Is it safe for Khan try prascend/pergolide (Dr. Kellon please weigh-in thank you)


Jessica Gunderson
 

Hello, Is it safe to give a non-PPID horse prascend? While Khan x-rays are better she never stopped being sore and on Friday she went into another acute laminitis attack.  Given we are 7 months in and the EMS protocols don't seem to be helping her I was wondering if we could try prascend to see if it helps? I was listening to Dr. Debra Taylor on the humble hoof podcast talk about undiagnosable PPID and doing a necropsy of a horse who tested negative for PPID but the necropsy showed the horse had PPID, as well as reading multiple personal accounts on the FB laminitis pages I follow where horses tested negative for PPID, some of them several times but they did have PPID and treating it was the only thing that helped.  My vet will not do a stim test on Khan because she feels it is too dangerous for her (will trigger laminitis) so I was wondering if I could safely give prascend to Khan to see if it helps given we have the diet and trim under control and she has never stopped being foot sore. Thank you.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


 

Hi Jessica,
I’m sure Dr. Kellon will weigh in as needed.  We often suggest a pergolide trial to see if that helps to solve problems such as you describe.  Yes, there are PPID horses which don’t show an elevated ACTH - ACTH is not the only hormone involved but it’s one that can be measured.  I’ve never read of the TRH stim test being dangerous - we certainly recommend it here.  The best time to do that is outside of the fall rise because we don’t have normals to which to compare the rise values.  If you put her on pergolide and then decide to do the stim test, you will need to remove the pergolide three weeks in advance of testing for the same reason - no testing normals.  Given her age, I would think her being PPID would be unlikely, although not impossible.  Not sure why the first test you did was so elevated, if it was because there are no units to compare to.

Her case history is a few months out of date so you may have made changes that aren’t reflected there.  I would not have her on NSAIDs and omeprazole.  That seems to be a dangerous combination in terms of gut health.  We don’t even recommend the long term use of bute.  Devil’s Claw is often a satisfactory substitute and doesn’t cause the same issues.
--
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


 
 


Jessica Gunderson
 

Thank you Martha for your quick response. You are correct the case history is out of date she has been off of bute and on phyto quench since the end of August. She is on bute again since Friday night so I stopped the phyto quench. Vet wants 3 days on 4 grams/day and then to taper off if pulses and heat are gone. I used bute for two other instances just one 2 gram dose/day during the last few months to help with a trim and x-rays, but otherwise she has been NSAID free since end of August. 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Eleanor Kellon, VMD
 

My reply just disappeared so trying again.

 

Your vet may be thinking of dexamethasone suppression rather than the TRH stimulation. TRH stim is safe and you can do it now.

 

We're very aware ACTH doesn't always test abnormal. The founder of this group had a mare like that. However, it's highly unlikely at her age and even if ACTH isn't up the mechanism is still high insulins and hers haven't been high enough for acute laminitis, although you should recheck.

 

Her trim was in such bad shape it's hard to picture that being corrected in only 3 months. Is she out of the appliances? Can you post photos? If she hasn't drained abscesses that would be my first suspicion. Pumping her full of bute every time you see a pain flare will prevent those collections from draining.


--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Jessica Gunderson
 

Thank you Dr. Kellon. When I was working with Rood and Riddle they mentioned they were having three year olds come in with PPID so I was unsure of how age driven it is still thought to be.

The appliances were taken off August 25th. I will post new pictures and new X-rays which don’t look great for a normal horse but considering where Khan was in August I was on cloud nine, now this. Including the link as well here if that is of any help.  https://keystone.asteris.com/#/share/KINGSLYEQ/share-request/74541822-1121-0100-2218-ffffff211110/share-recipient/21ffdac5-0100-7754-2218-ffffff211110 No signs of new abscesses that I can discern, my farrier did discover one on Tuesday. He thought it was old but was never able to drain. She has heat and pulses in 3 legs, it was all 4 for awhile, which is terrifying because she has never had anything in the backs before. Temperature is 98.7 so not elevated. 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Eleanor Kellon, VMD
 

As I'm sure you have noticed already, bute does little, if anything for the pain of laminitis and it blocks abscess exiting. You should get insulin checked ASAP and if you hay isn't analyzed, soak it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Jessica Gunderson
 

I have uploaded latest x-rays and more recent hoof pictures.  I have also uploaded the hay analysis, ESC + Starch = 8.94. I realize this is from last year but thinking to keep Khan on this hay until it runs out because the new hay is is over 14% combined.

I had Khan on phyto-quench and jaiogulan for 2.5 months and she remained sore.  Am I missing the cause or could it be because her trim got in such bad shape it will just take along time for her to walk comfortably?
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Jessica Gunderson
 

Oh also, vet is coming out tomorrow to draw of insulin and TRH stim test.  
I sent hair analysis of Khan to Uckele.  Is there anything in the results that might help me with whats going on with her? If so perhaps I should ask them to expedite processing given the recent turn in events?
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


 

Jessica, has Khan ever had a Lyme test done?  I don’t think it’s prevalent in your area but it might be worth checking, especially if you know she has traveled.  About 20 plus years ago, I ‘bought’ an unrideable upper level dressage horse in Connecticut.  We brought him to VT where no one had even considered Lyme before (now it is quite prevalent) and, on suggestion from another Connecticut resident, we tested him and he was positive.  As horse people here were still unfamiliar with the disease, I became somewhat of a pariah in the boarding barn for bringing Lyme to Vermont.  Please forgive me if I’ve suggested this before.
--
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


 
 


Jessica Gunderson
 

I appreciate all your suggestions! I did do a Lymes test as well as iron panel. Both negative but I should update Khans case file. I recall a vet once telling me in a heavy Lyme area they were suspicious the test is not 100% accurate and has false negatives because it did not test for all of the different spirochetes but that was many years ago and I imagine the test has improved.

I was reading that microlactin may be effective for pulses and heat. Is there any merit to that?

One thing I notice with Khan is the whites of her eyes get very red when she has an episode, is this normal?
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


Kirsten Rasmussen
 

Are you still soaking her hay, Jessica?  8.94% can be too high for some horses, especially if not being exercised. 

Is there any way you can source hay that is not 14%?  Even soaked, it's very possible hay with that much sugar and starch will be a problem.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Jessica Gunderson
 

Hi Kirsten,

Where are you getting the 14%.

Have not been soaking since end of August. Started soaking again just now. We soaked for 5 months and it did not seem like it did anything to mitigate laminitis, she is also underweight so I hate to soak and take out more calories but will do so until the Insulin test comes back. 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


 

Hi Jessica,
You mentioned in an earlier post that new hay you are getting is 14%, combined.  Keep in mind that this test was done using NIR (near infrared) rather than wet chemistry, which is more accurate, and may be as much as 20% off.  
--
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


 
 


Kirsten Rasmussen
 

Hi Jessica,

Martha answered for me, sorry I wasn't clear where the 14% came from, I was in a rush.  

So it looks like the Emergency diet, including soaking, were implemented before her first bloodwork that showed an insulin of 38 uIU/ml, is that right?  Similarly, her most recent bloodwork in August, before you stopped soaking, showed an insulin about 30 uIU/ml.  I suspect the soaking was helping her because during her laminitic event in early April insulin would have been much higher.  With insulins that low, if she was in pain it would be related to trim, damage due to the earlier laminitis (which takes time to resolve because the hoof must grow out first) and/or abscess mobilization, but not acute laminitis.  Unfortunately, soaking hay doesn't help with non-laminitic pain, but it might be that since you stopped soaking, her insulin has climbed again and you may be back into acute laminitis.  Your new bloodwork will tell us if her current pain is from acute laminitis, assuming blood was pulled before you restarted soaking hay today/yesterday.

Another volunteer mentioned to me privately that the numbers on your hay analysis are reported as dry matter, so the as fed/sampled values that we go by would actually be 7.9% ESC + starch once moisture is accounted for.  She also said that your hay analysis is by NIR, which as Martha pointed out can be inaccurate by a significant amount.  We find that NIR commonly UNDER reports actual sugar and starch contents.  If you add 20-30% to your as fed/sampled total, your actual average ESC and starch content could be as high as 10.27%.  Many IR horses will be sore on hay with this high of an ESC and starch, especially if not being exercised (which you cannot do at this time).  I would definitely be soaking.

While many of us have trialed pergolide, and it has helped some horses that did not appear to have elevated ACTH, usually we look for other signs of PPID, like topline loss or elevated ACTH during the seasonal rise to also justify meds.  However, I don't think a trial would cause any actual harm, other than the usual temporary veil effects we see, like lethargy and inappetance.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Jessica Gunderson
 

I have been using Phyto-quench for Khan and it is on backorder since Nov. 10, contacted Uckele and it sounds like it will be on back order for a few more weeks. What other alternatives can I give Khan given she will be done with bute tomorrow and only has a few more days left of phyto-quench after that?
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


 

Hi Jessica,
Are you using the pelleted Phyto-Quench?  That is popular because it contains Devil’s Claw but I’ve seen others here using other products with DC or DC by itself.  If you search the messages here on “Devil’s Claw” you’ll most likely find some alternatives.
--
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


 
 


Jessica Gunderson
 

Given Khan is so skinny, can I up the pounds of hay soaked she is getting from 20 to 22? 
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


 

I would say absolutely!  Does she seem hungry enough to eat more?  Could you include some body shots in your album?  Those numbers are just guidelines, mainly geared toward keeping a horse at good weight.  It may be that some of the numbers you’ve used to calculate the hay are incorrect or that she just needs more hay.  Extra unneeded pounds on her body will just get in the way of whatever is being done to relieve hoof pain.  

I keep returning to the diagnosis part of DDT&E.  In my mind, this has not been completely resolved but someone else might feel more comfortable about it.  I can’t quite dismiss the possible involvement of the puncture wound, even though I’m not sure how it might have contributed.  From her breed and her elevated insulin, I have no doubts she should be treated as IR but the cause of the laminitis isn’t clear to me as the insulin hasn’t been high enough to trigger that.  

--

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


 
 


Jessica Gunderson
 

She is most definitely hungry and would eat more.  I have uploaded body condition photos of Khan currently. I also am very anxious Khans laminitis is more complex.
Another hay question.  Can you soak multiple hay nets at once and then let one or more of them drain until the next feeding or do they need to be soaked and drained directly before feeding? If I could do both for the day, or even the night before for the next day that may be helpful.
--
Jessica and Khan
N.D., 2021
https://ecir.groups.io/g/CaseHistory/files/Jessica%20and%20Khan
CaseHistory@ECIR.groups.io | AlbumCaseHistory@ECIR.groups.io | Album


 

Jessica, when I need to soak, all my hay for the day gets soaked in the morning, hung inside the barn and fed out as needed.  I don’t take any special precautions against freezing.  Frozen hay doesn’t seem to bother the horses.
--
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