“Do you use the chemical pergolide?”

If your horse has PPID, Pituitary Pars Intermedia Dysfunction often referred to as (Equine Cushing’s Disease), then the answer is probably yes.

“Do you wear gloves when you handle it and/or wash your hands directly afterwards?
If the answer is ‘no’, I hope, after reading this, that you reconsider.

As conditions and diseases are researched and treatments discovered, the range and scope of available drugs to treat equine symptoms increases.

Many of these drugs are classified as S4 (Schedule 4) or S8 (Schedule 8) drugs, which means they are not drugs you can buy across the counter as they will have to be prescribed or supplied by your veterinarian. S4 refers to Prescription Only Medicines that don’t have sufficient addictiveness or risk of abuse to be classified as S8, which are poisons (labelled ‘Controlled Drug’) and are medicines with strict legislative controls.

Whilst there are definite regulations that veterinarians must comply with under the Veterinary Surgeons Board for each state and the Australian Veterinary Association, veterinarians are authorised to prescribe or supply most Schedule 4 and Schedule 8 drugs for animal use, and this includes dispensing them to be taken home and administered to the animal by the owner.

Horse owners handling any drugs need to be aware of the possible reactions or affects these medicines can have on them and take appropriate steps to handle the drug as directed.

There can be times when handling instructions are not evident on the label of a drug, are not discussed by the veterinarian or are misunderstood by the handler, with the result being that the handler experiences medical conditions arising from contact with some medicines.

When administering any drugs horse owners should develop the habit of donning protective, disposable gloves and disposing of them safely after use. This precaution should also extend to the handling of drug containers as often the mediction is spilt or drips onto the outside of these. Hands should be washed thoroughtly as soon as the job is completed

Of course, as horse owners we always seem to be busy, so sometimes, if the gloves are left in the house, we go ahead and treat the horse, thinking that it really won’t make much difference. Or, if our routine is disrupted by minor emergencies, we rush off without washing our hands.
Sharon’s story should make us all more aware of the consequences that not taking precautions can have on our own bodies.

Sharon’s story...
“PPID is one of the most common endocrine system diseases in horses. It causes the pituitary gland (which produces hormones to control body functions) to work overtime. In horses the early signs including: laminitis, recurrent infections, abnormal sweating, change in attitude/lethargy, decreased athletic performance, delayed hair shedding, tendonitis, infertility and abnormal fat deposits. (Almost sounds like menopause!) Advanced signs include: rounded abdomen, polyuria (excessive urination), polydipsia (excessive thirst), blindness, and seizure-like activity.

“My old mare was diagnosed with PPID and was started on pergolide mesylate tablets. Just prior to this my Dad was diagnosed as terminally ill and my world had turned upside down. I had entered into ‘functional’ mode, was running on adrenaline and hadn’t managed a good night’s sleep in weeks.

“It does say on the tablet packaging; ‘harmful if swallowed. Wash hands after use.’ And the leaflet has much more detail inside, but in my grief I hadn’t registered anything more than how to administer it to my horse.

“After six months my mare’s blood tests showed things were improving and the drug was doing its job.”

“The decision was made to change from tablets to a pergolide compound liquid suspension. (made by a pharmacist for the veterinarian, it was not one of the two registered products available in Australia) The liquid suspension was delivered in a plastic bag with two syringes. On the label it stated for animal use, and the vet label showed the daily administration rate. There were no paper instructions supplied. I was verbally told to shake well. Not surprisingly, the bottle ends up with an oily-film on the outside over time, like your olive oil bottle. But that’s not significant contact...right?

I would wash my hands after administering...eventually. Sometimes straight away and sometimes after completing whatever distraction was presented by the ‘farm’.

“Everyone deals with grief differently. Having lost an amazing parent I expected the journey would be slow and for me, feeling miserable had become normal. I couldn’t remember the last time I’d slept more than four hours at once and my whole body was out of whack. I’d heard it takes time to heal from grief, so I took one day at a time and tried not to be too hard on myself.

“My dad lost his battle with mesothelioma. In my grief the one positive was that my horse was moving better and looking like her old self.”

Right: Sharon’s 25yo Thoroughbred (bay) that has cushings.

“Months dragged on. I seemed to be getting more lethargic, I was regularly reduced to tears and had to force myself to keep working my young horse. I was broken and even horses didn’t seem to be healing me.

“One benefit of having a horse property is horses calling for breakfast are hard to ignore. You get up, do your chores, go to work (the thing you do that pays for the horses!), eat, sleep, repeat. Although my motivation levels were rock bottom I kept my young horse in work and continued to show up at rallies and events. I’m not sure if the universe was looking after me or laughing at me, but my young horse went lame. Scans showed he’d damaged his superficial flexor tendon. No riding for six months.

“My body was relieved. It seemed like an opportunity to have a break and get my emotions and body back on track. The relief was short lived as my health deteriorated. My gut was all over the place, switching between constipation and diarrhoea, near constant abdominal pain, headaches, insomnia (oh how I missed sleep), reflux and an insatiable craving for calcium in the form of milk, cheese and yoghurt. Daily pain was 8-10 out of 10. When I menstruated the pain was 10/10. Over the previous 8 months my periods had become ridiculously heavy. I was going through double the amount of girly products and was sometimes only getting two weeks break between cycles. I had no sex drive and found intercourse painful, followed by a half day of bleeding. I had put on weight and was constantly bloated. Pain killers had become normal, as had night sweats, and my bowels were so bad that I would break into a sweat when gas or stool reached the end of my colon. My vision had deteriorated and a muscle above my eye would twitch almost constantly.

Left: It doesn’t matter how you feel when you own a horse property... you get up, do your chores and then go to work. Eat, sleep, repeat.

“My pain reached a point where I had barely slept for three days and painkillers had no effect. I went to the doctor to request a colonoscopy thinking I had bowel cancer. There is over three months wait for this so he also sent me for a pelvic scan as he thought a burst ovarian cyst may have been the cause. I was desperate.

“My pain was out of control and I was taking the maximum amount of pain and anti-inflammation medication and nothing was helping.”

“A scan confirmed I had numerous cysts and the Dr told me these shouldn’t cause pain but some women can be more sensitive than others. (Yes... it was a male doctor!) As a woman over 40, these things are evidentially expected and considered normal. The Dr appeared bored when giving me the results and was not impressed when I insisted on blood tests. I have a high pain tolerance and knew there was more going on. A pap smear was next. There was so much inflammation that after numerous attempts a smaller speculum had to be used. The test was clear so this was considered normal, and blood tests suggested there was nothing wrong with me. So, from a medical perspective I was fine. From a personal perspective I was in immense pain.

“In a moment of clarity it occurred to me that pergolide affects hormones.”

“As there was no paperwork with the liquid I looked up the Sigma-Aldrich safety data sheet (SDS). It’s scary. Poison. Danger! Avoid skin contact, wear gloves and wash hands immediately. May cause reproductive disorders. Exposure can cause disorders of visual perception, extreme alterations of mood, depression, distortion of body image, anxiety, nausea, vomiting and variable effects on heart rate and blood pressure.

“Understandably I have not touched the bottle without gloves since. My digestive system is taking a bit longer to recover but there is obvious progress. My vet has been supportive and is helping to push for change in the industry. If the liquid had been provided with gloves (or any safety information) I would have automatically worn them. When we requested the Pergolide SDS we were also informed that the suspension contains almond oil, so if you have nut allergies beware! My vet was unaware of this. This is not ok and change is needed. But in the meantime, user beware. Don’t let your horse’s illness cause your own. Always wear gloves.

“Whilst my horse is back on the tablets to minimise my exposure to the drug, I still wear gloves and wash my hands – immediately! I will never be blasé about animal medication again.”

Thank you Sharon for sharing your story with Hoofbeat readers.We hope your return to health continues and that this article helps prevent others having to go through what you did.
To view the SDC go to (https://www.sigmaaldrich.com/MSDS/retriever.do?country=AU&language=EN&productNumber=P8828&brand=SIGMA)

NOTE:

This Reader’s Story highlighted the importance of correct handling procedures when administering horse medications, something everyone should be aware of, and many readers got in touch to acknowledge their appreciation of the reminder.
The Reader’s Story refers to a horse diagnosed and treated with medication for PPID (Cushing’s disease). We feel it is important to point out, there are two registered products in Australia for the treatment of Cushing’s Disease. Neither of these products were the product used by the author of the article. The available registered products have been approved for safety and efficacy by the independent regulatory body, the APVMA.
For those seeking information on appropriate treatments for horses suffering from PPID (Cushing’s disease), we suggest you speak to your vet for the appropriate treatment to help with relieving your horse’s symptoms and they can contact Ranvet on 1800 727 217 or Boehringer Ingelheim on 1800 226 315 for information.

Sharon, who has a background as a researcher has been campaigning to have more horse owners aware of the need to be diligent in the handling of any drugs when administering them to horses.

In her quest she has contacted

• the Australian Pesticides and Veterinary Medicines Authority about this issue
• her doctor has agreed to spread the word in medical circles.
• the owner of the compounding company has agreed to look at supplying Pergolide with gloves and safety warnings.
• the boss of the Melbourne Equine Dentistry Institution is adding a lecture on drug handling to their training.
• a Murdoch Vet Lecturer has indicated they will be using her example to highlight drug handling and client education to trainee vets.
• all vet clinics she contacted have agreed to educate those handling the drug.
• her farrier is discussing drug handling safety with all his clients.
• a member of the Vet Board has a copy of the article for discussion.

Sharon shared her story to help prevent others who may use any horse drugs without suitable safe handling.

If you have concerns relating to the use of any horse drugs then you should talk to your veterinarian. If relating to pergolide then the Ranvet and Boehringer Ingelheim contact numbers are above. There are also many references on the web related to its use for humans and horses.