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Increase of Pergolide question


Nancy & Vinnie & Summer
 

Hi there, I tried to search the files but couldn't find the answer.

When a horse is sore with pulses when one increases a pergolide dose how long would you wait to determine if that dose is the right dose for the horse.

Vinnie has been on .50 dose for 2 days with a small improvement yesterday but maybe a little more sore today with pulses still. I feel like perhaps I need to still up the dose to 1.0mg but wasn't sure how long to get the full effects of the current dose.

Thx Nancy 
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

 You can't gauge pergolide dose by pulses. It's time for blood work.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 


Nancy & Vinnie & Summer
 

Hi Dr Kellon, I just wanted to remind Vinnie has never had elevates acth even during the rise off prascend it was 24. When he was on prascend during Dec bloodwork his acth was 20.2 with insulin at 198. Which was why we went with invokana. Jan insulin came down to 40.94 but we didn't retest acth at that time.

I stopped prascend when we started invokana with the intent of doing  trh stim, but vinnie got sore again 32 days after stopping, so we restarted prascend.

Will his acth be a good indicator or are we looking for insulin response while in invokana and acth to determine whether we increase his prascend dose?
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

When dealing with laminitis, whether PPID or not, the focus should be on insulin. It's the insulin that causes problems.

Vinnie also has multiple issues that could cause hoof pain unrelated to insulin/laminitis or ACTH:

BOTH FRONT

- Sinking/poor ground clearance/sole depth
- Flares (traction on laminae)
- Breakover too far forward (traction on laminae)

LEFT FRONT

- Pastern enthesiophyte, probably distal sesamoidean ligament
- Pastern joint arthritis
- Flat palmar angle
- P3 bone loss

RIGHT FRONT

- P3 bone loss
- Probable unresolved collections
- Flat palmar angle
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 


Nancy & Vinnie & Summer
 

Just as a side note there are other signs he is PPID because he also developed guard hairs in the 32 days off prascend which I thought was super weird. 

Based on the pulses in all 4 feet I feel like this is a metabolic systemic response that something is uncontrolled. We are on .75 prascend now (total days back on prascend 5 and day 1 at this dose) and slowly seeing a limprovements.  I regret taking him off prascend when we started invokana :(.

Duly noted the other things that can cause foot pain, but when his insulin is controlled he looks almost sound. 
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Eleanor Kellon, VMD
 

Just get the blood work Nancy, and take it from there.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Just to clarify a little bit more, it wouldn't surprise me one bit if he does indeed have PPID but that doesn't mean it is the cause for hoof discomfort.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Nancy & Vinnie & Summer
 


Nancy & Vinnie & Summer
 

I have an appt March 8th for a recheck for both horses.  Since Vinnie is on prascend now should we do the trh stim test or just test acth and aim to have this number in the low end of the range to mid teens know that during Dec test prior to Invonaka he was 20.2 with a 198 insulin and laminitic?

Update in general: day 2 in .75 dose with now 6 days total on prascend, pulses decreased by 80% and soundness improved dramatically. 

--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104


Nancy & Vinnie & Summer
 

I am reading the other post about the same,and my take away is that TRH stim is not the way to go ans really for Vinnie it is insulin insulin insulin with context in acth perhaps?

--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104