My first PPID Horse: Long Ramblings

[lenapesadie]

My golden oldie, 22 yo TB, has received a PPID diagnosis based on TRH Stim test. His baseline ACTH is normal, and has been on previous ACTH draws, but the blood sample drawn after administering the TRH tests “solidly” in the positive for PPID range. I do not yet have the actual results. The above was relayed to me verbally by vet. If it matters, the samples were drawn first of April and horse lives on the northern Gulf Coast (Pensacola FL area). Vet clinic stocks Pergolide powder and I’ll be picking that up Monday. I do not have dosing instructions yet. I’m trying to lay out this horse’s background. This is gonna be long.

Horse does not present as “typical” PPID. He grows and sheds coat normally (if anything he has a wimpy winter coat). He’s not even the tiniest bit overweight and he does not have any weird fat deposits or a cresty neck. If anything he could carry more flesh. His “symptoms” are chronic scratches, over reaction to bug bites, seasonal abscesses, cold sensitivity and difficulty maintaining weight. Vet says the chronic scratches are the most “typical” of his symptoms. As in the others, in her opinion, may or may not be related to PPID.

Horse also has a history of laminitis and founder which may or may not be related to PPID. The acute laminitis he had while in my care, was attributed to non metabolic causes. But perhaps underlying PPID was a factor. He also has navicular changes seen on serial x rays spanning a decade and caudal heel pain. He has pedal ostitis too. He’s in an exploratory phase of shoe set ups under vet oversight. At this moment he’s in steel leverage reduction shoes, frog support pads and pour ins. He had an Osphos treatment in March. He also gets Bute as needed to keep him feeling his best.

Horse has been a picky ish eater as long as I have known him. I’ve tried a couple of different diets with him. TC Sr, TC Sr Gold, TC Balancer Gold, Hygain Munga, Purina Omega Match and Purina Ultium Gastric Care. We’ve also tried adding alfalfa pellets and beet pulp. Horse isn’t keen on anything smushy or soaked unfortunately. He’s eating 8lbs (split into two feedings) daily of the Gastric Care. While I like it the least of all the feeds we’ve tried, the horse likes it the most. The only thing he eats nearly as well is the Omega Match. Unfortunately the Omega Match doesn’t provide enough calories and horse has decided that being isolated with alfalfa hay is NOT APPROVED. I keep O/A available in turnout in case the horses get tired of eating grass. Straight alfalfa in TO isn’t an option. Quite frankly the old horse likes the O/A better anyways. On the upside, the Gastric Care does give horse some protection against the side effects of the Bute. Horse licks the bowl super clean with the Gastric Care.

My questions / concerns: Should I push for IR testing? Should I order APF now? Should I try mixing the pergolide powder into a paste and syringing it? Try adding it to his grain? I have sugar free peppermint (he’s bonkers for peppermint) syrup I could use in feed or in a syringe paste. If I need to syringe it, what’s the best way to mix it and get it in a syringe? Should I ask for the prascend tablets instead? Do I need to dose the pergolide at different times than his Bute? Vet has offered scripts for any type of ulcer med I want if horse acts like his tummy is upset. So far we’ve seen 0 indication that the Bute upsets his guts but if he develops inappetance after starting the pergolide would ulcer meds help? Should I put him back on KER EO3 oil? How do I monitor the impact of the pergolide? Repeat the TRH Stim testing that was spendy as hell? I’m supposed to introduce the pergolide very slowly correct? How long does it take for the pergolide to start to “work”?

If you’ve read all of my convulted ramblings, I really appreciate you!

[2tempe]

I have a mare diagnosed 6ish months ago. ACTH numbers out of bounds; some signs of fatty deposits, a bit cresty. We also did IR test at the same time. She is ok there. Given her retired living situation at a boarding facility, I wanted to know for sure re IR. Her other symptoms were a stubborn summer sore on belly that wouldn’t heal. Lethargic. Itchy and some rain rot problems, not at that time a long coat, but just different.
We put her on prascend tablets. She willingly eats her daily dose with a handful of grain. Most important is to make sure the horse actually gets it. So you could try the powder in a handful of grain and see how Mr. Picky reacts. If you can get him to eat it, I wouldn’t move to dosing. Personally I would prefer the tablets, but I’m not exactly a wealth of experience in this area. A slow ramp up of the pergolide should be done to be sure he doesn’t go off his feed. My vet gave me a detailed schedule that stretched over two or three weeks. .
Given that he is Mr. Picky I would also want to know about the IR situation in case you need to adjust feed due to that.
My mare never turned her nose up at food but did drop some weight over the first 3-4 months of prascend, and we upped her grain and hay accordingly.

[SusanO]

Just be aware that compounded pergolide is notoriously unstable and sometimes you don’t get what is supposed to be in the powder. Although Prascend is pricey you will get what you are paying for. You can always dissolve the pills in warm water. I just syringe it into my pony’s mouth because he will not eat it in any shape or form. But your horse may not be that picky.

[RMJacobs]

I agree with what @SusanO posted. I went with compounded pergolide powder in capsules for my elderly (30s) pony gelding, and I think I should have gone with Prascend. He just kept losing weight and finally died two days after getting his fall vaccinations. The vet agreed he wasn’t getting enough pergolide, and we were about to increase his dose when he died. He was seriously ancient, so it’s hard to say exactly what was going on with him. But having read a lot of opinions here about compounded pergolide versus Prascend, I wish I’d done Prascend for him. It may not have changed anything, but I’ll always wonder.

Rebecca

[Fiesta01]

So sorry for your loss. It’s horrible to be left with the wondering if you did the right thing. BTDT. {{{Hugs}}}

[RMJacobs]

Thank you! It’s been several years, but I still wake up in the middle of the night thinking about it.

Rebecca

[Renn_aissance]

First of all, I’m detecting a minor note of diagnosis panic in your OP. Your horse is going to be okay.

If he were my horse:
Your horse is an atypical presentation and is probably not IR, but I do like to have a baseline, so I’d test it now for peace of mind. That will also give you information about what to do with his diet.

I would be using Prascend, rather than the compounded pergolide- it’s expensive, but it’s more stable and you know what you’re getting in each pill as opposed to playing a bit of roulette trying to get your dose right. You can feed Prascend in the same time frame as bute. Your vet can advise on tapering up.

Since he’s a picky fellow, provided that his bloodwork doesn’t give you a compelling reason to switch foods AND his laminitis history did not clearly coincide with spring/fall grass season… I’d be inclined not to do that right now. He’s already in reasonable weight, and pergolide does bring inappetance. If controlling his blood sugar through diet is important, you’ve tried a lot of foods he won’t eat, and I’d look at things like hay and muzzles first. On that note: yes, I would go ahead and get APF now (it also purportedly helps with gastric symptoms,) and if you already know he eats EO3 oil, won’t hurt might help.

As far as when to retest- when my horse was first diagnosed we re-tested at the 3 month mark to see if his current dose had moved the needle, and at that point we wanted to see a reduction to inside of equivocal range. Now, that was 10 years ago. When we have made dose adjustments within the current decade we have generally retested in about a month to make sure we see a trend in the right direction. So recommendations may vary. Personally, as a matter of maintenance, I prefer to test in spring and fall to make sure that his levels are in good shape headed into spring grass season (when I also test for IR) and have not gone totally rogue during the seasonal rise period. Having said that, we’ve been doing this for 10 years, and at this point sometimes my vet comes out in the fall, looks at him, and says “I think you can skip the fall test this year.”

Just know that you’ll get everything under control, you’ll be good for a couple months, and then something will change. That’s how it goes. You’re a good pony parent- you will adapt to this and take good care of him.

[PaddockWood]

Be sure to taper up on the Prascend. Do you know about that? My mare eats hers right off the top of her am feed. I agree with your idea to check insulin too. Smart.

[lenapesadie]

I’ll definitely be watching closely to make sure horse gets his meds. I’m hopeful I can get him to eat it in his grain, but if not we’ll move to other approaches. Thank you for sharing!

[lenapesadie]

I’m sure the vet can order the Prascend or write me a script for it. I’m guessing they stock the Pergolide powder since it’s a bit less expensive and our area has both a lot of wealthy people and very poor people with horses. I think the tablets would be easier to feed in treats but maybe not.

[lenapesadie]

That’s so sad. 30 is a good long life though for a horse and I’m sure you did good by your pony.

[lenapesadie]

@Renn_aissance

First of all, I’m detecting a minor note of diagnosis panic in your OP. Your horse is going to be okay.

You are correct. It’s just a lot of known problems for one sweet old horse.

His baseline insulin has been tested when we did the plain metabolic panels and was normal. His ACTH was normal at those times as well. We only picked up the PPID doing the TRH Stimulation test; I understand there are some similar tests for insulin / glucose response. I just don’t know if it makes dollars and cents to do those tests.

I’m a bit concerned about having to repeat the TRH stim testing very often because it was so very expensive but if we need to repeat it here and there that would be manageable. With the horse’s other issues, he requires a lot of vet bills already

He doesn’t really care for the EO3 oil but I have been able to get it in him to an extent previously. I’ll look some more at the APF. I really can’t have him losing weight since he’s a touch underweight already.

I’ll be picking up the Pergolide powder on my lunch break today, bar disaster, so I guess we’ll see how the first taste goes at dinner tonight.

Thank you for verifying I can dose his Bute at the same time frame as the Pergolide. That’s a big relief

[S1969]

@lenapesadie

I’m sure the vet can order the Prascend or write me a script for it. I’m guessing they stock the Pergolide powder since it’s a bit less expensive and our area has both a lot of wealthy people and very poor people with horses. I think the tablets would be easier to feed in treats but maybe not.

Some horses will eat it; my pony wouldn’t touch it in anything. So, be prepared that you may have to syringe and/or mix up the manner of dosage (syringe for a week, treat a couple of times, maybe something else.) My pony would be good for a syringe for a while, and then be a total butt and we’d have to switch.

[avjudge]

@lenapesadie

I’m sure the vet can order the Prascend or write me a script for it. I’m guessing they stock the Pergolide powder since it’s a bit less expensive and our area has both a lot of wealthy people and very poor people with horses. I think the tablets would be easier to feed in treats but maybe not.

FYI, there is currently (through 7/15) a rebate on Prascend bought through your vet. With our vet’s pricing it worked out cheaper than buying online, where we could find no discounts. That will obviously depend on your vet’s markup.
https://www.boehringeringelheimequinerebates.com/

My husband originally fed his horse his Prascend in treats – gummies, then generic fig newtons or maybe it was in the reverse order — but eventually Dancer refused first one, then the other treat even without the Prascend. Now we just drop it on top of his breakfast and he eats it fine.

[lenapesadie]

I’d like to avoid making the horse sour on syringing since I have other stuff I need to give him via syringe. Hopefully I can be creative and flexible!

[lenapesadie]

Thanks for the tip

[jherold]

If he’s not insulin resistant, you can drizzle a little molasses on the powder. Don’t panic. Cushings is easy to manage. My 24 yr old was diagnosed at 14. His only symptom was sore feet after pulling his shoes for the winter that didn’t resolve. He was never insulin resistant so no changes to his diet were necessary. He goes out on full pasture. He had a full riding career until 4 yrs ago, but his retirement had nothing to do with cushings. Prascend is easy to give in a cookie or carrot, but it does dissolve and must taste bad, so pop ot in right before you give the treat. I’m currently using Wedgewood powder because the old man got wise to the treat thing.

[lenapesadie]

It would be amazing if treating my horse for PPID would relieve any measure of his foot pain. I won’t hold my breath though as he has lots of other legit reasons to be footsore.

Just talked to vet and she confirmed that his previous BW doesn’t show any signs of IR and that he doesn’t show any physical symptoms of IR either so in her opinion further IR testing doesn’t seem to be indicated.

I’ve got sugar free peppermint syrup to try on his grain with the pergolide. Horse is crazy for peppermint so hope it helps. I don’t like to add extra sugar as a general rule for either of my horses, but I’ll keep molasses in mind as a backup plan.

[jherold]

It definitely helped his feet. In fact, I’ve never retested the horse since the initial diagnosis. I’ve increased his pergolide solely based on how his feet are feeling. He lives on my farm and I can just tell when he’s a little foot sore. I call my vet and let them know we need to up the dosage and a week or so later he’s back to normal.

[Cassi1125]

My old boy presented one spring with the curling hair and not shedding. ACTH was high; insulin was normal. So recommend that you get the insulin level - at least as a baseline. Started on Prascend 1 tab/day. Pulled him back after he got food-finicky. Re-started on 1/2 tab/day, then up to 1/day when he was eating normally. He ended up on 2 tabs/day. Any of the horses who are on meds are generally getting them dosed in a syringe - just ended up easier on everyone and makes sure each horse gets its meds.