Hello,

My horse has been on the recommended diet for some years now. We have seen significant improvements but there are two things that have caused me to continue to suspect PPID

1. Despite "correct" diet, trim, lifestyle ect. his hooves still look nutritionally week. He loads properly and is much stronger but his whiteline connection is weaker than it should be and his frog is still more susceptible to infections. 

2. He will go all year without abscesses but as soon as fall hits,  he is riddled with them. This will persist into winter. They typically blow out of his heal or hoof wall. 

So, we had tested him in the fall and his ranges came back normal (see case history). We retested him in the spring with a TRH stim test (also in case study but will include here, too)

TRH Stim from 3/6/23

Pre: 20.3  (range 2-30)
Post 651 (range 2-110)

My vet is very kind and thorough but I would not say is super knowledgeable about PPID and latest research. So, I'd really like to make sure I get this groups thoughts on dosing before I discuss with her further.

1.With these ranges, is this considered early stages?
2.What are typical doses like for a horse in this case?
2. Would it make sense to medicate late summer, fall and winter only?

And I have to add - I'm very thankful to Dr Kellon, ECIr and this group. All the shared knowledge has allowed me to advocate for him, enhance his quality of life and given us more time together.

--
- Anne 
October 2021, Toledo, Ohio 
Case History: https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Blaze

Thank you, Sherry! We tested Insulin in October of 2021 and it was 15.61 (range: 10-40). At that time, we also did glucose which was 108 (range: 71-122)

My thought process is, I already manage him as if he is IR / EMS with hay testing and strict balanced diet so my disposable income is probably better spent on PPID medication and testing. Curious if you see any flaw in that logic?


--
- Anne 
October 2021, Toledo, Ohio 
Case History: https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Blaze

Understood. Thanks, Sherry. 

I was reading on another thread about there being a recommended medication protocol for horses who have a normal baseline but test out of range after TRH stim. Do I have this right? It sounded like it was best to pre-treat with APF then titrate dosage up every 4-5 days by .25 mg. 

If the above is correct, I have some questions:
- How far in advance do you pretreat with APF?
- Do you continue them on APF after administering medication? For how long? 
- For horses like this that are in early stages with subtle signs, is there a dosage that seems to work best? If even a range?
- How quickly do you typically observe improvements after medicating?  

Thanks, 

--
- Anne 
October 2021, Toledo, Ohio 
Case History: https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Blaze

--
Karen and Fhinland in Maryland

Case Study:   https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Fhinland

Hi Anne,

I'd consider that TRH result to be a likely positive for early PPID since you're seeing some physical signs, and so its worth a trial of Prascend for the next seasonal rise.   I'd try to have him on 1mg by mid-August at the latest.

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

Snickers' Case History
Snickers' Photo Album

Hi Karen,
Just want to remind others reading here that we don’t have the data we need to evaluate ACTH levels determined by post TRH Stim tests once the horse has started pergolide.  I know I have mentioned that to you a few times.  Don’t toss the data you’ve accumulated as it may become useful at some point.  If you have noted PPID symptoms which were alleviated by pergolide, those would be good to follow when deciding if a dose increase is needed.  And, if you’ve determined how following the post TRH stim data is helpful for you and Fhin, please share as it might help others doing follow up TRH stim tests.  I’m pretty sure that higher, lower, no change are worthy of noting.
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On Tue, Mar 14, 2023 at 12:59 PM, Sherry Morse wrote:

The recommendation to pre-treat with APF is true of any horse starting pergolide/Prascend.  For my gelding I did 8cc for 3 days prior to starting him on Prascend and then did the full 8cc for 3 days after he was on the medication.  I then weaned the APF a bit slowly going down a cc a day for 3 days (to 5 cc) and then did 2 days at 3cc and then stopped. He didn't have any veil issues using this technique.  If I have to bump him up from his current .5mg dose I'll probably do the same thing. 

Hi Sherry - I heard back from my vet. She is recommending 1 mg daily. What's the best way to get Dr. Kellon's input on that dosage per Blaze's test results and symptoms?

Thanks!
 
--
- Anne 
October 2021, Toledo, Ohio 
Case History: https://ecir.groups.io/g/CaseHistory/files/Anne%20and%20Blaze

Hi Anne,

1 mg is a standard starting dose.  For a horse with normal ACTH year-round, and only displaying physical signs in the fall, that is reasonable.  To get Dr Kellon's input, start a New Topic with her name in the Subject, and post your question.

In some rare horses ACTH is a poor measure of PPID status.  Your horse may be one of them, meaning you'll need to monitor physical signs of PPID closely.   Polydypsia is a big one and fairly easy to monitor by measuring volume of water consumed, as will be the degree of fall abscessing in your case.  Continue to check ACTH as well because one day it may start to climb.  And insulin should be checked regularly to assess laminitis risk.

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

Snickers' Case History
Snickers' Photo Album