Thank you Nancy & Sherry, appreciate your support.   I am starting to wonder if I should be increasing her dose of pergolide reading through what some other recommendations were for far lower results.  I just got the capsules from my vet, it says they are 1.1 mg, I still have the powder as well, the vet told me to give her one capsule and 1/2 scoop of the powder for a couple of weeks... and then I don't know what.  She is still so very sore and doesn't seem to be getting any better, so could it be she needs a higher dose?   Also, the vet said we should test her again in 2 to 3 months, but if we wait that long how do we even know if it's working?   She has been on it for a month and other than her losing weight because of her new diet I see no improvement in the amount of pain, it seems worse.  Would it hurt to bump her up to 2mg?   Or 1 of the capsules and a full scoop of the powder?  

Her results about a month ago::
Pre TRH Response at 25 pg/mL and post at 305.  Her Insulin was at 115.59 uIU/mL.  Prescribed  "a heaping scoop" of "Cushings Powder" (the label says 1- 5ml level scoop contains Pergolide 1mg and Cyproheptadine 180mg),    
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Lori J in NC 2022

Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Hi Sherry,  I did start working on the Case History, I'll try to finish that up and post it.  I will also get the full set of hoof photos, she was just trimmed yesterday.  She is quite comfortable in her boots/pads, if I take them off and she is on the pea gravel in the dry lot that is when she is very sore.  I did have blood drawn on Monday to re-test her insulin, waiting on results.  At that point she had been off metformin for a few days because I had run out of it and thought I had read that it wasn't really useful.  She had been on it for about 3 weeks before I ran out.   The vet asked me to put her back on it, so she is now getting 10-1000mg pills 2x per day.  

I don't have her on Phytoquench w/DC or Devil's Claw, is there any benefit to doing one over the other?  If I go with just DC, is there any certain brand that is best for her?  

I did check with the EA folks about the hay sample test and this is what she said:  
Based on my findings this sample was analyzed with the 601 Equi-Tech which is a combination of NIR and Wet Chemistry minerals.

So I think that means it is okay to feed her without soaking?

Thank you again for your help!
Lori

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Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Hi Lori,
The combination of wet chem and NIR means that the carbohydrates are measured with NIR and the minerals with wet chem.  If they still have the sample, you can ask them to rerun just the carbs with wet chemistry.  You are looking for ESC and starch values from wet chemistry testing.  The E-A 644 provides that but you’d need to ask if it’s wet chem because I’m not sure.  
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Thanks Martha,  I will ask them.
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Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Thank you Sherry.

Martha, this is what I heard back from EA:  Unfortunately we do not have this sample anymore as we are only able to retain samples for 2 weeks.  If you would like a wet chemistry test performed we will require a new sample.

So I guess that means I either need to keep looking or buy the hay and send another sample and keep soaking until I get results?
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Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Hi Lori

Not sure if this will help but....

I just got my wet chem results back and they are indeed 26% higher for ESC than a quickie NIR test I ran earlier. I use the NIR in this case so I could decide if it would be low enough to proceed. I use the 30% rule applied to NIR to see if I am still safe. I was. This helps me get back to the grower more quickly.

If we apply the "30% rule" to your NIR test that would put you at 8.45 for ESC. Given her current status you'll probably need to keep soaking at least in the foreseeable future. To add to confusion, some folks have not had the issue with variable ESC results when testing side by side NIR and Wet Chem. If you have good supply options to look elsewhere, that would be your safest bet.  Would the the grower hold the hay for you while you test wet chem?  Long shot, I know.

It's nice hay as far as palatability and digestibility go.  Protein good. Will need calcium and phosphorous, copper and zinc to balance.

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Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022

Thank you Nancy, That is helpful, I am curious though, if it was indeed at 8.45 for ESC, isn't that good since I thought we were looking for under 10?   This hay stuff is confusing!  Or, maybe you are just saying she will need it soaked because of how high her numbers were?    Unfortunately it's really difficult to find a supplier who actually tests their hay at all, this place boasts having hay low in sugar.  I have never used them before, so I am not really sure how fast they sell their hay or if they would hold it.    I am feeling like I need to get something better than fescue quickly even if I do have to soak it :(   and as you said, this hay does seem to be nice quality.  I have been giving her copper and zinc for years, I just bought some of the Triple Crown ground flax, will that give her enough calcium and phosphorous?   I think I read 4 oz. is the suggested amount to give?

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Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Lori,

We don't know the actual ESC or starch level of your hay. The 8.45 is an educated guess based on the NIR test results. That's why you still need to soak.
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Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response

PA 2014

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

Good afternoon,   I ended up having the timothy/orchard tested via the wet chem test to make sure it was okay to not soak, at the same time I sent in a sample of the fescue I have been feeding to my other two horses (I know it's not recommended, but I have been feeding this hay to them for at least 8 years without an issue) just to see what the numbers would be because sometimes my morgan gelding has a cresty neck.   It looks like both are under the 10% for ESC and Starch, so both should be safe to feed without soaking?   I have not been feeding Abbey the fescue, although she does end up getting some at night (it is soaked) because she is the boss of the herd and I don't have an easy way to separate her from the boys.  What should I be looking at for the protein values?   Are either of them too high in that regard?    I would like to avoid having my gelding go through this, although he is looking pretty good since he has been restricted to smaller pasture areas where Abbey can see him at all times :).  

I posted the results here:
https://ecir.groups.io/g/CaseHistory/files/Lori%20J%20and%20Abbey/EQ151480.pdf 

Thanks so much!

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Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Thank you Sherry,  My gelding actually looks really good right now, he has no fat pads (and never has) and his neck is not cresty, he's basically on a semi-diet because of what happened with Abbey.  I did have him tested a few years ago and he was not IR, I know that can change, but he doesn't really have signs of being IR like she did.  May be worth it anyway just for peace of mind, it is a good suggestion.

What I really wanted to know is given the hay tests I posted in my files, is it safe to not soak?  I just want to make sure I am looking at the right values to determine that for both types, because as I said she does sometimes eat a little bit of the fescue. 

Thank you.
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Lori J in NC 2022
Abbey's Case History: https://ecir.groups.io/g/CaseHistory/files/Lori%20J%20and%20Abbey
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Hello,   I have a quick question to the group to see if I am maybe over analyzing what my vet is telling me is okay for dosing pergolide for Abbey.  The situation is, I have her on 2.2mg right now, I am getting low, so I asked her admin person if she could order that for me, she said she would yesterday.  She just called me a little bit ago and said she has 2mg in stock and I could come get that.  I told her I didn't want to go down in dosage because of the seasonal rise, so she called the vet to see what she thought, called me back to say the vet said .2 is not going to make a difference.  I have no idea if this amount is even the correct dosage for her, I am going to have her retested in a couple weeks just to see, but it seems like I shouldn't change it, especially lowering it?

Thank you,
Lori
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Lori J in NC 2022
Abbey's Case History: https://ecir.groups.io/g/CaseHistory/files/Lori%20J%20and%20Abbey 
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Thank you Sherry,  that makes sense... both on the case history and the dosage.  
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Lori J in NC 2022
Abbey's Case History: https://ecir.groups.io/g/CaseHistory/files/Lori%20J%20and%20Abbey 
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Hi Lori,
How do you usually get your capsules - from the pharmacy or the vet?  My concern would be how long those capsules might have been sitting at the vet’s and under what conditions.  Could they have been purchased for someone else who didn’t collect them?   I’ve been getting mine directly from the pharmacy for many years, with different vets and different pharmacies.  If that’s an option, I’d recommend it.  As Sherry said, the dosage difference itself isn’t likely to make a difference - but fresher drugs might.
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Hi Martha,  I have only gotten them once so far (she was on the powder when this first started back in June before I found you all) and they were from the vet.  I didn't think to ask her at the time how long she had them, but the expiration date written on the container says December for whatever that's worth.   I will ask them on Monday how long they have had them and also ask if I can order them myself from the pharmacy so I don't have to go through this with them every time, it's very painful because they are so unorganized.   I have been reading in other posts about shipping in the heat/cold, how do you deal with that?  Or do you actually pick them up from the pharmacy yourself?

Thank you for your feedback!

Lori
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Lori J in NC 2022
Abbey's Case History: https://ecir.groups.io/g/CaseHistory/files/Lori%20J%20and%20Abbey 
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 

Hi Lori,
I would pick them up if they were close by but mine come from NYC.  They are always shipped overnight and to my house, not my mailbox.  You could have them shipped with a cold pack, if they’re protected from condensation.  Keep in mind that they were shipped to your vet somehow and undoubtedly sustained some heat if that process as well.
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