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When to retest after starting prascend trial

jmc
 

FYI, CH has been updated, and I've uploaded this year's hay analysis.

Yankee was started on Prascend on 25 July, 1/2 pill.  He did so well on 1/2 that I left him on that level until he started peeing more again... so he didn't reach full prescribed dose (1 pill) until Aug 8th.  He was last tested in Feb, ACTH was 39.5. He hasn't been retested since.

So, my question is - when's the best time to have him retested to see if the Prascend is having an effect? The main thing I've noticed is that his drinking/peeing is mostly reduced, though it seems to be a day by day thing.  He hasn't really gained any energy back. He's never shown any lami symptoms so nothing to go on there.

Also, if someone could take a peek at my new hay analysis (Reed; I left last years - Tolman- there for comparison if needed, and because I still have about 1/2 ton left)), I'm a bit concerned with the NSC value, though the ESC +Starch should be within bounds. Please ignore the mold count, it's very scary but it is hay that was rained on as bales still in the field, so that's the mold on the outside, which I pull off. Inside seems fine, though I'm pulling every flake apart and shaking off dust, just to be sure. it is a terrible year for hay here, so this is the best i could do :(


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Jodi
June 2018
NW Wyoming

Yankee Case History: https://ecir.groups.io/g/CaseHistory/files/Jodi%20and%20Yankee

Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=54386

Lavinia Fiscaletti
 

Hi Jody,

There is no doubt that the Prascend is having an effect. The question is whether you are getting complete control of the ACTH or not. Right now, the seasonal rise is in effect so ACTH is steadily rising. Because Yankee's ACTH was elevated back in Feb but he didn't start his meds until late July, you are "chasing the numbers" as the climbing ACTH keeps exceeding the current pergolide dose's ability to fully control it. That's why you see some improvement in the symptoms but not a steady one. In a PPID horse, the rise will continue into at least Oct before plateauing.

If this was one of my horses, I'd plan to increase the dose to at least 2mg before retesting, and hope that is enough of a jump to "catch up".

ESC+starch is 6% in your hay - which is definitely safe. NSC is an outdated term and doesn't matter.

The Smart metabo-lean and Smart lamina are a waste of your money. Stop the Redmond salt and only use plain white or iodized. Really should have your minerals balanced to your hay analysis as you have deficient copper and zinc; several supplements that are adding magnesium; imbalanced calcium to phosphorus ratios.

Realize you are in a tough spot regarding hay but horses are really sensitive to mold so be very, very careful.

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Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team

jmc
 

Lavinia - thanks for the advice. The Redmond is mixed with plain salt so I'm using that up before going to just plain loose salt (at this point the Redmond is less than 1/3);  I forgot to note on the CH that I do supplemeny copper and zinc; he is on a lot of supplemnts for his PSSM2, haven't sorted out the best way to note that. He needs a boatload of magnesium (various types) due to his muscle issues. He is complicated, but what he is getting is working for him. 

Bit when should we retest? Will do the full panel, as I want to ensure his IR is still under control as well.

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Jodi
June 2018
NW Wyoming

Yankee Case History: https://ecir.groups.io/g/CaseHistory/files/Jodi%20and%20Yankee

Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=54386

Tanna
 

Hi Jodi  

Consensus appears to be to retest three weeks after reaching your target dose. 

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Tanna 

April 2019, (Yahoo Group member 2008)
Langley, BC, Canada

Tula's Case History 

Tanna
 

Lavinia, Jodi's vet had recently agreed to allow for a "trial" of Prascend and prescribed a dose of 1 mg.

You have indicated that if this were your horse you would aim for 2 mg. Should it not be necessary for Jodi to consult with her vet about such an increase or do you, and others with far more experience than those of us who are newer to the journey of PPID, find yourselves increasing and adjusting during the rise regardless of "prescribed" doses? 

Thank you


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Tanna 

April 2019, (Yahoo Group member 2008)
Langley, BC, Canada

Tula's Case History 

celestinefarm
 

Hi Tanna,
Whether Jodi consults with her vet depends on the understanding she had with her vet regarding dosages for Yankee with Prascend was prescribed. There are many vets who understand the physiological reasons for a horse to become affected with PPID and there are some who do not. Members here have had to deal with vets who think because BI advertises that a "tablet' will control their horse's PPID , indicating that is a lifetime dose, that raising dosages higher is somehow out of standard practice, can cause liability issues, and also offends their position as appearing more knowledgeable than their client, since they are the licensed vet. 
It's a tough position to be in, and one that requires some finesse to manage. I don't know for certain what category her vet is in.
If I were Jodi, I would report to her vet what symptoms have been improved and what haven't, and that she wants to slowly increase the Prascend to 2mgs, if necessary, to see if the additional symptoms are improved.  If the vet balks, then she knows she has a problem and will have to address it accordingly.
I haven't looked at Yankee's ACTH testing to see what lab she used. MSU 's endocrinologists, for the past couple of years, have written in their interpretations of results I've received for my own horses, a lengthy encouragement to provide pergolide at dosages that control symptoms and to NOT simply treat by numbers. I would think they are not the only endocrinologists to encourage vets and clients to do so. If there are such notes, I would use that as backup for my position to increase Prascend.

To answer your question after that lengthy non answer, LOL, yes, those of us who are more experienced with PPID are often quicker to recognize symptoms and get an pergolide increase BEFORE a more serious symptom rears it's ugly head such as laminitis.  Unfortunately, that experience often came from missing symptoms early. It's why the group encourages members to keep a journal of symptoms, observations, etc on their horse, including the degree to which the symptoms are expressed, weather, stabling and turnout time, etc.  so they are more likely to see something early. Not everything is caused by PPID, but PPID and IR early signs are often assigned to other causes and can be mentally discounted as one off's ,etc. when they really are signs of increasing dysfunction. Those of us with experience are trying to help those with less not make the same mistake.
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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 .

Sherry Morse
 

Tanna,

One of the reasons for recommending a higher dose is that she's 'chasing the rise' right now and where he may have been controlled if he'd started on 1mg earlier this year now that we're into the seasonal rise period his ACTH may be increasing faster than the 1mg can control.  Dawn already addressed the BI marketing campaign that 1mg fits all needs which we've found to not be the case with so many horses here.

It's definitely a bit of a balancing act and one of the options is getting him on 1mg and then retesting after 3 weeks and assessing his numbers then.  Depending on symptoms I might opt to do that but would continue with a bump up (assuming the vet is wiling) unless that lab result showed him solidly in the middle of the reference range.  If the results came back as he was controlled in the midst of the rise on 1mg that would be wonderful and he could stay there rather than continuing up to 2mg.  


Lavinia Fiscaletti
 

Yankee was positively diagnosed with PPID in Feb but medication was not started until July - which puts you squarely in the position of "chasing the rise" to attempt to gain control of the increasing ACTH. There is no mention in the case history of why there was a delay in starting the meds.

Always need to discuss prescribed medication doses with your vet. No one here can prescribe for another member's horse but those with experience can relate those experiences as examples of what might need to happen. Those who have been on this PPID merry-go-round for a longer time, and have good working relationships and the consent of their vets, may have more leeway in making dosing changes more rapidly as needed.

Lack of consistent symptom control: ongoing flat feet and sensitivity plus lack of energy (possible sub-clinical laminitis), fluctuating PU/PD are red flags for lack of good control of the PPID, which would necessitate an increase in the dose of pergolide to correct. Based on the experiences of members here, it can take double, triple the non-seasonal dose of pergolide to maintain good control of the ACTH thru the seasonal rise period and keep the risk of laminitis to a minimum. That 2mg dose is an example of what it may take to get a handle on the situation with Yankee so that Jodi has information to use in a conversation with her vet.

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Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team

jmc
 

Thanks all. I have an excellent relationship with my vet, I think I'll sched the test for 3 weeks after he hit 1mg, then discuss if we are chasing the rise. He is doing well atm, this is my plan unless he starts leaving ponds again (ah, the joy of !ules teaching !y horse to pee in the same places, every time. Mule ponds, made by a horse with a gigantic bladder...
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Jodi
June 2018
NW Wyoming

Yankee Case History: https://ecir.groups.io/g/CaseHistory/files/Jodi%20and%20Yankee

Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=54386