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Hello I am new to this list.


marcia
 

I don’t have a lot of information from my vet because he has not given me the information.  Today I picked up the medication. I received the information last Monday that Priddy my 14 year old mare has Cushing’s.  My farrier had noticed when we got her in April 2019 that she had several rings on her hooves, and we had better watch her closely.

 

My question is this. We have Pergolide 2 mg in capsules. How do you divide this up without spilling the dust everywhere. My vet wants to give her ½ a cap in the morning & ½ at night for 10 days.  Then ½ cap once a day for 90 days.  I have texted him but have not heard back from him.

 

Thank you all for being here.

 

--
Marcia M
Texas
2020


 

Hi Marcia,

Welcome to the ECIR group!  I think we can probably provide all the information you need here to better understand your mare’s situation.  I will be including a welcome letter from the group which has all sorts of useful information and many links to more.  Don’t hesitate to ask questions if something isn’t clear.

To answer your question about dividing pergolide, the best way to do that is to first dissolve it in water.  Pergolide is quite unstable in water but it will last long enough for your purposes.  You will need several small dosing syringes.  Put 8 ml of of water in a container, open your capsule into the water and stir a bit.  If you draw half of that into a syringe, you will have 1 mg, which is the dose your vet recommends.

However, we have a protocol for starting pergolide which is generally more successful.  Start with 1/4 mg of pergolide or 1/8 th of the water, in this case 1 ml.   Give that once a day at the same time for 3-4 days and, if all seems well at that point, double the dose to 1/2 mg  (2 ml).  After a few days, increase to 3/4 mg and finally to 1 mg.  There is no need to give twice a day - in fact it has been shown to be a waste of your pergolide.

Depending on how sensitive your mare is, something you won’t know in advance, you might find that she reacts with a condition referred to as a veil.  There are lots of descriptions of this but they might seem depressed, slightly dopey and not too interested in food.  Some horses adjust rapidly and others not as quickly.  There is a product called Advanced Protection Formula (APF), containing adaptogens which will help your horse adapt to the hormonal changes more easily.  There are several options and sources if you do a Google search.  I’d go with the least expensive.  We recommend giving it for a few days before starting pergolide and continuing until a few days after reaching the 1 mg goal.  If you choose not to do the pretreatment and you are concerned about your horse’s response to the pergolide, you can discontinue the pergolide and restart it with several days of APF on board.  

That’s a lot to absorb when you thought you just needed to know how to split a capsule but it’s all important to know before you get started.

Please fill out your Case History promptly.  There is lots more information which we will be looking for in terms of her diagnosis and it should all be contained there.

Here’s the group welcome!

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and 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 Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 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: IR 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 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. 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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. 



--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Lorna Cane
 

P.S. Marcia.
We really need to know the results of the test confirming Cushing's , if you can get your vet to send them to you. They are yours to have for your records.
They will help you judge how to proceed, wrt pergolide dose required.
--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


Lorna Cane
 


I used to use an index card for this. I folded the card in half, opened the capsule, carefully tipped half of the capsule onto the fold of the card, carefully tipped the card over a syringe and let the powder go into the syringe....holding a finger over the syringe tip. I then sucked a bit of water up into the syringe,and syringed it into pony's mouth.
Then recap the capsule, and feed it the next time.
You can also put a bit of water into the syringe first,hold finger over the tip,and let tihe powder slip into that.
But in your case, I question feeding the pergolide twice a day instead of once. It appears to be a better idea to give it once daily,if possible.
Then the  concern becomes not wanting to start off with 2 mg. If it were me, I would start off using the method above,to halve the amount ,and retest in several weeks.
Some members here have titrated up to 1 mg,for starters,but I have never had to do that. I know they will speak up.
Has your vet explained why you should start with 2mg. ,and then back off to 1 mg. .
?
--

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php


LJ Friedman
 

Welcome to the group. Good for you for finding this group. You’ll find that often you need to tweak what your vet does. I’m curious as to why your vet started with 2 mg of compound pergolide ? Any reason why he didn’t start with 1 prascend? 
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

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