New labs in - advice on increasing Pergolide & arthritic pain relief


rozaniloc@...
 

Hello -

ACTH 30.3
insulin 33.4

We just received Sunday's ACTH & insulin results drawn July 1. While both are down from results at the end of May, ACTH is still too high, & while I am relieved insulin has come down, it is still too high. I assume I should increase his Prascend again - we increased it to 2 tabs the end of May, so I assume to increase by another tab, for 3 total? When I increase, should I do it by 1/4 tabs, or with him on it already can I increase it more quickly? My vet is totally on board with switching to compounded pergolide, which I will do as soon as I run out of Prascend, although I have enough for about 2 months - just bought a box. I wanted to confirm how to write the script please when my vet orders it from the pharmacy. Will it be 3 mg pergolide as pergolide mesylate? 
Sunday has significant soundness challenges & he does not do well with devil's claw. I give him chondroitin, boswellia, curcumin, HA powder & jiaogulin. We think most of his discomfort now is coming from the hind end, possibly sacroiliac joint &/or sacrum. My vet would like to just use firocoxib, given his age & the benefit more movement would give him. I know Dr Kellon does not like long term use - could you please explain the technicalities & I will, as I always do, pass it on to my vet. Thank you. If firocoxib is totally off the table, do you have other suggestions besides what I already use & devils claw. 

With gratitude for everything you have done for Sunday & me, my thanks. 

Rozanne & Sunday
July 02 2019  Larimer County, Colorado
case history:  https://ecir.groups.io/g/CaseHistory/files/Rozanne%20&%20Sunday 
photos:  https://ecir.groups.io/g/CaseHistory/album?id=93586  


Eleanor Kellon, VMD
 

Yes, I would go to 3 mg and prescription as you said. Many people decide to go with long term NSAIDs in older horses, and if there are no options it's not a bad thing,
even if it does cause kidney and/or colonic disease. Before going there, I would suggest a rectal exam to check the pelvis for fractures and the SI joints for displacement.  Do you have access to an acupuncturist? Acupuncture and/or trigger point injections with Sarapin would be my first choice.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


rozaniloc@...
 

Thank you Dr Kellon.

Yes, my vet is an acupuncturist, so I will see about scheduling a session. I believe his unsoundness is from deterioration age related to long term issues. When I started riding him, the vet who treated him then always mentioned the sacroiliac thing. He also had torn hamstrings in the past. Sunday was a stallion until his teens, when he was gelded after a testicular hernia. Then he was sold, although he did not pass the vet exam due to arthritic changes in left fore & I believe left hind. He came to live in this state, but when unsuitable for the new owner, could not be sold due to these issues. So he chose me as his new person. :) Lucky me! He has been such a blessing. He is walking out pretty sound, & also will canter & capriole :) - the lameness is most evident at the trot. I will try to get a short video to post this weekend. I may be able to supple up that sacrum area with some good ground work & lateral work at the walk - I just want him feeling as good as possible. Perhaps a short course of the firocoxib as we start his conditioning, seeing if it could be discontinued after a few weeks of suppling work. 

I will recheck his lab work in 3-4 weeks.

Thank you again!


--
Rozanne & Sunday
July 02 2019  Larimer County, Colorado
case history:  https://ecir.groups.io/g/CaseHistory/files/Rozanne%20&%20Sunday 
photos:  https://ecir.groups.io/g/CaseHistory/album?id=93586