cushings · Uncategorized

Pergolide v Prascend

Longer blog readers will remember that Tristan has Cushing’s disease, or more accurately pituitary pars intermedia dysfunction, PPID. He was diagnosed a number of years ago based on observed symptoms and then a blood test. We started him on 1mg daily of compounded pergolide and he responded beautifully. He’s been on that pergolide for several years now, and is maintaining well. I’ve written regular update posts about that.

Last week, I reached out to my vet to renew Tristan’s pergolide prescription at Wedgewood Pharmacy, since he was running low, and she gave me some bad news.

See, for a long time, the only way to get pergolide was just the way that I was buying it, through a compounding pharmacy. “Compounding” just means that they follow the recipe for mixing up a drug and then make that drug and sell it. The pergolide they were making was actually mixed up for humans and prescribed off-label for horses. As I understand it, the FDA agreed to allow this because there was a demonstrated need.

A few years ago, a company called Boehringer Ingelheim developed, tested, and patented an equine-specific formulation of pergolide. They put it into a pill form and named it Prascend. The new drug offered some good benefits: it could promise a more accurate dosage, in pill form it might be easier to feed, and it had jumped through all the hoops and so on.

Tristan was doing just fine on the compounded pergolide, and I had no intention of moving him to Prascend. It was in the back of my mind but seemingly unnecessary.

Until last week, when my vet filled in the last piece of the puzzle. As soon as Boehringer Ingelheim put Prascend on the market, that meant that technically the off-label use of compounded pergolide was no longer allowed by the FDA. A lot of vets still prescribed it, because it worked just fine and for many, even most horses, there was no medical reason to switch.

But the company has been putting pressure on vet boards to remind vets that they’re technically not supposed to prescribe the compounded pergolide, and my vet has decided that she can no longer prescribe it. I totally support her decision. I adore her and she’s saved Tristan’s life on more than one occasion. Reading through the PPID groups, it seems there is a legal basis to challenge and keep him on the pergolide, but it’s not without risks and is a huge pain, and I don’t want my vet to have to deal with any of that. So he’s switching to Prascend.

Here’s the catch. Of course there’s a catch. I wouldn’t be writing a long-winded blog post if there weren’t a catch.

I was paying $0.55/day to keep Tristan on pergolide. Because Prascend has the market cornered, the cheapest I can find it is $1.75/day. That means an increase from $200 a year to about $640 a year. That’s assuming he stays stable on 1mg a day – which is not a safe assumption. Cushing’s is a progressive disease and it could easily – and probably will – require an increased dosage to keep him happy and healthy.

Horses are expensive, and I got this news literally about two hours after writing my first Finance Friday post and scheduling it. I went through all the stages of grief, and landed on acceptance after a few days.

Tristan gets what he needs, always. That’s not in question. I’ll figure out a way to pay for it. But wow, do I feel kind of sucker punched right now. He was doing fine on the compounded pergolide, and the only reason we have to switch now is because of a drug company’s greed.

blanketing · cushings · winter

What to Wear: The Winter Horse Version

For those new, when Tristan was diagnosed with Cushings, one of his most obvious outward symptoms was that he went from a horse could live outside, naked, 24/7 in Vermont to a horse who needed a full set of blankets starting at 40 degrees. Most Cushings horses have trouble in summer and get overheated. Tristan wanted to buck the trend.

That first winter, I put out the call and between the barn and friends, I was blown away by generosity. I got a stable blanket from a friend’s beloved horse who had recently passed. A medium weight from another friend whose daughter’s horse had recently retired south, delivered to me via meetup at a highway rest stop on a trip to Montreal. The barn did an extraordinary job of monitoring him closely and working out the nitty-gritty of when he needed what blankets. Eventually, I came around to the idea of owning a horse who needed blanketing.

It’s been three years since that diagnosis and that first winter of blanketing, and I’ve learned a lot about what he actually needs and what fits him. This year, he got some new-to-him blankets. Luckily, one of the things I discovered in those two years is that Tris is actually pretty easy on blankets! He rolls hard in them, but he doesn’t play much in pasture (anymore).

Through trial and error, I discovered that Smartpak’s regular line of blankets fit him pretty darn well at a 72. I took advantage of two different sales to buy him an unlined turnout sheet and a medium weight stable blanket.

True confession time: he probably could have gotten through ok with most of what he had – he definitively needed a new turnout sheet, but the others could have continued hodgepodge – but I got some extra money from a side job, and I wanted him to match. Yeah. I’m not really proud to admit it, but that was part of my motivation. He clashes with most colors, so our colors have always been black and silver. Those Smartpak blankets come in black with gray trim. And they fit him great. And I wanted them. Adulthood mostly sucks, but if it means I get to buy new things for my horse just because I wanted them, then I will. SO THERE.

new turnout sheet

new turnout sheet in action

new stable blanket fitting session, just out of the box (to right)

The final new-ish piece is that he also wears a quarter sheet to warm up and cool down. Not all the time – but when it 30 or below, it really does make a difference. I spent a long time borrowing the barn ones, and then I made my own and I love it. I’m trying to work out a system to make these for the shop, but they’re awfully labor-intensive and my time is short around the holidays.

so handsome ❤ ❤ ❤

This combination of stable blanket + turnout sheet has been working quite well so far this winter, and it’s been well below zero a couple of times. The best barn staff checked on him and he was cozy and comfortable even when it got super cold. So I’m pleased with the system as it is.

He still has another medium-weight that’s a bit big on him that will serve admirably as another layer in the event that it gets even colder (always a possibility, thanks Vermont!). But I think we’ve got a good winter plan in place.

cushings · senior horse

Fall 2017 Cushings Update

I haven’t done one of these in a while (in fact, almost exactly two years) because it’s been going overall pretty darn well, but I wanted to sit down and make these notes if only for my own reference later on.

Tristan was diagnosed with Cushings or PPID in the fall of 2014. He was started on 1g of Pergolide a day, and has continued on that since.

We have not tested his ACTH levels since 2015, in part because the vet does a regular visual assessment of him every few months. I ask her each time, and each time she says that absent any resurgent symptoms, it doesn’t make sense to spend money on new testing. So, I’ve held off.

He’s holding on the same levels of food he was in 2015: 1/4 quart of Blue Seal’s Carb Guard, and a daily vitamin/mineral ration balancer supplement. I took him off the SmartPak supplements and put him on Blue Seal’s Min-a-Vite, because the barn offered it as part of grain, and he handled the transition just fine and is doing just as well.

blurry-headed but in good condition

With the colder weather, he got a teensy bit ribby, but the barn adjusted his hay upward and he’s looking terrific. So now he gets free choice hay in turnout, and 5 flakes a day in his stall, spread over three meals. He’s still eating out of his Nibble Net to slow him down.

He’s grown a thicker winter coat this year, but I’m not sure I’d attribute that to Cushings; I think it’s going to be a bad winter. He hasn’t had any trouble shedding his coat out yet, so this spring will be the real test.

He is running a bit colder overall. I invested in some new blankets this year, a turnout sheet and a stable blanket with medium fill, to give him more options as we get colder and darker. I am holding in reserve the possibility of buying another new blanket as needed; potentially a heavyweight. We’ll see.

pretty good muscling, too!

Energy levels are pretty darn good, and his fitness is holding better than it has in some time. He’s in higher-level work than he’s ever been (which, I grant you, is not much) and he’s adapting and bearing up nicely. He’s overall cheerful and happy, too, which is the best part of everything.

So, three years of Cushings, and a healthy, happy horse.