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Pergolide for Insulin Resistant horse?

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  • Pergolide for Insulin Resistant horse?

    Does anyone give their Insulin Resistant horse Pergolide if their ACTH and cortisol levels are normal? I've heard conflicting information. Some say it will help an IR horse and some say you don't ever give it unless the horse is Cushings. My thoughts are not to give it. If it is given, what dose is typical?

  • #2
    Yes, years ago I tried pergolide on a horse that tested normal for ACTH, but high for insulin. Then I'd stop it after she was sound. Whenever she got sore, it seemed to help so I left her on it. After a few years, her ACTH showed she did have PPID. The tests for PPID are not always accurate. You may have some false negative tests. While I'm not a vet, I have heard some that will try pergolide on refractory laminitis cases when removing excess sugar and starch from the diet does not work. They say "if it looks like a duck, and quacks like a duck, it's a duck". If a 30 day trial of pergolide helps, then leave them on it.

    I started with 1 mg. 8 years later she needed 3 mg to keep ACTH in normal range.
    Are you feeding your horse like a cow? www.safergrass.org

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    • #3
      We're actually just starting my boy on Pergolide this weekend (just received the meds from Wedgewood today). Vet is starting him on a very low dose, just 0.5mg/daily for the time being.

      His ACTH levels have been normal the last two years he's been tested (January '09 & '10) but he's IR and very, very hairy. Vet suspects he may have Cushings but just not testing positive, for whatever reason, right now. Kinda like what Katy stated above.

      FWIW, his diet has been very regulated since the IR diagnosis and he still had some bout of subclinical laminitis in the past 8ish months. Have no clue what triggered it or when exactly it happened but now we're hoping with the meds he'll start improving again.
      Proud owner of Gus & Gringo.
      See G2's blog
      Photos

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      • #4
        My 23 yr old TWH was diagnosed as IR in May, 2007. He is not on Pergolide yet but is managed to-date with a strict diet that includes a muzzle.

        That being said, the vet will be here next week to run some tests on my 25 yr old Arab and to save a road fee in a couple months, I am having him run some tests on my IR horse too --- meaning maybe he will suggest Pergolide and maybe he won't

        All I know at this point is that I will need $200 come next Wednesday morning for both these horses tests

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        • #5
          What actually is the relationship between Cushings/high ACTH (not IR) and lameness?


          Originally posted by Katy Watts View Post
          Yes, years ago I tried pergolide on a horse that tested normal for ACTH, but high for insulin. Then I'd stop it after she was sound. Whenever she got sore, it seemed to help so I left her on it. After a few years, her ACTH showed she did have PPID. The tests for PPID are not always accurate. You may have some false negative tests. While I'm not a vet, I have heard some that will try pergolide on refractory laminitis cases when removing excess sugar and starch from the diet does not work. They say "if it looks like a duck, and quacks like a duck, it's a duck". If a 30 day trial of pergolide helps, then leave them on it.

          I started with 1 mg. 8 years later she needed 3 mg to keep ACTH in normal range.

          Comment


          • #6
            Originally posted by Androcles View Post
            What actually is the relationship between Cushings/high ACTH (not IR) and lameness?
            Prevalence of PPID as defined by a single high plasma ACTH concentration was 70%.Evidence of PPID is common among horses with laminitis in a primary-care ambulatory setting. Horses with laminitis may have PPID without other clinical signs commonly associated with the disease.
            Are you feeding your horse like a cow? www.safergrass.org

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            • #7
              Insulin resistance is often caused by Cushing's/PPID, either of which can and often does cause chronic active laminitis unless treated.

              Cushing's is hyperadrenocorticism, or excess secretion of cortisol by the adrenal glands, which in the vast majority of cases is caused by inappropriately increased secretion of ACTH (adrenocorticotropic hormone) by the pituitary due to a tumor or hyperplasia. Hence the term pituitary pars intermedia dysfunction. There is a normal diurnal rhythm to secretion of cortisol, with the highest (I think) being in the morning. There is also seasonal variation, with levels naturally higher in fall.

              A single normal cortisol level is not useful, since a horse with PPID may dip back in to the normal range. ACTH is more useful but not all Cushingoid horses have ACTH levels outside the normal range, and the sample also requires careful and rapid processing to get an accurate level.
              More on testing for PPID

              I haven't had endocrinology yet, so hopefully one of the real vets will come along and check my work.

              ETA: I see I've been beaten to it.
              The plural of anecdote is not data.
              Eventing Yahoo In Training

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              • #8
                My question is much more straightforward than that? Why do their feet hurt if they have Cushings? If it's inflammation, they what causes the inflammation? And if it is inflammation, then Pergolide shouldn't help because it's not an anti-inflammatory. I guess another way to phrase the question would be why does Pergolide take away the soreness?

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                • #9
                  Because the pergolide takes away the underlying condition causing the laminitis. Chronic Cushingoid laminitis, IMO, is a different beast from the acute laminitis of, say, colitis or other infections. It is a slow, insidious process that can cause rotation and sinking but can also cause chronic foot pain out of proportion to the degree of rotation. I'm not sure anyone knows for sure how hyperadrenocorticism leads to laminitis, since cortisol has a wide range of effects that can be immediate (change in receptor configuration and presence in the cell membrane) to medium term (change in gene expression) and can be mediated through downstream effects on other signaling molecules (like insulin). Whatever it does that causes the laminitis, if you take away the effects of cortisol, you take away the pain of the laminitis.
                  The plural of anecdote is not data.
                  Eventing Yahoo In Training

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                  • #10
                    My question is much more straightforward than that? Why do their feet hurt if they have Cushings?
                    One reason may be that high cortisol levels causes a breakdown of connective tissues(It is called "catabolism", where the cortisol removes protein from the tissues). The connective tissues include the laminae, so the laminae in cushings horses do not rapidly disconnect in a few hours as in other more "classic" acute type laminitis laminitis but instead the coffin bone can very slowly sinks within the capsule and tears things up.
                    If it's inflammation, they what causes the inflammation? And if it is inflammation, then Pergolide shouldn't help because it's not an anti-inflammatory. I guess another way to phrase the question would be why does Pergolide take away the soreness?
                    because it helps stabilize the hormone levels ,including the cortisol, that are at fault. Also certain kinds of fat, particularly the fat in the abnormal pads seen in IR and cushings horses, actually produces inflammatory chemicals so getting that fat down via controlling the abnormal hormones also reduces the inflammation. At least that's the way I think that part works ... I am not a vet or a doctor.
                    Patty Stiller CNBBT,CNBF,CLS, CE
                    Natural Balance Certified Lameness Specialist ,instructor.
                    www.hoofcareonline.com

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                    • #11
                      GG has it right. Nobody has proven what causes laminitis in PPID horses, although there are several pathways by which cortisol seems the culprit.
                      Are you feeding your horse like a cow? www.safergrass.org

                      Comment


                      • #12
                        I REALLY appreciate the knowledge on here.

                        My mind cannot absorb and retain all this information at once; I have to bookmark this, maybe if I read it 987 times it will all sink in - maybe----------

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                        • #13
                          Originally posted by Patty Stiller View Post
                          One reason may be that high cortisol levels causes a breakdown of connective tissues(It is called "catabolism", where the cortisol removes protein from the tissues). The connective tissues include the laminae, so the laminae in cushings horses do not rapidly disconnect in a few hours as in other more "classic" acute type laminitis laminitis but instead the coffin bone can very slowly sinks within the capsule and tears things up.
                          This mechanism has more importance since Michelle Visser's work presented at the 2009 AAEP Laminitis researcher workshop. Temporal changes in basement membrane proteolysis and protease expression during laminitis development

                          She found that type IV collagen in the lamina starting breaking down 12 hours post FOS dose. This happened before activation of MMP's. Collagen fibers help hold the structure of the lamina together. This same gradual breakdown of connective tissue is why PPID horses get sway backed.

                          That said, if this is the only mechanism at work, it is hard for me to attribute the rapid return of soundness at 10-14 days that occurs when pergolide is given to laminitic PPID horses. Could a new collagen support system be grown in that amount of time?
                          Katy
                          Are you feeding your horse like a cow? www.safergrass.org

                          Comment


                          • #14
                            Originally posted by Katy Watts View Post
                            She found that type IV collagen in the lamina starting breaking down 12 hours post FOS dose. This happened before activation of MMP's. Collagen fibers help hold the structure of the lamina together. This same gradual breakdown of connective tissue is why PPID horses get sway backed.
                            What is FOS?

                            That said, if this is the only mechanism at work, it is hard for me to attribute the rapid return of soundness at 10-14 days that occurs when pergolide is given to laminitic PPID horses. Could a new collagen support system be grown in that amount of time?
                            Katy
                            This is what baffles me. I've seen soundness return in even less time than 10-14 days. There must be something else going on. Ugh, my favorite answer, nobody knows.

                            Comment


                            • #15
                              I'll hazard a guess FOS=fructo-oligosacchaide.
                              "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

                              ...just settin' on the Group W bench.

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