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update on Rico - end of September blood draw shows early PPID??
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Hello all,
I'm not sure how to link to the last thread on Rico, it was in August. Based on his blood work then and my strict management, the advice here and from my vet, we decided to try him on Metformin. Due to mishap with online pharmacy and vacation, there was a gap, but I was able to start the Metformin on September 18th. Vet was out ten days later to draw blood. Bloodwork results from 9/28/2022: Insulin 48uIU/mL ACTH 137 pg/mL glucose - vet did not include in her email report, I will have to ask if they ran it or not Previous bloodwork on 8/4/2022: Insulin 56.03 ACTH 34.8 Glucose 98 Vet is suggesting a start on prascend/Pergolide at 1/4 tab once a day. For 1 to 3 months and then recheck bloodwork. I am happy to start him on pergolide. And I believe this is what Kristen with Shaku would recommend as she was the one who specifically recommended having his ACTH checked in late September in order to help diagnose early onset PPID. Please correct me if I misunderstood. They also suggest keeping Rico on the Metformin, as perhaps it has helped keep the insulin a bit lower even though it's fighting against the PPID. I just wanted to update everyone and also, to please request your very experienced opinion on both the start dosage of the pergolide, him remaining on Metformin, and the bloodwork recheck time frame. Also if you would recommend the item that helps decrease/eliminate the potential veil? I forget what it is exactly as even though I read the digest regularly, I have absorbed more of the info about IR than PPID. Thanks so much, so very thankful for your help, Jenny and Rico -- Jenny Heishman and Rico Bainbridge Island, WA June 2018 https://ecir.groups.io/g/CaseHistory/files/Jenny%20and%20Rico https://ecir.groups.io/g/CaseHistory/album?id=60437 |
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Hi Jenny,
I would stay on the Metformin for now since it could be helping through the seasonal rise. I don't think 1/4 Prascend will do much, at a minimum I would aim for 0.5 Prascend now, and 1 full Prascend for the next seasonal rise unless your test results indicate otherwise. At this point it's too late in the rise for the medication to have much effect, but you might find outside the rise that Rico's insulin comes down. APF from Auburn Laboratories is what we recommend to help with the veil, although if you start at 1/4 tab and 3 or 4 days later move up to 1/2 tab, you might not have much of a veil. -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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Thanks so much for your reply, Kirsten!
I will ask my vet about starting him at 0.5 Prascend I'm ordering the APF. I will keep him on the Metformin. He's beginning to reject it in his usual mash (we are at day 17 on the drug) and I'm getting creative with mint tea and extra LMF Low Carb pellets in order to get him to eat it. I checked his mouth and I don't see any ulceration or anything different. I have noticed that in general, he isn't as ravenous - which is weird, because I thought that was linked to elevated insulin and his insulin really hasn't come down that much. Are other folks seeing this shift on Metformin? How do we diagnose if a horse is both IR and PPID. Do you agree that Rico is PPID? Thanks again, Jenny -- Jenny Heishman and Rico Bainbridge Island, WA June 2018 https://ecir.groups.io/g/CaseHistory/files/Jenny%20and%20Rico https://ecir.groups.io/g/CaseHistory/album?id=60437 |
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Yes, he needs treatment for early PPID as his ACTH is over 2x the upper limit for young healthy horses (~55-60 pg/ml) at peak seasonal rise. My older horse was diagnosed with an ACTH of 102 within a week or 2 of peak rise.
I did suggest 0.5 Prascend initially, but 1 full Prascend is probably more appropriate. Whatever you do is unlikely to help much until the rise ends, although you should still get him on pergolide, then you might decide to maintain him on a 0.5 to 1 mg dose until next July when you should test again in preparation for the seasonal rise. -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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I made a request to our vet to start at 0.5 Prascend (rather than the 1/4 tab they suggested, haven't heard back yet)
Don't know that I want to write them again and request 1 tab. What are you looking at to make that suggestion? Just curious. Is it Rico's ACTH level on 9/28? Here's what I'm thinking for a plan: start him on 1/4 tab (with APF on board) for four days. Then up to 1/2 tab. Retest bloodwork two months after he is up to 1/2 tab dose. Continue Metformin. If the numbers look good......keep him at 1/2 tab and perhaps stop the Metformin(?) Next July 2023, bump him up to 1 tab. Test bloodwork end of September 2023 What I don't understand is how do I know if he still needs the Metformin or if the insulin numbers have lowered due to the Prascend helping control his PPID? How do we diagnose both IR and PPID? thanks so much, Jenny -- Jenny Heishman and Rico Bainbridge Island, WA June 2018 https://ecir.groups.io/g/CaseHistory/files/Jenny%20and%20Rico https://ecir.groups.io/g/CaseHistory/album?id=60437 |
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Sherry Morse
Jenny, Unless the Metformin stops working or his insulin drops to a safe level once you treat the PPID and you want to experiment by taking him off the metformin and seeing if his insulin stays down he should stay on it. Once you have your Prascend dose figured out for now you can retest next year around the end of June to see if he's still well controlled on whatever dose he is on at that point or if he's starting to creep up and may need an adjustment for the seasonal rise. I wouldn't just bump him up without knowing if you needed to. Your bloodwork results tell you that he's both IR and at the very least early PPID. Treating both conditions is going to be vital to having him feel good going forward.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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To elaborate on Sherry's response, if Rico didn't have EMS as well his insulin wouldn't be so difficult to control. The added complication of PPID is probably making that harder, but the high insulin in early stages of PPID is because he has EMS at baseline. Conversely, many non-EMS PPID horses never have high insulin or get laminitis, at least not until later PPID stages. They will have other issues associated with PPID, but often insulin isn't all that elevated.
Your plan is fine. My recommendation is because I personally prefer to give a bit too much pergolide rather than a bit too little to be on the safe side, since over-medicating only affects my bank account (a valid concern!) but under-medicating affects my horse's health and apparently means I have to be more careful with diet. I also didn't see positive changes on 0.5 mg or even 1 mg, I had to go much higher before topline and muscle wasting improved. Since ACTH was normal outside seasonal rise, I couldn't use that to determine how well the PPID was controlled, so I has someone experienced with PPID look at my horse's body condition and help me find the right dose. When we settled on the new dose and I tested at peak rise in the first year on pergolide, ACTH came back at around 27 pg/ml (down from 102 the previous year). That showed I was on track with the much higher dose even though he had normal ACTH outside the rise. Note that 27 is still a bit higher than we like to see here: the goal is low 20s to midteens. -- Kirsten and Shaku (IR + PPID) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album |
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