughts about it?  Has anyone tried the Medi-Melt pergolide tablets from https://www.wedgewoodpetrx.com/pet-and-horse-owners/medi-melts.html  I'd hate to invest in yet another method and find it rejected like the dozens of others.
Hi Joy,
Well, that's the first time I have heard of someone using two gallons of water to dose pergolide!  It might sort of work, but there are so many variables and unknowns, it would be better to find another solution. Prascend appears to taste worse than the compounded pergolide and if you are using the Prascend, you can try putting the Prascend in an empty capsule to reduce the likelihood of tasting it.  Eva's discussion thread would be worth looking at for other ideas:
 
The Medi-melts are geared towards dogs and cats, so likely your girl will not like chicken flavor, but they also have Medi-mints.  You would want to know if sugar is used or not.  I get my compounded pergolide from Wedgewood, but haven't tried any special delivery.  I have more trouble with Prascend, so if your vet is willing to prescribe compounded pergolide, that would be my first choice.  Some people core a small piece of carrot and put the pergolide inside, but highly recommend putting Prascend in a capsule before putting in the carrot.  It sounds like your lucky and very smart girl is already suspicious of attempts to medicate her.
Thanks for working on her case history. Let us know if you run into difficulties with that or have other questions.  Meanwhile, I am including a general summary of the protocol we use here to help IR and PPID horses regain/maintain their best health.  It contains lots of good information and useful links, so it's handy to keep a copy for reference.

The ECIR provides the best, most up to date information on Cushing's (PPID) and Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

In order to help you and your equine quickly and effectively, we need you to explain your equine's situation by following the instructions you were sent upon joining. Your completed case history form and ECIR Signature will save days of back and forth questions. If you haven't done so yet, please join our case history sub-group. Follow the uploading instructions so your folder is properly set up and then upload your case history. If you have any trouble, just post a message or email the case history group explaining specifically where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: IR is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

 

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

 

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

We ask all members to sign their first name, general location, date of joining and link to the case history and photo album every time they post. It helps us to find your info faster to answer your questions better. You can set up an automatic signature so you don't have to remember to do it. 

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.
If you have any technical difficulties, please let us know so we can help you. 

 
--
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

 


lorraine kitral
 

Hi, I use apple flavored pergolide encapsulated powder from Wedgewood pharmacy. I put it in a syringe along with a tad of unsweetened apple sauce and some water. Shake it up and it goes in easy and doesn't seem to bother my horse. She won't take it any other way. This is in 20cc syringe


joyh2obury@...
 

THANK YOU PAULA HANCOCK!!!!!  I had some empty capsules on hand and tried your suggestion.  Worked perfectly!  She swallowed it down in her first mouthful of pellets without incident!  Wooo Hoooo!!! 

Wedgewood has an apple/molasses flavored Medi-Melt available, but I'm so glad I don't have to go that route.  I was not thrilled at throwing more $ away on something I know probably would not work for her.

Thanks again!


Paula Hancock
 

On Sat, Feb 9, 2019 at 03:45 PM, <joyh2obury@...> wrote:
I had some empty capsules on hand and tried your suggestion.  Worked perfectly!  She swallowed it down in her first mouthful of pellets without incident!
Hi Joy,
So glad it went well!  Another member mentioned the empty capsule trick some time ago, so I got the idea from her. 
I had to laugh because yesterday morning, Remy apparently bit into the Prascend through the capsule and he wouldn't touch his breakfast half an hour later, so on to another trick for him.  My other two horses are on 3 or 4 mg of compounded pergolide that come in capsules and I have not had any issues with dosing with 1/4 cup Stabul 1 feed pellets.  This morning for Remy, I used a small piece of carrot, cored out and put the Prascend in a capsule in the carrot and that worked fine and no problem eating breakfast half hour later.  I won't use carrot for Cory because he is incredibly insulin resistant, but Remy is not so much.
It's good to follow along and make note of other members' suggestions because you never know when it will come in handy.
 
--
Paula with Cory (IR & PPID?and Onyx (IR/PPID)

  and Remy (ir/PPID)

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

 


Joy
 

I want to thank everyone for their suggestions.  Putting the tablet in a capsule worked for about two weeks but not flawlessly.  Once she discovered the capsule in her morning feeding she began sifting through her pellets with those super sensitive horse lips, when she'd find it she'd push it out of the way.  I tried making the capsule look and feel like a pellet.  Actually put a small pellet in the space inside the capsule, so if she bit down on it, it would'nt squish, then I put a thin coat of water on the capsule and rolled in in pulverized powdered pellets (thank you Vita-mix blender) and let it dry.  That worked for a day or two.  Then she stopped eating her morning ration altogether.  I moved pill time to the evening and for a few days it seemed she would consume it sometime in the night.  This morning I discovered a torn open capsule, a broken pill and a horse that did not finish her dinner from last night.

The biggest thing for me is the trust issue.  She doesn't trust me, and I don't know if she ever will.  Can't get near her mouth with a syringe of any kind and every time I try, even if I'm successful, I pay for it with a horse that won't look me in the eye, and turns tail when I get near her.  It seems like every time I make a little progress with her trust it's time for worming or screwing with her food.  The only treat she accepts now is celery and that's because it's the only thing we haven't tried to put Prascend in.  (can you imagine a horse that used to love all kinds of treats and now completely rejects peanut butter, molasses, apples, carrots, and fig newtons)

I'm thinking about Caberoline, which the vet offers.  As distrustful as she is at oral medications, she could care less if I inject her.  Also with Caberoline injections (given every 10 days to 2 weeks) I stand a chance of having my neighbor be able to care for her if we take a little break.

I would appreciate any thoughts on this.  I know compounded pergolide might taste better, but at this point her level of suspicion is so high, I think it would be rejected as would any new flavor or treat.

Another thought I had was just treating her with herbs alone.  She's already getting Chaste Tree berry.  

As always, any advice is deeply appreciated.






--
Joy and Emmy
WI, Feb 2019
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Emmy


Johnson, Cathy
 

Joy,

This is the exact same reason we switched to Cabergoline.  Even after 9 months of the shot, Red still remembers that he got his Prascend in a variety of carriers and most days he won't accept any treat at all.  We have had very good control with Cabergoline every 14 days.  It has been a learning curve, though, as we did have to increase the dose 0.1 ml through the seasonal rise. 
--
Cathy Johnson

 

Roy, WA

October 12, 2016

https://ecir.groups.io/g/CaseHistory/files/Cathy%20and%20Red


Paula Hancock
 

On Fri, Feb 22, 2019 at 03:18 AM, Joy Waterbury wrote:
I would appreciate any thoughts on this.  I know compounded pergolide might taste better, but at this point her level of suspicion is so high, I think it would be rejected as would any new flavor or treat.

Another thought I had was just treating her with herbs alone.  She's already getting Chaste Tree berry.  
If you decide to switch to caberoline, it's best to do that well before the autumn when the seasonal rise kicks in.  That way you can determine her dose before things are changing.
There are no herbs that successfully control PPID.
--
Paula with Cory (IR & PPID?and Onyx (IR/PPID)

  and Remy (ir/PPID)

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

 


Pat Gauvreau <pgauvreau@...>
 

Hi Joy
of you buy a pill crusher at any drug store you can easily crush Prascend to a fine powder and add it to soaked Alfalfa cubes which most horses love. I also give compounded pergoloide capsules but I empty the powder into the same soaked Alfalfa cubes. Stir it up to blend well and they can’t pick it out. It’s never failed in my case. Worth trying and so easy for you. Post how it worked for you. Wishing you success. 
--
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


Eva Stettner
 

of you buy a pill crusher at any drug store you can easily crush Prascend to a fine powder and add it to soaked Alfalfa cubes which most horses love.
Hi Pat,
The package insert on Prascend says not to crush because of danger to human absorbing. So if you do crush, please use gloves and a mask until you dissolve in water so you don't ingest any powder.



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

Apollo's Case History


Donna Coughlin
 

Prascend dissolves almost instantly in water, a bit faster in lukewarm water. So instead of bothering with a pill crusher, you could dissolve and top the feed with the Prascend "tea." I would only worry that somehow it wouldn't all be consumed. I dissolve 3.5 Prascend tablets in a 6 ml syringe filled with about 4 ml water and syringe it in, followed by a peanut for good measure!



--

Donna Coughlin, Duke, Robin Goodfellow, Ariel Max and Obi over the Rainbow Bridge (5/17)


CT 2009

 

 


Joy
 

just an update on Emmy's recent Prascend drama.  (RECAP: She hates it, she recognizes it coming no matter how I try to give it, and she associates my presence in her world as the EVIL one behind the conspiracy.  Putting the pill in a capsule worked really well until she noticed a difference in the texture of the pill and was able to push it aside.  I moistened the capsule and rolled it in some of the dust from her pellets.  The disguise worked until she bit into the capsule, broke the pill and spit it out.  I went back to putting Prascend in the water bucket again.)

After Emmy discovered the recent plot to poison her, she went off her feed for the past week in fear that the dreaded pill was lurking somewhere in among the normally delicious pellets.  Of course all her vitamins and minerals are in those pellets.  I had to do something to get her eating again.  I found a supplement called MYO-Ease Plus.  I found some discussion about it here on the ECIR forum, but from 2004-2005.  Don't know if anyone uses it today.  But I top dressed her feed with one ounce and she loves it.  It got her eating again.  We are done with Prascend.

We are going to try Cabergoline injections .5 cc which I'll be able to do myself, IM every two weeks (saves huge on the cost).  So looking forward to doing something besides worrying how I'm going to get the next dose of Prascend into her and whether it's even getting in her at all.  She's a good girl with injections, doesn't even notice.  Now I can actually consider boarding her somewhere.

Thanks for your help all.

--
Joy and Emmy
WI, Feb 2019
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Emmy


 

Gosh, these horses!  Keep us in the loop about the cabergoline and how it goes.

If you do end up going back to Prascend, try come clicker-training to get her to like syringes first (ie, a snifter of apple sauce in a syringe *without* any Prascend). When she is solid on that, you can try Prascend in a syringe, follow up with a click and treat, then a "blank" syringe with just applesauce, click and treat.
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
ECIR mod/support, BC 09
DDT+E = effective treatment for PPID and EMS/IR equines: https://bit.ly/2J4ZgYT

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


Paula Hancock
 

On Tue, Feb 26, 2019 at 10:11 AM, Joy Waterbury wrote:
I found a supplement called MYO-Ease Plus.  I found some discussion about it here on the ECIR forum, but from 2004-2005.  Don't know if anyone uses it today.  But I top dressed her feed with one ounce and she loves it.  It got her eating again. 
Hi Joy,
The MYO-Ease Plus contains wheat mids, which are very high starch, which is probably why she likes it.  According to Equianalytical feed profile, avereage is 23% starch.  If she is IR, may be risky.  Another ingredient is soybean hulls, which is safe for IR horses.  If you can get those from a feed mill near you, it might be worth a try.  She's lucky you are persistent!
 
--
Paula with Cory (IR & PPID?and Onyx (IR/PPID)

  and Remy (ir/PPID)

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