Cushing's PPD, would you put this horse on pergolide?

[Sansena]

ACTH results in. This from my vet:

ACTH level is 67.8 (normal 9-35 BUT this time of year negative would be <50, equivocal is 50-100, & positive is >100).

Insulin is normal (no numbers given).

Acute value of lyme is negative & the chronic value is equivocal. I would recommend repeating the lyme in 6-8 wks to see if it goes up.

She suggested doing the TRH Stem test December 1.

And his scratches persist. Horse continues to pee up a storm, drink a ton, is lethargic, dimpled fat and itchy. No swelling above eyes. Feet occasionally hot and reluctant to move forward. Vet seems to think I"m overreacting WRT my suspicion of Cushing’s b/c this is the time of year ACTH is elevated anyway.

Is there any harm in giving a non-coshing’s horse pergolide?

[Bluey]

Time for another vet, a second opinion?

[SLedbetter]

Describes my horse to a ‘T’. Much improved on Prascend.

[fjordmom]

If your vet says no to pergolide, have you considered chasteberry? My vet said she had seen good results with it. (She recommended Smartpak’s pellets and she will very rarely recommend any brand name.) My IR (but not Cushings, according to test; 18.8) horse is on it. At least it would give some pituitary support if you’re not quite ready for pergolide.

​​​​Vet and I both feel his symptoms are at least pre-Cushings - fat pad, itching, irregular sweating at times that are not always appropriate, curly coat areas. Fortunately, no hoof issues. No skin problems. Still has good energy level. He is 23, so not a spring chicken, but plenty of “appropriate” energy. Maybe drinking slightly more, but it seems appropriate given the sweating. He was never much of a drinker, so I’m actually pleased to see him drinking a bit more. It’s certainly not in excess and still less than my other horses.

Side note: Is the lethargy new/possibly seasonal? We had an unusally much warmer and very humid summer here. The humidity especially, really took the energy out of man and beast. Now that we have seasonable/much cooler fall weather the energy level is vastly improved for all of us.

This horse is mildly IR and low thyroid. He is on Heiro (magnesium, vitamin E, and some supportive herbs) and low dose Thyro-L. Heiro is supposed to help with laminitc horses. It did bring his insulin levels down slightly, kicking it back down just into the normal level. Thyro-L did help bring down weight slightly and reduce the fat pads considerably.

I feel your indecision, find myself in the same boat. I might be inclined to get a second opinion too.

My vet has been quite good in discussing options/fine tuning meds and management, so I’m sticking with her recommendations for now. Additionally, I use a traveling chiropractor who is also a vet. He’s schooled in acupuncture and Chinese herbs as well. I’ve asked his opinion and he is said also on board with our current plan.

I keep a close eye on it all and am prepared to make changes, add pergolide, etc as the horse changes. Some might say I’m “overreacting” too, but my vet says it’s good that I catch these things in their early stages.

[Sansena]

@Bluey

Time for another vet, a second opinion?

Yes, of course. However, I am asking here to see what the CoTH community’s experience has been. Do you have any experience with PPD/ Cushing’s horses, Bluey?

Sledbetter, thank you for the relevant contribution.

[Bluey]

@Sansena

Yes, of course. However, I am asking here to see what the CoTH community’s experience has been. Do you have any experience with PPD/ Cushing’s horses, Bluey?

Sledbetter, thank you for the relevant contribution.

Yes, have a horse right now on four years of Prascend and we added the last two years thyroid medication.

It doesn’t hurt to have a second vet look at any case we are not sure our regular vet is addressing above question.

Hope your horse is not going down that route, but if he does, there is so much out there today to help them have a good quality of life.
Our farrier was here yesterday evening and said how wonderful he looks, excellent quality of hooves for a Cushing’s affected horse.

No, I can’t answer for you if you can use Prascend safely on a horse that doesn’t has any kind of impaired metabolism that addresses, but maybe someone else will help you there.

[S1969]

Well, I’m one that would probably try it. I mentioned my Cushings pony that had “normal” ACTH on Prascend, but still had significant symptoms - particularly laminitis. I increased his dosage and he improved fairly quickly.

I read an article - I will try to find it - that suggested ACTH is only one measure of Cushings, and may not be entirely accurate for all horses.

In general - Prascend is fairly expensive, horses may have decreased appetite. So, if you have one that is a hard keeper already it might not be an ideal test method. But if not…it might be worth a try,
;
Or, I agree that chasteberry might help although I have never tried it with my own pony.

[Gainer]

I have a gelding who had chronic laminitis, no matter how well I monitored him and his food intake. Lived in a muzzle, etc. Finally started developing a shaggy coat that had to be clipped. Had been tested for several for Cushings but always tested negative.

Vet finally said screw it and put him on Prascend anyway. Hasn’t had a single bout of laminitis in two years, still grows a shaggy coat, but also sheds it out and is doing much better overall.

If it walks like a duck and quacks like a duck…

I actually prefer pergolide over Prascend (fewer side effects) but most vets seem unwilling to prescribe it. I had an old mare that was on pergolide for 15 years and did great. Ni side effects and we only had to increase her dosage twice in all those years.

[Sansena]

@Gainer

I have a gelding who had chronic laminitis, no matter how well I monitored him and his food intake. Lived in a muzzle, etc. Finally started developing a shaggy coat that had to be clipped. Had been tested for several for Cushings but always tested negative.

Vet finally said screw it and put him on Prascend anyway. Hasn’t had a single bout of laminitis in two years, still grows a shaggy coat, but also sheds it out and is doing much better overall.

If it walks like a duck and quacks like a duck…

I actually prefer pergolide over Prascend (fewer side effects) but most vets seem unwilling to prescribe it. I had an old mare that was on pergolide for 15 years and did great. Ni side effects and we only had to increase her dosage twice in all those years.

Thank you. Where do you find pergolide, (NOT Prascend)?

[Bluey]

Here is more why pergolide in Prascend is better than compounded pergolide:

https://thehorse.com/121115/fda-no-l…de-production/

Here is direct experience with both:

https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/9838642-prascend-vs-pergolide

[Gainer]

@Sansena

Thank you. Where do you find pergolide, (NOT Prascend)?

I used to get it at Wickliffe Veterinary Pharmacy, but my mare has been gone for six years. I assume you can still get it from them but you need a prescription.

[Sansena]

See, back when I managed The Land of Misfit Toys, we had several on pergolide or cyproheptadine. It was a liquid we either put in grain or squirted directly in their mouths. They were --AFIR-- not compounded, per se. However, back then I simply called the vet when we were out and it majikally appeared on my desk in a day or two.

I have a few sources from which I can obtain pharmaceuticals if I just describe symptoms or forward blood work results. Like how it used to be before everyone became litigious, pretended they knew things b/c of google, and when my network was much smaller. I’ll start with them, pick their brains and see how they feel.

I appreciate everyone who understood that I came here for anecdotal evidence. Anyone else care to share their first hand experience? Much appreciated. Keep 'em coming.

[Gainer]

@Sansena

See, back when I managed The Land of Misfit Toys, we had several on pergolide or cyproheptadine. It was a liquid we either put in grain or squirted directly in their mouths. They were --AFIR-- not compounded, per se. However, back then I simply called the vet when we were out and it majikally appeared on my desk in a day or two.

I have a few sources from which I can obtain pharmaceuticals if I just describe symptoms or forward blood work results. Like how it used to be before everyone became litigious, pretended they knew things b/c of google, and when my network was much smaller. I’ll start with them, pick their brains and see how they feel.

I appreciate everyone who understood that I came here for anecdotal evidence. Anyone else care to share their first hand experience? Much appreciated. Keep 'em coming.

The liquid pergolide is the compounded medication. I guarantee your vet probably had it made up at Wickliffe or a similar lab.

[Libby2563]

@Sansena

And his scratches persist. Horse continues to pee up a storm, drink a ton, is lethargic, dimpled fat and itchy. No swelling above eyes. Feet occasionally hot and reluctant to move forward. Vet seems to think I"m overreacting WRT my suspicion of Cushing’s b/c this is the time of year ACTH is elevated anyway.

Is there any harm in giving a non-coshing’s horse pergolide?

I asked a sort of similar question in a thread last year, perhaps some of the replies will be helpful to you too: https://www.chronofhorse.com/forum/f…-many-symptoms

IIWM I would try medicating. I’m not a vet and don’t have a ton of experience with Cushings, but my interpretation would be that if ACTH is in the “equivocal” range, clinical signs can tip the scale in either direction. Your horse has several clinical signs, some of which are fairly concerning (hot/painful feet).

There seem to be many anecdotes on COTH about horses whose symptoms preceded their positive test results. I think the tests just aren’t all that great yet TBH.

[AKB]

My horse’s ACTH was 42.7 today. We won’t start him on Prascend since he is energetic and not hairy. What about starting Prascend and retesting in the spring?

Also, have you read Cornell’s website? The ACTH can be falsely decreased if the blood sample was not spun within 4 hours, chilled and immediately mailed overnight or frozen and then send with cold packs. I was worried about my test because we had hot weather this week.

[Alpha_Mare]

Treat the horse, not the lab test. If he’s symptomatic, go ahead. The tests are not THAT accurate - they are pretty good but as others have said, the lab results can look fine but horse is not.

Really don’t like the sound of ouch-y feet

[Simkie]

I don’t see why you wouldn’t treat this horse. His lab results aren’t in normal range and he’s symptomatic. I hope he feels better with some meds on board!

[S1969]

@Simkie

I don’t see why you wouldn’t treat this horse. His lab results aren’t in normal range and he’s symptomatic. I hope he feels better with some meds on board!

I think some vets would consider that number so close to “normal” in September that they may say it’s a “negative.” But I agree - because the horse is symptomatic AND the results could be positive, I would go ahead.

[Simkie]

@S1969

I think some vets would consider that number so close to “normal” in September that they may say it’s a “negative.” But I agree - because the horse is symptomatic AND the results could be positive, I would go ahead.

Sure–if I tested my old lady mare who has zero symptoms but is 20, and we got this result, I’d retest in the spring and not treat.

But holy cow, this list of symptoms, plus a grey area lab report? Prascend!

And @Sansena there wasn’t a pergolide product for equines prior to prascend. Whatever you were using before was compounded. A better result with compounded versus name brand night be due to the inherent instability of the compounded products. A horse that does better on compounded may do equally well on a lower dose of the more stable name brand product.

[newhorsemommy]

My gelding started with a very subtle lack of topline. Then he got raging laminitis. Tested and came back normal (not even remotely high). We did not start the Prascend but in hindsight probably should have. The following fall I had him tested again and it came back high enough to start the Prascend. He never had the bulging above the eyes, an excssively long or curly hair coat, etc. He gets a THICK hair coat and is slow to shed but was for years and still is, even on the Prascend. He will eventually shed on his own, but I clip him once in the spring when it starts to warm up and so far once per year has been adequate. I give chasteberry along with the Prascend because it does help his coat some, but I would not give it in place of the Prascend. And I would always go with Prascend over the compounded pergolide because it is more stable and the doseage is more accurate.