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  1. #1
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    Default Pergolide-- cost? Effectiveness in chronic laminitic?

    Dealing with a chronicallly laminitic pony. I asked about long-term plans with vets- not a ton of ideas except for Pergolide. Anyone used it for that reason? I don't believe he has cushing's but he hasn't been tested. How much does it cost/day? I'm looking at another option but want to have an approximate cost for each- to compare for my boss.



  2. #2
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    You are SO going to get a ton of replies. Laminitis is usually because of Insulin Resistance and is dealt with via diet. Cushings is dealt with via pergolide. If the horse has cushings then pergolide very well might be all the horse needs although I think this is unlikely. What more than likely is the case is the horse is insulin resistant which means he cannot process sugars like a normal horse. He needs to be taken off of grass and grain completely. Hay tested to make sure it is low sugar OR soaked daily but the horse still needs 1.5-2% of it's body weight in hay. And the horse needs to be supplemented appropriately with vitamins and minerals amoung other things. I would suggest either testing the hay and balancing appropriately or feeding something like Triple Crown's low starch.

    If you really want to know if it is Cushings vs Insulin Resistance or a combination of the two (untreated cushings can cause insulin resistance) then get the horse tested - ACTH for cushings and insulin and glucose for IR and you should also get the thyroid tested while you are at it. That is my cliff notes version of it! Good luck though. I have heard of many chronic laminitic horses making a dramatic turnaround in just a few days when the diet is addressed.



  3. #3
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    Yes, and I highly recommend you visit the Yahoo Equine Cushings group for more support and info: http://pets.groups.yahoo.com/group/EquineCushings/

    Best wishes!



  4. #4
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    Quote Originally Posted by Jenn2674 View Post
    You are SO going to get a ton of replies. Laminitis is usually because of Insulin Resistance and is dealt with via diet. Cushings is dealt with via pergolide. If the horse has cushings then pergolide very well might be all the horse needs although I think this is unlikely.
    I'm not sure what you're basing this on. Laminitis is the result of any inflammation and Cushings horses do produce a lot of inflammation, which is present in the feet and visible in the white line. Cushings horses have shown immediate improvement in their feet when Pergolide is given. It is not an anti-inflammatory but somehow reduces the inflammation nevertheless. Jenn264, What do you mean is unlikely - that the horse will need only Pergolide?
    Having said that, she should certainly investigate both of the possibilities rather than just dumping drugs into the pony.
    Last edited by Androcles; Apr. 12, 2009 at 07:33 PM.



  5. #5
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    Simple - only Cushings horses need pergolide to control their symptoms. Horses who just have IR do not need pergolide. Both most likely however will need strict diet management!

    Oh and Tillie, you may want to refer your vet to the Equine Cushings group as well, so he/she can read up on it and be more current in education about this issue



  6. #6
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    Quote Originally Posted by BornToRide View Post
    Simple - only Cushings horses need pergolide to control their symptoms. Horses who just have IR do not need pergolide. Both most likely however will need strict diet management!

    Oh and Tillie, you may want to refer your vet to the Equine Cushings group as well, so he/she can read up on it and be more current in education about this issue
    So you're answering for Jenn?



  7. #7
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    Quote Originally Posted by Tillie View Post
    Dealing with a chronicallly laminitic pony. I asked about long-term plans with vets- not a ton of ideas except for Pergolide. Anyone used it for that reason? I don't believe he has cushing's but he hasn't been tested. How much does it cost/day? I'm looking at another option but want to have an approximate cost for each- to compare for my boss.
    I really wish someone in the veterinary world would bring many of our vets up to speed on the difference between full blown Cushings and Insulin Resistance.

    Two years ago, I got the same answer from one of my two vets as you did. Had I started my non-cushings, but insulin resistant horse on Pergolide, it would have been the biggest mistake of my life.

    I say that because, from all I have read, which includes the Yahoo Equine Cushings Group, it is thought Pergolide may actually cause laminitis in I-R horses, but it is needed for Cushings horses.

    I did have two vets in separate counties, who use different labs, do the ACTH tests and the glucose tests. Both sets of tests came back within the "high-normal" range.

    From that my regular vet said my horse was "cushionoid, start him on Pergolide and watch his diet". The out-of-county vet said my horse is "probably I-R, would stay away from Pergolide and to watch his diet".

    Neither of them could tell me even a loose interpretation of what "watch his diet meant".

    I belong to a lot of message boards and I have to say the best help, by far, came from this board. I received a couple PM's that were life-savers for my horse, as far as I am concerned, and will always be grateful for experienced and logical folks in the know stepping up to help.

    The horse in question is now 21-1/2. He is on pasture 10-11 hours/daily even though that's supposed to be a no-no. Drylotting is the better option, but:

    1. This horse is the strong alpha-dominant leader in my herd of four and went crazy non-stop, for over an hour when I kept him up by the barn. I decided his mental state would cause him a lot more harm than the spring grass, so I opened up the gate and let him go oversee his herd.

    2. We have 14 acres of rolling pasture. The Boys cannot get from Point "A" to Point "B" without going up and down a hill of some sort, so this horse gets plenty of exercise every day.

    2.1 Because of him being on grass a big portion of the day, my entire 3 days/week pay check goes toward all the herbs and minerals he needs to keep him healthy. Winter was fantastic for him as we had a lot more cold this winter than usual. It was the best thing for him and I almost hate to see spring arrive.

    3. His hooves are under the guidance of a good barefoot trimmer that comes every five weeks. If his soles or frogs indicate they need some sloughing off in-between, I take care of that.

    His days of sliding his butt down hills and digging up the other side are long-since over, but he is very ridable and could go several hours on an easy hack.

    I didn't mean to veer off the path. Just wanted to tell you my I-R story. Spring is the ideal time to get the ACTH tests done so, as others have said, I would try and get them done.

    I am also against the dexamethazone (sp?) test because I have also read they can cause founder. Point-being, start out with the least invasive tests. Also make some major diet changes before the tests even come back; it will put you ahead of the I-R game and might be all you will need to do.
    Last edited by walkinthewalk; Apr. 12, 2009 at 08:07 PM.



  8. #8
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    Quote Originally Posted by walkinthewalk View Post
    I really wish someone in the veterinary world would bring many of our vets up to speed on the difference between full blown Cushings and Insulin Resistance.
    Well it doesn't even sound like the vet has made any diagnosis, just laminitic = try Pergolide.
    From what I understand though, it is now considered to be 'equine metabolic resistance', to encompass all the symptoms and account for the fact that many horses have symptoms across the spectrum, as well as that horses now show cushinoid symptoms without actually having tumors.



  9. #9
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    Quote Originally Posted by Androcles View Post
    Well it doesn't even sound like the vet has made any diagnosis, just laminitic = try Pergolide.
    From what I understand though, it is now considered to be 'equine metabolic resistance', to encompass all the symptoms and account for the fact that many horses have symptoms across the spectrum, as well as that horses now show cushinoid symptoms without actually having tumors.
    I agree it doesn't sound as if the vet has made a diagnosis. All the more reason to not be saying "try Pergolide". That isn't any different than a human medical doctor prescribing a drug without first confirming the malady that person has

    Case-in-point that many vets need to be updated on the difference between Cushings and I-R/EMS, including my two whom I have the greatest respect for 95% of the time.

    Even though I am not a fan of Purina and won't feed anything they produce, they really do have great information on Cushings and I-R/EMS.

    There are links in the blue bar on the left.

    http://www.wellsolveequine.com/



  10. #10

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    I've got 2 Cushings horses and 1 severe IR. One I tested and one I didn't. Both are on Pergolide and the changes were amazing for both. One foundered repeatedly without pergolide, one abcessed repeatedly without pergolide. Coat was never really an issue with one, feet, crusty eyes were issues with both. Both were on IR diet for safety reasons years before diagnosis due to severe IR mare that I have whose glucose/insulin levels were off the charts. She was also tested for Cushings the same time one of my geldings was tested few years back but came back negative.

    Each horse is different and I can assure you that not every horse will show the old textbook Cushings symptoms vets were relying on for years. IR is a whole 'nuther game. Does your horse have the classic fat deposits? Those don't seem to lie. Find a vet you trust and have good communication with!
    "Concern for animals is a matter of taking the side of the weak against the strong, something the best people have always done." Harriet Beecher Stowe 1811-1896

    Ponies are cool!



  11. #11
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    My pony is severely IR and also PPID. She's on Pergolide - capsules from Thriving Pets pharmacy for $15 a month for 1 mg. daily. VERY good people to work with, affordable, and you just call them and give all your info. on the phone and your vet info to get started.

    IR and PPID are two different things and are managed differently. I've been managing the IR in 2 of my horses for years, but PPID is new to me. It's scary at first, but with the Pergolide and continued IR diet and good trimming, my pony is doing awesome.

    I also can recommend Welsolve L/S for giving supplements and pergolide. It does not make her sore and she can eat a whole pound and really felt like she got something. It's expensive but worth it. Also you can feed soaked no-molasses beet pulp. Very high fiber, initiates almost no glycemic response and is very safe for IR and PPID horses. good stuff!

    Hang in there.



  12. #12
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    Quote Originally Posted by walkinthewalk View Post

    Case-in-point that many vets need to be updated on the difference between Cushings and I-R/EMS, including my two whom I have the greatest respect for 95% of the time.
    Absolutely - as hoofcare professionals we have to fight this battle way too often. Most vets are unable to read subtle problem signs and tend to tell the clients not to waste any money on testing



  13. #13
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    Default have him tested.

    you don't need to do the dex suppression test to test for cushings. your vet can draw blood and test the acth levels. this time of year the results are pretty accurate. you should also have the insulin glucose levels tested and when you get the results, run the ratio by the equine cushings yahoo group. sometimes the vet will tell you the numbers are within norm but it's the ratio that will give away what is actually happening.

    certainly no sense in giving pergolide if horse is not cushings.
    but diet management is key for both cusings and IR horses. someone posted that they have their IR horse on pasture turnout. that may be okay for some horses, but would likely kill mine. it's a fine line and there are no definite answers. b/c we can't be sure what will work for each individual horse, there are general dietary recommendations made which will likely keep your horse laminitis free. again refer to the equine cushings group in their files they have something called the "emergency diet". it'll explain to you what to do initially and how to proceed from that to maintenance diet.

    i think as we all deal with metabolically challenged horses (cushings or IR) we discover their individual limitations. so while over the years i've learned that my mare cannot be on grass turnout, i also know that i can safely let her graze for few hours per day on the weekends without any repercussions.

    there is a lot of info on the web about these two conditions. read up. sounds like you'll need to educate yourself so you can have an educated discussion with your vet.
    http://www.eponashoe.com/
    TQ(Trail Queen) \"Learn How to Ride or Move Over!!\" Clique



  14. #14
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    Quote Originally Posted by marta View Post
    you don't need to do the dex suppression test to test for cushings. your vet can draw blood and test the acth levels. this time of year the results are pretty accurate. you should also have the insulin glucose levels tested and when you get the results, run the ratio by the equine cushings yahoo group. sometimes the vet will tell you the numbers are within norm but it's the ratio that will give away what is actually happening.

    certainly no sense in giving pergolide if horse is not cushings.
    but diet management is key for both cusings and IR horses. someone posted that they have their IR horse on pasture turnout. that may be okay for some horses, but would likely kill mine. it's a fine line and there are no definite answers. b/c we can't be sure what will work for each individual horse, there are general dietary recommendations made which will likely keep your horse laminitis free. again refer to the equine cushings group in their files they have something called the "emergency diet". it'll explain to you what to do initially and how to proceed from that to maintenance diet.

    i think as we all deal with metabolically challenged horses (cushings or IR) we discover their individual limitations. so while over the years i've learned that my mare cannot be on grass turnout, i also know that i can safely let her graze for few hours per day on the weekends without any repercussions.

    there is a lot of info on the web about these two conditions. read up. sounds like you'll need to educate yourself so you can have an educated discussion with your vet.


    Summed up in a great way and is the bottom line

    It is my horse that is out on pasture 10-11 hours/daily and I sure don't recommend that to anyone. It has been two years since his diagnosis and herbal/mineral treatments were started; thankfully his half day pasture turn outs are working for me --- so far.

    Him being the alpha dominant horse, I hope I can continue giving him daily pasture turn out for many more years and I hope I never need to put him on Pergolide as that means he's taken an insulin resistant downhill slide



  15. #15
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    Quote Originally Posted by marta View Post
    you should also have the insulin glucose levels tested and when you get the results, run the ratio by the equine cushings yahoo group. sometimes the vet will tell you the numbers are within norm but it's the ratio that will give away what is actually happening.
    None of the university researchers, or speakers who attend conferences on EMS believe that ratio is useful. Glucose is so variable the ratio is rendered meaningless. High insulin is diagnostic for IR. High glucose indicates long term IR, often as the result of end stage PPID.
    Katy



  16. #16
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    Default katy

    Quote Originally Posted by Katy Watts View Post
    None of the university researchers, or speakers who attend conferences on EMS believe that ratio is useful. Glucose is so variable the ratio is rendered meaningless. High insulin is diagnostic for IR. High glucose indicates long term IR, often as the result of end stage PPID.
    Katy
    i didn't realize that. dr. kellon seems to think it has some significance. i guess the OP will have to educate herself re that as well...
    http://www.eponashoe.com/
    TQ(Trail Queen) \"Learn How to Ride or Move Over!!\" Clique



  17. #17
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    Quote Originally Posted by marta View Post
    i didn't realize that. dr. kellon seems to think it has some significance.
    Quite a few of EK's recommendations are...... unique. Vets who still practice on real horses and who attend conferences disagree with much of cyber-practice. I'm now lecturing at Vet Med Assoc. conferences, and some practicing equine vets have shared with me that they refuse to spend any time debunking internet myths. Threaten to back out of a case if the clients insists on following contradictory advice from the internet. The internet really has become a virtual reality, with virtual Drs and we even have some virtual equine diseases now. Best advice is to get information from many sources, consider credibility, and apply critical thinking.



  18. #18
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    Quote Originally Posted by marta View Post
    i didn't realize that. dr. kellon seems to think it has some significance. i guess the OP will have to educate herself re that as well...
    Libbey was tested at a fairly "state of the art" facility and they did not do a ratio. They tested both, but it was the high insulin number that got her diagnosed with IR. They said that glucose is extremely variable based on a whole bunch of factors.

    And FWIW, I tend to agree with Katy - the more I read the Yahoo Cushings group, the more I am taking most of it with a grain of salt. Some of the suggestions are really "out there" and don't check out with what my own vets say, and some of the other experts in the field. After having private email conversations with 2 diffent whackadoodles over there, I decided to just do what's best for MY horse, and not get caught up in the group.



  19. #19
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    I have been a member of the Yahoo Cushings group since 2002, and I have picked up some good information there. However, I strongly believe that you need to be your own horses advocate, and, knowing your horse/pony best, let that knowledge inform your decisions.

    Dr. Kellon has done a bunch of research- but that group is, essentially, a fabulous opportunity for her to have a huge resevoir of testing data that no one else has been able to fund. To her credit, she also spends time trying to answer the questions of those who are willing to fill out the case studies. Quid Pro Quo.

    No one has mentioned "peripheral" Cushings here, and I have no question that it exists. However, the testing parameters for any of the metabolic syndromes, are, IMHO, really at the "stone knives and bear skins" level. Without a base line for your healthy horse- prior to any metabolic issues, and taken at a time during the day without any prospect of spikes, etc. (how the hell do you do THAT?) the real validity of these tests is, IMHO, questionable, at best. But- it is all we have to work with currently, making Vets, and everyone else fighting this nothing more than glorified mechanics, most of the time. "Change this, and see hat happens". As well intended as we all are- still the best solution is to "trust, and verify", and be your horses best advocate.
    When someone shows you who they are, BELIEVE them- Maya Angelou
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  20. #20
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    Default ASB Stars

    well put.
    i agree.


    my mare was "diagnosed" IR 5 years ago. handled as such until last year when she was diagnosed as cushings. although last year she had elevated ACTH, her IR levels went back to normal... go figure. so now she's cushings and no longer IR... but when we took a look back at her IR levels over the last 5 years they were wholly inconsistent year to year (one result actually was so skewed that it is pretty apparent the blood was mishandled after collection...)
    http://www.eponashoe.com/
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