Paradigm Farms Horse Retirement: July 2015

Thursday, July 30, 2015

Meet Remmy

Remmy is a Dutch Warmblood gelding who joined us for retirement last fall. Remmy was born in Holland in 1998. Remmy is beautifully bred with wonderful jumper bloodlines including Voltaire, Furioso II and Cor De La Bryere. Despite all the jumper blood in his pedigree Remmy always hated jumping, even walking over poles on the ground, and he found his niche as a dressage horse.

Remmy

Remmy has a very unique marking on his left side. I asked if it was a scar or if he was born with it, and he was born with it.

braided for a show

Remmy spent his first few years in Holland before being imported to Ohio by a dressage trainer in 2004. Around the same time Remmy was imported his mom began searching for a new horse. She had another horse that her niece was currently riding. Rather than have both of them trying to share a horse she decided to get another horse for her to ride. She had never had an easy time sitting the trot on her other horse and she wanted to continue her dressage education. She didn't necessarily want to go to shows, but she wanted to progress beyond training level, so an extensive horse search began to find the perfect horse for her to progress on.

Remmy and his mom

Remmy's mom and her trainer searched all over the country for months looking for the perfect horse, including making trips to both coasts. After coming up empty-handed in their horse search they began planning a trip to Europe to look at horses there. A few days before the plane tickets were to be purchased, her trainer (who was Bergie's mom) called and said she wanted them to look at horse that was in their state, Ohio, only about 40 miles away. It was there that they found Remmy.

Remmy on the right (doing some of his famous rope twirling) and his "brother" Baner on the left

Remmy and his mom on the right. his brother Baner and his mom's trainer (also Bergie's mom) on the left

The trainer who had imported him had suffered a very bad fall from another horse a few months before they went to see Remmy. When they went to try him Remmy was very underweight and out of shape. When Remmy's mom rode him for the first time her trainer said that Remmy was "the one" because his mom had a huge smile on her face as she sat his trot. Remmy's life underwent a huge upgrade the day his mom bought him in 2005. In addition to being very underweight, when his mom had his teeth floated shortly after bringing him home her dentist told her it looked like his teeth had never been floated. He was also kept very isolated from other horses at his former barn, always ridden and turnout out alone. Given how social Remmy is this would have been incredibly hard on him. Thankfully Remmy found himself with a wonderful new home and he and his mom began their journey together.

What Remmy looked like when his mom first bought him, underweight and a little bit sad. Here he is with his mom's niece, happy to be getting some much-needed attention.

As she did the first time she rode him, Remmy's mom found riding Remmy to be pure joy. His trot was was smooth and wonderful to sit. His canter was very uphill and his mom said it took her a few months to learn to ride it effectively, but once she did she loved it. She learned how to ride a First Level dressage test in preparation for her debut at that level at a show. When they were at the show they had a perfect warm-up. However, as she was riding around the dressage arena waiting for the judge to ring the bell, Remmy spotted some horses off in the distance. He decided he would rather be with those horses than doing their dressage test at the arena.

Remmy in the show ring with his mom's trainer riding

Remmy began passaging his way around the arena and showing off his FEI level moves as they were waiting to start their First Level test. His mom managed to get him back into a working trot but she said she was a bit off balance as they entered the ring and trotted down the centerline. Thus, when Remmy put his head down, squealed and bucked, she came off and landed in a mud puddle, coating her brand new derby and show coat in mud. It was quite an entrance!

Remmy showing with one of his mom's friends

Since Remmy had a tendency to become unpredictable at shows his mom never felt comfortable showing him after that. However they continued to train at home and her riding continued to progress. Riding Remmy she learned to sit the trot, leg yield, shoulder in, and the start of half pass at the trot. She enjoyed watching her trainer and one of her trainer's other students show Remmy. Eventually she was able to feel comfortable getting on Remmy and schooling him at a show although not actually showing him. She was sad that it didn't work out for Remmy to be her show horse, but they still managed to have a lot of fun together and she learned a lot from riding him.

Remmy showing with his mom's friend Sara

Remmy was also quite the character when not being ridden. He is an expert rope twirler and loved to grab a leadrope with his mouth and twirl it around and around in circles. Once when they were at a show Remmy's mom didn't bring his nylon lead because she had purchased a fancy, braided leather one. Remmy soon became extremely unhappy because every time he went to twirl his leadrope it wouldn't twirl. Remmy was so beside himself that his mom had to borrow a nylon lead for Remmy to use for the rest of the show. Once he could twirl his leadrope again he was his usual happy self again.

Remmy saying "give me the leadrope mom, I need to twirl it!"

Remmy and his mom at a show

In 2010 Remmy began to stumble and his left lead canter got very stiff. It was initially thought his hocks and stifles might be bothering him so they were injected. The injections helped but weren't enough. In 2011 his mom took him to Ohio State to get his neck radiographed as it was suspected he might have some neck arthritis. His mom knew something was wrong when her vet asked her to come talk to the radiologist about what they found. Remmy had subluxations at C6 and C7 in his neck, it looked like his spine had a "V" in it. Thankfully a follow-up myelogram showed only slight compression of his spine. After having three vets review his records they all agreed that Remmy would be fine to continue being ridden.

Remmy and his mom enjoying what turned out to be their last ride together

Everything hummed along nicely for a couple of years. Then, in 2013, Remmy had a suspensory strain. After several months of lay-up and rehab Remmy was back in full work in the spring of 2014. However he still didn't feel right behind. After another trip to Ohio State it was determined that the best decisionn for Remmy was to be retired.

Hesse and Remmy in one of their first turnouts together. They became instant best friends and still are today.

Remmy made the trip to our farm from Ohio last October. Remmy's mom knew that he would have no issues adjusting to retirement because he was so social with her other horse and any other horse he had the opportunity to interact with. She said that Remmy used to spend hours looking out the window of his stall. He would always come to greet his mom when she came in the barn, but the moment she left Remmy was back at his window looking out again. His arrival happened to coincide with that of another arrival, Hesse. Remmy and Hesse became instant friends with each other and they remain best friends to this day.

Remmy did, indeed, have a seamless adjustment to retirement. He loves it so much that the hardest part about living with Remmy is when he decides he doesn't want to be caught. He loves being with his friends and lets you know that he has no interest at all in being separated from them. Once he's sure he has made it clear he doesn't wish to be caught Remmy ususally gives up the chase and walks over for a cookie. Once Remmy is caught he has the most perfect manners of any horse we have ever met, and he will still happily demonstrate his expert leadrope twirling skills from time to time.

We hope you have enjoyed getting to know Remmy as much as we have!

_________________________

Remmy on the run with friends Hesse and Duesy

Remmy and Merlin napping with Fabrizzio and Walden hanging out

Remmy saying to Lucky, "play with me!"

Remy and Hesse being wild

Duesy, Hesse, Remmy and Merlin

Remmy galloping through the pasture with Lightning, Lucky and Hesse

Hesse and Remmy posing under the sunrise

grooming with his friend Hesse

Remmy surveying his retirement kingdom

Remmy, Hesse, Walden, Fabrizzio and Merlin

Remmy, Walden and Fabrizzio

Hesse and Remmy

Tuesday, July 28, 2015

Cushings/PPID Primer, Part III

Welcome to Part III of the Cushings/PPID primer. In this part we'll discuss what you can do after your horse has been diagnosed with PPID. If you have not already done so it will be helpful to read the first two posts on the topic:

Cushings/PPID Primer Part I - What is PPID

Cushings/PPID Primer Part II - Diagnosing PPID

I want to remind everyone that we are presenting information in layman's terms and as simply as possible for ease of understanding in all of these posts.

As we discussed in Part II, diagnosing a horse with PPID isn't always straightforward. At this point in time the general consensus is there is NO test available at this time that is sensitive enough to catch early cases, or even all cases that are not early, of PPID. There is general agreement among veterinarians and researchers that if your horse presents with clinical symptoms of PPID but a negative test, it is best to assume the horse has PPID and you should manage the horse accordingly.

PPID is not a curable disease. Once your horse has PPID he/she has it for life. The goal is to manage PPID and keep the symptoms minimized as much as possible. When it is caught extremely early it is significantly easier to manage symptoms. We see a big difference in mitigation of symptoms in horses that begin treatment sooner rather than later.

A critical step in managing PPID is drug therapy. As we discussed in Part I, PPID is a metabolic condition, or a disorder of the endocrine system. PPID is initiated when hypothalamic dopamine producing neurons fail. When this failure occurs the suppression mechanism of the pars intermedia fails.

The failure of the suppression mechanism leads to an increased hormone production in the pars intermedia. The result of this increased hormone production means the hormone levels within the pars intermedia, including ACTH, can be up to 100 times higher than that in a horse that does not have PPID. There are a lot of side effects to these dramatically increased hormone levels. The classic PPID sign is the long and/or non-shedding hair coat. Other symptoms include being very prone to skin infections or other infections, drinking extremely excessive amounts of water, muscle loss, abnormal fat deposits, excessive or abnormal sweating, and laminitis. These are all things you want to get under control as best you can.

Pergolide mesylate, marketed under the brand name Prascend, is the medication used for controlling PPID. Prascend/pergolide mesylate is used to manage the lack of dopamine in horses with PPID. The pergolide mesylate attaches to dopamine receptors within the pars intermedia lobe of the pituitary gland and mimics the actions of dopamine. When the drug binds to the dopamine receptors it decreases the secretion of hormones by the pars intermedia. Since it is the excess of hormones being releasted by the pars intermedia that causes PPID this makes drug therapy with pergolide mesylate/Prascend a crucial factor in managing PPID.

In our experience we generally start seeing improvements in PPID horses treated with Prascend somewhere between 30 days and a few months. It really varies from horse to horse. Ideally we will re-test the horse at the 90 day mark to see if the dosage needs to be adjusted. We will also re-test when a horse that has been on the same dose of Prascend for a period of time with no change in symptoms starts exhibiting a change/increase in symptoms. If the horse had very mild symptoms and was diagnosed and began treatment early the symptoms will often virtually disappear. In other cases we're happy if we keep the symptoms contained to about the same level of presentation without progressing, and of course other horses fall somewhere in between. PPID presents and responds to management very differently in each horse.

The standard dose of Prascend/pergolide mesylate is 1.0mg per day for an average sized horse. We have learned that it is best not to begin treatment at this dose. The most common side effect we see when we begin treatment with Prascend/pergolide mesylate is a loss of appetite and/or a lethargic attitude. Some people refer to this as the Pergolide Veil.

Most horses do not experience the Pergolide Veil, however in our experience the ones that do really do. Thus, we generally start at 0.5/mg per day which is the equivalent of half of a Prascend tablet, If the horse is sensitive to that dose we stop treatment for about 10 days and then start at 0.25mg per day, or a quarter tablet of Prascend. We stay on this dose for 4 weeks, then alternate between that and a half tablet (0.5mg) for a few days before moving up to a half tablet for four weeks, and proceed accordingly until we reach 1 tablet (1mg) per day.

With the horses that prove to be very sensitive to the pergolide it can take 2 or 3 months to work them up to the 1mg dose. We have found that if you really take your time working up to the 1mg dose that the Pergolide Veil symptoms can be kept at bay. With these sensitive horses we sometimes re-test when we are at 0.5mg or or 0.75mg per day to see if this dose is sufficient to bring ACTH levels within normal limits instead of waiting until we get to the standard 1mg per day.

We find that a lot of people think Prascend is a new drug. It is "new" in the sense that Boehringer Ingelheim received FDA approval to be the sole marketer of pergolide mesylate about four years ago. Many people see this and automatically assume it is a new drug and new method of treatment. In reality it is the same pergolide mesylate that has been used to manage PPID in horses for a long.long time.

We used to have to get pergolide mesylate through compounding pharmacies as they were the only suppliers, but now we have Prascend. It was easily shown during the approval process that the dosages of pergolide mesylate made by the compounding pharmacies were very inconsistent. Your 1mg/scoop of pergolide powder may have actually been 0.7mg/scoop or 1.1mg per scoop as an example. Compounding pharmacies have their place but it is no secret that they can certainly have their issues. Thus we were happy to have a more controlled source being held to higher standards from which to purchase the pergolide when Prascend came on the market.

In addition to drug therapy with Prascend movement is extremely important in managing a horse with PPID. Note that I did not say turnout, I said movement. When your horse is turned out in a dry lot and parked at his hay the entire time that isn't movement. When your horse goes out in a beautiful but small grassy paddock and basically slowly turns on his haunches while he stuffs his face that isn't movement. Both of those examples are "turnout" but they don't produce movement.

Every part of a horse's body depends on movement. Their endocrine system, their digestive system, their joints, healthy hooves - everything - works better when the horse gets continual, low impact movement. A good 45 minute ride helps, but constant casual walking with friends around a large pasture will do far more good for the horse. If you can do both that is even better. Many horses that test positive for PPID also test positive for IR (insulin resistance). Interestingly at our farm, of all the horses that have tested positive for PPID through the years, only one of them has also tested positive for IR. One. And that one horse doesn't currently show any IR symptoms which is pretty impressive given that the horses live on good grass many months out of the year. Movement is crucial for a horse, it is critical, and it can never be understated. A no turnout lifestyle is about the worst thing there is for a horse as it goes against all of their body's natural workings. Limited or no turnout is really bad for a horse with any metabolic disorder.

Diet also needs to be considered when managing a PPID horse, or any metabolic horse. We aim for a diet that is reasonably low in NSCs (non structural carbohydrates). Forages, be it grass or hay, that come from warm season grasses are generally lower in NSCs than forages from cool season grasses. Feed as little grain as necessary (none if it isn't needed) and keep it low NSC as well. We are able to manage our horses on grass because they live in groups in big pastures so they naturally keep each other moving around. A few years ago we put pedometers on some of them and they were walking several miles per day, up to 10 in some cases. If this were not the case we would try using grazing muzzles to restrict grass intake. If you cannot feed hay that tests low in NSCs, soaking the hay in water and then draining the water off will help a lot. I'm not a big fan of dry lots just because they are so mentally unstimulating for a horse and don't encourage movement, but they are a tool used by many with success. I like the idea of paddock paradise set-ups better than regular dry lots.

You will occasionally come across people pushing Chastetree Berry as a treatment for PPID. Although there is evidence to support the idea that Chastetree Berry helps control the presentation of some symptoms, mainly the haircoat, there isn't any evidence that it offers meaningful clinical management. A couple of extremely limited and very small in scope studies on Chastetree Berry (the only studies done to date) showed that the effects of Chastetree Berry on ACTH and insulin levels were quite varied and inconsistent. I would need to see some more credible research done that involved more than 10 horses before I was convinced of its efficacy. I'm not opposed, the clinical and even anecdotal evidence simply isn't there.

That brings us to the end of our series of posts in the Cushings/PPID primer. I want to remind everyone again that we are presenting this information in layman's terms and as simply as possible. These posts are not meant to be published in a veterinary journal. I hope some of you have found them useful. As always, if you have questions we will be happy to answer them if we can!

____________________________

Lofty, Asterik and Romeo