Is it safe for Khan try prascend/pergolide (Dr. Kellon please weigh-in thank you)


 

Jessica, I’d like to add that I’ve had good luck giving APF at the maximum dose twice daily when my horse experienced the veil after eating my other horse’s pergolide. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


 

I guess it is variable, Jessica.  I have noticed the veil a day or two after starting pergolide but it sounds like you started her on pergolide a week ago.  Usually we pretreat with APF for a few days before starting the pergolide, but you can go ahead and start her on that now and see if it’s helpful.  I found myself in a similar position a few years ago.  The veil lifted the day after I started APF but I don’t know that it might have done the same without the APF.
The starting dose of pergolide is generally 1.0 mg but there are some controlled with less.  And some who require much more.  Carefully tracking her ACTH levels, appearance and attitude will tell you when the dose is correct.  
--
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


 
 


Jessica Gunderson
 

How quickly can the prascend veil start to take effect? I was surprised to find a zombie horse with no appetite this morning. We started Prascend just on Wednesday and I was thinking it would take longer to see any effect. APF just arrived, worried because she is already too skinny.

My vet had her start at .5 tablet, though I did .25 for 2 days so .5 since Friday and she is thinking that is all she will need. Does that seem like the right dose? 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


 

Hi Jessica,
No need to feel deflated.  We, you included, are narrowing down the causes of Khan’s discomfort.  I would start her on pergolide to eliminate any lingering thoughts that it might still be an issue.  Then start a new posting thread, focusing on her feet.  Having a new thread with a different heading keeps everyone focused on what the issue is.  It also freshens peoples’ minds and interest in the topic. 
--

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
 

Assuming the hay in your folder is what you are feeding you should be able to stop soaking. Jiaogulan may  help her quite a bit but you can't use it until the trim has been corrected and on schedule for trims at least every 3 weeks for now. You could try acetyl-L-carnitine https://uckele.com/acetyl-l-carnitine.html for neuropathic pain, 1 gram per 100 lbs of weight, twice a day for two weeks then once a day.

As an aside, once her  trims become more physiological/functional you can expect some discomfort after trims from collections mobilizing or weak tissues being brought back into use again. Both are good things and temporary.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Jessica Gunderson
 


Sherry Morse
 

Jessica,

You should start a new topic and call it something like "Trim & Booting Advice Needed".  You can do a trial of pergolide to see if it helps but if the issue is starting with the trim (which seems quite likely given her insulin level being well controlled right now) that needs to be fixed for her to feel better.  We always say this is a marathon not a sprint and there are no quick fixes.





Eleanor Kellon, VMD
 

Jessica,

There are several things that are not right and they're going to take time. Her hoof capsule is distorted from poor trim.  She has collections/abscesses to drain. Her metabolic condition requires long term vigilance. Since she is chronic there may be an element of neuropathic pain. All of this can be managed but it won't be overnight.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Jessica Gunderson
 

Do I need to continue to soak hay?
Is it safe to give jaiogulan at this time?
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Jessica Gunderson
 

Do I start that as a private thread for improved trimming and booting?
I have updated my case history and added some new photos as well, I did not add the new results since they have not been finalized.
My thoughts: I'm completely deflated that prascend will not help her.

--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Jessica Gunderson
 

Non-fasting. But she is in more pain again - something is not right.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Sherry Morse
 

Hi Jessica,

Was the bloodwork done fasting or non-fasting?  She's definitely showing early PPID response to the TRH stim test but I think that based on her earlier results and physical signs she is IR but it's under better control now.




 

I have a questions about varying levels of ACTH, can that also influence baseline insulin levels? If baseline ACTH is wnl, would that correspond with possible lower levels of Insulin? And when ACTH levels are higher, could that correspond with higher baseline insulin levels? 
--
Mary and Halo (Heavenly Halo), Wellon (IR) and Tsjibbe (IR, PPID) and Lady Di (PPID, IR)

West Fargo, ND, USA

Joined April 2016

https://ecir.groups.io/g/CaseHistory/files/Tsjibbe

Halo's Case History

Halo's Photos


 

Hi Jessica,
My first thought is that I guess that addresses the question you asked, many posts earlier.  We’re interested in her ACTH because high ACTH can result in high insulin, which can cause laminitis.  Elevated ACTH itself does not cause laminitis.  My horse, Logo, had PPID which was difficult to control but never did he have elevated insulin, nor laminitis.  If Khan’s insulin is not elevated because of your management, then good for you.  It’s important to keep it that way, but giving pergolide will not do the job for you.
My second thought is that your case history needs updating, not only with the new labs but with everything else that has happened in the last three months.  I know I have asked about the omeprazole and bute she was getting and you’ve replied but that should be a signal that your case history needs an update.  I honestly can’t remember your answer.
My third thought would be that it’s time to start a new thread on improving Khan’s comfort through booting and improved trimming.  If you can’t find a trimmer who is willing to follow Lavinia’s advice, you could do it yourself, as many others here have done.  I feel a bit weird suggesting this as I’m not one of them but those who have seem to make good progress.
And my fourth (and final for now) is wondering what your thoughts are.  
--
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


 
 


Jessica Gunderson
 

I uploaded Khans interm Cornell results, looks like Cushings to me, not high insulin.  Thoughts?
beta1-vv (groups.io)
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Sherry Morse
 

Hi Jessica,

Khan had no sole to spare based on current pictures and x-rays so given that additional information it's not actually surprising that she's more sore now than she was.  At this point you need to make sure she's in boots and pads that are helping to keep her as comfortable as possible and do not let anybody touch her soles or frogs when they trim. 




Jessica Gunderson
 

There was heat and pulses in all 4 legs for a few days. She was trimmed on Tuesday by my regular farrier who comes every 2 weeks and became sore on Friday. I had an osteopath/trimmer out on Thursday night to check the trim, which she was overall happy with other than she removed more bar on both fronts. 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Kirsten Rasmussen
 

I'm sorry to hear that, Jessica.  Keep soaking her hay until you get her insulin result back and can re-evaluate, just in case.

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


Lavinia Fiscaletti
 

Is there any heat in her feet? This could be abscessing, which can be worse than laminitis pain.

Did her pain increase after her most recent trim?

--
Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR


Jessica Gunderson
 

She is really suffering right now and it has been 4 days. Makes me sick and breaks my heart to see her like this.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album