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Vet doesn't want to prescribe prascend

 

Ok, Po's new blood work is in his Case History folder. I plugged in his info to the calculator and he's still Compensated IR. Which is good. But he's still unexplainably laminitic, still drinks TONS of water, and still doesn't sweat. His new ACTH numbers are higher than 5 years ago (both taken in Oct): 44 vs 57. My vet doesn't want to put him on pergolide because in her opinion his numbers didn't reflect PPID. I floated the idea past her of putting him on pergolide anyway since he's symptomatic. I also told her I'd post on this forum to get y'alls opinion. 

So, in y'alls opinion, should he be on pergolide?
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Coral & Po

Sept 2013

Midland, Texas

Case History: https://ecir.groups.io/g/CaseHistory/files/Coral%20and%20Poseido  .
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=107390  
**On the old forum site I had a bunch of hoof photos posted but those appear to be lost. **

Lorna
 

Hi Coral,

I was just in his CH,but only see blood work from 2015. Did I misunderstand ?

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Lorna Cane
Ontario, Canada
2002


 

celestinefarm
 

Coral,
Print out or give your vet the following information 
https://cvm.msu.edu/vdl/client-education/guides-for-pet-owners/equine-endocrinology-pituitary-pars-intermedia-dysfunction-ppid
Here is an important section to highlight.
"For horses with more subtle clinical signs, sometimes called “early” PPID, ACTH can remain normal and dynamic tests may be needed to uncover abnormal hormonal responses caused by PPID. These tests include the overnight dexamethasone suppression test and thyrotropin releasing hormone stimulation test which evaluate the pituitary gland’s ability to respond to administration of these agents. Unfortunately, diagnostic tests have limitations and may still yield normal results in the early stages of PPID. Until more sensitive tests are developed, the decision to begin treatment is sometimes based on the presence of clinical signs alone. "

http://www.thelaminitissite.org/articles/is-it-ppid-or-is-it-ems
"There appears to be a transitional period between the diseases during which horses have both EMS and PPID at the same time.  These horses often have higher insulin concentrations and potentially a greater risk of laminitis, therefore treatment should be instigated as early as possible.

It isn’t yet known whether EMS and PPID are causitively linked – i.e. whether having EMS causes PPID.

In Dr McFarlane’s experience, a horse with PPID that has never had laminitis and has normal insulin is not at greater risk of developing laminitis than any other horse.

Equine endocrine diseases are progressive and difficult to diagnose in the early stages – there will always be a grey zone for testing in the early stages of a progressive disease.  Retest horses that are suspected of having EMS/PPID if they have negative results, and/or instigate treatment.

History and clinical signs are essential for early diagnosis – a diagnosis should not be made on the basis of diagnostic test results if there are no clinical signs."
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Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

 

Hi Lorna,

His new blood work is in there. Here's the direct link: https://ecir.groups.io/g/CaseHistory/files/Coral%20and%20Poseido/POSEIDO-RICHLINE-CORNELL-LAB-RESULTS%20OCT%202019.pdf

His ACTH is much higher than the lab normals, but I dunno what constitutes a high enough ACTH to diagnose PPID. 

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Coral & Po

Sept 2013

Midland, Texas

Case History: https://ecir.groups.io/g/CaseHistory/files/Coral%20and%20Poseido  .
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=107390  
**On the old forum site I had a bunch of hoof photos posted but those appear to be lost. **

Lorna
 

Hi Coral,

Thanks.
If he were mine I'd be treating for PPID and IR, both.

Can you transfer your blood work results to your case history,so that we have all the information in one place?

Last blood work there is 2015. But you can see that the ACTH has increased since then,looking at October as the month being compared.

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Lorna Cane
Ontario, Canada
2002


 

 

OK, that's how I feel too. He has several symptoms, he's just not at the acute phase yet. I don't understand why my vet doesn't want to give him pergolide, but I'll try to push it. I guess if she won't prescribe it, I'll try a different vet. 

I'll enter his labs into the case history file. 

Thanks,

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Coral & Po

Sept 2013

Midland, Texas

Case History: https://ecir.groups.io/g/CaseHistory/files/Coral%20and%20Poseido  .
Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=107390  
**On the old forum site I had a bunch of hoof photos posted but those appear to be lost. **

Eleanor Kellon, VMD
 

You could ask your vet about doing a TRH or domperidone stimulation test.
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Eleanor in PA

www.drkellon.com  2 for 1 course sale
EC Owner 2001