Current vet will not increase pergolide dosage for 29 yo horse with ACTH at 353 pg/ml, what now?


My Trakehner gelding Pax was diagnosed w/ PPID in 2012, and we have not been able to control his ACTH.  He is reasonably healthy, is slow to shed, and has had 2 bouts of laminitis, not recent.  He has been traditionally an easy keeper, but is now slightly underweight, and has worn teeth that impedes his hay chewing.  He tested at ACTH of 353 in late July, tested at 686 in 2021.  I wonder if some of this high ACTH is "inactive", since he remains sound, active, and has a good appetite.  We had him at 2 mg. compounded pergolide until late August, when his vet insisted on putting him on a combo of 125 mg cyproheptadine + 1 mg. pergolide.  I did not agree, based on all the info from the ECIR site, but has to go with this new prescription because I was out of pergolide.  

After more reading about the need to increase the pergolide dosage and the lack of support for cypro,  I am very concerned that Pax will be very susceptible to fall laminits at this low dosage.  My current vet insists that her recommendation is the only way to treat Pax, and I contacted another local vet who will only treat PPID horses with Prascend. I am limited financially, and need to continue with compounded pergolide from Avrio Pharmacy.

I am getting desperate here, with the threat of fall laminitis, and I do not want to risk trailering this old horse for hours to another clinic.  Has any member had any experience with getting a virtual consult on their horse's meds?

Many thanks to Nancy Collins for her advice and assistance in getting Pax's case history set up.

Mary in mid-coast Maine
joined 2012

Trisha DePietro

Hi Mary. This is a difficult situation. I have not seen folks getting a "virtual appointment" but its not a bad idea. I would think that calling around to the different vets, you may be able to find one who is open to a virtual appointment.I personally have never done it. But, that does not mean its not doable.  I would try Myhre Equine Clinic in New Hampshire...perhaps they can help you with a virtual visit. I don;t know if they can or can't but its a good place to start. 
Trisha DePietro
Aug 2018
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Another option to try might be Atlantic Equine Services in Dover, NH.  They cover ME, which means they’re licensed to prescribe there.  Jacqueline Bartol, DVM is (was?) head of internal medicine there, which includes Cushings.  I had an incredible experience with her when she was a resident at Rochester Equine Hospital, which is now Myhre Equine Clinic.  She and Dr. Mike Davis went from there to found New England Equine, also in Dover, NH.  Fortunately, we now have an equine hospital locally so I haven’t been there in 20 years.  The horse Dr. Bartol worked on is still alive and doing well at 31.  He had a grapefruit size mass on his bladder, the likes of which no one had seen before.  They put him on antibiotics and it shrunk down and firmed up.  Had to do that once again and since then we eased off on the annual rectal exams and all seems well.
Martha in Vermont
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LJ Friedman

have you been testing insulin? Are the results normal?
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

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