Tips to help vets understand compound pergolide legality #legalityofpergolide
I am a pharmacist in Oregon. I too have had issues with veterinarians mis-understanding there ability to prescribe certain medications or dosages. Although you may have a state difference I can offer some help you decide to work with your veterinarian or to move on to a new veterinarian.
1. you are filling a prescription for cash (no insurance) - you may legally refill this at any time - even if you just refilled it yesterday for the full amount - as long as you have refills on the prescription.
2. call the state board of pharmacy for your state and ask the investigator or board member what the laws are in your state regarding the use of compounded pergolide vs pracend etc. Reading the actual laws is daunting.
3. call the compounding pharmacy you wish to use and speak to a pharmacist. He/She can then call your vet to request a prescription for a safe dose explaining the wide variation in doses required as well as the legal implications.
You may have to be persistent but I would go with option 3 first - I have had the most success this way. Then my vet can discuss the legal issues with the pharmacy who would also be liable.
toggle quoted messageShow quoted text
Her office is closed today and tomorrow. I have it all ready to take to her Monday morning. Just continuing my search for any other detail that may help.
Do others have this issue when they need higher doses of pergolide? Are big city areas easier with more knowledgeable vets?
Since upping the dose slowly up to 3 mg, he can now walk without sole pain, his neck is smaller he has more go than whoa and I can exercise him when before he was stand still lethargic, not walking much at all, his neck was huge and sheath looked like it was going to split open. I will tell her all of this too. She is the hopeful newer vet and is so nice and understood as I explained I needed a higher dose.
If she is not convinced of the legality of writing a script for me, I will then take all the papers printed out along with a symptoms list and recovery list to the current vet and once again literally beg and then if nothing, I will ask her to recommend someone who will even if I have to drive two hours away. Which hauling will not go well for the ACTH anyway. But I have to keep trying.
In researching, I find it alarming that in the 'studies' one only had around six horses and in some studies the horses died and in others no papers were written beyond the description about the study.
I'm going out to hug my boy Malachi now and promise him I'll try harder.
Kim Lee in NW PA
Malachi (IR, PPID) Mateo (IR)
On Sat, Dec 9, 2017 at 6:47 PM, Lorna Cane <windybriars@...> wrote:
What did your vet say about the information Dr. Kellon gave you yesterday, Kim?
toggle quoted messageShow quoted text
Thank you Eva,
I did # 3 but have not requested the second half. Will look to getting that done on Monday after meeting with the vet/vets. I have also done # 1 and it is almost at the end, 30 1 mgs for 3 refills, 10 days left I just counted them. Will do # 2 before I leave to see the vet on Monday.
Thank you ever so much.
Kim Lee NW PA
Malachi (IR, PPID) Mateo (IR)
On Sat, Dec 9, 2017 at 6:51 PM, Eva <esestric@...> wrote:
Welcome to the group!
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 etiquette, what 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.
No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:
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.
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.
EXERCISE: The 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.
Lavinia and George Too
Dante, Peanut, Nappi and George over the Bridge
Jan 05, RI
ECIR Support Team
Great information, Eva - thank you!
Jaini Clougher (BSc,BVSc)
Merlin (over the bridge) ,Maggie,Gypsy, Ranger