Your opinions please.

[Lorraine L]

What would you think ?
"Tom" little welsh section A, aged 24 years suffered repeated laminitis two years ago ( this incidentally was after removing his shoes because of retirement )

So, in consultation after the vet came out, ' she ' suggested that we were probably looking at Cushings being the cause and the long thick coat and slight fat pads confirmed her thoughts.

Tom was prescribed 0.5mg of pergolide and for the past two years he has gone from strength to strength. You might remember that he is now having regular lessons and exercise with the great niece and has had no further bouts of lami.

My sister phoned the vets today to ask for a new prescription. She was told that she will only be sent one month's supply and then she must have an ACTH test.

I then phoned our vet, only to find out that she has left and the new lady answered my questions as: It wasn't a requirement of the drug company / She felt that all horses and ponies should have a test done every 6 months / She could not comment on why the old vet had blindly prescribed but that she was not prepared to supply more drugs without the test ?

So: The cynic in me says " Is this a money maker for the practise "?
Should we demand that she comes out to visit him and then decides after seeing his condition and levels of fitness ?
To be perfectly honest, its more about the fact that this is going to crop for me with Sunny next month when i ask for supply drugs but he was tested in the beginning and i incorporated Vitex rather than up the pergolide when i felt that the meds weren't enough for him ( after consulting the vet of course )
Both horses are well. We take all necessary precautions and diets to ensure that we cope as best we can with the condition but should we take more results to confirm our beliefs ?
Its annoyed me a bit because i asked how reliable the test would be when they are already on the drug ? She said that if the levels came back fine, all well and good but did not say where we go if they aren't at a level she requires as such ? I have already been down the metformin route without sucess and like Tom, i know the key to Sunny's health is exercise.

Your thoughts please guys ?

[Deleted]

I don't have any experience of this myself but it would seem from the metabolic horse group that this new vet's opinion isn't standard practice.

[smallhunter]

My mum works at a vets and it is a legal requirement for them to have a medication check every 6 months otherwise they can loose their license.

[jill]

My vet is happy to prescribe on a repeat basis for Sabria, although there are restrictions - he can't prescribe more than a months worth at one time for example, and she can only have Pergolide (rather than the more expensive Prascend) because she was already on it when the restrictions came in. So my feeling is it is down to the vet in your case, and it may be that they feel they need to check because the dose may need changing. Sabria is on 1000mg and it has kept her okay, like yours she was diagnosed on presenting symptoms (+ a glucose urine test) at the start. It seems to me she is more concerned with dose levels, so plead and discuss and confirm that the presenting symptoms have all been alleviated. If she wil suply the prescription you can get it at a good price from Chemist Direct, that's where I get mine from and it's a really good service www.chemistdirect.co.uk/pergolide-tablet-250mcg_4_15948.html
MTA Vet usually just casts his eye over Sabria in passing when he is on th eyard anyway, passes for a 6 monthly check!

[Lorraine L]

Thank you very much guys. Michelle, can i ask which practise you use for Talin and Co,. ?

[kathrynp]

If I am suspicious of Cushings I will always advise that an ACTH test be done before starting on prascend and then re-check the ACTH after 4-6 weeks to make sure the dose is correct and I believe this is best practice. In extenuating circumstances I may be persuaded to start medication without the test (because owners wont pay for it) but to be honest if you can afford long term prascend the blood test (approx £35) is very reasonable.
Because of this approach I know you cannot acurately predict ACTH levels based on clinical signs and many times have tested horses and found the dose needed to be increased.
Most hores with cushings are not diagnosed until they have multiple problems and are never really got under control.
The fact Tom looks so well and has a good quality of life makes correct treatment so worth while. If his ACTH is high (and it may still be because he is on the lowest dose of prascend) then despite looking well he is still at high risk of laminitis. I know how devestated you would be if he got laminitis and would have thought for £35 you would want to be sure he wasn't at risk so for me its a no brainer. I think its a bit unfair of you to suggest the vet is out to make money when she has given you the best clinic advise possible. If you choose not to proceed or to increase the drug dose for financial reasons I quite understand and I'm sure she would too.

[Lorraine L]

I appriecate your views from the point of view of the vet and understand how you see the testing, diagnosis and conclusion of treament. The last ACTH test and call out that i had came out at nearly £200 but that aside, i still have more questions than answers.

The new vet is wishing to test Tom to see if the pergolide is beneficial. What happens if the test comes back in the normal range ? Do we continue the 0.5mg believing this is doing its job or stop them because we believe he didn't need them 2 years ago after the first vet saw him ?

As the practise has not issued any communication for change of policy other than introducing costs for writing prescriptions, is each vet able to insist on a better clinical diagnosis in the way of actual testing ? Why would the practise not make clients aware that it is indeed a requirement or is it the luck of the draw according to what vet attends ?
I always want the best for my horses and have been with the same practise since childhood. The practise said " We will not prescibe further prescriptions until you have the test "From a customer point of view surely " We would like you to consider a test after issuing this prescription because ...... " might have been better ?

I think the sad part is the turn over of vets. We used to have long term vets who knew our ponies and horses very well and indeed remembered time frames of how, when and why we had done certain blood tests or what advise we had been given etc. I will have the tests done for both Tom and Sunny to see exactly where we are with their treatment but hope that clients are properly informed when other vets only prescibe these drugs to " See how they get on "

[specialized]

I would have thought it was good protocol from the vet to insist on a 6 monthly monitoring check, rather than blindly subscribe medication. If anything happened to your horse that was proven to have been caused by a prescribed drug and the vet had prescribed without testing then the vet could be deemed liable and face serious consequences.
I would suggest your original vet was acting irresponsibly by prescribing without testing, as there is no reference point to use to monitor change, and the new vet is suggesting a more sensible approach.

[Lorraine L]

Thats a very good point Specialized. I am amazed by the amount of owners of oldies who are given this drug and asked to ' see how they get on ' ! Scarey isn't it ?

[specialized]

Just to add as we cross-posted.
If you were charged £200 for a visit and test I think you were seriously ripped-off, half of that would be excessive.

[laurac]

Not the same situation but my dogs vets insist on seeing him every 6 months to then represcribe his arthritis medication not sure if its some law that they have to do this
Hope you get a satisfactory outcome x

[kathrynp]

It is unfortunate that you are in a difficult position now because no test was originally done and regretable that you were not given the option. A reminder for me of why I should push clients to always test first. I would say in toms case you have had such strong positive response in clinical signs on the prascend there can be no doubt that he has Cushings. If the test comes back in the normal range now great, I would feel very uncomfortable taking him of the drug for 2 weeks (there is no definitve time for how long you would have stop it but 2 weeks would be all my nerves could take) just to find out what his true base line is. I would do it if a client really wanted me to as long as they we well aware of the risks. For future reference the best time of year to do the test is November and in 2011 there was a national campaign and £15 off the test vouchers available for the month. I believe this will be repeated next year so keep an eye out. I reccomend to my clients they re-test every nov. I emphasize reccomend, I never insist on anything and think that is an unfortunate use of langauage.
You are partly right in that it is luck of the draw which vet you have and infinately preferable to have a vet who knows you and the situation but unfortunately vets dont hang around for ever and you will have to see if you can build a successful relationship with the new vet. The more informed you get the better position you will be in to discuss what you want. Ultimately she can refuse to prescribe the drug without a test but in my opinion it would be a strange decision to make without a very strong clinical reason.
I cant really comment on your practices general policies but understand why you are a bit miffed.

[jen1]

there are £25 money off vouchers and long term use of pergolide can be harmful or so im told, have a look at liverpool for the most recant papers on the test, it has to be done first thing in the morning , after 7 hours starving , and blood needs to be tested within 40 to 60 mins of it being drawn , we used frozen peas as an ice bag,

[kathrynp]

"it has to be done first thing in the morning , after 7 hours starving , and blood needs to be tested within 40 to 60 mins of it being drawn , we used frozen peas as an ice bag"

I assume you are thinking of insulin because none of the above is correct for ACTH testing and not accurate for insulin testing either.

[daviesbaby20]

Hi

I used to work in a small animal practice and dealt with a dog with Cushings I appreciate it is a horse not a dog that's being discussed however to monitor the progress of how the particular animal is responding to treatment is normally the best way forward imo if the test comes back in normal ranges then great but think its best to know where you stand x