Is 1.0 ml too much pergolide? #wiki-notice


Lisa
 

Hello! 

I have slowly restarted and increased compounded pergolide suspension (1 mg/ml in oil) for Nira again since later in June. She is doing great, unless I increase the dose to 1.0 ml. She started to lose her appetite again, so I decreased back to 0.75 ml. In addition to losing her appetite, she gets super, super sweaty a few hours after I give it to her and also acts listless. This happened last time too, but I was so concerned about her total lack of appetite that I didn't pay much attention until it started happening again this time. Is 1.0 ml too much for her? Should I keep her at 0.75, or try again to get her up to 1.0? When should I test ACTH again? (Last test was in May, we were only using 0.5 ml of pergolide but her test numbers came back higher instead of lower.)

She is doing well with transitioning to unsoaked hay, she is getting about 75% unsoaked now. She is, however, still losing weight. She is down to about 890 now. My other question would be if she doesn't stop losing weight and I have managed to get her transitioned totally to unsoaked hay, should I consider trying to stop the metformin? I would think if I did try that I would want to do an insulin blood test before and then again after about a week to see if her numbers are staying stable? Would that be correct?

Thank you again! 

--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Sherry Morse
 

Hi Lisa,

The correct dose of pergolide is the one that controls the ACTH level.  You want to test 3 weeks after reaching your target dose, whatever that might be.  Based on previous testing she needs to be on at least a .75mg dose but you may need more at some point.  

As far as the metformin - you could stop it but you want to test bloodwork prior to stopping (and obviously get those results back before stopping it) and then 7 - 10 days later to see if her insulin is staying down or not.

Oh and one thing about the weight - if you're still feeding her less than 2% of her ideal weight (which would about 900lbs so 18lbs a day) you may need to bump that up to the full 18lbs to make sure she maintains weight and doesn't lose too much.




Eleanor Kellon, VMD
 

I would retest her at 0.75 ASAP. Have you tried APF to counteract side effects?

Your hay is rather high calorie when unsoaked. She should maintain when on 15 to 18 pounds unsoaked. Her weight is a matter of calories, not metformin. I would continue that as long as it is working.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lisa
 

Thank you for your responses. I am feeding her 18 pounds of hay a day. 
 
I will contact my vet to try to get her scheduled for a retest of her ACTH and insulin levels next week. That would be 3 weeks of 0.75 ml of pergolide a day. I have not used the APF. When I looked at the ingredients it contains, most of those are in the custom mineral supplement she gets, so I didn't really feel like it would be helpful. Please let me know if you think I am wrong about that. I am using Bon Appetit. 
 
Thank you!
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Lesley Bludworth
 

Lisa, I'm no expert but APF is not a mineral supplement but contains adaptogens.
But your minerals already contain these they may not be in amounts high enough to counter act the pergolide.
Eleutherococcus senticosus (Siberia ginseng)
Schizandra chinenis (Chinese magnolia)
Rhodiola rosea (I take this one :)
Echinopanax elatus 


From: main@ECIR.groups.io <main@ECIR.groups.io> on behalf of Lisa <larsen.lisaa@...>
Sent: Tuesday, July 19, 2022 1:38:54 AM
To: main@ECIR.groups.io <main@ECIR.groups.io>
Subject: Re: [ECIR] Is 1.0 ml too much pergolide? #wiki-notice
 
Thank you for your responses. I am feeding her 18 pounds of hay a day. 
 
I will contact my vet to try to get her scheduled for a retest of her ACTH and insulin levels next week. That would be 3 weeks of 0.75 ml of pergolide a day. I have not used the APF. When I looked at the ingredients it contains, most of those are in the custom mineral supplement she gets, so I didn't really feel like it would be helpful. Please let me know if you think I am wrong about that. I am using Bon Appetit. 
 
Thank you!
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134

--
Lesley Bludworth 
Phoenix, AZ
Sophie Case History 7/2022
https://ecir.groups.io/g/CaseHistory/files/SophieB%20Case%20History


Eleanor Kellon, VMD
 

Dried herbs in a supplement are a very different thing from liquid extracts. "It's in there" doesn't guarantee effectiveness. Where is the custom supplement coming from and what levels of these herbs are in there?
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Lisa
 

Thank you for the information. I am really not sure what I looked at when I read the ingredients, because this is nothing like what I thought it was. 

I ordered some. Vet is set up for blood testing next week. 

Thank you! 
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Lisa
 

Good afternoon,

I got blood test results today for Nira. Her ACTH came back at 12 on a scale of 2 - 30. Her insulin level was 27.8 on a scale of 10 - 40.

I have her completely switched to unsoaked hay. She is doing well and is maintaining her weight at about 890. The vet felt that her weight looked good. The APF arrived yesterday so I started that, but I don't think I need to increase the pergolide from the 0.75 ml that she is currently on based on these numbers. Please let me know if that is not correct thinking. 

Thank you!
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134


Sherry Morse
 

Hi Lisa,

Personally I would be thrilled with those numbers and if that insulin was on the unsoaked hay I'd keep doing what you're doing.  Obviously you want to keep an eye on crest/fat pockets but overall things sound good.




Eleanor Kellon, VMD
 

Lisa,

Thanks for the great case history.  Very helpful.  Do you know anything about her history before you got her?  Her radiographs suggest this was not an acute problem but onset of laminitis in mid-life always raises the suspicion of PPID, which you have confirmed.  My only concern is that her May TRH stimulation was higher than prior but your baseline ACTH has now dropped substantially.  Her insulin is also dropping.

It wouldn't hurt to take her up to 1 ml for the seasonal rise but I can't say for sure that would help her. The timing of the laminitis is most consistent with winter/cold induced pain so definitely be prepared for that.

You're doing a great job. Her BCS in the July photo you posted looks perfect.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Bobbie Day
 

Lisa
just wanted to add that she is gorgeous, I think she looks amazing. Great job.


--

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Maggie
https://ecir.groups.io/g/CaseHistory/album?id=271156

https://ecir.groups.io/g/CaseHistory/files/Bobbie%20and%20Desi 
https://ecir.groups.io/g/CaseHistory/album?id=78821


Lisa
 

Thanks everyone for the kind replies. 


I bought Nira in June 2020 from a lady in Green Bay, Wisconsin. She got Nira at age 6 completely untrained from a breeder in that area. She trained her and did a lot of trail riding but sold her because her husband retired and they were moving. She shared all of the vet records with me and there was nothing indicating any problems. 

I know Nira is in the early stages of PPID and is IR, but I also think that her getting cast in the snow triggered the acute laminitis. She started getting sore about two days after that happened the end of January. She unfortunately had put on some weight and was getting less exercise for about six weeks prior to that because I had a head injury and was unable to feed her or ride her. She was getting over fed by the caretaker during that time, and I wasn’t able to keep a handle on things. I really can’t tell you how hard this has been to navigate while recovering from a concussion. I have been very grateful for this group! Your help and encouragement has been invaluable!

I am hopeful in a few more months she will have grown a completely new hoof capsule and we can get some new X-rays to see how things look. 

Thank you! 
--
Lisa L
August 2020 Milaca Minnesota
Case History: https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Nira
Nira Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=273134