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Update on Ruger and pergolide dosage advice please


riggslippert@...
 

Hello,

My first horse with PPID, Ruger, just celebrated his 4 year anniversary of colic surgery to remove a jejunal (small bowel) carcinoma.  I diagnosed him with seasonal PPID last year and started treatment in late September.  He's done better this year since I started in early August and kept him on APF Pro fairly consistently, although I still feel like I'm "chasing the seasonal rise".  He has continued to receive increased flax and Top 3 Aminos supplementation.  There has been less muscle loss and he's maintained his social status in the herd, but he is still lethargic and more spooky than normal.  His most recent test results showed ACTH of 308 pg/mL (9-35 pg/mL) 3 weeks after increasing his Prascend to 2 mg QD.  I have since increased him to 2.5 mg QD.  I'm wondering if I should increase further to 3 mg QD or recheck his ACTH on the lower dosage?  Does this pattern of increase give any indication of whether he will need the pergolide year round now?  His case history is up to date.  Thank you in advance for any advice!
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102




 

Hi Aunna,
I’m not sure what conclusions are to be drawn from the ACTH ‘pattern‘ you’re seeing.  If he were my horse, I would be continuing to increase his pergolide.  If you increase it to 3 mg and then test him appropriately and find it low, you can always cut back.  I try to test at the same time of day each time, preferably early in the morning.  Likewise, I administer pergolide before breakfast each day.  Is it possible he had some excitement on the last testing day, not that I would expect it to jump quite that much In response.
Many of us have found that 3 mg of Prascend were simply not enough to control the ACTH.  There is a database of pergolide dosages on the ECIR site but, due to some work which is being done on the website, I don’t think it’s available at this time.  My horse, Logo, would have been at the top of the list but when I switched him to cabergoline, it became apparent that the pergolide was no longer doing the job for him.
I have not gone back to reread you earlier posts to make sure there’s not something I’m overlooking.  I’ve seen it recommended not to test unless your horse is symptomatic but I don’t know if that might lead to erratic testing results such as you’re seeing.  Would you describe him as symptomatic now?  His lethargy and asthma might be less of an issue with better controlled ACTH, the spookiness I’m not sure about.

--
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


 
 


 

Aunna,
I looked at Ruger's case history and didn't see any blood test results. I urge you to get tall of the test results from your vet and enter them into his case history document.

I think it would be wise to include tests for insulin and glucose for any horse who has high ACTH levels. We can usually see physical symptoms for Cushings but high insulin levels often go un-noticed until our horse develops laminitis. It is fairly common for insulin levels to rise as ACTH levels rise. 

Has Ruger been tested for insulin during this seasonal rise? 
--
Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album


riggslippert@...
 

Thank you Martha and Bonnie.  Bonnie, I click on the link in my signature and I can see all of Ruger's bloodwork results.  I am a DVM and collect, process, and ship all of the samples myself.  He's had two submissions this year; the first in September had a lower insulin than in previous years and he has never had foot tenderness, so I did not resubmit the insulin in October.  Martha, in retrospect, I would called him symptomatic last year, as he lost a lot of topline and hindquarter muscle.  I did not want this to happen again this year and he had a convincingly positive TRH response test in January, so I think it was best to treat him and he benefited from my starting treatment earlier.  Hopefully, that makes my situation more clear.  Bonnie, let me know if you still can't see the bloodwork in Ruger's CH.  Maybe I need to do something differently.  Thank you!
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102




 

Aunna, I guess I was trying to understand why you might be hesitant to increase his dose with such a high ACTH reading.  I have seen a few cases here where a small amount of pergolide resulted in a precipitous drop in ACTH but that hasn’t been the case with any of my horses.  I just keep increasing the dose until the ACTH is in the middle of the testing range – upper teens to low twenties – and then try to maintain it there with small pergolide increases, generally coinciding with the fall rise.

--

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


 
 


Sherry Morse
 

Hi Aunna,

Were Ruger my horse with a test result that high I would increase him up to 3mg without even pausing to test at 2.5.  I would plan on retesting him after the seasonal rise is over and see how he is being controlled on that dose and go from there.




riggslippert@...
 

Martha, I'm very willing to increase his dose.  The only reason I'm asking is because waiting on the increase was suggested by my equine veterinarian.  Fortunately, I am not dependent upon her for my prescription.  Per your and Sherry's recommendation, I will go ahead with 3 mg QD.  Thank you!
--
Aunna
October 2018
Oakland County, Michigan, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102




 

Thanks, Aunna!  That I can understand.  Knowing you are a vet, yourself, I thought I might be missing a relevant earlier discussion.
--
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


 
 


Eleanor Kellon, VMD
 

You could increase him to 3 but since we're in the downward trend you won't know if it was the increase or time responsible for any decreases.  Increases are also sometimes futile when instituted during the rise. Since he's not laminitic or hyperinsulinemic I'd be inclined to wait until late December or early January to retest. If well within normal at that time you can decide if you want to try a lower dose then.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001