Audi Update (Increase Pergolide?)


lindsaykrauland@...
 

Audi is doing pretty well, but I’m looking for advice on what to do next.

He’s been on 2 mg CP for about a month, after his most recent ACTH was 33.7 pg/ml and he was still symptomatic.  Most notably, he was not gaining weight despite a diet recommended by Dr. Kellon, careful mineral balancing, etc.  Case history is current, and diet is there for anyone interested. 

Overall, I’m pleased.  After switching from 1 mg CP to 2 mg, Audi became brighter and now has a definite “spark” in his eyes.  He’s also moving significantly better, and I’ve started to “formally” rehab him.  We’re currently hand walking 5 days/week for about 30 min, and he’s doing fine with that.  I also believe he’s gaining some weight, albeit slowly.  I’m just not good with a weigh tape... or something... and I get inconsistent weights on him, but the tape generally registers a gain of 20-30 lb compared to this time last month.  That said, it seems like an excruciatingly slow process to get him to gain weight, and although I do think he’s looking a bit more “filled in,” I would have expected more gain by now.  (Perhaps I’m mistaken?)

In addition to the slow weight gain, Audi has been having an exaggerated reaction to fly/bug bites compared to our other gelding, Mo.  He now has several crusty lesions under his belly where the flies like to congregate.  (He is on a feed-through fly control, Jeffers’ Get Away, and I fly spray him occasionally, although he protests.) He also is urinating frequently again, and he *might* be sweating more than Mo is right now.  So overall, I’d say Audi is doing MUCH better than he had been but isn’t quite “normal” yet.

His ACTH never was very high.  Initial ACTH was 45 pg/ml, and on 1 mg CP it came down to 33.7 pg/ml.  At this point, having been on 2 mg CP for a month, I’m trying to decide between re-testing ACTH and going from there or simply bumping him up to 2.5 or 3 mg and seeing what that does to his PPID signs.  Best practice, I assume, dictates test first, but in all honesty, I can take him up to 3 mg CP for nearly two months, and it’ll still cost me less than what my vet charges for a single ACTH check.  And aside from a possible veil (which he hasn’t experienced yet), I really don’t see a downside to trying him on a higher dose.

Thoughts?

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Sherry Morse
 

Hi Lindsay,

I will obviously defer to Dr. Kellon, but since he was still relatively high on 1 mg before the rise and he's showing some symptoms still after being on 2mg for a month it may not be a bad idea to try him at a higher dose at least until November.  You should have an idea relatively quickly if it's helping with things like the fly allergy and urination and possibly even weight gain.

Just for our comparison, could you load a current body picture of him?  




 

Good to hear, Lindsay!  If he were mine, I would increase his dose again, the caveat being that you might not see much effect until after the rise.  Others may have a different opinion.  The peak of the rise is mostly upon us but some horses with PPID have an extended rise.  With Logo, it lasted until into January.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


lindsaykrauland@...
 

PS-

I just added new photos to Audi’s album.

Also- Is it worth it to test Audi for anything other than PPID at this point?  I’ve heard it said EPM can mimic PPID.  How strong is the case for testing for EPM versus continuing on the assumption that Audi’s issues all stem from his PPID?  Honestly, I feel like Audi looks a lot more like a PPID horse than an EPM one, but I’d hate to be missing something obvious, and I am a bit surprised that he didn’t respond better to a low dose of pergolide, although I do know the response is unpredictable and that ACTH level doesn’t necessarily correlate well to degree of symptoms.  

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


 

I certainly don’t think he looks worse, Lindsay, and he might even look better.  The lighting is so different, he has more coat now and my eye may not be good enough to tell.  I don’t recall what sort of discussions have been held on his feet.  His RF still looks a bit long in the toe but maybe this is a work in progress?
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


lindsaykrauland@...
 

Hi Martha, and thanks for the replies. 

Right, he definitely doesn’t look worse! My question is, how much better does he look (I go back and forth on this one), and does he seem to be improving at an acceptable rate?  Like you said, he’s getting his winter coat, and it’s a bit hard to tell, even in person, whether he’s significantly improved versus simply holding ground.  I would think that if his dose were correct, we would expect more than just holding ground?  And I’m not sure how much weight I should expect him to put on each month?

The feet are still a work in progress, yes.  I just posted for a bit of reference on where we are now with those.

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Eleanor Kellon, VMD
 

There are many possibilities here from parasites to PPID to organ failure or cancer but EPM would be the very last thing to consider.  The only similarity I can come up with is muscle loss but the muscle loss in EPM is always asymmetrical and EPM is a neurological disease. He has PPID but his insulin is borderline positive. If your vet agrees I would bump him up another 1 mg in pergolide.  If it hasn't already been done, a CBC and serum chemistry as screens for general health would also be a good idea. You could also consider adding a safe but more concentrated calorie source like soybean hulls if you can source them, or Stabul 1.  Do you know how much he is actually eating?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

I agree with Martha on both how he looks now compared to the end of July pictures - it's definitely not as much of a gain as I'd have been hoping to see in 6 weeks but still think he looks like he's put on some weight. 



 
 


lindsaykrauland@...
 

Thanks, Dr. Kellon.  I’ll try Audi on 3 mg.  Unfortunately, I don’t really have my vet on board with his treatment.  He wrote the prescription for pergolide, of course, but only as a “trial” and so far hasn’t agreed to write for anything over 1 mg.  (Since Audi’s ACTH was technically “in range” at his recheck, the office felt everything looked good.) My vet doesn’t seem well versed in PPID, but he does keep an open mind and hasn’t disagreed too strongly with me on anything yet.  If Audi seems to be doing well on 3 mg, I’ll test his ACTH after a month or so.  I think if we have a good ACTH + a horse who’s looking well, my vet is more likely to get on board with everything. 

I didn’t know that about EPM muscle wasting being asymmetrical.  That’s good to know, thanks! And I will consider Stabul 1.

Regarding blood work, I did have a serum chemistry run in late July.  Everything was within normal limits.  I have the report in my CH.  I have not done a CBC but can certainly have that run next time I do bloodwork.

I think the chem panel has ruled out organ failure?  

Regarding parasites, I dewormed Audi in late June.  He had had a clean fecal exam in April, but I went ahead and wormed him based on advice here in case any parasites were lurking that couldn’t be seen on the fecal.  As you can see from the photos, he didn’t gain any significant weight following the deworming. The dewormer used was EquiMax (ivermectin 1.87%/praziquantel 14.03%). Going forward, I plan to deworm him with the EquiMax twice a year, in addition to twice-yearly fecals and treatment as necessary.  Is this a sound strategy?

I honestly don’t think his issue is a dietary one, as I’ve changed up his diet multiple times based on advice here, and there has been no appreciable change in weight as a result.  We’ve added in beet pulp, increased beet pulp,  removed beet pulp, increased his TCTBC, added in Safe Starch, increased flax, added Tri-Amino, etc, and it just doesn’t seem to matter.  His weight has been pretty steady for months regardless of our dietary interventions.

That said, I separate the horses for mealtimes, so I know that Audi eats:
*5 lb TC Timothy Balance Cubes
*2 lb TC Golden Ground Flax
*2-5+ lb Safe Starch (I start with 2 lb and top off his bowl until he finally leaves it.  He goes through a 40lb bag in +/-5 days.)
*Supplements including 20g Tri Amino

The horses are together to eat their hay, so I can’t say for certain how much each consumes.  When I took the time to weight hay bags recently, the two horses consumed a total of 34.5 lb in twenty-four hours.  We have multiple hay nets set up, and I don’t see any significant competition between the horses for hay.  So far, I’ve been free-feeding hay in slow feeder nets, but my other gelding is getting too fat, so I’m going to start being more careful about limiting/weighing hay for him while giving Audi ample time to eat as much as he wants.

Our hay is low in protein, although we’re down to the last round bale and will hopefully get better quality hay going forward.  In the meanwhile, I’m trying to calculate dietary protein to ensure each horse gets an adequate amount.  I’m not sure how the Tri Amino factors into those calculations.  Does the Tri Amino “count” for a particular amount of protein?

Thanks, Sherry, for the thoughts!  I agree with your and Martha’s observations.  I’m curious, though— How much weight would you expect a horse to gain in a month?  I “feel” like Audi is gaining too slowly, but I honestly can’t say what an expected/healthy weight gain would be?!

--
Lindsay in TX 2020

Audi Case History:  https://ecir.groups.io/g/CaseHistory/files/Lindsay%20and%20Audi

Audi Photo Album:
https://ecir.groups.io/g/CaseHistory/album?id=248156 


Sherry Morse
 

Hi Lindsay,

Re: the weight gain question.  I board my horses and we've had several new boarder horses come to the farm as skinny as Audi looks in the July pictures (or skinnier).  Usually by the time they've been with us 2 months they've put on enough weight that ribs are almost no longer visible and they've filled in on their butts.  I would guess the average weight gain in that time is about 50lbs but we're not good about putting a weight tape on the horses when they arrive and then on a regular basis to check. 

We do have one that came in on the first of this month who was super skinny - I should take some pictures of him now and put a tape on him just to see where he's at as he's gained some weight, but not a whole lot yet.  If anything most of the horses run to fat and not skinny once they've been with us a while.