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Correct Pergolide dosage before seasonal rise?

Dawn & Qharma
 

Hi all,

Forgive me Dr Kellon, for I have been a bad mom, it's been 11 months since my last bloodwork and unfortunately the recent numbers came back bad.  I should have clued in earlier as his skin/coat has been bad and he got a little tenderfooted for no reason.

He's on 2.5 mg Pergolide and the ACTH is 112.

My question is should I double the Pergolide dose now?  Or increase gradually in 1 mg increments?  Increase to what dose?  How long will it take for the ACTH level to decrease?

He's only 10 yrs old - I'm scared what dose he's going to be on when he's 20!

The calculator shows that he went from a RSQI of Uncompensated IR in 04/16/2019 to Poorly Compensated IR.  Which is worse?

I seem to vaguely remember reading that there is a surgery to remove the tumor that causes PPID?  Is there such a surgery or am I just wishful thinking?

Thanks for your help!
Dawn
--
Dawn & Qharma
December 2017, Phoenix, AZ

Case History: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma  
Hay Analysis: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma/Hay%20Analysis
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=66067

LJ Friedman
 


-- why are you scared at his dose at 20 years old?  cost doesnt jump up much.  my horse jesse needed increases in cp always .   
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos

 

Sherry Morse
 

Hi Dawn,

What kind of pergolide are you using?  As I'm sure you know not all types are created equal and not all maintain their potency over a period of time so that's the first thing to be addressed.  Were he mine and depending on the type of pergolide you're using I would titrate him up a full mg (3.5mg total) and then retest 3 weeks after that dose has been started.  If he's still showing an elevated reading that would be a sign that a further increase is needed or you may want to look at Cabergoline as an option, but again to start - what type of pergolide is he on?

As far as the dosage question - the correct dose is the one that controls the ACTH of the horse, and that obviously varies from one individual to another.




On Thursday, March 26, 2020, 12:35:30 PM EDT, Dawn & Qharma <dawn_winans@...> wrote:


Hi all,

Forgive me Dr Kellon, for I have been a bad mom, it's been 11 months since my last bloodwork and unfortunately the recent numbers came back bad.  I should have clued in earlier as his skin/coat has been bad and he got a little tenderfooted for no reason.

He's on 2.5 mg Pergolide and the ACTH is 112.

My question is should I double the Pergolide dose now?  Or increase gradually in 1 mg increments?  Increase to what dose?  How long will it take for the ACTH level to decrease?

He's only 10 yrs old - I'm scared what dose he's going to be on when he's 20!

The calculator shows that he went from a RSQI of Uncompensated IR in 04/16/2019 to Poorly Compensated IR.  Which is worse?

I seem to vaguely remember reading that there is a surgery to remove the tumor that causes PPID?  Is there such a surgery or am I just wishful thinking?

Thanks for your help!
Dawn
--
Dawn & Qharma
December 2017, Phoenix, AZ

Case History: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma  
Hay Analysis: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma/Hay%20Analysis
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=66067

Dawn & Qharma
 

Sherry,

Thanks for your response. 

I get the compound Pergolide from Pet Health Pharmacy.  I've read that they are a reliable source.

--
Dawn & Qharma
December 2017, Phoenix, AZ

Case History: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma  
Hay Analysis: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma/Hay%20Analysis
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=66067

celestinefarm
 

Dawn,
Sherry was asking if you were using capsules, or oil, or paste.  The form makes a difference as oil does not have as long a shelf life.

--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Dawn & Qharma
 

Sherry Morse
 

Hi Dawn,

So a further question - are they being stored inside in a place that wouldn't cause degradation due to heat or exposure to sunlight or air?  I don't use Pet Health so I don't know if they come in a blister pack or a bottle that exposes them to air every time it's opened.

Basically, if we rule out that the pergolide itself could be a problem the only answer is to increase his dose now to what controls the disease and worry about what happens when he's 20 later.




Dawn & Qharma
 

Sherry,

The capsules are being stored in a pill bottle that I keep in the fridge and the prescription was filled 20 days ago so I doubt it's a bad medication.

I have also ruled out false high due to exercise, stress and pain.  Although he has been footsore recently we put glue-on shoes on him 4 weeks ago which has made him increasing more comfortable.

Doing blood work every 3 weeks until his ACTH is controlled is not financially feasible. Since Dr Kellon recommends the number be in the teens and he's in the 100s I feel like 1 mg will not be enough to get it down sufficiently.  But maybe somebody with more experience will be more knowledgeable about that.

Thanks for your help,
Dawn

--
Dawn & Qharma
December 2017, Phoenix, AZ

Case History: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma  
Hay Analysis: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma/Hay%20Analysis
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=66067

Lorna in Ontario
 

Hi Dawn,

Considering the details you have given, if it were me I would increase by 1mg right now. I would watch clinical signs,making notes in my daily journal . I'm guessing you should see a positive sign....don't ask me,every horse is different....within several days. Maybe not.
But, for example, a horse's weepy eyes can clear up. Or a slightly different energy(more) level can appear. Or slightly happier horse. Sometimes signs are subtle,sometimes more obvious.A sore horse can appear obviously less sore...if trim is appropriate.
Again,for me ,considering his numbers,it would make semse to go up another mg in the next week.
Repeat careful watching.
I'm not a vet. 
This is just from having 7 of my then-herd of 9 dealing with PPID and IR.

--

Lorna  in Eastern  Ontario
2002


 

Dawn & Qharma
 

Thank you Lorna.  That makes sense.  Sounds like a good plan.  The signs that he's showing now are pretty subtle but I will be able to tell when they clear up.  
--
Dawn & Qharma
December 2017, Phoenix, AZ

Case History: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma  
Hay Analysis: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Qharma/Hay%20Analysis
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=66067

Eleanor Kellon, VMD
 

Dawn,

It's impossible to suggest dose from the ACTH number. Some horses respond dramatically to small dosages, others not at all.  No one can predict whether you are right or wrong about needing more than a 1 mg increase. The only way to know though will be to check. No getting around that.

Just for the record, I never said the target was in the teens. There are horses that continue to be symptomatic when in high "normal" ranges but that's not all horses.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001

Dawn & Qharma
 

Kath Margaret
 

Re age of pergolide: the date you fill any prescription is not an indicator of how old the drug is. The date on the original bottle of pills is what counts (I’ve  been given other drugs by the vet right before it expires). Apart from that, and the ‘bad batch’ issue (you could ask if anyone else’s horse is having the same issue - it’s how most bad batches of anything are discovered), it is my understanding (albeit from the brand name company rep so take this with a grain of salt) that the drug declines very quickly when exposed to air which was part of the difficulty in developing the drug after the old med was stricken from production due to its dangers to humans.  It deteriorates so quickly that when a half pill is part of a dose it needs to go back into the blister pack and be covered as best as possible to lessen deterioration to the next dose. Is it impossible or cost prohibitive to get the brand drug where you are?  At least to start? Though I know of people that have used the compounded drug in addition to the brand one,  you might consider using the brand to get it under control and then using the compounded to add to a base of the brand name?  One horse I know was at the max dose of the brand name and her horse’s levels were still too high though. So each horse’s disease has its own difficulties. Dr K might wish to comment on her experience with compounded vs brand name. 

--
Kath H, Orleans Ont Jan 2019