Senior Gelding - first Endogenous ACTH Test


StaceyMaloney
 

Hi all, 

I'm looking for direction for our senior gelding Smokey - when do we know it's time to start treatment? 

Smokey is a 25 year old QH Gelding who is having difficulty maintain his muscle mass. He also has some recessed teeth that could be contributing. I tested his Endogenous ACTH this week and the result was 80.8 pmol/L when the normal range the lab suggests for fall is 2-10 pmol/L. 

He is not in a lamintic crisis but his feet are sensitive on gravel. I think overall he looks good but he is missing a bit of topline and if he breathes deeply I can see some ribs but they do have some cover when at rest. Those are his only symptoms. 

He grows a mean wooly winter coat to deal with AB's cold cold winter but he does shed it all in the spring, he's usually the last one to fully shed though. He does not have an inappropriately long hair coat in the summer. 

4 years ago in his previous home he had an episode of spring laminitis but he was also out of work and standing in a lush field quite overweight at the time. 

Can someone point me at the documents that tell us how to know when we should start to treat him, how often should I monitor his ACTH if we chose not to treat at this time. 

Thanks for any input.

Stacey and Smokey.

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Stacey M. 

Central Alberta, Canada
Joined 2019


 

Hi Stacey,
Not all signs of PPID are immediately obvious but, once you being treating, you will most likely begin to notice changes and see the connection.  Long hair is one of the last signs to appear while diminished healing is much earlier, as is lack of muscle mass.  We generally recommend treating as soon as the horse is diagnosed with PPID.  The goal is to keep the ACTH level in the mid range of normal, which is generally in the mid teens to low 20’s for Cornell testing.  Mid range for your lab would be about 5-7.  You are trying to avoid a laminitic crisis, not waiting to treat it.  Once you start to treat, you should wait three weeks before testing again.  At that point, you will learn whether the pergolide you are giving him is adequate.  It’s hard to know how often you should test to decide when to treat because at this point you should be aware that he is ready for treatment now.  If you choose not to treat with the testing you have, it’s not really possible for us to tell you what might work better for you.
--
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


 
 


Kirsten Rasmussen
 

Hi Stacey,

With such a high ACTH Smokey should be started on pergolide now.  With treatment, he can live a long life, and he will feel much better.  As Martha said, you want to avoid the laminitis that comes with PPID.

If your vet is willing to prescribe compounded pergolide, the pharmacy of choice in Canada is Island Pharmacy on Vancouver Island.   Your vet would fax a prescription to them, and they will bill you and mail it directly to you.  Island Pharmacy does regular quality control testing, and we have had their product tested independently and found it to be correct.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


StaceyMaloney
 

Thank you for the replies. Prascend has been ordered from my veterinarian for pick up next week. 

Is Island Pharmacy a compounding pharmacy?
--
Stacey M. 

Central Alberta, Canada
Joined 2019


Cheryl Oickle
 

Yes Island Pharmacy is located in Duncan Shawnigan Lake area on Vancouver Island

--
Cheryl and Jewel
Oct 2018
Port Alberni BC Canada
https://ecir.groups.io/g/CaseHistory/files/Cheryl%20and%20Jewel
https://ecir.groups.io/g/CaseHistory/album?id=81063