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Discussion on Pergoglide dosage
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Member:
gwenyth
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Posted on Wednesday, Aug 25, 2010 - 8:46 am:
Dr. O,
My horse has been on pergoglide for about 4 months. I have seen significant improvement in his water consumption lessening, his coat shedding almost completely, and weight loss. He is now a BCS of 4.5 down from a 7.5., so he has lost a fair bit of weight.
We started him on a dosage of 1.5 mg as he was about 1350# or maybe more, but obviously has lost considerable weight. I have noticed in the past 2-3 weeks that he seems somewhat
"quieter", so I re-read your article on Cushing's and it talks about toxicity causing depression and lethargy, and I think this may be what I am seeing - that the initial dose, which worked well, may now be too high, since that he has lost weight? (maybe 200# is my vet's guess)
I give him the pergoglide in a 1.5 mg capsule that he eats whole, so i can't divide it between feedings as you suggest might help.
My vet is open to all suggestions - so what would your advice be - I just ordered 60 days of the 1.5 mg capsules, but I was wondering if I should order some 1.0 mg capsules and alternate them daily and see if that helps?
Any suggestions or advice is greatly appreciated. I don't have evidence that he is getting too much pergoglide except that he does seem less active than before.
Thanks,
nancy
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Member:
dustee
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Posted on Wednesday, Aug 25, 2010 - 4:13 pm:
This is one of those situations where we know our animals best of all, and can pick up on tiny nuances that no one else would ever observe. I had a quarter horse mare, and after a while realized she needed her dosage DrOpped daily, and permanently. The original dosage just became too much for her, so you probably are on the right track. I talked to my vet about it, and he totally agreed with this decision, and told me just to keep my eyes open - who knows if we would have to reduce it again. Good luck!!
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Moderator:
DrO
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Posted on Wednesday, Aug 25, 2010 - 8:17 pm:
Nancy, there are many reasons a horse can "act quieter" so I would start with a good exam to see if a cause can be identified. If after the exam you and your veterinarian feel the pergolide might still be the cause you will need to split or reduce the dosage as directed in the article. Capsules can be opened and the contents split.
DrO
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Member:
gwenyth
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Posted on Thursday, Aug 26, 2010 - 10:38 am:
Dr. O, I just had CBC, complete panel and IR testing done, plus exam, and it was all normal except that his RBC count was slightly low. My vet suggested adding Vit B12, as she felt iron was inappropriate to add to the diet of a Cushing's horse. So I will add that and see if I get any response in 30-60 days or so.
I was also concerned about lowering the pergoglide in the fall, as I believe that is the time of year that ACTH levels rise in all horses, correct? So it might be prudent to wait about reducing the pergoglide until this season is past?
Thanks,
Nancy
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Moderator:
DrO
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Posted on Thursday, Aug 26, 2010 - 6:27 pm:
No if after exam and careful consideration you feel the cause is toxicity from pergolide I would not wait.
DrO
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Member:
paul303
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Posted on Friday, Aug 27, 2010 - 9:43 pm:
This may have nothing to do with your horse and your experience, Nancy, just a "heads up" to watch things carefully.
If you cut back, watch carefully for increased water consumption and urination. That winter coat should be starting, so watch that carefully.
My mare ( about 950lbs., 14.2HH, and 30 yrs. old ), started out about 5 yrs. ago on .5mg. pergolide. We've had to steadily increase her until she leveled out at 2mg. The symptoms that caused us to increase it, were, mainly, lethargy and depression. Her head was down, her ears were down, she showed no interest in her surroundings, food did not interest her and she spent much time sleeping. We increased her each time by .5mg. For my mare, when she hit 2mg. her response leveled out to: a great ( nearly normal) coat, normal appetite, normal water consumption and urination, perfect hoof health ( no heat or near founder ), and a serious increase in her interest and enjoyment of life.
Just watch carefully....you could be under or you could be over. You don't want either one. At some point, you'll come to the perfect balance for your horse. Good luck, Nancy, pergolide can be a miracle drug when you discover the perfect dose. Could be less, could be more. Hang in there, till you find it.
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Member:
scooter
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Posted on Saturday, Aug 28, 2010 - 1:06 am:
Nancy I am kind of the same boat with Sam and with fall around the corner I have been wondering about his dosage. He always gets "weird" in the fall starting at about this time. Right now he seems fine, tho he is really really talkative, he whinnys all the time even when just out in the pasture with all the other horses...it's weird. He has always been very talkative, but this is even a little extreme for him. He looks pretty good otherwise (for him) grew his summer coat back in after balding out again, except a few LONG hairs. I find this time of year to be a little difficult with him until around the winter solstice. he needs to be managed carefully or he will get a little depressed and if not on my toes with his diet is prone to founder. I have him on 1mg of pergolide right now and if any changes occur I may up it a little. Sam has had cushings for a good 8 yrs. now tho and he is extremely IR.
When the vet was here for Hanks abscess he said Sam looked 10 yrs younger then before the pergolide and he does... figuring the dosage and working with the "bad" time of year for cushings horses can prove to be difficult sometimes you have to experiment or even go with your gut feelings. It can always be adjusted back up or down. I have found Sam tolerates his pergolide MUCH better if I split the dosage AM and PM.
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Member:
gwenyth
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Posted on Monday, Aug 30, 2010 - 11:24 am:
Diane, maybe I will split the dosage as Dr. O suggests in his article before I reduce or increase it. That is good to know that it works for your horse that way.
Lee, thanks for your insight and your concern.
Mine seems to be doing better now that it has cooled down some. I am going to wait a week before I do anything different, now that temps are down in the 80's from the upper 90s and 100s. What I saw in him may be due to the heat more than anything. Don't want to change too much at one time.
Nancy
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Member:
gwenyth
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Posted on Tuesday, Sep 7, 2010 - 10:06 pm:
Dr. O - do you think I should do an ACTH test before I start reducing my horse's pergoglide?
We cut back the pergoglide by about 1/4 for 3 days, and it seems to be improving the lethargy, but I am worried about this time of year - I have been warned it is dangerous to cut back on the pergoglide and was told that I am taking a terrible risk with him.
Would it be prudent to test for ACTH before I do anything, or would that only confuse the issue? Is there any accuracy about the test as far as control of PPID, and possibility of founder?
Thanks for your advice.
nancy
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Member:
scooter
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Posted on Tuesday, Sep 7, 2010 - 10:37 pm:
Nancy, I am curious what Dr.O. says about this too.
I thought I have read the ACTH tests aren't all that accurate, especially this time of year.
Sam has a bad time of it starting around the end of August. I did up his pergolide(and he got diarrhea again) and really didn't see a difference in his symptoms, which include a little depression, possibly laminitis (still not sure on that one this year) and just not himself.
I decided to lock his butt up and "play it safe" until he shows me he is coming out of his "fall funk" he is in a dry lot with absolutely no grass, I am soaking his hay, and he is getting nothing sweet if I can help it! Sam is NOT fat, he has had a GOOD summer, this time of year is just hard on him. I did lower his pergolide dose back down to where it has been 1mg. split A.M and P.M. after I locked his butt up, After a good week of this routine he is snapping out of it (thankfully) I keep the Old girl Flash in with him for company and he is happy. (She isn't
When this "fall funk" is deemed over (usually sometime in early Oct. he can go back to his "normal" restricted diet. I am not sure why his diet has to be so VERY strict this time of year for sure, don't they put out more cortisol now ???
Anyway that is what is working for Sam... so far. Playing with his pergolide did not seem to make a difference at this point.
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Moderator:
DrO
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Posted on Wednesday, Sep 8, 2010 - 7:40 am:
Nancy, the article on Cushings deals in detail with your questions about testing. What great danger and risk is supposed to occur if you reduce the dosage of pergolide a little?
DrO
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Member:
gwenyth
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Posted on Wednesday, Sep 8, 2010 - 8:40 am:
Dr. O, this is why I am confused. I have read - and re-read -your Cushing's article thoroughly, which is why I felt the need to see if he was experiencing pergoglide toxicity, as you indicated in your article could be possible.
I am sure you are well aware that there is an internet group exclusively concerned with ECD and IR moderated by a well known veterinarian who graduated from Cornell. Out of curiosity as to what they would recommend as protocol as per reducing the pergoglide, and others' experiences with it, I contacted them online. I was blown away by the response from the "list members" - that I was dooming my horse to laminitis. To wit I received this message from the list moderator:
"Your concern as I understand it is that his pergolide dose may be too high for
his needs. The only way to determine that is with ACTH testing.
The reference to substituting G:I ratio/insulin for ACTH during the seasonal
rise was with respect to laminitis risk. At this point, all you know is that his
current 1.5 mg dose is sufficient to keep him out of high risk for fall
laminitis.
PPID eventually causes IR. How soon that happens depends on the starting point.
If the horse is IR to begin with, even early PPID/seasonal rises can push them
over the edge into laminitis very easily. When the horse is not prone to IR,
they could even go through the stage of classical symptoms of coat change and
PU/PD before showing laminitis. Warmbloods are not typically IR, so your horse
would fit into the second group. There is no direct correlation between an ACTH
value and insulin. A doubling of ACTH in the seasonal rise (typical "average" in
a recent study) could have very different consequences in an IR pony than in a
thoroughbred stallion. It depends on the starting point when ACTH began to rise.
Again, all you know right now is that the 1.5 mg dose has kept him out of the
high laminitis risk category by G:I ratio/insulin - although we're just getting
into the highest risk month so even that could change.
Only ACTH can tell you if you might be able to lower the dose, but this is a
very high risk time of year to do that. Well controlled PPID horses do not show
a seasonal rise. If you have a normal G:I/insulin and ACTH well within normal,
you might be able to lower the dose but you won't know ahead of time what the
effect of that will be. Lowering it could lea to lead to the G:I deteriorated.
There is no way to predict that. Our focus here is ALWAYS "no laminitis, ever".
Lethargy is better than laminitis any day, but your concern about this is
certainly valid. It may well be pergolide in excess of need, but there are other
possibilities. The major one that comes immediately to mind with the high heat
scenario is dehydration and electrolyte depletion. For every hour of light
sweating (defined as visible sweating), the horse needs an extra ounce of sodium
chloride/salt. Horses that are pasture ornaments need 3 to 4 ounces of salt/day
to replace losses in high heat and humidity. This also leads to obvious weight
loss (which is actually dehydration). If you are still having heat issues, try
syringing 3 ounces of salt into him every day. If that's the issue, you'll know
in 24 to 72 hours.
If your equine vet cannot handle the sample processing because of their schedule
(very understandable), you can still have your vet pull the blood, give you the
paperwork and materials for shipping, then you can take the blood to your small
animal vet or even a human lab for processing and mail it (overnight) yourself."
"
So, Dr. O, I know what you told me about the pergoglide toxicity in your article and my question above from a few weeks ago, that if I needed to reduce it, to do so. I will say that when I have asked questions from you, I have never been steered wrong. But to get this response from this person was, frankly, out of the blue and stuns me that somehow I could doom my horse by reducing his pergoglide this time of year.
Do the scientific data support her statements? I try to keep up on the literature, but I am no expert - lol!
You can imagine that I am very confused. Your article about Cushing's - as I understand it - is how I made my diagnosis of ECD to begin with - I saw the coat getting longer and the polydipsea and polyurea, plus the pot bellied appearance. I did not have testing done, but started the pergoglide due to symptoms, which I must say have nearly resolved, but the lethargy is getting worse, the longer he is on the drug. I think my mistake was not insisting on the 1mg dose to begin with, as my vet wanted to start him at 1.5 mg straight off.
Please tell me what you think about this warning about ensuing laminitis if I reduce his pergoglide, I was thinking of doing it by 0.25mg. increments - 2-4 weeks before making any other changes. I won't be exact, as I have to split the pills, but we would be as consistent as possible
And I will honestly say that I was flabbergasted when she said warmbloods were not typically IR - I've found that many warmbloods are fat and have those odd fat pockets.
Thank you for your help. I truly appreciate it.
nancy.
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Moderator:
DrO
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Posted on Wednesday, Sep 8, 2010 - 6:20 pm:
Nancy,
a slight reduction in pergolide to see if pergolide toxicity is occurring is not going to doom your horse.
DrO
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Member:
scooter
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Posted on Wednesday, Sep 8, 2010 - 8:26 pm:
Nancy I hope you don't mind if I add a couple questions as it is related to your question, maybe even you know the answer from researching.
Dr.O. what confuses me in the pergolide dosage is how is one to figure out if the lethargy is due to too much pergolide or not enough? My understanding is both can cause this.
My vet said that if you lower or up the dose of pergolide on a horse that has been on it for awhile it takes quite awhile to see the results, by quite awhile he means a month or more. Is this true in your experience or in the literature?. He told me this last winter when Sam was going through that terrible bout of laminitis and stupor. If it is true it would seem it would be hard to tell which way to go. He did tell me the reason, and at the time it did make sense, but for the life of me I can't remember it .
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Member:
gwenyth
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Posted on Wednesday, Sep 8, 2010 - 9:04 pm:
Diane, those are good questions, I have the same problem. I THINK it might be too much pergoglide, but it may be too LITTLE pergoglide.
Dr. O, is there anything to do but try and see what works?
Nancy
ps thanks for saying that I won't "doom my horse" Frankly, I was offended by what that other person said, as if I would knowingly do anything wrong!
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Member:
scooter
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Posted on Wednesday, Sep 8, 2010 - 9:55 pm:
Nancy unfortunately I think all we can do is adjust it if we think it needs to be adjusted, the big question is which way, and how long to wait to make the decision if it worked. Then there is all the coincidences that can happen and we are just left guessing .
Like you with your horse I have noticed Sam is just not himself, like you I noticed this mid-end of Aug.(every year it is at this time), it WAS very Hot and humid. He got trimmed and then seemed to have laminitis (coincidences) dunno very hard to decipher it all.
From what I can gather the PPID horses "danger" time starts around Sept... we fall into that category for time. Are the "coincidences" clouding the CD symptoms???
As I said above I have Sam on a VERY, VERY strict diet right now, that stopped his spiral downward, and he has "stabalized" but the symptoms are still there.... (lethargy and what appears to be laminitis) I have really been debating HARD about upping his pergolide, and leaving it there until Jan.
I guess if we think about it your horse has been on pergolide for quite awhile now I think, he had no problems until Aug.-sept. area. Sam also, so if this was due to toxicity (which I wondered also) wouldn't it have shown up before now?? And is it one of those coincidences or is it the time of year?
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Member:
gwenyth
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Posted on Wednesday, Sep 8, 2010 - 10:29 pm:
Diane, you bring up some good points. I do know the the heat was a major factor for him this summer. He sweated terribly, and he is not a bad sweat- er.
My husband reminded me that the horse hasn't been "himself" for a number of months, but we just assumed it was the heat. I'd say the end of June he was pretty bad off - but was it the abscesses he was having? Again, I don't know. Is my horse sore from laminitis, or from his WLD? I don't know.
But, reading Dr. O's article, I kept thinking that it was too much pergoglide, since he's lost so much weight AND his G:I ratio is "normal" and his symptoms of drinking excess water are in check- I would think if his ECD was really bad, his G:I ratio would be really bad too, or some other bloodwork really bad, and that he;d be drinking water again. But maybe I'm wrong about that?
All I know is that reducing the dose seems to have made him slightly more active (but maybe it's due to the cooler weather??) and that when he's out in the sun, the other horses are "normal" sweaty and so is he now.
Right now I am going to do as Dr. O suggests, reduce the drug slightly and give it a few weeks to see what happens. If i get nothing definitive, than I have to decide if he needs MORE drug or LESS. Geez!
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Member:
scooter
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Posted on Wednesday, Sep 8, 2010 - 11:02 pm:
AHHH very interesting, but remember weight loss is a "symptom" of PPID
Nancy I feel for you I know how hard it is to make these decisions in the "dark"
I go between reducing the pergolide and upping it, sometimes I just want to slowly remove it period!!!
It was SOOOO nice to have Sam shed this year, he did grow it back and then shed again....BUT that is the only difference I can see that it has made. He started pergolide last year around this time. He had a horrible winter last year with that founder and turning into a "zombie", that I am pretty sure wasn't CD related but who knows . The more pergolide I gave him at that time (vet's advice) the worse he got!) coincidences???
I have always had a problem with Sam in the early fall since he stopped shedding, this year is no different and he IS on pergolide. He is not drinking or peeing more then normal, He is in good weight.
He managed as well, if NOT better without the pergolide and good management... I think I started the pergolide hoping I could slack a little on the tough management and as an added bonus not have to clip him (which I ended up doing anyway!) I go back and forth with this. One thing that bothers me since I started the pergolide is the look in his eye is different... not good different, bad different... it's a tough call and very individual. Good LUCK
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Member:
scooter
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Posted on Thursday, Sep 9, 2010 - 7:55 am:
Nancy I forgot to ask, from your last post above does your horse seem to be laminatic now too?
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Member:
gwenyth
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Posted on Thursday, Sep 9, 2010 - 8:27 am:
Yes, I know about the wight loss - but it also happened when I took him off pasture - he was either muzzled or getting hat out of SMHNs. ALL my horses lost between 100-200# (they were all obese - my bad from that wet spring)
The thing you say about "sam's look" - can you describe it more closely? Do his eyes water, do they look sunken, does it look like he has a headache? Any or all of the above? Does he seem to eat as well? HOw are his ears - normal, more floppy than normal? Does he seem completely disinterested in everything? Does he still like to eat, or has he lost some interest? Does he hand around with the other horses? Lots questions - answer what you think you see.....
I do not think my horse is laminitic - but what is odd is that he keeps getting abscesses or bruises. One foot he'll be really lame on, it will pop, then another one. One of my other horses has also done it this summer too. His diet is NOT as strictly controlled as it was this spring, I will admit, but the more he is out eating grass, the better he has seemed. If I keep him locked up he seems much worse.
nancy
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Member:
scooter
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Posted on Thursday, Sep 9, 2010 - 11:52 am:
Hard to describe, Sam is interested in most things, just not as much. His eyes water a little but are much better than they used to be. I can honestly say I have never paid much attention to his ears So they are probably "normal"
The look in his eye is that of a "drugged" horse, with a bad hangover, So yes something like a headache look. His appetite is good.. he seems interested in the herd but doesn't intermingle as much or want to participate in mutual grooming ect. He whinnys way more than he normally used to for no apparent reason. He LOOKS uncomfortable.
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Member:
gwenyth
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Posted on Thursday, Sep 9, 2010 - 2:49 pm:
Ok, the "drugged look" are the same exact words my husband used. His mother was in a nursing home and had her drugged to the gills until we DrOve up to Wi and made them stop, and she became mentally normal again.
This is what I did, not recommending it, but to give you an idea. Of course, every horse is different.
We noticed that whether he was lame or not, he seemed "drugged". If he was lame from an abscess, then it was worse. When it was 100o, it was worse. So, we just said - how much worse can it get?? So, on Sunday, we thought we would split a pill in half and give it to him. He refused to eat his morning grain with 1/2 topdressed, not in a capsule, so I tossed it. So he got no drug that morning. Then that afternoon, when my husband saw him, he said "he looks better, what did you do". And I told him. So we decided to wait until the next morning to give him the other 1/2 of the pill. Then T/W/T (today) we gave him about 3/4 of a capsule, the rest was discarded.
Today he ran away from me, and his ears are normal. He is walking better (coincidence?maybe) But his eyes are not the "drugged" look.
I think what helped was for him to have 24 hours without drug for it to clear his system. This might not be right for Sam, but I just wanted you to know what we did. I plan to keep him on 3/4 pill, probably about 1.25mg instead of 1.5 mg. I figure if a mg treats a 1100# horse, that is one POWERFUL drug. Cutting it by 0.25mg may be just enough for him.
nancy
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Member:
scooter
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Posted on Thursday, Sep 9, 2010 - 4:57 pm:
Interesting Though I really wonder if the pergolide clears the system that quickly. I don't know what is right either and I may see how he is by DrOpping it down, or eliminating it. I don't think pergolide dosage is weight based as most drugs, I think it is more symptom based. Thanks Nancy, maybe we will figure these boys out yet
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Member:
gwenyth
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Posted on Thursday, Sep 9, 2010 - 5:05 pm:
yes, I agree , I shouldn't have said "clear his system" but "reduce the amount in his system" lol!!
I think is is symptom based, absolutely, but the average beginning dose is suggested to be 1.0mg/500kg. Still, even 2mg is a tiny amount of drug to cause these powerful changes.
let me know how Sam does.
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Member:
scooter
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Posted on Thursday, Sep 9, 2010 - 9:04 pm:
I went for a ride tonight and asked my friend to look in Sam's eyes and asked her what she saw...She asked if I aced him...guess that says it all. I never know if I am imagining things or not, I didn't tell her what I saw, just if she saw anything different. I think I will lower his dose a bit also and see what happens, if no differences occur I may slowly lower and remove and see where we stand. Hard decisions. Let me know how your horse does.
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Member:
scooter
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Posted on Friday, Sep 10, 2010 - 6:32 pm:
Nancy I thought I'd tell you what my vet said today. He called about something about the cows, so took the opportunity to feel him out on Sam's pergolide dosage.
Since his ordeal last winter he has been getting approx 1.25 mg. a day. Before he had his "ordeal" I found the once a day dosage of .65 mg was good for him...no drugged look, he did fine.
Vet said this isn't a real good time of year to "play" with the dosage and that it took weeks to see the difference of increased or decreased dosage..... Dr.O. do you have any info on this????
I am going to slowly decrease Sam back to the dosage that seemed to agree with him .65 mg's. Vet said if he doesn't have any strong DP's or acting laminatic to go ahead and try...BUT if he isn't stable he wouldn't do it yet.
He also said he has very good results adding ciphro(sP) to the pergolide...if that interests you, you can google it and get some results....interesting.
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Member:
scooter
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Posted on Friday, Sep 10, 2010 - 6:37 pm:
Sorry double posted
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Member:
gwenyth
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Posted on Friday, Sep 10, 2010 - 9:19 pm:
Diane, I already asked Dr. O about the time of year, and he suggested that if I thought it was pergoglide toxicity "not to wait" to reduce it (see above) since he #1 has a normal I:G ration and #2 is not lame (right now that could change tomorrow) I thought I would try reducing it by .25mg. Dr. O seems OK with this.
All I know is that the "drugged look" has gone away. If it is coincidental, then it is, and I am not going to reduce it by more in the near future. He is well within Dr. O's suggestion of 1mg/per 500kg starting dose.
I had a horse years ago on Crypo - I didn't think it worked as well as the pergoglide, but that was another horses, and as we all know, they are individuals.
Thanks for telling me what your vet said.
Nancy
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Moderator:
DrO
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Posted on Saturday, Sep 11, 2010 - 8:59 am:
Diane, you should not "play" around with medication dosages at anytime. But my post on Aug 26th stands.
As to how long it might take to see a difference, toxicity is often noted when the treatment is first begun but because you may be looking for subtle effects that can be confused with under dosage you will want to give it time to try and see the natural waxing and waning of subtle changes.
DrO
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Member:
scooter
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Posted on Saturday, Sep 11, 2010 - 9:03 am:
My vet said he uses the pergolide and cipro together with very good results. I don't intend to do this but found it interesting and maybe another option if needed. I have Sam down to the dose that agreed with him before .65 (for 4 days now) will see where that takes us. He does look brighter
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Member:
scooter
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Posted on Saturday, Sep 11, 2010 - 9:22 am:
Was posting the same time as you Dr.O.
Dr.O Pergolide seems to be a drug you have to "play" with a little as there really are no standards as to how it will affect a horse individually.
My vet said he has some horses on 5mg's and some horses on .5 mg's with the same results. I suppose starting at the lowest dose that works is the way to go, but then there are the darn coincidences and finding that lowest dose.
Nancy sorry about interrupting your discussion
Thanks
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Moderator:
DrO
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Posted on Saturday, Sep 11, 2010 - 8:18 pm:
Diane, it may be the cavalier implication that the work "play" has that your vet was objecting to.
DrO
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Member:
scooter
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Posted on Saturday, Sep 11, 2010 - 10:55 pm:
I don't think it was the wording Dr.O., he objects to lowering the dose this time of year, and actually suggested I up his dose if he was acting and looking "sedated". At this point I am going with my "gut" feeling and lowering where I know it was effective, yet he didn't look sedated. When I told him I thought he looked brighter(after 3 days) and not so drugged he said he doubted that was possible as it takes weeks to see a difference in a dosage adjustment???
Thanks
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Member:
gwenyth
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Posted on Sunday, Sep 12, 2010 - 10:11 am:
Diane, I think that your vet is not unreasonable, that most horses probably do need a dosage increase this time of year. What you and I are trying to do is opposite to the "norm"; however, I think we are in tune with our horses and have seen them "look drugged" for a couple of months, so we want to do something to see if we can help them.
All I know is that every horse is different, and lowering my horse's dose very slightly has helped him IMHO. I will see my vet on Thursday, and we'll see what her opinion is, since she hasn't seen him in about 4 weeks, since we did the blood work and exam. I agree with Dr. O that we need to wait and see the subtle changes before doing anything more with the dose.
However, I DO think it is possible to see changes in 2-3 days; I also think that with some cases it could take a month or more. Medicine is an art more than a science, for sure, in cases like these!
Nancy
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Member:
scooter
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Posted on Sunday, Sep 12, 2010 - 10:33 am:
Nancy I don't think my vet is being unreasonable at all... I AM LOL. Once we get our cow vet bill paid off I would like to have his insulin checked again to see where we stand.
Let me know what your vet says
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Member:
gwenyth
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Posted on Sunday, Sep 12, 2010 - 12:17 pm:
Yes, that is a very good idea, and having my horse's done really helped with my decision that I needed to reduce the pergoglide and not increase, since his insulin was so low.
nancy
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Member:
gwenyth
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Posted on Sunday, Sep 12, 2010 - 4:53 pm:
Diane, I decided to ride Feivel today and I have to say that it was a better experience than the last time I rode him about a month ago. The thing I noticed the most was how much more secure he felt, as last time I really feared that he would fall over, as he felt before as if his legs were all tangled up> i can tell he is still "ouchy" to walk, but he strode right out whenever the footing was soft enough that he could do so, My husband says that he had some of his "old spark" back, AND he really was hassled by the flies - last time it's as if I were riding a zombie, he didn't care about anything at all.
So I am going to leave the meds as they are and just hope for some slow improvement.
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Member:
scooter
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Posted on Sunday, Sep 12, 2010 - 6:02 pm:
Glad to hear it Nancy . Sam is still a little tender, tho I still suspect his trim, he was fine up until that day. In his Easy boot RX's he looks great. Without them he is still tender on hard ground, his feet are a mess.
I thought about throwing Sams Old Macs on and riding him today, it would be good for him, but want him a little less ouchy first. Other than that he is doing well on his lower dosage and the drugged looked had diminished, the other symptoms have NOT returned
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Member:
gwenyth
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Posted on Monday, Sep 13, 2010 - 9:37 pm:
Diane, I had an interesting "test" - my trimmer came today (who does two of my horses, I do the other 2), and Feivel came right up to us with the other horses. Matt said he looked "great".. I gave Feivel his pergoglide right then, and 15 minutes later, after we'd worked on my mare, it was as if Feivel was numb. His ears fell down, he was much lamer, his hind end would not work, he could barely open his eyes. Matt was flabbergasted - he said it's like the horse changed into a different horse. Staring tomorrow I am splitting the dose am and pm, I just don't think he can handle it at all. I may even ask the vet about eliminating it all together after the fall ACTH rise is over with.
I also wonder if what I thought was "ouchy feet" is somehow related to this drug. It's sooooo odd.....
nancy
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Member:
scooter
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Posted on Monday, Sep 13, 2010 - 9:59 pm:
Boy Nancy, I am experiencing the same things. I have feed tubs for the 4 horses here and they have their first initials on them so I know who's is who's. This morning for some reason I got Sam's and Flashes mixed up... Flash got Sam's pergolide (which she didn't eat) and Sam got flashes feed (so no pergolide). He looked better today then he has in quite sometime. The lameness was GONE????
So my boarder (friend) came out tonight and said wow what did you do to Sam he is moving really well and looks good....
I would really like to know how to decipher this, it does go against the vet's and quite frankly my grain to remove it, BUT he seems better without it. Today was the first time in ages he wasn't standing all stretched out like he has a belly ache or something weird going on, it was quite a relief to see that.
Right now, other than his missed dose today I have been giving him .5ml's I am going to hold there for a week, and see what happens. Like you I would really like to try to eliminate, will play that by ear. I know pergolide does work miracles for some and some how we have to decide what is "coincidence" and what is not.
Keep me updated
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Member:
gwenyth
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Posted on Monday, Sep 13, 2010 - 10:18 pm:
WOW oh WOW - The belly ache thing! Diane, what is going on here???? Mine has the same thing - and I am telling you, he is much less lame.
If it wasn't for the time of year, I'd cut it out completely (slowly of course)
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Member:
gwenyth
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Posted on Tuesday, Sep 14, 2010 - 8:46 am:
Diane, you are dosing .5mg twice a day, correct? What dosage did you have him on previously?
Nancy
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Member:
scooter
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Posted on Tuesday, Sep 14, 2010 - 12:40 pm:
Nancy I am giving him .5ml in the A.M. that's it. Before I worked him down he was on about .75 AM AND PM.
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Member:
gwenyth
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Posted on Tuesday, Sep 14, 2010 - 3:47 pm:
Diane, the latest update. I did not give him the meds this am, but planned to start doing half pm and then half am. Anyway, he looked really good today so I hopped on him and he was sound at the walk barefoot - no boots - and marched right along! I mean MARCHED! It's hotter here today, so he sweated under the saddle, but no more of this overwhelming sweat that he was having on the high does of meds. I can tell he is still not 100% himself, but he DID challenge me under saddle, and was his ornery old self that way.
I honestly don't know how much to give him. he has been at 1.25 for a week, once a day, and that is still too much for him. I am going to dose him 1/2 that twice daily, and if that is not enough, reduce it to 0.5 twice daily.
Hope Sam's still doing good.
Nancy
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Member:
scooter
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Posted on Tuesday, Sep 14, 2010 - 5:14 pm:
Sam is "holding his own" as you say still not quite himself...but definitely big improvement. We do have to be careful with coincidences I believe, maybe Sam was on the upswing anyway...so hard to tell and figure out. I am going to leave him at .5 ml's a day and see if that is enough to keep his cushing symptoms under control...I hope so as I think the higher dose did not agree with him at all.
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Member:
gwenyth
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Posted on Tuesday, Sep 14, 2010 - 6:12 pm:
Diane, look at this - we are not crazy!
https://www.chronofhorse.com/forum/showthread.php?t=247933
nancy
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Member:
scooter
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Posted on Tuesday, Sep 14, 2010 - 6:55 pm:
LOL that's good to know some days I wonder, my vet says I think outside the box too much, but I KNOW my horses well, as I am sure you do. Sam actually did ok without pergolide, except this time of year and having to clip him. My goal is to wean him off it if possible, he was galloping around tonight and looked sound as Sam gets. He still has a bit of a drugged look about him, but not nearly as bad. BTW I did try chasteberries on him, I didn't really see a difference with it, but at least it didn't "bother" him either. I must go back to not being lazy, if I am strict with his diet at critical times of the year he does pretty well.
Keep me updated on feivels progress...misery loves company ya know
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Member:
gwenyth
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Posted on Tuesday, Sep 14, 2010 - 8:10 pm:
You know, I think that's the best advice - keep and eye on weight and diet (like Dr. O says!) and go from there.
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Member:
scooter
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Posted on Wednesday, Sep 15, 2010 - 7:38 am:
I hope I can get away with just diet, or at least a small dosage of pergolide. He definitely is a classic cushings horse and has had it for around 8years so he is well into the disease. When I started it last year he was peeing ALOT, and drinking ALOT, so hopefully keeping an eye on that will tell me how he's doing. IF he remains "symptom free" other than all that hair, and bright on .5ml's I will leave him there. He sure looks better right now, so will see what another week brings at that dose.
He definitely is less depressed, his "bellyache" seems MUCH better, his stomach isn't loud anymore, it was always growling, he quit whinnying out of the blue for absolutely no reason, that was really bad, we were considering taping his mouth shut His lameness went from 4/5 to 1/5 and still improving, no more boots peeing and drinking are still "normal"
I probably didn't reduce it as slow as protocol would call for, but he seems no worse for it (at this point)
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Member:
gwenyth
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Posted on Wednesday, Sep 15, 2010 - 8:43 pm:
Dr. O,
I decided that I really needed to understand the molecular mechanism of how pergoglide works (at least a rudimentary knowledge)
I understand it to be one of the most potent dopaminergic agonist in humans - at the post synaptic receptors. (Pergoglide stimulates dopamine receptors.)
The binding of dopamine at the recognition site of a post-synaptic DA receptor sets off a chain of reactions which ultimately causes ion pores along the post-synaptic membrane to open and an action potential to be stimulated. Found in four major tracts of the brain (the nigrostrial tract, the tuberoinfundibular tract, the mesolimbic tract, and the mesocortical tract), DA plays an important role in the control of both motor and emotional behavior.
SOOO - does that mean that too much pergoglide would cause the post-synaptic membranes to be TOO stimulated? Thus causing the ion pores to be too open, and have too many action potentials? Too MUCH stimulation?
Or do I have it backward, and it binds to the receptors and causes too little activity in the brain?
I am trying to remember my college biology (LOL) but I really would like to understand what is going on with my horse (if that is truly possible - lol!)
nancy
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Member:
gwenyth
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Posted on Wednesday, Sep 15, 2010 - 8:49 pm:
Diane, just FYI, the side effects of the drug in humans:
**** are mine
SIDE EFFECTS: **Headache**, nausea, dizziness, constipation, **loss of appetite**, dry mouth or DrOwsiness may occur. If these effects persist or worsen, notify your doctor promptly. To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water or use saliva substitute. Report promptly:**** trouble moving or walking***, hallucinations, confusion, ***severe muscle stiffness***, trouble sleeping. Unlikely but report promptly: new pains (including chest pain or pressure), restlessness, vision problems, fever. Tell your doctor immediately if any of these unlikely but serious side effects occur: **sudden irresistible urge to sleep**. In rare instances, this medication may cause very serious heart valve problems or swelling around the heart and lungs (e.g., pleural fibrosis or effusion, pericarditis). Tell your doctor immediately if you develop: chest pain, fainting, unusually slow or fast heartbeat, trouble breathing, leg or foot swelling, **unusual weakness**. If you notice other effects not listed above, contact your doctor or pharmacist.
I bet that when people took this drug they didn't tell them to take MORE of it when the people had these symptoms - but they tell horse people to give their horses MORE drug! lol!
nancy
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Member:
scooter
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Posted on Thursday, Sep 16, 2010 - 4:10 pm:
Nancy I think comparatively speaking the dose for humans was MUCH higher. BUT different drugs effect different species and individuals differently.
Sam has always been very tolerant when given drugs when needed. Hank on TOH doesn't tolerate anything very well, even sedation, he takes half the normal dose to sedate him, then has a very hard time snapping out of it, NOW Sam usually takes double OR more to what it takes to sedate a normal horse, and snaps out of it quickly. Through trial and error we have discovered this. I think it would be the same with pergolide, trial and error, with a small percentage not tolerating it at all.
On a VERY good note Sam IS back to "normal" galloping and playing...no more out of the blue whinnying, no more stretching out.. He looks pretty good again for a long standing cushings horse.
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Member:
gwenyth
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Posted on Thursday, Sep 16, 2010 - 5:13 pm:
Oh, yes, for sure a much higher dose, and yes, different drugs react differently in different species, but Pergoglide works on the DA receptor in both species.
Report from my vet visit - I told her what was happening and what I had done with the dosage and she was 100% in agreement. Said he looked greatly improved from a month ago. She was frankly surprised that the ECIR group had told me to "increase" the dosage - she said that a horse with normal I;G, normal urination, normal water intake who had the symptoms that Sam and Feivel are having, it was logical (as we thought) to try to reduce the dosage first. She also had not much good to say about a "group" that would say that they know "more than the vets", especially since she's been a vet for over 25 years. She said that what is needed for PPID and IR is more scientific data, but that more and more is coming out all the time, and not to look to the internet for "solutions" - it's just like Dr. O answering our questions, but always referring us to our attending vet for the final answer/outcome.
So I am to keep him on this dosage for another 2 weeks and if he remains normal to reduce by another.25mg. Maybe we can reduce it in the spring and increase back to 1 mg in the fall.
Unfortunately, she said my mare needed to lose more weight - lol!!
nancy
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Member:
scooter
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Posted on Thursday, Sep 16, 2010 - 10:44 pm:
Thanks for the report Nancy, I talked to my vet again today when getting the fat cat his special million dollar food. He thinks I am crazy lowering Sam's dose. I had been raising Sam's dose a little since the beginning of Aug. to try to avoid this Fall crash he has every year (per vet). He seemed to go downhill from there. I can't believe how good he is acting now. He is still on a strict diet and will be for the rest of his life, especially this time of year. He is going out on pasture for a few hours a day, it is not lush looking at all and quite short, it's more for exercise than anything. He leads the pack out at a dead gallop, tail flagging and looks so good.
I can't be 100% sure the lower dosage is what snapped him out of it, there ARE alot of coincidences involved. However the lower dosage sure isn't hurting him either it would seem, and the drugged look is gone. The weird whinnying is really what I found strange, he never shut up, we really did want to tape his mouth shut. On one 2 hour ride my friend and I were trying to come up with ways to keep his mouth shut the whole ride LOL, it was like a dog that never stops barking. Soon as we hit .5ml's it stopped, except his normal talking at feed time ect.
My vet said there is no such thing as pergolide toxicity....
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Member:
gwenyth
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Posted on Friday, Sep 17, 2010 - 7:22 am:
Diane, I think ANY drug can be given at too high of a dose. That's just fact. Otherwise, we could take 50-60 aspirin a day without consequences.
So happy about Sam and Feivel. And yes, there are coincidences, but since both of them seem to be acting better, we just have to go with what we observe. My vet said that you dose for symptoms, (as does Dr. Kellon), but reducing the dose or increasing the dose, we want to give the smallest amount of drug that controls the polydipsea/polyurea/laminitis.
All I know is that I am so grateful that HA exists and that we were able to discuss this!!!
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Member:
scooter
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Posted on Friday, Sep 17, 2010 - 8:10 am:
Nancy I know, that is what my vet said
I am glad we were able to discuss this also, really gets me thinking about some things Sam has gone through while on pergolide. Is is nice to see him back to normal, I hope he has a good winter unlike last year, I have a feeling he will. I hope fievel continues to improve also, keep me updated as to his process as you DrOp his dose, and thanks for sharing this thread...sorry I interrupted, but Sam's symptoms were very much like feivels. We have not gone through the fall flush of grass yet, Sam is going to have his butt locked up when that happens.
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Member:
gwenyth
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Posted on Monday, Sep 20, 2010 - 11:41 pm:
Diane, talked to an equine specialist this weekend at a horse show. described Sam and Feivel - she was NOT surprised and had some pretty bad stories of her own about horses with bad reactions to pergoglide in general or to high dosages> Said it has happened in her own practice a few times. Reducing the dose is always the way to go before increasing it, to see if that will solve the problem.
Was an interesting talk and she said to keep reducing Feivel's dose to find his optimal.
nancy
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Member:
scooter
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Posted on Tuesday, Sep 21, 2010 - 6:01 am:
Nancy funny you posted this, yesterday as I watched Sam gallop SOUNDLY out for his turnout I thought about Feivel and wondered how he was doing. Only a couple weeks ago he was standing in the lean-to with his head hanging in the corner and didn't even want to come out. I'm glad I have my boarder here now so I know I am not "imagining" things. Last night I said can you believe the difference in Sam, and she said she hated to say anything at the time, but she felt horrible for him when she came out during the day to do chores. He would have his head pressed in the corner and wouldn't even acknowledge she was there (Sam is VERY social)!
The hard thing about this whole thing is common sense would say they need more when acting like this, especially this time of year. I really didn't know which way to go as I suspected the pergolide like you, and my vet said to up it his dosage. I'm glad you started this thread, when someone else notices the same things at least you don't think you are crazy! Sam is still at .5ml's, his depression, very strange whinnying, lameness, looking like he has a bellyache, is all gone while his PPID symptoms remain under control, he does have quite a bit of hair coming in, but he did while on pergolide after he went bald too. I still think he looks a little drugged tho, but not nearly as bad.
Thanks for the update and hope feivel is doing well too
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Member:
gwenyth
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Posted on Tuesday, Sep 21, 2010 - 9:03 am:
I think Feivel still seems a little drugged, too, but only right after he gets his dose. I am going to get him down to 1mg if I can.
I think that with horses, sometimes I know that I might read too much on the 'net and my husband ignores all that stuff. All he knew is that the horse looked "drugged" to him - lol!!
Feivel hanging with the other horses now, grooming them, pushing them around and in general being his obnoxious self.. I hope in a few weeks we can start riding in earnest. He needs the exercise!
Great great news about Sam.
nancy
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Member:
scooter
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Posted on Tuesday, Sep 21, 2010 - 11:27 pm:
So it's been about 3 weeks since I lowered Sam's dose to .5 ml.
Tonight I would say my good old Sam is back! He was prancing around like a stallion, rolling in the mud (his favorite thing) he had quit doing that too. Back to keeping Hank in line...he's back!! The drugged look has disappeared finally. Quite a different horse.
Nancy thanks for letting me brainstorm with you, I'm not sure I would have DrOpped his dose without this thread...even though my gut told me to.
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Member:
gwenyth
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Posted on Wednesday, Sep 22, 2010 - 8:39 am:
Diane, we both have to thank my husband, lol!!!
And Diane, if you re-read this thread, which I just did, you started to reduce Sam's dosage on Sept 10th, which is 12 days ago. Look at how fast that happened!!
AND we should thank Dr. O, who told me I wouldn't "doom my horse" if I lowered the dose. That was key for me, since the "experts" on Cushing's were dead set against me lowering the dose this time of year. "Experts" sometimes don't have common sense - I see that with the people my husband works with at the local university all the time.
I'm going to lower Feivel's dose to 1mg starting today - two .5mg pills twice daily. Yesterday I trimmed his hind feet and he trotted off afterwards - what a change that was, too. I just can NOT believe how foot sore the drug made him.
nancy
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Member:
scooter
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Posted on Sunday, Sep 26, 2010 - 9:47 am:
Nancy wonder why pergolide would make a horse foot sore? Could it be coincidences, I wish I knew Sam's lameness has continued to improve also, I took him off the "starvation" diet and put him back to careful monitoring..I CAN see his ribs, so this wasn't caused by obesity. I had held him at .5 ML's for a little bit, then lowered it to .25 ish ML's. While this makes me nervous, he continues to get even better All of his PPID symptoms remain under control, and he looks good (for him) and his normal crazy Sam behavior has returned..he is an "up" arab like he used to be, rather than dragging / limping around depressed.
The possible coincidences... a short trim? ( I didn't think so)...never been sore after farrier before.
Was hot and humid/ now cool....heat never bothered him much before, but things change.
Put him on very strict diet, tho not obese.
Every fall for years he gets like this....on pergolide this year he seemed a little worse than "usual" Lowering pergolide he got better very quickly... Accordingly it would seem from reading anyway, this is still a very bad time of year for PPID horses. It's all kind of strange and would go against "protocol". Sam has seemed NQR in many ways since starting pergolide, I believe he is one of those that needs as low of dose as possible yet still control his "symptoms" This is not one of those drugs that has "specific" guidelines.
How is Feivel on his lower dose??
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Member:
gwenyth
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Posted on Friday, Oct 1, 2010 - 4:33 pm:
Diane, I am not sure that anyone knows what causes the pergoglide to cause foot soreness, but after talking to a number of people, I do not think we are alone! I was blaming the trimming, but I have trimmed him since I took him down on the drug and no lameness so far.
I think that, in Feivel's case, we just started off with a bigger dose than needed. He is doing really well on 0.5mg twice a day, and I intend to lower it again, as he is still sluggish after he gets his pill. My goal is to try to wean him off it in the winter and spring, and then have him on it in the summer and fall when it's at its worse. Whatever is the best thing for him. that's what I'll do.
Someone also suggested to me that it might be an autoimmune disease. Which makes sense. Have you ever heard of this "transfer factor" idea of treating PPID? My husband says it might make sense, but that he is skeptical.
If Sam is OK on .25mg, why not??? Ar his age, he should be feeling good everyday, and if that means his symptoms aren't as well controlled, well then??? I'm sure he'd rather feel good and live a few years less, than feel miserable all the time. Ask any nursing home resident!! I feel that Feivel needs to feel his best as long as he can.
I am also considering cyptoheptedine, as I had another horse on that drug and it SEEMED to me there were fewer side effects, but it was so long ago, I could be dreaming. lol!
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Member:
scooter
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Posted on Friday, Oct 1, 2010 - 5:25 pm:
When I had the vet out for Sam's abscess he said he looked GREAT...other than being 3 legged lame I told him he was on less than .25 mgs. He didn't believe me, said I would have to up it in the spring if that's the case.
While I believe Sam is a cushings horse, I think his IR affects him way more, Now figuring out if it is the PPID causing the IR OR he is just IR is another thing!! I think if I keep his diet under control, I may be able to take him off pergolide. Other than this abscess that resolved quickly once the vet pared it out he is doing VERY well. I am about out of pergolide and time to re-order, while no one can make the decision other than me I am considering, just removing it and see how he does... it does scare me a bit, but we managed just as well without it, other than he didn't shed. It does scare me a bit tho....will let you know how it goes if indeed I decide to do that, I know my vet won't agree
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Member:
scooter
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Posted on Saturday, Oct 2, 2010 - 11:06 am:
Do you ever wonder if your mind tries to tell you something subconsciously . I don't know why, but I forgot Sam's pergolide this morning, I never forget it, he had already eaten his stuff when it occured to me, so I decided to try to take him off it and see what happens, I guess this way I still will have some on hand if he doesn't do well. My gut says he'll be fine as long as I keep his diet "tight"...my gut has been wrong once or twice tho! Usually right tho...will let you know how it goes.
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Moderator:
DrO
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Posted on Saturday, Oct 2, 2010 - 11:18 am:
nancy,
I am unaware of any scientific or epidemiological work to suggest the careful use (as defined in our article) causes foot lameness. Nor do I find evidence of that in your posts above. You are relying too heavily on temporal events in a few (or even a few hundred) cases while ignoring the experience of thousand or even millions if you consider how commonly this drug is used and where no problems is reported. Indeed a large number of these horses with lameness are helped.
Consider the effects of your words: you may discourage the use of a known beneficial treatment to someone's horse who may really need it over a very conjectural proposition.
DrO
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Member:
gwenyth
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Posted on Saturday, Oct 2, 2010 - 12:02 pm:
Dr. O, I am so sorry! And I apologize!
I thought I had made it clear in my posts above that I felt that he had been started on too high of a dose initially. If I had followed your advice about dosing, which was more conservative than my vet's was, I think he would not have encountered the issues that he did. If this is not clear to other people who read this thread that the problem was too high of a dose, I am really sorry.
I do know that most horse's lameness and PPID symptoms are indeed helped by the drug. But I do know that it has to be "careful use" as defined in your article. That's where I should have requested - more strongly - a starting dose of 1mg/day. rather than 1.5mg/day.
Now that we are back to a moderate dose, he is better. I think that what I have learned from this experience, is that pergoglide should be started very moderately, and that it might not cure all cases. I am not against pergoglide use and know that it has helped my horse. But overdosing did not help him.
The last thing I would want to do is to discourage someone from using the drug if their horse needed it. But I do think that I am more aware of the side effects than I was beforehand, and if I had only known earlier, I would have reduced the drug earlier. But that's water over the dam.
Again, I don't want to discourage anyone from using this drug. It's just that it happened that both Diane and I had vets that encouraged higher doses than our horses needed, although I know for sure they had only the best interests of the horses in mind. I know that your indicating that I could reduce the drug slightly, helped me significantly, and I thank you for that. Not having an equine specialist around here does make these kinds of situations difficult. That's why I appreciate your advice.
Thanks
nancy
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