I’d also be looking at the protein in the alfalfa and making sure it’s not excessive and driving up her insulin. https://www.americanfarriers.com/articles/8036-alfalfa-and-the-insulin-resistant-horse
My elderly pony (well into his 30s) tested positive for Cushing’s. He started on compounded pergolide capsules, and he just didn’t seem to be doing any better. He was far too thin and his coat wouldn’t shed out until late summer. I had the vet out again, and we decided to increase his dose. Unfortunately, he died two days later, so I never found out if it would have helped. When he died, I suspected the compounded pergolide just wasn’t doing what it needed to.
I was strongly considering euthanizing him when he died on his own. He seemed happy all the way to the end, with foals to watch and lots of human attention, and he’d nicker to me when I arrived at the barn. But his physical condition was just breaking my heart, and I thought it was time to let him go.
Rebecca
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I have a 28 year old PPID mare. She has muscle wasting, but other wise does very well. She’s on 2 gms powdered Pergolide, and Chromium Yeast from Platinum Perfomance (2 scoops/day). The CY helps to maintain normal blood sugar levels.
OP- questions:
Could you post all or more lab results for these tests? (Dates and doses).
Was your horse originally dx’d via TRH Stim Test? The results shown here a follow up perhaps?
Why was this Stim test done?
The baseline here looks positive for PPID.
What does +10 and +60 mean?
There are horses that need higher doses.
Maybe your’s is one of them?
My horse would not accept / eat Prascend so he’s been on compounded Pergolide since diagnosis about a year ago.
(Baselines negative two previous tests - positive TRH Stim).
Dose 2 mg/day - increased to 4 mg/day for seasonal rise this past summer - which was not enough.
Last summer (not Dx’d - no meds) and this past summer my horse abscessed badly front hooves.
July 2021 when SR was gearing up.
Last week of September 2022 - the very week of peak of SR.
We’ve kept my horse on 4 mg/day and will increase even more for 2023 SR.
The ECIR group goal is of course no laminitis. I also say no abscesses.
The elevated ACTH is catabolic to tissues ie tendons and ligaments.
It effects so many parts of the horse.
I buy the compounded capsules from Wedgewood - 30 days at a time and store properly.
I’ve seen where some horses need 5, 10 and more mg’s a day.
At this high of a dose it only makes sense to go with compounded from a reputable pharmacy.
The dose that controls PPID symptoms is the dose you want to give - which can also have effects on insulin - by lowering it.
If you don’t want to read on the ECIR group - there is a FB group for equine PPID/ Cushings.
Very knowledgeable and helpful folks on both groups.
Also IIRC trailering to vet could effect the tests.
Maybe re-test again soon?
I’ll see if I can get all these answered.
Last test was November 2020. TRH stim, which indicates the +10; ten minutes post TRH stim. Results were 72 pg/mL baseline, 851 at +10.
The +60 is 60 minutes post-karo syrup for the insulin testing.
At the time of the 2020 test, she had been on 1 mg per day Prascend with previous owner without testing due to muscle wasting and lack of shedding.
After I had her tested in 2020, we bumped to 1.5 mg per day. I thought I had her tested a second time, but I’m not finding results in my email. The vet(s) are at CSU’s reproduction lab. So having the mare in and out for breeding, we may have had had conversations regarding clinical symptoms and decided to bump her dosage. I honestly can’t remember if there was another intermediate bump in there somewhere.
Summer last year we bumped to 3 mg as the mare was not shedding despite a very hot summer. She started shedding a few weeks after the dosage bump.
It would appear my vet is going by literature that the max dose is 5 mg. I can’t quite wrap my head around doing much more than that. $$$$
I do realize the effects that PPID has on the body. It would appear despite high test results, my mare isn’t as effected as some. Her feet are great, knock on wood, has not abscessed since I’ve had her. Not lamanitic now or in the past. Not obese but not skinny either. Easily keeps good body weight. Symptoms being muscle wasting on her top line and some fat deposits that aren’t extreme by any means.
So it seems to me that test results aren’t proportional to symptoms. Which begs the question: treat the test results? Or treat the symptoms?
Could test again but it won’t be at home. I love a little over an hour from CSU and they are who do the testing. I doubt my local vet would do it, and even if they did, they don’t do farm calls as far out as I am. So unfortunately, hauling for testing is my only option.
The IR testing was done so that I know if I can safely turn her out on a little bit of grass during the very short growing season I have. I know it would make her old lady heart so happy to have some grass…. But only if it’s safe.
Years ago when I had my previous horse he was taking 5mg Pergolide and was still testing above normal levels. My vet didn’t want to increase it and insisted I start Prascend, which was still a bit new then. I changed to Prascend and he was controlled on just 1mg, then a few years later needed 1.5mg. The Prascend is just more stable and exact. More expensive, yes, but probably about the same as a much higher dose of Pergolide.
You could try chastberry powder, which was supposed to be an herbal treatment for Cushings. It does control the symptoms, like coat/shedding, energy, increased thirst/urination, but did not control the ACTH. SmartPak has their Smart Pituitary supplement that is helpful (but many reviewers incorrectly use it as a replacement for Prascend).
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I thought I had found some reason to not use chastberry. But I can’t remember what. Maybe it was the anecdotal evidence that it doesn’t work. But who knows the other variables; maybe the horse wasn’t on pergolide and they were wanting cheaper results from chastberry alone. Need to make sure there won’t be any negative effects on reproduction; she gets embryos flushed every spring.
I want to try Prascend again and possibly some other added support via chastberry and/or cyproheptadine. But one at a time so I know what works and what doesn’t.
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Bromo - No don’t use Chaste tree berry with Pergolide or Prascend.
It interferes.
I think you need to read on ECIR and the FB page Equine PPID (Cushings).
I’ve learned a lot from both groups.
The FB page is more user friendly - at least for me.
Post your questions there ?
I would ask on both groups, personally.
Dr Kellon - ECIR - recently started a study on the Stim test.
My horse is in the study.
The post Stim results value is mostly an unknown in regards to dosing.
Something to keep in mind.
My horse had two normal baselines (Feb 2019 and July 2021) before we did the Stim test. ( April 2022).
We did the Stim tests two months apart.
Both baselines for my horse were in normal range. The two posts were elevated - giving DX of PPID.
First Stim test horse was not on meds and was done in April - a known low month for ACTH levels. (Though an untreated PPID horse should still show elevated levels).
Second Stim test he had been on Pergolide ~two months - and was done in June during the start of the seasonal rise - which IMHO skewed the post results…
Some horses - like mine - show normal baselines for years.
When symptoms present it’s a good idea to do the Stim test.
My understanding is that the Stim test is for diagnostic purposes only.
So with my horse we will have to adjust his dose acc to symptoms.
I’ve also learned my lesson the hard way - as others have - to be mindful of the annual seasonal rise.
It can hit some horses surprisingly and unexpectedly hard.
All seems relatively Ok until the day you see your horse lame ASF.
Abscesses and/or laminitis.
Don’t let that happen.
That’s a big part of the goal.
The PPID needs to be controlled.
As well insulin
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@BroncoMo So …a few things to take into account …was this a fasting bloodwork /OST ? , second trailering can cause stress which can elevate results , 3rd if acth remains uncontrolled it will continue to drive the insulin higher and also has Lyme been checked ? That also can elevate insulin, how are the teeth ? Reason I ask is because my gelding has EORTH and his acth and insulin were always high despite medication and proper diet management…one his teeth were removed which in turn removed infection and inflammation from his mouth his numbers came down drastically -so something else to consider …and yes Cyproheptadine can be given in addition to Pergolide for refractory cases that aren’t responding favorably to Pergolide alone.
What is your horses diet specifically? Often times that has a lot to do with IR/EMS/Cushings ?? Are you feeding tested low sugar hay ? Or soaking hay if you don’t know the analysis? I would recommend following the ECIR guidelines of the emergency diet and refer to Dr Kellon until these numbers are back to normal ranges
Yes the interference is what I was concerned with. I did some googling and found the literature I was thinking of, but got swamped with work and did not have the energy to come back and post my findings.
I have been on the ECIR page and group for a while and still find information aggravating to find. I’ve asked questions in the group before and never got a response, so that was quite a turn off. I still maintain that there should be some focus in the group on non-laminitic PPID horses. Yes, I realize my horse could turn laminitic as well. I totally understand that. But it seems the group is focused on “NO MORE LAMINITIS! Stop it now! Here’s an emergency diet!” Well my horse isn’t in an emergency. I just want to know how to interpret insulin and glucose results. It would be great if they had a section on that…
I’ll post the question again, but the group and page have been quite the turn off in the past…
I do realize the TRH stim test does not correlate to dosage. That’s why we have done a the “try this dosage and adjust later” method. If there is a different test to use, please advise. Because again, the ECIR group has not been useful to me in that sense. If that information exists, perhaps they should make it more easily accessible.
So you say that you’ve had to adjust dosing to control the symptoms. That is what we are trying to do. But my (repro guru) vet is concerned about the ACTH levels. Admittedly I do not know the magnitude of her symptoms at the moment since I am 14,000 miles from home. But I do know that she started shedding last summer when increased from 2 to 3 mg per day of compounded pergolide.
The question still remains, and I have asked my (endocrinology guru) vet: do we treat just the symptoms, or the ACTH levels as well? What if horse returns to normal body composition and hair coat, but her ACTH levels are still in the 800s post-stim? Then what? Because I’ve seen positive results from dosage changes, but ACTH remains elevated…
As for the seasonal rise, how long before (or rather what month) do you increase prascend dosage to keep the seasonal rise under control? And for how long have you kept an increased dosage?
I do realize PPID needs to be controlled. That is what I’m trying to do… As well as insulin. But I still have yet to get an answer on whether or not her insulin levels are a concern.
Sorry for the frustration. I just get sick of hearing that I need to read info from the group, when I have, and I’m still struggling to get answers…
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The insulin test was not done fasting. She had hay available, no grain.
I realize trailering causes stress. There’s not much I can do about that. I don’t have competent vets that will come to my place. I guess it would be feasible for me to do the OST test on my own as the ECIR group said the chilled blood needs to be spun within 2 hours. That’s feasible as the diagnostics lab is an hour drive for me. I may ask if I can do that when I get home in a few months, but still. That is then and I’m worked up in a tizzy now… As far as the ACTH test, I cannot do that one on my own as I obviously do not have TRH stim available at my disposal.
Dental was done last summer. Not saying she couldn’t have issues now, but no major issues at that time and the ACTH has been high for 3 years (at least) now.
I have not tested for Lyme. Ticks are practically non existent in my area, so it has not crossed my mind. Granted the mare has lived in other areas of the country where ticks are prevalent, so I can entertain testing for it. I just hadn’t thought of it.
Diet is free choice alfalfa and 1 1/3 pounds of Enrich ration balancer, added Custom Equine copper/zinc, and Santa Cruz Vitamin E. I was able to find my hay results. Test dry matter as follows:
Starch: .2%
ESC: 6%
WSC: 8.6
The test did not contain a result for sugar, but it would appear that fructan can be calculated by subtracting ESC from WSC; results in 2.6%.
The horse is NOT obese on this diet but rather maintains nicely on it. Aside from some moderate wasting of her topline and some mild fat pockets.
Just chiming in to say that I’ve also struggled with the ECIR group and its focus on laminitis.
In an ideal world, IMO, you treat both. If the horse’s current symptoms improve, it’s a sign you’re on the right track, but significantly elevated ACTH can be a risk factor for other problems. My vet and I have discussed this as it appeared at one point that my horse was no longer responding to the maximum dosage of Prascend that we thought likely to contribute to his wellbeing (vs. inducing side effects that would make him miserable.) In that case, for a horse whose ACTH had previously been well-controlled but who was evidently aging into tolerance, her recommendation (in consultation with New Bolton) was to treat the symptoms. This is a 28-year-old who has been treated for 10 years; there is a point where the disease takes its course. You’ve got a 22-year-old. Practically a teenager. 
Given that you have a potential alternate option available in Prascend, I would personally do that and see if it helps with ACTH control before concluding to treat the symptoms.
I will note that after the conversation about treating my horse’s symptoms we made a dietary modification that seems to have had an impressively positive result on ACTH- increased his omega-3 fatty acid intake and switched from plant to marine sources. But that’s not the first lever I would pull, in your shoes.
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Ok I’ve made some headway on interpreting the IR results. On the ECIR site, I found the EMS calculator the other day. But it did not contain instructions on how to interpret results. I just now found those instructions (seriously, this stuff could be way more user friendly).
Her baseline ratio is 2.18.
Post test baseline is 1.62.
I found that <4.5 is considered IR. So I guess that semi-answers that…
Thank you!! It seems my frustration often falls on deaf ears. Even the diet recommendations are focused on stopping laminitis. I don’t have laminitis to stop!
I have forgotten about the increased Omega-3s. I think you had posted recently about this?
I definitely want to switch to Prascend and see how that works. My endocrinologist vet should be back in the office tomorrow and I expect an email from her shortly. Switching to prascend is the first thing I want to try. But also I am all about nutritional changes that could help. And if I remember correctly from that thread, it was a pretty life changing result for your horse.
I think someone posted about impressive results with some immune system supplement? Granted I’m all about scientific evidence. But if something works strictly via PFM, and results are evident, then I’ll pull that trigger too.
Thank you for reminding me of that.
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Yes, I posted a thread about marine source omega-3’s last year. I feed Mad Barn’s W-3 oil, but there are others as well. Now, having said that, correlation is not causation, this was not done in the context of a study, and I am looking forward to seeing his spring testing results to see if the ACTH improvement held up for a full year.
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Yes I fully agree. I want to do some of my own experimenting when I get home. Get her on Prascend again, test, add W-3, test. And just see where it goes. Correlation does not equal causation, but if something is pure f***ing magic and helps in some way, then I’ll keep it up.
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Just wanted to bump this up with a bit of an update. I switched this mare over from 3 mg of compounded pergolide to 2 mg of Prascend. At 30 days, her baseline ACTH level went from 124 to 168. Granted this isn’t quite an apples to apples comparison as we dropped the dosage, but it is a good comparison in terms of cost; both dosages cost about $175 per month.
As I posted in my spin off thread, I have started her on KER EO-3 oil and will retest in 30 days.
I figured I would update this thread as not every thread gets updated. Hopefully someone finds this useful.
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Hi sorry to drag this back up. But have you done the spring test on your horse yet?
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It was the worst test he’s ever had and yet he looks the best he has in 10 years. My vet blames steroid joint injections done over the winter. He is at the top end of the dosing range already, and New Bolton advised treating the symptoms and not the bloodwork, so we decided to make no changes to his care plan as long as he continues to look and act well. Next test is in August.
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Our two doubled their ACTH levels between October 1 and March 1, in spite of being on Prascend, which has historically controlled things well. That said, both have been feeling good and looking marvellous. My vet called BI about the rise, and they can’t account for it, as nothing in their management has changed at all, and they said the same thing as New Bolton: treat the horse not the bloodwork. So, we’re maintaining, and we’ve added W3 oil in case it helps, we’ll see what the levels are the next time around.
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