ACTH during, after rise for horses *without PPID/IR?


Jensmccabe
 

Just redrew labs (9.27, results 10.1) to see if our current med levels are maintaining good values for my herd after peak of rise.

In particular, I’m wondering if I should:
1. Increase Pergolide for my mustang Odin (now)
2. Consider small dose (would be first time) of Pergolide for my Arabian gelding Fiki or attempt to increase exercise and monitor 
*all ponies on dry lot during the day, but Rafiki has been turned out in a huge lush grass field overnight 

Here’s what we’ve got:

Bella: ACTH 25.6; Insulin 23.4
- 6mg compounded Pergolide daily 
- 1t Metformin daily
- 3x weekly ring/arena work, just adding 1x weekly trail ride 3-5 miles
- Barefoot, showing some tenderness on rocky areas (within her normal; I have EZ Care boots for her)

Odin: ACTH 39.2; Insulin 18.16
- 2mg compounded Pergolide daily 
- 1t Metformin daily 
- Handwalk 5x weekly, 10-15 min tack walk 3x/week
- Therapeutic rocker shoes (2nd cycle) with pads, intermittent grade 2 lameness RF (at some point will go back to boots)
- very wooly and thick shaggy winter coat which started growing in very early Sept
- intermittent other symptoms, Lyme this year suspected, did a long course of Doxy July/August

Rafiki: ACTH 32.0; Insulin 21.49
- no meds 
- Handwalk 3-5x weekly, 30 min tack walk 1x/week
- barefoot
- chubby

I’m interested in what is a “normal” or expected range of ACTH values for horses that *don’t have known metabolic issues during and after rise?

Asking because we took the first metabolic panel for my young Arabian gelding to get a baseline and he’s at ACTH 32. 

Wondering if I should put him on 1/2-1 tablet now to get that back down into the 20s, increase exercise and retest early spring? And be ready to have him on some Pergolide next year pre-rise?


NOTE: My other two are tested every 3-4 mos or more often if I see suspected symptoms. 


TIA,
Jen
--
Jen McCabe
Laytonsville, Maryland 
Joined 2022
+ Odin (2010 BLM Mustang Gelding - IR, dx 2022), Bella (2008 BLM Mustang Mare - PPID/Cushings dx 2000) + Fiki (2015 Arabian, ok so far!)
Odin and Bella Case Histories


Eleanor Kellon, VMD
 

Jen,

Our main concern with the seasonal rise is that it will push insulin into the acute laminitis range.  To avoid that, it is best to aim to keep ACTH normal all year in horses with insulin problems. Otherwise, the seasonally adjusted range should be right on your lab reports. It varies depending on the study and also on the age of the horse. Very young horses may not even go outside the regular normal range. Older horses with no signs of PPID may go as high as 80.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


ferne fedeli
 

You are giving 1t Metformin daily?  What is that about?  The correct dosage is 30mg/kg 2 X a day...  My Icelandic has 8000mg twice a day--8-1000mg tablets ground and mixed in his supplements...  I'm a little confused as to whether you are giving for some other purpose...
--

Ferne Fedeli  Magic & Jack   2007

Point Arena, Mendocino County, California
Case History

 

 


Jensmccabe
 

Sorry Ferne, I measure out of a powder I make from the pills and it’s measured out for each horse daily (pre ground); I hit send before I finished typing 🤦🏻‍♀️. What I get for ECIR’ing pre-coffee! 


My gelding gets 11 pills and mare gets 13 (ground in coffee grinder), based on the 30mg/kg 2x daily (but I do once daily combined dose in very wet Stabul 1 mash with Vit E and Mag). 


Both their dose is ~approx 1T not 1t, I made a mistake while typing. 
--
Jen McCabe
Laytonsville, Maryland 
Joined 2022
+ Odin (2010 BLM Mustang Gelding - IR, dx 2022), Bella (2008 BLM Mustang Mare - PPID/Cushings dx 2000) + Fiki (2015 Arabian, ok so far!)
Odin and Bella Case Histories


Jensmccabe
 

Thank you Dr. Kellon!

Given Odin is at ACTH 39 right now - should I increase his Pergolide (at 2mg, was holding him in 20s before the ride). He’s the most sensitive to laminitis of mine…

And for my young gelding Rafiki with no symptoms or known PPID or IR but ACTH at 32 should I be concerned? Start Pergolide or hold off? (This is the first time I’ve done a metabolic panel for him) 
--
Jen McCabe
Laytonsville, Maryland 
Joined 2022
+ Odin (2010 BLM Mustang Gelding - IR, dx 2022), Bella (2008 BLM Mustang Mare - PPID/Cushings dx 2000) + Fiki (2015 Arabian, ok so far!)
Odin and Bella Case Histories


ferne fedeli
 

Whew!  Okay, I DO UNDERSTAND about trying to send messages before COFFEE!!!  Been there, done that!!!  Okay.  I always thought we were supposed to dose Metformin twice a day though...  Don't know if there is an issue with dosing only once--even if doubling up...
--

Ferne Fedeli  Magic & Jack   2007

Point Arena, Mendocino County, California
Case History

 

 


Sherry Morse
 

Hi Jen,

I would think about upping Odin at least for the seasonal rise based on what his level is prior to the rise next year.  Rafiki is in range for a normal horse at this time of year based on Liphook's numbers as far as ACTH.  As his insulin is slightly elevated for a non-fasting test I would work on getting his diet tighter and manage him as if he's IR.  

As you know the recommendation for dosing metformin is 2x a day for maximum effectiveness.  You might see better insulin numbers if you went to that dosing vs. once a day.




Eleanor Kellon, VMD
 

For Odin, if his insulin is not spiking at the same time and no change in hoof comfort, don't make any changes.

A seasonal ACTH of 32 for Rasfiki is of no concern. What is his age?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Eleanor Kellon, VMD
 

Ferne,

Metformin is supposed to be dosed twice a day - some even speculate (no supporting research) three times a day.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Jensmccabe
 

Thanks Dr. Kellon! 

Rafiki is somewhere between 6-7 (rescue). 

J
--
Jen McCabe
Laytonsville, Maryland 
Joined 2022
+ Odin (2010 BLM Mustang Gelding - IR, dx 2022), Bella (2008 BLM Mustang Mare - PPID/Cushings dx 2000) + Fiki (2015 Arabian, ok so far!)
Odin and Bella Case Histories


Jensmccabe
 

Yep I'm aware of the 2x/day recommendation for Metformin, but can only manage 1x/day dose consistently unfortunately, so we do the best we can with what we've got.  

J
--
Jen McCabe
Laytonsville, Maryland 
Joined 2022
+ Odin (2010 BLM Mustang Gelding - IR, dx 2022), Bella (2008 BLM Mustang Mare - PPID/Cushings dx 2000) + Fiki (2015 Arabian, ok so far!)
Odin and Bella Case Histories


Jensmccabe
 

Thanks Sherry! I can unfortunately only manage 1x/day dose of meds/supplements right now (boarded, work schedule) consistently, but the good news is that *definitely* seems to have significantly lowered both Odin and Bella's insulin. 

I'm looking for a barn closer to home where I could manage 2x/day dosages reliably, but no dice so far.

We do have assistance feeding at our current boarding barn, but one worker reliably doses meds and follows feeding instructions (wet down etc) and the other one does not, feeds unapproved grain, and too much of it, without meds - yikes.

When I'm not traveling, I give the horses their Stabul 1 mix plus meds+. But when I travel, I ask the reliable staff member to do meds and supplements during her daily feeding. 
--
Jen McCabe
Laytonsville, Maryland 
Joined 2022
+ Odin (2010 BLM Mustang Gelding - IR, dx 2022), Bella (2008 BLM Mustang Mare - PPID/Cushings dx 2000) + Fiki (2015 Arabian, ok so far!)
Odin and Bella Case Histories