PERGOLIDE NOT HELPING WITH CUSHINGS

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kellyjo

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My 19yr old Arabian was diagnosed last June with cushings disease, I had noticed weight loss, no top line, no shedding and skin issues. The vet told me we had caught it early and immediately started him on Pergolide and changed his diet.

6 months later he started going lame, so I took him to the vet and had his blood rechecked to find out that his cushings and his insuline levels have more than doubled.

The vet had me double up on his Pergolide which is now 2mg and 1mg of Bute for the pain from his feet. A week after that my poor horse is still in pain and can barely walk, so I call the vet again and now he is getting 2mg of Bute a day in addition to the 2mg of Pergolide, plus icing his pasterns twice a day.

Yesterday I took him back to the vet because after 5 days of all that medicine you would think I would see some difference, The vet took x-rays of his feet to comfirm that his coffin bones have sunk and one is a little rotated. I have had this horse for seventeen years and he has never had feet problems of any kind.

Now the vet wants my Farrier to put shoes on his front feet backwards, but my farrier doesn't seem to think it will help and that it will just cause him more pain. Can someone please help, I don't know what to do for my horse, he is eating fine and for the most part seems to be his normal sweet self. I can't stand seeing him in pain.
 
Well I guess the pain in his feet is from laminitis so is he on a strict lami diet? Ie little to know grass, soaked hay, very low sugar diet like safe and sound etc? If his pedal bones have rotated then heartbars are the way to go, they did ths for my mare and within 6 months the rotation actually corrected itself! Often the drugs do need time to build up and work my horse was on an increasing dose (I think it went upto about 2mg) before she stabilised and we could reduce the dose.

The pergolide is not going to solve the foot pain that is now a secondary condition and needs to be treated accordingly.

It sounds lie he also has insulin problems so should be perhaps on a metaformin regimen also. But f you are not happy then seek a second opinion.
 
That is a seriously high dosage. Move this to the vet forum where vets do lurk and do ask for a second opinion. Also could be worth contacting someone like Naf who do a product which I think is called cushiness. People on the vets forum have had a lot of success and when we thought my mare had it, my vet ( very good equine practise) was in favour.
 
But I think it depends on how long it takes to stabilise my mare went up to 2mg before her bloods levelled off and then we were able to reduce to the maintenance level which for her is 1.25 mg, I think it can depend on the horse as to what level they will need.
 
My advice is join the Yahoo group linked down the page. There's help with interpreting bloods, dosage, diet and all aspects of dealing with Cushings, IR and laminitis. http://www.ecirhorse.com/ Hundreds and hundreds of horses and owners have been helped over the many years this group has been going.
Put her on the emergency diet described in the laminitis tab to start with. http://www.ecirhorse.com/index.php/laminitis
 
I have never heard of Pergolide not working unless there are other issues such as IR. She sounds as though she needs to be on metaformin for the Insulin resistance, perhaps you should get a second opinion from another horse vet? Your farrier should be able to make her feet more comfortable by remedial trimming in conjunction with the x.rays. but I think the the jury is out on whether heart bars help or hinder. Our cushings pony has just had her dosage of pergolide increased to 2mg per day, but we do get her bloods tested regularly, so we might be able to reduce this as the days get longer.

I would definitely follow Amandap's recommendation and vsisit the EMIR website, you'll get lots of help there.
 
I would be looking into the insulin resistance further. Ask your vet about completing the laminitis risk profile and whether he thinks treating for EMS would be sensible. He may have already run the test from the sounds of it. He could speak to Liphook for further advice.

Otherwise, i would not necessarily expect a turn around with laminitis in 5 days. A large proprotion respond quickly, but there are always some that dont. As for the shoes, different things work for different horses/ponies. I assume you already hve her on a deep shaving bed? I would ask your vet and farrier to work together to decide on how best to deal with her feet.
 
Gosh! Your poor horse! :eek:
My 23 year old pony is diagnosed with Cushings and laminitis, and after using pergolide for many years, he leads an ordinary life.
But recently, as he has got older, my farrier has had to cut back his feet and put pads under his shoes for extra support, which have really helped him. This may be good for your horse.
I would seek a second opinion but I know how expensive pergolide is! ;)
 
Thank all of you for your advice. I will look into it all. As for the Pergalide which is now Prescend was $120 for 60 1mg pills. Which I think is stupid because now that it is FDA approved for horses it comes in a pill form instead of powder which for me was much easier to administer. I know your thinking "just crush the pills", well it says that can be harmful to humans if the pills are crushed. So tonight I shoved the two pills in half of an apple, and for tonight that worked, we'll see what happens tomorrow. He's very smart and picky.
 
Thank you for the very helpful website. I learned a lot and I am seriously considering getting another opion and I feel relieved to know that my farrier is just not full of s**t.
 
Hi KellyJo, I hope things have improved by now. I'm sorry I didn't see your post earlier, I usually follow the Vet and New Lounge forums.
Your story sounds very similar to mine which started in 2009. I didn't have x-rays done but my boy was very sore and didn't respond to Pergolide straight away.
BTW I have been crushing my Pergo for the last two years and I wear gloves when handling it and blow any powder flying about away from me. I then put it into a liquid to syringe it into my boys mouth as he is very picky and all the disguises ended up being rejected so this is the only way to ensure he has his full daily dose.
After 12 months of increasing the dose and re-testing, I managed to get his ACTH down to normal but I had to increase the dose up to 4 tablets to achieve that. Despite this large dose, his feet were still sore and after the 12 months, his feet did not appear outwardly to be affected by lamininits and my vet eventually agreed that it didn't look like he had had lami.
After every night for those 12 mo on the 'net, I came to the conclusion that the pain wasn't all originating from his feet.
If you haven't found the answer yet and your boy still is in pain, please pm me and I will let you know where my research led me.
My boy is now on 6mg of Pergo and pain free, and at the age of 24, the vet has complemented me on how well he looks for his age and says whatever I am doing, it must be working because he looks fantastic.
I hope you don't need me though, good luck
 
Excerpts from Practical Herbalism

Vitex (Chaste tree) has been used for thousands of years for its beneficial affect on the female glandular system, and its restraining effect on male hormones. Modern research has confirmed at least one of these uses, and the berries are now widely used to restore balance and function to the female reproductive system, by stimulating the natural production of progesterone.

Some of the old herbals classify the berries as anaphrodisiac, accounting for the name Monk's pepper, and the tradition of using the kernels to lessen the urges of the flesh. Other sources list the Vitex fruit as aphrodisiac, implying the opposite tendency. The truth is that the Vitex, like many other herbs, exerts a normalizing influence on the body restoring that which is absent, and constraining excessive tendencies.

Vitex acts upon the pituitary gland, reducing the production of certain hormones and increasing the production of other, shifting the balance in favor of the gestagens, hormones that normally condition the body for pregnancy. It has found a wide following of users for imbalances of the female reproductive system, especially when they are related to excessive estrogen or xen-estrogen influence, and has been used with great effect in restoring absent menstruation, regulating heavy periods, restoring fertility when caused by hormonal imbalance, relieve PMS tension, and easing the changes of menopause.

A tincture of the berries has also been used externally for the relief of paralysis, pains in the limbs, and neuropathic muscular weakness.



Chaste tree berry is a type of herb that has medicinal qualities. It is often fed to horses to treat the symptoms of Cushing's disease, which is the result of a hormonal imbalance, usually in older horses.

Read more: Chaste Tree Berry & Cushings Disease | eHow.com http://www.ehow.com/facts_6181516_chaste-tree-berry-cushings-disease.html#ixzz1khUMoSwj





Chasteberry for Cushing's Disease
Jun 8, 2011 | By Julie Revel

Julie Revel, a former neurobiologist in pharmaceuticals, began writing professionally in 2009 with a focus on health and disease prevention. Based in New Jersey, she works as a medical writer in the healthcare industry. Revel graduated from Drew University with a B.A. in neuroscience and is currently pursuing her Doctor of Medical Humanities.
Chasteberry for Cushing's Disease Photo Credit Jupiterimages/Photos.com/Getty Images

Early detection and treatment of Cushing's disease is an essential part of providing a better quality of life for affected animals. The onset of Cushing's disease typically begins in the late teens to 20s, but can start as early as 8 years old. Although several synthetic drugs are available to treat this condition, herbal alternatives such as chasteberry have shown to be viable treatment options. In a clinical study directed by Robert Eustace, FRCVS, after treatment with chasteberry extract, "all owners reported improvement in the demeanor of their animals, they became more active, less depressed and the term 'rejuvenated' was often used by owners."
Cushing's Disease

Cushing's disease, also known as hyperadrenocorticism, is a metabolic disorder caused by an overactive pituitary gland. The pituitary gland is a critical part of the endocrine system that helps regulate hormones. As the disease progresses, benign tumors can form on the pituitary gland, causing pressure to be put on other parts of the brain. A horse with Cushing's disease produces increased amounts of proopiomelanocortin peptides, which in turn stimulates the adrenal glands to overproduce cortisol.
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Diagnosis of Cushing's Disease

The onset of Cushing's disease is usually marked with an increased thirst, with affected horses drinking up to 20 gallons per day as opposed to a normal 5 to 8 gallons. They may also have an increased appetite paired with weight loss. The most iconic symptom is the long, wavy hair coat that these horses grow in the winter and fail to shed in the summer. Several diagnostic tests can provide a definitive diagnosis of Cushing 's disease. Dr. Phillip Johnson, a veterinarian from the University of Missouri, has developed a test that measures the levels of 11-beta hydroxysteroid dehydrogenase (HSD) in the tissues, as elevated levels of HSD are a marker of cortisol dysregulation. Other tests available include a dexamethasone suppression test and adrenocorticotropic hormone stimulation to determine abnormal hormone levels caused by an overactive pituitary gland.
Chasteberry

Chasteberry is the fruit of the flowering chaste tree that originates from southwestern Europe and western Asia. Dr. Beatrix Roemhelm-Hamm, from Robert Wood Johnson School, cites the use of chasteberry as far back as 2,500 years to treat hormonal dysregulation. Once used to decrease libido, chasteberry offers an herbal alternative to provide relief of premenstrual syndrome and menstrual discomfort.
How Chasteberry Works

The extract of the berry contains iridoid glycosides, flavonoids and oils that have shown to have an effect on the dopaminergic system both in vivo and in vitro. The dopamine system plays a role in the inhibition of prolactin release and its downstream effects help mediate the hormonal imbalances caused by Cushing's disease, although the exact mechanism remains unknown. Studies conducted by Eustace and Russell both returned results that indicated positive outcomes, including rapid shedding of the winter coats. However, other studies, such as the one completed by a team of veterinarians from the University of Pennsylvania, showed no significant changes in clinical measures of Cushing's disease when a chasteberry extract was compared to a commercially available dopaminergic agonist that is the current standard of care. More research is needed to make a definitive determination of the effectiveness of chasteberry on Cushing's disease.

Read more: http://www.livestrong.com/article/466178-chasteberry-for-cushings-disease/#ixzz1khUbNylQ





i had a gelding with Cushing's who was maintained on Evitex which is chasteberry extract for many years after diagnosis. His symptoms never advanced beyond a slight crest and some loss of topline muscling. I also provided certain lifestyle changes to reduce stressors, such as providing 24/7 turnout on pasture with a mare he got along well with, with a very nice run in shelter with matted ends, cooled by fans all summer and heated trough and quality hay fed 24/7 all winter along with good senior feed and access to mineral and salt blocks. He received Evitex every day for three weeks out of every four and never required Pergolide. Here is the product I fed............
 
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My friends horse has cushings just like this. Your horse could also have a metabolic disorder too. Cushings is a disorder that only gets worse, treatment only helps the symptoms I am afraid. As caused by a brain tumour there isnt much more you can do other than keep him comfy. If he is in pain the best thing to do is have him PTS as there is no miracle cure. My friends horse is going downhill and it wont be long until he will be put out of his pain. Its sad but its the kindest thing to do
 
My mare has Cushings but was also diagnosed with EMS, after 18mnths blood testing she is now just on 1mg pergolide a day, however at the beginning when she was lame with laminitus she was also on 20 metformin a day to lower her insulin levels.
It was explained to me that the laminae require a lot of glucose and because of the high insulin levels her feet weren't getting enough glucose therefore causing the laminitus (admittedly this was 18mnths ago and I was in Kentucky with a time difference and long distance telephone call to deal with, if anyone can tell me I'm wrong please do so).
Metformin was eventually lowered to 10 per day with 0.5mg pergolide, blood test in July put her back up to 1mg and the metformin was cut out entirely as her insulin is now under control. She was also put on very strict box rest for 3mnths initally to cut down on rotation.
She will be 24 in 12 weeks and went out to her first competition yesterday in 16 years and managed to get a 70% in her first test, either your horses medication is wrong or it may be time to look at a difficult decision (I'm dreading this happening already)
 
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