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| Discussion on Can pergolide raise insulin? | |
| Author | Message |
| Member: scooter |
Posted on Saturday, Oct 9, 2010 - 2:56 pm: Hi Dr.O. this is kind of a continuation of Nancy's discussion where we wondered if somehow pergolide may be contributing to our horses laminitis.While I understand that pergolide is a god send for most horses diagnosed with PPID, I really wonder about the few others it may not be, while they may not be in the majority, we must also consider the minority, especially if your horse is one of them  . I removed Sam from pergolide last week, he really didn't seem to tolerate it well. I had his insulin tested while off the pergolide and it was 40 with 5-20 being "normal" a far cry from his 420 insulin this winter While on pergolide. Very many variables there, but still marked improvement. Sam is definitely PPID since he is hirsute ( I guess) but his IR seems to be more involved in his over all well being. I know I must keep "coincidence"/ temporal events separate here if I can, and I do try to weed through it all. Since the removal of the pergolide his PPID "symptoms" have not returned YET anyway. I do have him on a fairly strict diet of grass hay, handful of alfalfa pellets, grazing when not lush. When I posted on Hanks thread about EMS and the cresty neck, I was curious about something about EMS and googled it, surprisingly it brought up things about pergolide and how it does NOT help with EMS/IR and may actually make it worse due to the fact that pergolide can actually raise insulin  I know "coincidences can be involves in this, but it is strange the more pergolide Sam got during his horrible founder last winter the worse he got until I took him off it until he stabilized and then slowly added it back. Then early this Aug. I raised his dose (per vet) to stave off his "fall funk" and he almost immediately got worse. Then Nancy had her post saying she had heard that pergolide MAY cause lameness, I could not see how pergolide MAY cause lameness and obviously from your reply you did not either. Well after what I ran into when searching about EMS I'm starting to wonder if it is possible, especially if the horse is IR and PPID. I am NOT trying to discourage anyone from using pergolide on their horse, I do believe there is the minority that don't tolerate it well and maybe quite possibly it could tip the IR horses scale. Here are a few references would love your thoughts. This is from Wedgewood pharmacy, where I get Sam's pergolide from take note of the last sentence. The two medications used most frequently to treat Cushing’s in horses are pergolide mesylate and cyproheptadine. Treatment is typically given orally once a day. Pergolide was originally used to treat Parkinson’s disease in humans. It helps to decrease hormone levels in the circulation. Pergolide does have some drawbacks in that it can worsen the chronic foundering (laminitis) seen in horses with Cushing’s. From pubmed Further reference material on insulin and ECS: Horses with ECS are frequently insulin resistant and have increased serum glucose and insulin concentrations (Garcia & Beech, 1986). Hyperglycaemia, while only having a reported sensitivity of 64% may be a useful guide for evaluating response to treatment. In The Michigan Cushing’s Project (Schott et al., 2001), of 77 horses enrolled in the study, serum insulin concentrations were elevated in 71% of horses that had DST or TRH results supportive of Cushing’s SynDrOme. A group of horses were identified who had clinical signs of abnormal fat deposition and laminitis, without hirsutism but had elevated serum insulin concentrations and normal DST or TRH results. Differential diagnosis of these horses is important as they would not be expected to improve with treatment with pergolide. A lack of decline in serum insulin concentrations in pergolide treated horses has been observed (Donaldson et al., 2002). This may be due to incomplete factors that result in dysregulation of insulin secretion. Because of normal daily fluctuations in insulin level, the evaluation of single samples may be misleading (McGowan et al., 2004). It is also possible that hyperinsulinaemia might persist in spite of effective control of ECS in obese horses. From kentucky equine research...again last sentence is interesting Medication. No medication is suitable for treating metabolic synDrOme. The two most commonly used medications for the management of Cushing’s synDrOme, pergolide and cyproheptadine, have proven ineffective for treatment of metabolic synDrOme. Both medications have a tendency to limit pancreatic insulin secretion, which only adds to the problem. |
| Moderator: DrO |
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| Member: scooter |
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| Moderator: DrO |
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| Member: scooter |
Posted on Monday, Oct 11, 2010 - 8:22 am: Thanks Dr.O. after I put that title in I wanted to change it but couldn't . It seems to be much more complicated then that and I don't understand some of the studies I read about this, that is why I wanted your take on it. While I know that Wedgewood isn't pub med but the statement that it could make laminitis worse sure jumped out at me, since they are selling the drug I wouldn't think they would state that for no reason Wedgewood Pergolide does have some drawbacks in that it can worsen the chronic foundering (laminitis) seen in horses with Cushing’s. KER Both medications have a tendency to limit pancreatic insulin secretion, which only adds to the problem. The statement from KER and some others studies seem to mean it limits insulin, so how would that add to the problem of an EMS horse? From what I gather it actually would effect glucose more?? Just trying to understand.....Thank you |
| New Member: jdonohue |
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| Member: scooter |
Posted on Monday, Oct 11, 2010 - 8:26 pm: Hi Jodi, I can't access all the articles online in the AVJ. However I did look around a little more and found thisThis drug was originally used to treat human Parkinson's disease. At the doses considered successful in treating Cushing's disease, however, pergolide mesylate had a severe vasoconstricting effect that served to worsen the chronic laminitis that frequently accompanies Cushing's disease. In the early '90s, Montana equine veterinarian, Dr. Duncan Peters, decided to give a very small dose of the drug to a horse suffering from Cushing's disease. This dose was roughly equivalent to one-sixth of the amount considered appropriate for a human. The horse responded positively. In a further study, Dr. Peters was able to duplicate the positive results in eight of nine horses/ponies with no negative side effects.(MY NOTE 8 of 9 horses, wonder about the other one???) The average response time was close to three weeks, and improvement continued until the horses stabilized at an average 21 weeks. Since these results were published, pergolide mesylate has become an acceptable treatment option for Cushing's disease. SOOO it would seem that statement on petmd is a bit mis-leading, if I understand right it affected vascoconstriction at higher doses then given now ( IF I understand right) I am NOT trying to knock this drug, as I said above I have seen it work wonders for some. Sam seemed to get a bit toxic with it, I'm sure he isn't the only one, sometimes these toxic reactions aren't easy to separate from temporal events as Dr.O. says making us owners PPID horses a bit of a challenge I know my horses very well, just like my kids when they were young, I could look in their eyes and know they didn't feel well....Sam had that look while on pergolide and acted it too. Figuring out whether it is not enough Pergolide, or too much is NOT an easy chore as symptoms present almost the same in each event and maybe people should be warned of this too. I don't know about everyone, but I can't afford to have my horses blood tested to check this all the time. Just to have his insulin glucose checked and the old girls teeth done it cost OVER $400  Sam has been titrated down from 1.5 mg.s to completely off it now for 9 days. I read pregolide clears fairly quickly from the system, I am going to keep a close eye on him as I would think with-in a month if I have done him an injustice by removing it. At the moment he hasn't looked and acted this good since starting the pergolide a year ago. For some reason I don't even have to be as strict with his diet (I'm still quite strict don't get me wrong)! When I started upping his dose slowly (per vet) to help with his fall funk...laminitis, depression ect. he started going zombie again and was VERY lame ( I had him locked in the dry lot, getting soaked hay) These may be temopral events, but since starting the pergolide everytime Sam is trimmed he can't walk for about a month, we know I have farrier problems, but he has never lamed Sam before. He is getting trimmed Weds. we'll see how that goes, the ground is rock hard now. this may tell me if this has been temporal events. If he can't walk again I guess I can take this off the list. His eyes are back to normal, they looked like they wanted to pop out of his head  and he acted depressed. He was like this even on a small dose, but not as bad. I don't know why, but his IR symptoms seemed worse, I keep these horses on a very low carb diet if you look at the difference in Hank you can tell ( I do learn eventually!) ALL in all Sam just wasn't Sam  and it didn't seem to help anything much other than he went totally bald twice and I still ended up shaving him anyway. I don't know if you remember Sam's ordeal last winter, but other than possibly ingesting locust pods there was absolutely no reason for him to have had that happen. There was 6 ins. of snow on the ground at the time. His "symptoms" started about 3 weeks after getting pergolide on a regular basis. Thanks for listening, I do believe pergolide can have toxic effects on some horses, even at small doses. Sam about 2 mos. before I started pergolide ugly shave job and all, but at least looked good, happy and alert.  Sam 1 week of pergolide  Sam on pergolide for about 3-4 weeks, kept upping the dose per vet, temporal event I don't know, but once I removed all meds he started improving, his head was swollen a lot, with no obvious trauma, he became a Zombie, and foundered very badly, especially in the rears. 
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| Member: scooter |
Posted on Sunday, Oct 17, 2010 - 5:19 pm: Dr.O Sam has been hirsute for around 9 yrs maybe longer, but at least 9 years. I have read that PPID is a progressive disease and that pergolide is the the best way to "buy" them a FEW more good years.If Sam has been hirsute for at least 9 years that means he has had CD as long, if not longer right??. He really gives no indication of "getting worse" if I keep him on a tight diet.... exercise is very beneficial too . Can EMS/IR or anything else cause him not to shed? While he does have an abnormal hair coat (VERY VERY thick and long) it is healthy, shiny and not curly. He definitely doesn't shed all the way out, not even close. A couple years ago when Hank foundered badly Sam became my main riding horse and I rode him quite often. I remember the vet telling me he would shed out since he was getting exercised, keeping his insulin under control, and in very good weight and fit. Well he was wrong, but I'll admit, Sam came very close to shedding all the way out, more so than he had in years. Does hirsute ALWAYS mean PPID? Sam has been off of pergolide for 2 weeks now, he is on an EMS/IR diet and I am slowly bringing him back into work, he is very sound even gravel doesn't bother him. He is much hairier than Hank and Flash, tho Flash is close. He is full of energy and raring to go, he does tire easy, but I haven't ridden him in 3 yrs., he is getting stronger every ride. If it wasn't for that hairy non-shedding coat I really wouldn't consider him a PPID horse looking at him. He is about 24 yo. He did go completely bald twice while on pergolide and grew his long coat back both times and it didn't take long, I did have to clip him mid-summer. When he went bald he quit sweating, even when he grew his hair back. He is sweating again since I weaned him off the pergolide. 
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| Moderator: DrO |
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| Member: scooter |
Posted on Wednesday, Oct 20, 2010 - 8:34 pm: Thanks Dr.O. I have read the article many times, especially when my vet suggested pergolide for Sam last fall and hence my thread "is it time for pergolide" He was quite lame and uncomfortable and the vet blamed "the tumor in his head" I wasn't so sure. He suggested the pergolide.I kind of had a feeling it was one of those temporal events, but how is one to know??? I think I slacked too much on his management and caused it When I started the pergolide I also locked him up and put him on a VERY low carb diet. He improved...then I figured out I wasn't actually getting the pergolide in the syringe so he really wasn't getting any, but yet still he improved I started him again on the powder so I know he was getting it and 2-3 weeks later he was a "zombie" if you recall my thread last winter about Sam's weird founder, his insulin spiked to 420, his head swelled up, and he foundered in the rears, his backend was basically paralyzed. temporal events, I don't know and never will. Anyway if you don't mind answering a few more question, Can IR cause excessive drinking and urination? It seems anytime Sam starts this is when I make a mistake in his diet and probably spike his insulin. He isn't consistent with this symptom. He will be off pergolide 3 weeks Fri. Would the excessive drinking and urination have begun to return now if it was caused by his PPID? Do you know how long it takes pergolide to "clear" the system. Thanks again
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| Moderator: DrO |
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| Member: scooter |
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| Moderator: DrO |
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| Member: scooter |
Posted on Wednesday, Oct 27, 2010 - 7:16 pm: Dr.O. I'm pretty sure I can rule out hard irregular ground in Sam's case we had tons of snow on the ground and it was pretty fluffy, even Hank was fine.Sam continues to do well off of the pergolide, he is past the 3 week mark last Fri. Actually he is doing wonderfully  . My vet seems to think high insulin, is one of the mainstays of a PPID diagnosis, whether this is true or not I don't know. If you recall his blood work last Dec. showed an insulin level of 420 and on the statement it suggested an insulin level > than 90 should be tested for PPID... I'm pretty sure Sam was toxic from something. Again my vet has an interesting theory, I was up getting my cats their special million dollar food and was chatting with him, he told me that maybe I should try thyroid meds on him to help keep his insulin low, matter of fact he thinks all my fatties would benefit from it. While the 3 of them look pretty good now, they can tend to get fat over the winter if I am not very careful, which is very hard with our frigid winters. Vet said to put them on thyroid meds over the winter so they emerge in good BCS in the spring and it helps keep insulin lower. Seems like the easy way out, but then again, it is sooo hard to feed them practically nothing when it is -50 with a windchill. I am considering it
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| Member: cheryl |
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| Member: scooter |
Posted on Wednesday, Oct 27, 2010 - 10:20 pm: Hi Cheryl, I was surprised by how much thyroid meds cost now at the vet office... they use pala-tec or something like that and it was 30 something dollars for a pound. My vet has been trying to get me to try Hank on it for years! Hank actually looks pretty good, I was able to keep him in a good exercise regimen this year sine we didn't have any founder issues for the first time in a LONG time! So I think I have his diet pretty good, getting rid of the clover helped him out a lot! All spring/summer I fought the fat horse fight and won! They were able to graze way more then they normally can, but I brought out all the guns, I soaked their hay they got at night, I exercised them whenever I could, I paid attention to what their bodies were doing and I did it!!! I tell you it is so hard to keep horses like this (but well worth it) YET they still have that EMS look about them, not as bad, but it is still there. With winter coming, exercise pretty much ends, soaking hay becomes very problematic, and it just gets too cold to "starve" them. While I believe I FINALLY got a grip on their spring/summer/fall diets...winter proves to be a bit tougher all around. While what I have read about thyroid supplementation in the EMS horse CAN be beneficial to help them lose weight the protocol now seems to be to actually to give them excess thyroid meds to make them a bit HYPERthyroid, then when they lose the weight titrate down. One of many articles/studies I was reading about this https://www.wisconsinequineclinic.com/blog.php?ID=40 I'm not sure a "scoop" would do anything, I may try it "a scoop" because they really don't need to lose much if any weight, but if I could maintain their weight with a scoop it would almost be worth it and see if the EMS look would dissipate... slightly cresty necks, fat lumps on butts ect. Wonder if it would be a do no harm type of thing??? How did Fox do this year with her founder??? |
| Member: cheryl |
Posted on Thursday, Oct 28, 2010 - 9:41 am: I read the article you sent - never allowing a horse to graze is beyond my ability --- absolutely not possible for me to do - If Fox can't be a horse I will put her down. I looked up the Thyro-L on KV Vet Supply - 180.00 for 10 pounds - I don't know what you vet is using - have never heard of it - I'm thinking a different brand.Thanks to you and the get rid of the clover campaign - Fox hasn't foundered this year - she has been out on the big pasture - which has a few patches of clover I didn't get killed - will try again in the Spring - She has not lost any weight - she also hasn't gained any weight - and has been out 24 hours a day - they didn't get into the big pasture until after haying the first of August - I've been having to do their feet - long story not for here - but have managed to keep her pain free enough that she is running bucking and kicking most of the time. I'm pretty sure the difference is the clover - I just wish it weren't so blasted hard to kill 
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| Member: scooter |
Posted on Thursday, Oct 28, 2010 - 4:28 pm: Thanks Cheryl, My horses are grazing more with the death of the clover too. Glad Fox had a normal summer! I wasn't suggesting taking them off pasture with the article, I wanted to show you what it said about "over" supplementing them with thyroid meds if they are obese. Fortunately mine are finally out of the obese category and more in the pleasantly plump to almost normal category .5-6 bcs My clover is making a resurgence too, and I see spraying again next spring in my future I'm going to research a little more and see if I can't find something that will get rid of it without having to spray it 3-4 times!!! I think doing it earlier in the spring would be quite helpful, tho I did do some spot spraying this spring and it hardly put a dent in it! As always I am getting off subject AGAIN! I think I am going to try the thyroid sup and see what happens after a month... If I find something to kill the clover I will post it in Hanks Experiment thread. |
| Member: cheryl |
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| Member: scooter |
Posted on Saturday, Oct 30, 2010 - 11:34 am: Cheryl I think I am about due for another experiment . I Did start the horses on the thyroid meds Tues. Just a scoop, which is 12mgs.same as Thyro-L. scoop. Just a different brand. Your welcome and I hope our fat ponies can continue to live "normally" it is SOOOO nice. My vet even said he was impressed was the first spring/summer he didn't get a call out here for a founder episode and finally it wasn't real hard and they didn't have to be "starved"! Stay tuned for the thyroid supplement and EMS experiment LOL. |
| Member: scooter |
Posted on Wednesday, Nov 10, 2010 - 7:04 am: Dr.O. IF a horse is PPID and their symptoms don't return after removal of pergolide...what would that mean??? Sam has been off of it for about 6 weeks now, and other than the hair none of his symptoms have re-appeared he actually is having a great fall!. I know in the scheme of things 6 weeks isn't a long time, but I am just curious (as usual).
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| Moderator: DrO |
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| Member: scooter |
Posted on Saturday, Nov 13, 2010 - 12:38 pm: Thanks Dr.O. Sam has had more symptoms than hirsutism, matter of fact I think he has had every symptom listed in the article, especially last year. He was urinating all the time, and drinking alot and got laminitis. I still have a sneaking suspicion this was due to his IR. Hank also went through a phase like this and I don't believe him to Have PPID, but do believe he has EMS.The million dollar question is can EMS and PPID be treated as their own entities or does one cause the other and need to be treated with pergolide. Pergolide seemed to make Sam toxic after he was on it for awhile. He went completely bald twice and I mean completely, when he did this his coat would get real sticky, like someone had brushed tree sap all over his whole body (we have no trees in the horse pasture) Was a strange thing. Then his coat would grow back...and not be "sticky" until he was ready to go bald again, I could not brush/bathe this sticky stuff off it was his hair from end to root! Neither of the other 2 had that, so I'm pretty sure Sam manifested this somehow, especially since it was every hair on his body, including his underside. Anyway, since I have gotten his IR under better control, the excessive urination, drinking,laminitis, depression, is gone, but why? Unless the pergolide is still having an effect after 7 weeks removal or it is his EMS/IR that causes us all this havoc. My vet has been encouraging me to try Thyroid meds and cyphro for ems, I asked him why the cyphro for IR, he said horses he has on both these drugs can graze all day with no adverse effects The reason he says is because cyphro is an antihistamine/anti-inflammatory and he believes or has read (not sure) that the horses have a type of allergic reaction to the grass, the thyro-L helps keep insulin and fat in check along with the cyphro. Now I can almost believe this, even tho at first I thought he was bit crazy. I have read that these "weird" adipose tissues that horses get can be an allergic reaction.... cresty necks, fat butt lumps, weird fat on sides. It sure acts like some kind of reaction the way it grows overnight sometimes. My vet said with thyro-L and Cyphro he has EMS horse grazing 24/7 with no problems... Sam's PPID symptoms remain gone, his hair even isn't growing the weird cushings coat YET anyway. He is quite hairy tho, but for now it seems normal. I may add cyphro to the thyro-L later and see how that goes. Any thought on this?? |
