Climbing ACTH numbers


Sue Ring
 

I'm relatively new to treating my PPID horse, Shifty, diagnosed in 3/2021.  His numbers at diagnosis were Insulin 22.51 and ACTH Pre:  28 and Post:  328.  He was started on 1 ml Pergolide and has been on that since (approx 2 mos).  He also has ERU, which was diagnosed last Fall (pre PPID diagnosis) and treated into remission with diclofenac and neo-poly-dex.  He was weaned off of the neo and diclofanec until beginning of June, when a check up revealed his ERU was flaring again.  Went back on diclofenac and neo 2X daily and when I advised vet he was diagnosed PPID, she said that the neo was a small amount, going directly into his eyes (he has posterior uveitis in both eyes), it would be okay.  I had his blood re-checked for Pergolide effectiveness on June 11 and his numbers came back astronomic.....I don't have the results copy from my vet yet but was told over the phone they were something like Insulin DOWN (17) but ACTH was a whopper, in the 500's.

I am dealing with two vets here.  We are in a small rural community with a VERY high concentration of horses and a LARGE, internationally known Equestrian Center....so we have it all.  PLENTY of access to quality care for our horses in a peaceful, rural setting.  The vet handling the PPID diagnosis is my farm vet and knows my horse well.  The vet handling the ERU is at the local equine hospital because they have more equipment to diagnose and examine horses with ocular problems such as ERU.  The vet handling the PPID has recommended that I start a cypro/Pergolide compound she uses to get the ACTH numbers down.  I have asked her about the possibility of the neo-poly-dex spiking his numbers, but have not heard back yet.

Help!  Could the small amount of neo needed to treat his ERU flare be causing the ACTH numbers to spike??  What is the experience of others with the effectiveness of the cypro/Pergolide compound?  Any ideas or has anyone suffered through fighting this battle on two fronts?? 
--
Sue R in NC 2021

CASE HISTORY:  https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty

PHOTO FILES: 


 


Sherry Morse
 

Hi Sue,

Cypro has been found to have no effect on ACTH numbers.  Dr. Kellon just commented on this fairly recently: https://ecir.groups.io/g/main/message/265080

Are you using Prascend or compounded pergolide?  Given Shifty's post-TRH number being in the 300s I'd think he'd need at least 2mg Prascend or compounded pergolide to offer good control so would recommend upping his current dose by at least 1mg and then retesting in three weeks. 

I don't think the NeoPolyDex would have an affect on his ACTH numbers but his elevated ACTH numbers could certainly have a knock on effect on the ERU: https://ecir.groups.io/g/main/topic/ppid_horse_with_equine/83320466?p=Created,,,20,2,0,0




Sue Ring
 

Hey Sherry,  Thanks so much for all of the info and links.  I currently am administering 1.0 mg Pergolide compound.  After reading all of the links and Dr Kellon's information on the use of Pergolide with cypro I am about to send an email to my vet to let her know about the recent research (along with the linked information).  She is a very reasonable, helpful person, so I expect to get good feedback from her regarding my concerns.  I feel very strongly about the use of an increased dosage of Pergolide before we go veering off into other options.  He is getting so much stuff now for treatment of his ERU - PLUS I have been trying to wean him from the Equioxx over to the Phyto-Quench w/Devil's Claw....so alot of changes for his body to adjust to.  He has a hearty appetite and I try to make any changes for him gradually and uneventful to eliminate a chance of colic.......

Thank you VERY much for your prompt, informative response......I also need to up my secretarial skills and get my case history updated with Shifty's new numbers according to the Cornell test and his updated treatment for his ERU.
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Sue R in NC 2021

CASE HISTORY:  https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty

PHOTO FILES: 


 


LJ Friedman
 


-1.0 mg pergolide compound
what type?  capsule? from which pharmacy? -
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Sherry Morse
 

Hi Sue,

Not all compounded pergolide is created the same way and there are storage concerns with some types so knowing where you're getting the compounded from and in what form can also help us with providing advice on that.





Sue Ring
 

Hey Sherry,

Are you referring to the Pergolide he is currently receiving (at the 1.0 mg caplet dosage that does NOT seem to be controlling his Cushing's) or are you referring to the Pergolide/Cypro compound that she wants to give him in an attempt to reduce his high ACTH numbers from his most recent blood draw??  I have contacted her and expressed my desire to have his Pergolide dosage upped instead of going right to the Pergolide/Cypro compound?  I am not sure about the Pergolide/Cypro compound dosages other than that it comes in a powder.  I do not believe she has ordered it as I contacted her office and said I wanted to 1.)  Discuss her reasons for wanting to give the Pergolide/Cypro compound to him and 2.)  Discuss with her my preference to use an increased dosage of Pergolide alone and see how that works.

Thanks.....
--
Sue R in NC 2021

CASE HISTORY:  https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty

PHOTO FILES: 


 


 

Hi Sue,
As we would not recommend a pergolide/ cypro combination, I would guess Sherry is referring to the compounding pharmacy for pergolide itself.  There are at least several who have lots of experience and know that it’s relatively unstable under conditions where any water might be introduced.  When I first began using pergolide, eons ago, I was referred to a local compounding pharmacy which prepared a flavored oil suspension which seemed to work fine.  The same preparation in water would have lost activity rapidly.  Now I purchase capsules from Pet Health Pharmacy but there are other sources our members use as well.  Using a reliable source lets you know whether or not 1mg was adequate because you can trust that the drug itself is fresh and well tended.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

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