chewy for compounded pergolide, how they doing?


LJ Friedman
 

thought I’d share an incident that would just maybe warrant a slight amount of caution. I changed my cats provider of prednisolone transdermal   from wedgewood to Chewy.. After using the chewy product for two days, my cat started vomiting. And he has not vomited on the current wedgewood medication for months. So I dropped the chewy product. Just wanted people to know that.
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


 

LJ, did you let Chewy know? 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


LJ Friedman
 

not yet.  i will request a refund today etc
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


 

I changed from Prascend and began compounded encapsulated Pergolide from Chewy at the beginning of July 2022. I did a slight dosage increase. We do 2mg twice daily. I had bloodwork done mid August and results came back improved from the previous bloodwork which had been done about 4 months prior. ACTH 25.7, Insulin 15.30, Glucose 72.  I had a two month supply and just started a new order last week.  I did reg vaccinations + Strangles (we are only vaccinating her 1 time per year) after the blood draw 3 weeks ago. Brownie began showing signs of laminitis a few days ago. Now I'm wondering if it's the new batch of Pergolide or if it's the vaccinations.  Her blood work was great a couple of weeks ago using the Chewy compounding pharmacy. I wouldn't mind sending for independent testing if someone were to provide me with where and how to send. 
--
Jane B Homestead, FL 2020
Brownie, PPID, foaled 1997


Nancy C
 

Hi Jane

Than you very much for your willingness to test your pergolide.

In the past we have used ARL Bio Pharma. I have not checked pricing recently, but it will be a couple hundred dollars, I believe.

ARL Bio Pharma | 840 Research Parkway, Ste. 546, Oklahoma City, OK 73104
https://www.arlok.com/
Toll Free: (800) 393-1595 Phone: (405) 271-1144
Fax: (405) 271-1174
E-mail: info@...

Many thanks again.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Eleanor Kellon, VMD
 

Jane,

There is no way to tell if the laminitis was from the vaccination or the seasonal rise not being adequately controlled but you can certainly recheck ACTH and insulin. Why are you doing Stangles vaccines? Are those done yearly? Is your horse on premises where Strangles has been a problem or young horses are frequently brought in?
--
Eleanor in PA

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


Lavinia Fiscaletti
 


Hello Jane,

Welcome to the group!

Nancy has already addressed your question regarding the pergolide testing. Thanks again for considering doing this.

One other thing to consider is that while your mare was doing well in Aug, that was also the start of the seasonal rise period and her ACTH and insulin could easily have risen much higher since the testing was done.If so, combining that with the vaccinations could have put her over the edge. We wouldn't generally recommend vaccinating an IR/PPID horse at the height of the rise, nor administering multiple vaccinations at one time, as that could be problematic in-and-of-itself.

Is there a specific reason you are dosing the pergolide twice per day? The general recommendation is to dose only once per day 
It would be extremely helpful to see a case history on your girl as there is a place on the form for entering all the test results, along with the lab's reference ranges.

Although you've been a member since 2020, this is your first post so I'm including our Official Welcome Message to new members. It explains the basis of ECIR's recommendations and also contains links to more in-depth reading about many of the topics touched on. Many find it helpful to save it somewhere easy to find for future reference.


The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.

 

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.

 

There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you.


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


 

Dr. Kellon,

In South Florida, Miami-Dade, the protocol has been to do the "core vaccines" (EEE, WEE, TET, WNV, FLU, RHINO) Spring and Fall, rotating Strangles and Rabies-one in spring, one in fall.  I think our previous vet did Rabies and Strangles together.  Our new vet rotates.  We got the new vet January 2021 and after discussing Brownie's PPID and me saying I think she reacts to the vaccines, the new vet said let's just vaccinate 1 time per year and we can alternate the Rabies & Strangles so they are every other year.  I opted to vaccinate Spring/Summer for her, since we are in an area with lots of mosquitoes in the summer.  I'm thinking I'd like to look into titers for her.  

I will work on the case history to provide better context and more specific details on diet, deworming, test results, dosage history, body condition etc, but for now:  she was diagnosed PPID in Nov 2018.  She is on a private property in a closed herd.  There are no young horses in and out and she doesn't leave the property.  To answer your question on if there is a specific reason for the Strangles, no, not particularly.  I think because it's just how it's done here.

The Pergolide was delivered and left in the yard in the beating afternoon sun from about 3:30PM until I got home in the night on 8/31/22.  So it was outside in the heat of the day here.  It was in a small box stuffed with paper and in the opaque container with opaque capsules, but since she's sore now I'm having a new order sent just in case.  I started that new order last week.

In the past I've seen her seasonal rise really begin around mid July.  So right now it's likely either the vaccinations, the Pergolide was weakened, or the seasonal rise not adequately controlled.  My goal is to reduce the possibilities to consider in the future.
--
Jane B Homestead, FL 2020
Brownie, PPID, foaled 1997


 

Hi Lavinia,

She was tested on Aug 16th, just 3 1/2 weeks ago.  Typically, in the short 4 years since she's been diagnosed, I might notice more "symptoms" from a seasonal rise in mid-July.  I will work on the case history and at least get all of her test results uploaded.

Why am I breaking it into 2 per day?  She is up to ~3mg of Prascend/4mg of compounded Pergolide mesylate.  I have been getting blood work done every 4-6 months and have not been super satisfied with the results until now. Even though the vet has been okay with ACTH at 39 because it falls within the range, I know from reading here that that is not really well controlled PPID so I've been doing small increases to her dosage because she has hit the veil in the past.  The increases have been ongoing for 2 years, .25mg/day increase when I bump her up.  It's kept her tolerating the increases very well.  The first time she hit the veil was after 1yr and 4 months of a consistent dosage.  She doesn't stop eating hay, but she won't eat the vit/min/AA she gets in her bucket with TC Nat Tim Bal Cubes w/ 1/2 cup Stabul 1.  So aside from the sheer amount she's on at this point, I've also read that the half life is really quite short, less than 12 hours, so since I'm able to, I'd rather keep her medicated as steady as possible.  So in short, I don't think she would tolerate what she needs all at once daily, and I'd rather keep a steady amount in her system day to day.
--
Jane B Homestead, FL 2020
Brownie, PPID, foaled 1997


Eleanor Kellon, VMD
 

On Fri, Sep 9, 2022 at 11:53 AM, LJ Friedman wrote:
thought I’d share an incident that would just maybe warrant a slight amount of caution. I changed my cats provider of prednisolone transdermal   from wedgewood to Chewy.. After using the chewy product for two days, my cat started vomiting. And he has not vomited on the current wedgewood medication for months. So I dropped the chewy product. Just wanted people to know that.
Jesse,

You should know by now that is meaningless. We don't know your cat's condition, why it was getting transdermal prednisolone, what latest physical findings and blood work were, any environmental changes, etc., etc..
 
--
Eleanor in PA

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


 

Hi Nancy,

Thank you for the information.  I found it online and it's $220 for the standard turn around on the stability testing.  I'll give an update once I receive the results.
--
Jane B Homestead, FL 2020
Brownie, PPID, foaled 1997


Eleanor Kellon, VMD
 

Jane,

Does she live in a barn with a lot of traffic in and out, young horses coming and going? If not, Flu and Rhino are not core vaccines, and either is Strangles. Definitely at least get a Strangles titer. There are titers which are a direct contraindication to vaccinating.
--
Eleanor in PA

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


Eleanor Kellon, VMD
 

Jane,

The half life only refers to blood level,  not tissue level. It has been well documented that the effect of a single dose lasts at least 24 hours. We have had members here split the dose and have the horse go downhill. If you used a single dose you might not need the second one - although now is not the time to fool around with it. Change in appetite after 1 year and 4 months of a consistent dosage is not a pergolide side effect. Sounds more like gastric ulcers.
--
Eleanor in PA

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


 

Thank you Dr. Kellon,

Regarding the vaccines and titers, at this point, I know in the 10 years I've known Brownie she has been regularly vaccinated and at the age of 25, if it's possible to safely reduce or eliminate the vaccines I will.  Titer is only something I've glanced at and really don't know anything about, so I need to do a little homework on it since it's kind of a foreign word for me.  

I understand why you would be skeptical of the veil just popping out of nowhere, but I stupidly let her go off of the meds and she resumed eating her bucket.  Then a month or so later the consequences of taking her off the meds kicked us in the butt.  I'll get her case history together.

I'm not opposed to trying to medicate once daily, you ARE the expert, but I agree, now is probably not the time.  I'm a little nervous about it, but perhaps I can wait until we're out of the height of the seasonal rise and a month or two before the next blood test to give it a shot.  Thanks so much for your time.
--
Jane B Homestead, FL 2020
Brownie, PPID, foaled 1997


Eleanor Kellon, VMD
 

Re vaccines, it would help to know her exposure. Is she is a closed herd or isolated situation? Does she live in a busy barn?

 One possibility for the veil appearing like that out of nowhere is you started a new batch of drug and had been using drug that was below potency.
--
Eleanor in PA

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


 

"I will work on the case history to provide better context and more specific details on diet, deworming, test results, dosage history, body condition etc, but for now:  she was diagnosed PPID in Nov 2018.  She is on a private property in a closed herd.  There are no young horses in and out and she doesn't leave the property.  To answer your question on if there is a specific reason for the Strangles, no, not particularly.  I think because it's just how it's done here."
--
Jane B Homestead, FL 2020
Brownie, PPID, foaled 1997