Good morning,
I have written up a handful of questions and took them to the vet's clinic on Monday. I have not heard anything back, yet. I'd like y'all's input, too, please.
Babe's ACTH was 45 and he was fasting when they drew blood. He also had abscesses in both front hooves. He WAS moving some that day, so it wasn't the worst day, but he was not comfortable.
Would pain affect his ACTH levels?

We've had several mornings in the upper 30s (F) this last week. Babe has come down shivering. This is atypical weather and atypical of him to be chilled in that temp range (me, not so much, and I'm ALWAYS cold!). He is also shedding. I cannot tell if this is his normal shedding from grooming or not- my other horse is also shedding some. Babe's hair is short and glossy- maybe 1/4" long and always has been, in warm months.
Would pergolide be affecting his ability to stay warm? This is going to be a very long hard winter, if that's the case. We get between 10-20 (F) in winter.

What does a TRH test (the vet who is too far away suggested doing that in Jan, my vets haven't mentioned it) tell a vet that ACTH doesn't? All I know is it measures tryptophan levels, but not what role those play.

I've read some about chasteberry (vitex) here and other respected sites and still do not have a comprehensive grasp of what that herb could do for him if the pergolide is going to cause him issues. 

would there be any reason NOT to give him CBD? I know that it can help with pain and inflammation. 

They put him on Hot Hoof 2, but did not say whether this is for long term use or flareups? I took him off of it a few days ago, he's still a little tender, but no heat and not really limping. 
The farrier will be out as soon as he can get this way (we live in a rather remote area) to rasp his toes and I know that will help. If I had a clue what I was doing, I'd do it, but I'm not about to go make anything worse for him.

They never would check for Lyme, just told me that his bloodwork 'didn't indicate the need for it'. We live in the woods and have for 5 years. I'd be amazed if my boys hadn't been exposed. But what in the regular CBC would tell a vet that there's no need for a Lyme test? I'd like to understand.

I've had a hard time accepting that this may be what we're dealing with, unlike his heaves. That I could see for myself. This has had too many questions that I haven't gotten answers to. It may very well BE PPID. But I don't want him looking droopy and doped (I can definitely see a change after a week of pergolide) on meds that can have serious side effects if it's not certain that's what's going on.
He has a 5 year history (since we moved from the Gulf Coast and sandy soil to rocks and mud in the mountains) of occasional abscesses, and then this, a month or so ago, was the first time both fronts were affected. I didn't know about NSAIDS and antibiotics potentially prolonging abscesses and may have done him a disservice, there, as these just drug on for weeks. This is the first I know of laminitis and rotation, but also the first we've done radiographs, so I do not know if he's ever been laminitic before.
I think this is all of my questions for now...
Thanks for your help.
Anna
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Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album

Hi Anna,
I can begin by answering a few of your questions and hope others will be along to complete the picture.
We don’t advise fasting as it will decrease the ACTH level.  Things that increase it artificially are trailering to a testing site and veterinary procedures such as dental work which might cause stress.  You want the testing situation to be as quiet and normal as possible.  So many horses for which we recommend ACTH testing have laminitis as part of their diagnosis but we never suggest waiting until that has resolved before testing because it may in fact be a part of the problem.  Perhaps an intense sharp sudden pain directly before testing might cause an elevated result, I’m not sure.
Temperature dysregulation can be a symptom of PPID.  Do you generally blanket him over the winter?  I’m in New England and blanket but I have not started yet.  I would if I had a shivering TB.  One of the problems with blankets is that they flatten the coat and diminish its insulating quality.  Just something to keep in mind as you decide whether or not to throw on a blanket on a particular day.
Here’s a link to Cornell’s description of the various testing protocol for PPID.  TRH Stim testing measures the same ACTH as the normal endogenous testing, before and after administration of TRH (thyrotropin-releasing hormone).  The horses needs not to be on pergolide or in the rise when this is done as there are no testing ranges described for those situations.
Chasteberry has been found useful for helping the horse shed out but does not affect ACTH levels.  I’ve used it when a horse was on pergolide and still not shedding out.
I don’t think there would be any reason not to use CBD.  It may help him with some issues.  Laminitis is not considered an inflammatory process so that wouldn’t be how it helps.  The only thing that will truly eliminate pain is to identify and remove its cause.
I live in a hot Lyme zone and I’ve never had a vet question my wish for a Lyme test.  Maybe you could ask them what in his bloodwork is influencing that decision.  It doesn’t make sense to me.
Is he still on 0.5 tab of Prascend?  Did you titrate him up to that (very small) dose or start him on that directly?  Did you give any APF before starting the Prascend?  How long did it take for the droopiness to appear?  Prascend is not known to have serious side effects.  If it’s not needed, it probably would have no effect at all.  The dopiness people notice after starting their horses on Prascend (veil) has more to do with the horse adapting to a new better hormonal normal.  There are a small number of horses who don’t tolerate it well but, from what I’ve read, their symptoms are different from a veil and tend more toward agitation.  

And those are all my answers for now.  Feel free to pose more questions.
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Thank you, ladies!

I do not know what APF is. The vet had me start Babe on a half tab of pergolide (.o5 mg) daily. I have not given it for 2 days because I've been worried about his behavior and waiting for answers. Is it advisable to start with half of that and build up? If so, how long for building up to the half dose? They just said give him half a tab daily and we retest in 30 days. How long does the adjustment period from no meds to on meds generally take? 
I used the word 'droopy' but in thinking on it, that wasn't quite the right word. He just has a different look and air to him- not depressed, but sort of vacant? Just not quite hmself- less alert. That might not be quite the right word, either, but I can't grab what really is, right now.

Does the TRH give a more well-rounded picture, or is it just not necessary if a horse has been diagnosed with PPID?

I have been given no real reason not to test for Lyme, and this same senior vet didn't want to run one 2 years ago, either. I acquiesced that time, but this time I have asked repeatedly for an explanation and not gotten a satisfactory answer. If there were indicators in a CBC for Lyme, why would one need a Lyme test, other than to verify? It has never made sense to me, either, I do not understand her aversion to testing for it. The younger vet agreed to run it, but then consulted with her and deferred to her judgment.  I'm in the panhandle of WV, in the mountains, in the woods.

I have so much to learn- I thought laminitis was absolutely an inflammation issue! I mean, I understand that it's more than that, but I was under the impression that the inflammation was what led to the other problems with it.

His test was run fasting because they were' testing other things, as well'. They did not elaborate- I don't know what test they needed him fasting for...that's all they told me. This is much of my frustration with this clinic, I cannot get full explanations. There is not another equine vet locally, at least not one that anyone would recommend (many don't recommend this clinic, either).

We did have a rather sudden dip in temps. They're back up and gradually declining, now. I do blanket as needed, and understand how the horse 'fluffs up' to trap warm air to keep himself warm. The days he was shivering, I tossed his fly sheet over him while he ate, and then he seemed to be okay, it had warmed up a degree or two and he had food in his belly (warm mash). They always have hay available. For the first time, I've ordered lightweight blankets, because we seem to have a lot of days that wouldn't be so bad if it wasn't raining, but add the rain and I have wet, chilly horses. I've wanted to get them for some time, but just had med. weight and fleece coolers to put under them when I needed heavyweight. He's a hard enough keeper that I don't let him shiver for long. My Appaloosa could lose a pound or 50 and be okay, but he gets blanketed when Babe does because otherwise he'll tear at Babe's. Little brother wants what big brother has. lol

His heaves is largely under control and has been for almost a year and a half. Prior to that, he went two years with it not under control while we tried to find what would work. Aliera is expensive, but it's a Godsend, too. His 'bad' days don't involve wheezing, but do involve increased respirations, and those are typically hot days, which we don't have many of here. 

thank you so much for y'all's responses!


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Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album

I cannot recall the timeline for Hot Hoof and blood draw for ACTH- he may have been on it and may not have been (I thnk he was), but I think maybe I'm glad I took him off of it, reading Dr. Kellon's comments.
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Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album

I found APF and APF Pro- which do I want and is this only for use for the first couple of weeks or month, or all the time?
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Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album

Hi Anna,
Here’s a link to APF.  You can purchase it from their website but there are numerous other online sources, some of which might offer a better deal.  Most of us use the regular but I have also used the Pro. It’s an adaptogen blend but I’m not really up on the workings of adaptogens.  I just know that this works.  We start it a few days before starting Pergolide and taper off after you reach your planned dose and the horse seems pretty normal again.  Maybe a week later?  

When I started Logo on pergolide, I was told to give him 1 mg of pergolide (this was before Prascend) and that he might seem disoriented for awhile.  I noticed that for a few days and then he was back to normal.  I guess I was lucky.  Sensitive horses seem to do better if their pergolide is increased very gradually.  If your planned dose is 0.5 mg (which is quite small) you can accurately portion out the half tablet by dissolving it in a known amount of water, drawing a portion up into a syringe for administration and saving the rest for the next few days.  You could do 1/8 mg, 1/4 mg, 3/8 mg and 1/2 mg, doing each dose for two days.  Normally we suggest starting at 1/4 mg on the way up to the fairly standard initial dose of 1 mg.  If you do the 1/8 mg steps, add 8 ml water to dissolve the tablet and then draw out 1 ml (or 2, 3 or 4 ml) as you increase the dose.

The attitude you describe sounds very much like the veil.  The TRH test is not necessary if your horse has been diagnosed with PPID.  

Maybe getting a Lyme test done would be a good opportunity to engage with a different vet?  An interview of sorts.  The most highly recommended vets in my area are not my first choice.  I just relate to the others better.  I have a working relationship with most of the local vets, mainly because I’ve been doing this a long time, but also because they have different strengths.

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Thank you, Martha :)

 I maybe should have done more reading before I asked more questions, but I'm sort of glad I did ask anyway, because you broke it down for me even further, which I appreciate.  We live just outside a town of 5K- which means there are a few small animal vets around the surrounding area, but to get a large animal vet that knows horses (a cow vet is easier to find) is like the proverbial needle in a haystack. I do think these two are personable and knowledgeable, they just don't share information so well- much of my unease could have been prevented with a couple of comprehensive conversations, I think.

I looked at the ginseng option, but that seems overwhelming to sort out right now, so I think I'll just go with the APF. The company prices are pretty close to the same as Valley Vet or Smartkpak, thank you.

We will start small and build his dose to where they want it, and maybe he won't look so spaced out. I'm eager to have the farrier out. He's 45 minutes away, so scheduling is not always instantaneous. I was spoiled in South Texas- close to everyone and the barn owner had a trailer. Here, we have no trailer, but the horses are right outside my door :). I'm just not a fan of winter and frequent mud!
Anna
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Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album

Anna, since you stopped the pergolide a few days ago and need to wait for the ACTH (oops, meant APF) to arrive before starting it again, I would be super observant of his attitude while you’re waiting.  Does it improve or does it get worse?  Are there other things you notice?  Keep some good notes.  While the attitude you describe is reminiscent of the veil, the timing seems a bit off, compared to what I’ve experienced.  Every horse responds a bit differently so there are no cut and dry rules about what you’ll find, but we can help sort it out.
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Thank you, Martha,
I assume you meant the APF?
i keep a log and have for years, of events in their lives, so I can certainly remember to do that. Today he’s been his normal self, save for tender feet. Bright eyed and watchful and engaging.

what seems off to you?
still nothing from the vet’s office.
i ordered the APF, though
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Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album

Yes, sorry.  A lot going on here, haha.
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My experience with the veil has been that I’ve noticed it by day 2 and it’s disappeared by day 5-7.  It seemed as though you felt it was still increasing at day 5.  But, every horse is indeed different and I’m glad you’re keeping good notes.
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Thanks, Martha, 
and boy, I can relate! lol

Babe was ouchy enough still when we started the pergolide that I didn't notice his demeanor changing right away, whereas if he hadn't been, I'd have definitely seen something different, if that makes sense?  This is day three without it and I did notice yesterday that he was brighter. He was on it for 9 days, and when I get the APF, I'll start him back on it at the 1/8 tab dosage.
I appreciate having folks here to bounce things off of when this has all been stressful and scary and I haven't really gotten satisfactory answers from the very people I'm actually paying to provide them. I asked the farrier and he doesn't know any other horse vets in the area. He is who recommended the lady who wouldn't come this far. The only other one I know of is just as far away as she is.
Anna

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Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album

I went this morning to pay on my vet bill and reminded the clerk that I hadn't heard from the vet(s) about my questions. Within an hour, the senior vet called me and she did answer my questions, except the one about CBD, I think I've asked her about that before and she says she cannot discuss it and keep her license.
I did not tell her that we were waiting on APF to try again with pergolide, and when I mentioned the veil, she sort of dismissed that. I get that there is still a LOT unknown about the issues our horses face, so there will be differences of opinion and available information, as well as anecdotal information.
it did help to talk to her, just as it has helped to visit with y'all, I feel like it has taken both in order to feel like I have any grasp at all on what we're doing or need to be doing.
She is of the suspicion that this is very likely just seasonal with him and I pray that's an accurate suspicion!
Anna

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Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album

Hi Anna. To answer your question about adaptogens- and what they are,  here is a link I found for you to review. APF is considered an adaptogen. 
https://ecir.groups.io/g/main/files/APF/Adaptogens.pdf 
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Trisha DePietro
Aug 2018
NH
Dolly and Hope's Case Histories https://ecir.groups.io/g/CaseHistory/files/Trisha%20and%20Dolly%20-%20Hope
Dolly's Photos 
Hope's Photos 
Primary Responder