Cushings and Pergolide...

ImogenBurrows said:
Thanks to everyone who has posted replies to give their experiences - this is really what I was looking for.

I am glad to hear so many positive experiences with treatment, I personally believe it is a very beneficial treatment as as I said in the OP, my experience of managing cases using pergolide is good.

I don't necessarily think that if your horse has Cushings (or signs suggestive thereof) you need to rush into treatment. As the above post says, some horses do very well with environmental management, usually the ones vets see and diganose get treated as there may be an associated problem - or we probably wouldn't be there in the first place!:p

I'd like to post a photo similar to that of one of my client's ponies...this one had Cushing's - I think although no tests were done and the owner did not have the horse on treatment. He coped very well!!
Cushings_long_haircoat.jpg


Secondly, I would like to comment on my OP.

It has been brought to my attention by members of my profession that my OP was poorly worded, so much as to say it has been a hotly debated and controversial topic of conversation in other veterinary forums.

I fear that my OP has done two things that I certainly did not intend and as such would like to put the record straight.

It has been pointed out that the OP could be interpreted in such a way to suggest that I do not approve of vets that had chosen to prescribe the higher levels of pergolide for certain cases.

This is NOT the case. Each veterinary surgeon managing each individual case will have the benefit of examination, lab results, a full history etc and will make a clinical decision for treatment based on all this information. I know of references supporting higher levels of Pergolide doses in specific cases. I do NOT consider use of these doses to be negative - I would feel sure that they are indicated as they have been prescribed.

As such, colleagues may have felt this thread undermined their decisions to use higher doses, and for this I sincerely apologise. The intention was purely to find out owner's experiences so that I, as a vet, will be able to discuss risks etc with my own clients should I need to use these higher doses in the future. As I have no experience with use of these dose levels, I personally felt your opinions matter.

It was also pointed out that veterinary surgeons have a code of professional conduct to stick too and that by undermining other veterinary surgeons decisions or knowledge, could compromise this.

I will be posting another thread to clarify my own feelings regarding my contributions on this site to avoid future controversy I hope!

Happy posting.
Imogen
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Shame your post was taken the wrong way. I didn't read it like that at all (albeit I am not a vet) and found it extremely interesting to have a vets view/perspective and questions on this subject. Yes we talk to our own vets but threads like this are brilliant for prompting other thoughts and questions that we might not perhaps think of on our own.

My mare who is a TB x 16.3 is on 2mg at the moment because that is the level she was on when she came home. Now my own vet is questioning this but not from a perspective of critisisim of the previous vet but rather she wants to understand the diagonisis that led to my mare having this level prescribed - and we are going through this at the moment. I am new to cushings so all this information is very helpful - my own mare is very overweight as was out of work and is a very good doer but has certainly firmed up since starting fittening work again.

Please keep posting Imogen, anything that helps broaden our experience can only be for the good!
 
Luci07 said:
Shame your post was taken the wrong way. I didn't read it like that at all (albeit I am not a vet) and found it extremely interesting to have a vets view/perspective and questions on this subject. Yes we talk to our own vets but threads like this are brilliant for prompting other thoughts and questions that we might not perhaps think of on our own.

My mare who is a TB x 16.3 is on 2mg at the moment because that is the level she was on when she came home. Now my own vet is questioning this but not from a perspective of critisisim of the previous vet but rather she wants to understand the diagonisis that led to my mare having this level prescribed - and we are going through this at the moment. I am new to cushings so all this information is very helpful - my own mare is very overweight as was out of work and is a very good doer but has certainly firmed up since starting fittening work again.

Please keep posting Imogen, anything that helps broaden our experience can only be for the good!
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Thank you and best of luck - keep us updated of your mare!
Imogen
 
The dose range for pergolide is 1-5mg/500kg horse/day. The two most prominent researchers into endocrine laminitis are probably Cathy McGowan at Liverpool, and Andy Durham at Liphook, and both will happily use up to 5mg a day if needed. 1/2mg a day is only really appropriate in small ponies with mild disease.
As far as diagnosis and monitoring, then ideally we should be using a dex suppression test, ACTH assay and insulin assay, although the dex suppression is commonly missed out. Clinical signs are obviously key as well.
I've never seen a horse with pergolide side effects, so IME the consequences of underdose are far more severe than the consequences of overdose.
 
alsiola said:
The dose range for pergolide is 1-5mg/500kg horse/day. The two most prominent researchers into endocrine laminitis are probably Cathy McGowan at Liverpool, and Andy Durham at Liphook, and both will happily use up to 5mg a day if needed. 1/2mg a day is only really appropriate in small ponies with mild disease.
As far as diagnosis and monitoring, then ideally we should be using a dex suppression test, ACTH assay and insulin assay, although the dex suppression is commonly missed out. Clinical signs are obviously key as well.
I've never seen a horse with pergolide side effects, so IME the consequences of underdose are far more severe than the consequences of overdose.
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I've not seen a horse with side-effects either, but then as I stated in the OP, I personally have not needed to use doses higher than 1mg.

I hope you realise that I am NOT criticising other vets how have used/do use higher doses - it is just something I do not have experience with, and several people had been reporting possible side-effects so I felt it interesting to try and see how most people felt about the effects of higher dose treatments, from an owner's perspective.

I am however, interested as to why you feel diagnosis and monitoring should be made with both the low dose dex suppression test and acth as well as insulin levels....we send off ACTH and insulin (if req'd) to Liphook and I'm not sure many of my clients would want both dex and acth every time....I was under the impression that with the latest seasonal reference ranges established, that the ACTH alone is a pretty accurate diagnostic and monitoring tool. I would be interested in your thoughts.

There is no doubt there are wide ranges of the levels of pergolide required in the horse/pony to stabilise Cushings. The dose required is the correct one IMO.

Again, apologies if you feel offended by my OP or posts, this was started out of genuine interest, rather than to criticise.

Kind regards,
Imogen
 
My 14hh 19yold was diagnosed last monday with a level of 1200, which apparently is ludicrously high!!! after i saw a slight change in his weight and coat. I've had him over 13years so know him pretty damn well.

He started Pergolide Saturday, on half a tablet for 7 days, which will be followed by 1 tablet for 7 days, then 2 for 2 weeks then another blood test to hopefully be able to reduce the doesage - we will see.

Any help advice on an already VERY hard to manage pony appreciated!
 
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Just bringing this back up....

He's due for his blood test, but i'm having terrible trouble getting the Pergolide into him now, he was fine to begin with. He's not a food orientate pony so would rather go without than have something that wasn't 'right' in his books!!
Managing, just, to get it in with a apple & extra strong mint puree! He won't put up with a daily syringe either..

Any help/advice appreciated!!
 
Cut an apple into segments and push the tablet well into the middle of a segment.

This is how the Pergolide is administered to my girl and so far she is happily takng the apple slice :)

Sadiemay
 
My 15.2 Welsh cob was diagnosed with Cushings about a year ago, Nov 2009. My vet put him straight on to Pergolide 1mg daily. My vet gave me prescriptions and I took them to a local Lloyds Pharmacy. 100 tablets were around £40 this way although I had to pay £8 for each prescription as well.

Over the winter he seemed to put on some condition and his fat pads went down. Although he did develop quite a nasty bout of COPD over the winter and had to have Ventopulmin. I was told that Cushings plays havoc with their immune system and they will get all sorts of infection.

When February came, he got hind leg laminitis (in both legs). He lost alot more condition and then got laminitis in both his front feet as well. He had not had laminitis before this for four years, and then for six years before that.

He was in so much pain and had lost so much condition that only a dose of four bute a day would make a difference to him. Obviously this could not continue and he was put to sleep on 14th June this year. He was 23 when he died. I miss him very much. A horse of his type should have gone on alot longer and his loss is tragic.
 
Sadiemay said:
Cut an apple into segments and push the tablet well into the middle of a segment.

This is how the Pergolide is administered to my girl and so far she is happily takng the apple slice :)

Sadiemay
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He won't even entertaining sniffing it, never mind eating it!! He can tell straight away that it is in the apple/carrot/chocobiscuit etc :(

We tried crushing it & syringing it with an apple juie, but it made him violently object and throw himself against the stable wall.
 
I had a welsh cob (now sadly passed away) who was on Pergolide for years. I just opened his lips and tucked the tablet down inside his cheek and let it dissolve.
My other horse will not tolerate it in any way except when the tablet is broken in half and then hidden in half a scoop of cool mix - he loves it.
 
I too have a great interest in this thread.

My 7 year old (homebred) mare has been ill for 3 months. Initial symptoms were an enlarged ovary and granulosa cell tumour was suspected (inhibin level at 0.7).

Whilst waiting to confirm this diagnosis and decide whether to operate to remove her ovary she developed laminitis - she has teh classic symptoms of fat deposits on her shoulders, crest and rump.

She also has a cracked heel which I cannot get top heal up - depressed immune system?

Current view is that she has a pituitary adenoma and has just started on one tablet a day of percolide - hence the relevance to this thread. (She couldn't start on the percolide until the laminitis had subsided - she is also on bute and sedalin)

I am also feeding her milk thistle to support her liver.

I love this little mare to bits and will be devastated to lose her. There is very little info on pituitary problems in young horses and my vet says it is not Cushings per se (she has no curly coat - indeed her coat is coming our in handfuls.)

I share this in case it helps anyone who has related issues or if anyone has encountered something similar.

Debbie
 
Crackerz said:
Just bringing this back up....

He's due for his blood test, but i'm having terrible trouble getting the Pergolide into him now, he was fine to begin with. He's not a food orientate pony so would rather go without than have something that wasn't 'right' in his books!!
Managing, just, to get it in with a apple & extra strong mint puree! He won't put up with a daily syringe either..

Any help/advice appreciated!!
Click to expand...

I too like you had this issue, mine was on 2 x 1mg a day started off ok and eating it out of a apple slice, then i started to notice a difference in him, he actually looked depressed and lacking of any kind of energy or enthusiasm (which if you knew him is not what he is like at all), he then stopped eating any food at all other than hay, refused to take anything from my hand or anyone elses. I resorted to trying every possible feed/mints/fruit and no luck.. even marmite he seemed to still know it was there, then i tried syringing.. which he spat out and threw a proper tantrum (to me it wasnt worth him getting stressed) i then tried blow piping down throat.. same result.

Feeling defeated i done hours of internet research on case studies and what other people have tried (mainly in the USA) and thought this was basically his last chance - so i gave up trying the pergolide and put him on Cushylife liquid supplement, Echinacea (3 weeks on, 1 week off) and Milk Thistle and he improved dramatically within a month - bright shiny coat and eyes, got his cheekiness back and was full of beans, he has been on this combo for a year now and touch wood.. doing well. I am due to get his levels checked soon so i will be interested to see if there is a difference.
 
Hi - thread of interest to me too - horse aged 8, initial diagnosis laminitis, then blood test at Liphook showed Cushings - all shocked.On 1mg Pergolide a day, next blood test next Tues to check levels against oringinal test. Also being checked for EMS. Like you Debbie, no curly coat, but agian fat pads on rump, above eyes and on rump. Fully in work and fit and no other signs but was very mareish and now is not. 4th week box rest; read avidly of any info that can help.
 
debbier4 said:
I too have a great interest in this thread.

My 7 year old (homebred) mare has been ill for 3 months. Initial symptoms were an enlarged ovary and granulosa cell tumour was suspected (inhibin level at 0.7).

Whilst waiting to confirm this diagnosis and decide whether to operate to remove her ovary she developed laminitis - she has teh classic symptoms of fat deposits on her shoulders, crest and rump.

She also has a cracked heel which I cannot get top heal up - depressed immune system?

Current view is that she has a pituitary adenoma and has just started on one tablet a day of percolide - hence the relevance to this thread. (She couldn't start on the percolide until the laminitis had subsided - she is also on bute and sedalin)

I am also feeding her milk thistle to support her liver.

I love this little mare to bits and will be devastated to lose her. There is very little info on pituitary problems in young horses and my vet says it is not Cushings per se (she has no curly coat - indeed her coat is coming our in handfuls.)

I share this in case it helps anyone who has related issues or if anyone has encountered something similar.

Debbie
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I have been seeing a similar case recently - a mare with a confirmed GCT (diagnosed 3 years ago, not removed for various reasons) who has recently developed laminitis. She has normal ACTH levels (i.e. no Cushings) but significant insulin resistance. Although it is entirely possible this is down to Equine Metabolic Syndrome, she is fed sensibly and was exercised regularly up until the lami. I did some research into insulin resistance and sex hormone disturbances, which is fairly well studied in humans (think pregnancy diabetes etc.). It seems that in humans ANY sex hormone imbalance can lead to insulin resistance, and as we know in horses IR can lead to lami. There is a possibility that the laminitis is due to insulin resistance, caused primarily by abnormal sex hormone concentrations from the GCT. We tested Oestrogen, Testosterone and Progesterone - the first two were low/normal, the progesterone was raised.
As it turns out from the human literature, IR secondary to sex hormone imbalance is most often treated with Metformin, which helps not only with the IR, but has also been know to somewhat normalise the underlying hormonal problem. Metformin is also the current recommended treatment for EMS. We are currently treating with metformin, and will resample both insulin and sex hormones after around 6 weeks therapy. I will be interested to see the results.
The bottom line of my waffly post is that sex hormone imbalances may a cause of laminitis, and treatment with metformin may be beneficial.
 
Thanks Alsiola - very interesting and cobwithattitude - all young horses.
In my case - mare had ovaries scanned yesterday and vet has ruled out GCT as both ovaries are similar size.

Doesn't want ot use metformin yet as feels it could cause hypolypaemia (sp?) ie liver problems if the signifcant fat deposits break down too quickly.

It would be good to keep in touch for moral support if nothing else.

I am currently investigating if glue on support shoes would help.
 
Sorry to hijack your post but my horse has been diagnosed with cushings last week, i had his reports back which mean nothing to me, next to ACTH it reads 43.0 pg/ml {<29} that sounds low to me having read what other people have wrote, what is a normal reading, where it says insulin it says 14.0mlU/L {<20} is that normal, {the vet said he only has cushings.
 
Hi Debbier4 - would be good to keep in touch re what is happening and what is going to happen in the future or what is going to be able to happen in the future - vet came on Tuesday and is retesting mare next week - mare hates needled, so sedalin first and then fingers crossed and hard hats on! Vet pleased with mare progress but still needs to be on box rest. ho hum!!! very kind people offering me horses to ride but i really only want to be able to get back on mine!
 
ameeyal said:
Sorry to hijack your post but my horse has been diagnosed with cushings last week, i had his reports back which mean nothing to me, next to ACTH it reads 43.0 pg/ml {<29} that sounds low to me having read what other people have wrote, what is a normal reading, where it says insulin it says 14.0mlU/L {<20} is that normal, {the vet said he only has cushings.
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The normal values are the ones in brackets, so Insulin is normal, and ACTH is mildly raised. Not a dramatic ACTH level, but probably significant and probably worth treating. And as it always says on my lab results - a normal fasting insulin does not mean that there is no insulin resistance.
 
Hi Imogen. I have a Cushings pony diagnosed in June last year after mild lami. I think he can be termed actively laminitic as he went down with it at Christmas despite all precautions and still unsound on one foot. Very active riding pony and I am desperate to get him back on the road.

He started on a lower dose but he is now on 1mg of Perg per day since about 4 months. Having a great deal of trouble getting it into him. Tomorrow I am resorting to a worming bit with a dosing syringe but I still expect a fight. Have tried many tempting things but he seems to smell it. Sometimes after the feed has stood for a day he will eat it but I am not certain if the drug is still active after this length of time being immersed in soggy feed. Any idea? Any tips for getting the drug into him?

He is tested by Liphook with seasonal adjustment. Last test ACTH was 65.2pg/ml. Script mentioned that inappetance may be due to laminar pain (prob was) but could also be due to Perg. Advised potential increase in Perg as Cushings not under control.

Missed doses at Christmas probably due to laminar pain/inappetance and became madly diabetic - weeing and drinking stacks. I have managed to get the Perg into him most days since and this has abated.

Behaviour: the spark has gone! sometimes very lethargic but could also be partly due to change in lifestyle - no grazing and no outings of course due to unsoundness. Also agressive with me over hay mainly - I have owned him for 18 years and been his sole carer.

I am trying to get hold of the laminitis clinic to see about A. a lightbox to counteract winter onset of lami b. use of Vitex 4 Equids. Has anyone had any success with these please?
 
Update on Dixie....

Have had to switch from Equipalazone to Danilon as she wouldn't eat the former.

Sedalin increased to 2.5 three times a day as digital pulse is still raging.

Pergolide being administered by dissolving tablet in water and pouring on feed - no problem so far - she has been on this for 4 days.

She still has fat deposits above eyes, behind saddle and crest.

Hind feet better, front feet still bad.

Has now been on box rest for 11 days (feels like 11 weeks) .... how hard is it watching a horse you love in pain. But vet still optimistic about prognosis.
 
METFORMIN

Previous poster on this: I have had success with Metformin. I have another lami pony due to EMS. A shetland going down with it towards the shortest day of the year period (so winter onset - pineal gland issue). He has been on Metformin for over 4 years and only this year went down with lami over the very cold weather period. He is good now, sound but he is not a riding pony. Thanks to Metformin he has (at least up to now) 4 years of extra life.
 
Update on Iestyn: bloods taken Monday, result yesterday show a decrease of 14 from 65 January to 51 now (should be 30 seasonally adjusted). Pergolide increased to 1.5mg. Next bloodtest 6 weeks time.
Any more recommendations on how to get it down 'em! I tired garlic puree - 1/2 tablet in the middle of a dollop - worked once yesterday, today Zilch result! Now resorting to worming bit and dosing syringe rearing or not!
P.S. www.themetabolichorse - really good website on this sort of stuff. Very helpful diet sheet sent immediately out to me. Many thanks Jackie Taylor and to poster on here who recommended.
 
My pony has had cushings for about 7 yrs. He has been on pergolide 1mg. Last Feb he came down with laminitis, he recovered well. The same has happened this year only this time he seems worse. These are the first time he has had lami since being on pergolide.

I am going to have a chat to my vet about getting his acht levels checked to see if everything is in order. If the levels are high will increasing the pergolide help with his lami? He has had it for about 2 weeks now and is still really lame. He is not fat.

Any help would be appreciated.

Thanks

Vikki
 
Vikkic - if his ACTH levels are high then increasing the pergolide levels should help the lami as the current dose would not sufficiently be controlling the Cushings. Might be worth geting tested for EMS at the same time.
 
My horse blood retested by Liphook and now normal levels. Blood test showed no insulin restistance. Vet talking about reducing Pergolide down form 1mg. Been in box 8 weeks and still really footy - never realised before how awful laminitis is and how long it may take to recover; one step forward, 2 back at mo.
 
Oh how I agree. Dixie now in 4th week of box rest and frankly I have seen little change.

She is currently on bute, percolide and about to start Metformin.

I hadn't realised that Metformin are sugar coated human tablets - how are you all feeding them?

I am dissolving the percolide in water and pouring on her feed which is working OK - wondering if I can do the same for the 8 tablets a day of metformin.
 
I don't want to hijack this thread with my first post, but there are vets here and people with a lot more experience of dealing with Cushings than I have. My 25 year old, Welsh cob mare was diagnosed at the end of last year. Her only symptom currently is a slightly wavy coat this winter (which seems to be starting to shed) and an iffy blood test. My vet is totally against prescribing Pergolide as she feels the side effects are too nasty. Should I be arguing? I intend to put her on Vitus Agnus Castus anyway, as I really feel I can't do nothing.

I would very much appreciate your thoughts.

Best wishes

Sally
 
sallym said:
I don't want to hijack this thread with my first post, but there are vets here and people with a lot more experience of dealing with Cushings than I have. My 25 year old, Welsh cob mare was diagnosed at the end of last year. Her only symptom currently is a slightly wavy coat this winter (which seems to be starting to shed) and an iffy blood test. My vet is totally against prescribing Pergolide as she feels the side effects are too nasty. Should I be arguing? I intend to put her on Vitus Agnus Castus anyway, as I really feel I can't do nothing.

I would very much appreciate your thoughts.

Best wishes

Sally
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What side effects? Having used a lot of pergolide on many horses I have seen a very few become slightly depressed for maybe a week or so after starting but that is all. In humans, heart conditions and a predisposition to gambling addiction (!) have been reported, but these aren't reported in horses.
I personally wouldn't waste money on Vitus Agnus, it has effectively been proved to do nothing of any benefit for Cushings.
 
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