Prascend to pergolide
I have my 25 year old on 2.5 MG prascend daily to anticipate the horrid seasonal rise that set him over the edge last year and brought on laminitis. The cost at $340 a box at 2.5 pills a day is roughly $170 a month and I cannot keep up with that cost. What is the conversion rate from prascend to compounded pergolide capsules? Where are the best places to buy the compounded capsules?
Or should I consider cabergoline?
Diet is below but can you advise if I'm doing things properly?
I have him on magnesium oxide powder daily as well as chromium in hopes that those two additions can help ensure insulin levels stay balanced.
Also gets stabilized flax seed and Cal Trace Plus. His supplements are mixed in 1 quart of Hygain Zero and 1 quart of 50/50 alfalfa Timothy pellets that are given once daily. He won't eat straight Timothy pellets( gotten very picky as he's gotten older). He gets hay twice a day in a hay net for slower eating with a snack sometimes mid day depending on how quickly he finishes his morning hay. AM is 1 flake of alfalfa and 2 flakes of bermuda(would prefer Timothy but due to dental issues brought on by cushings Bermuda is easier for him to chew. He's been on Bermuda for 2 years with no issues). Would like for him to be off alfalfa but his weight has been harder to manage the last couple years. PM hay is 2-3 flakes of Bermuda.
Will be having PPID labs done in the next week or so to see if what I'm doing is working to manage ACTH and Insulin levels.
Erica H CA 2021
Others will join in and help answer your question, but it is best to complete a case history for us to help you. I personally have 2 equines on compounded pergolide at 2.75mg each. I also couldn't afford having them on Prascend either- so I feel your pain! Many of us use Pet Health for our compounded pergolide. They are very friendly, convenient and helped me personally with my conversions. If you use the search bar for "pharmacy" you can see many reviews. You can also visit www.pethealthrx.net to receive some answers on that particular Pharmacy. Your vet will still have to write you a prescription though. Also, please know the ins and outs of having to properly store it and how many days of supply to have on hand, since it does lose its potency. You may or may not have issues trying to convince your vet to write you a prescription depending on their knowledge and experiences- that's why its best for you to be well versed on the subject so you can argue your case.
The two supplements do not balance insulin levels- so not sure where you received that information. Diet and exercise are what will help or hinder insulin levels. I alos do not recommend giving any alfalfa.
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Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.
DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.
The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".
In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk
*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.
*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now.
Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed.
No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:
We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse.
*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it). The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers.
There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it.
What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only.
No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.
We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.
TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.
Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet.
You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.
EXERCISE: The best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.
There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.
If you have any technical difficulties, please let us know so we can help you.--
Primary Response Team
September 2018, Summerfield, FL
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If you do switch from Pracsend to Pergolide be sure your vet writes the prescription correctly: "x mg of pergolide, as pergolide mesylate" so your horse is getting the same does of pergolide. At that amount of pergolide cabergoline is going to be more expensive so I wouldn't considering switching at this point.
I'm not sure how told you MgOx and Chromium will help with insulin levels but that just isn't true. What will help is tight diet control and exercise. Has your horse been diagnosed with IR or just PPID? We don't recommend any IR horse be given alfalfa but even some PPID horses can't handle it. If he's having issues maintain weight you need to make sure his PPID is well controlled by his dose of medication.