Please share yours. My horse was diagnosed with Cushings recently and I have had trouble keeping weight on him this winter. Vet says low carb because he could founder. He used to be an airfern so I don't want to blow him out with tons of feed. I have just been increasing the low carb feed and adding Red Cell (blood work came back slightly anemic so vet recommended it) as supplement. He gets grass hay due to founder risk.
Also, has anyone had luck with this medication? How pricey is it for you and do you think the treatment offsets the costs of potential founder?
Prascend is well spoken of on here, It's more costly but supposedly more effective per unit. My vet is old as the hills so we are still using Pergolide.
I used to make up my own feed blend with beet pulp and a 10% sweet feed and it just wasn't doing the job, during our first and second winters we had abcessing, some people say that abcessing in a Cushing's horse is a pre-laminitis symptom, at any rate the diet, although nice and cheap, wasn't keeping the weight on him and I switched to TC Sr and also added timothy pellets to his diet which seemed to work well as far as foot ouchiness, but again the weight was an issue so we finally sat down and worked over the diet and the dosage of Pergolide.
I had been top dressing his meals with the Pergolide after trying stuffing it in apples etc and he was leaving part of his meals. I finally just got real about it and dosed him with the syringe (although I give him a ml of Coke in the syringe too. Yep, you read that right, Coca cola. Flat.)
One of the benefits of the Prascend is palatability, although the old guy no longer runs away at the sight of the syringe and swallows the stuff I can't really recommend what I am doing as the height of low sugar management. No he doesn't like Diet. The Prascend is a smallish pill and works so well I've read here that a lot of people reduce the dose so the cost is the same, it keeps better etc. The Pergolide costs me about $1.33 per ml and we are at 1.5 mls/day right now.
Where was I? Oh yeah, the medication is absolutely worth the cost in combination with a low NSC diet to avoid founder and some of the other issues they will get such as poor wound healing, depression, difficulty with handling heat and elevated respirations. I still have a wooly bear with a funny lumpy crest and I have cushioned boots for times when he is more sensitive (hot dry hard ground for him). I also give him a full body clip in May for comfort.
After a thorough workup including ulcer treatment and deworming we were able to get him to start gaining on the TC Sr and have changed to Alf Tim cubes, soaked, he is so far holding his weight during this frozen He!! of a winter here on 5 lbs TC Sr generally all in one meal plus about 3 lbs cubes, a half cup of oil, and a medium quality hay, (not great but not cow hay either). He is in pasture with another horse so I have some difficulty feeding him properly, that's why the big single meal, if I can separate him he gets another meal of 4 lbs TC SR. Over the summer he got 9 lbs overnight in two containers and would munch all night.
I'm very happy with the TC Sr which is beet pulp and alfalfa based, has a high protein of 14% I think and high fat of 10%. and a low NSC of I think 11%. ( I haven't looked it up to write this) It's not cheap at about $22 per 50lb bag though.
didn't your vet prescribe pergolide? prascend is just essentially peroglide but not compounded. it is more expensive than compounded pergolide but it's supposed to be more stable and reliable as far as strength b/c it's not compounded. 60/1mg prascend run around $120. compouned pergolide is cheaper.
as far as diet, it really depends on a horse and its sensitivity. my mare gets a full large scoop (the standard feed scoops you can buy) of fibergized twice per day. from late spring until early fall she is muzzled on grass. but in the winter she needs more calories to keep weight so we supplement her orchard mix hay with alfalfa (she currently gets a flake every other day).
this was not always her diet. like i said, you have to figure out what works for your horse and then modify it once in a while as they age, their disease progresses, etc.
Thank you for your post! I had him on senior feed but the vet said to switch to low starch. I will have another discussion with him.
Some Sr feeds are higher in starch, some are lower. The TSC Sr is pretty low in starch.
I haven't worried too much about pasturage because ours isn't one of those lovely lush things, and he spends time in a dry lot/pen. I'm afraid I don't think about that enough, it's definitely an issue.
AFAIK Insulin Resistance is thought to run hand in hand with Cushing's and that's where the bulk of the founder risk is coming from, in the excess sugars - though whether they make their way to the hindgut and mess up the fermentation processes or it's excess sugar in the bloodstream I can't say - might be a question to ask your vet.
My mare is 20 and was diagnosed with Cushings last summer. She's done very well on pergolide. She has never been laminitic or shown any signs of it, but right now she gets unlimited grass hay and ~3 pounds per day of concentrate (Nutrena Safe Choice Senior, which is about 20% nsc. I've fed and really like TC Senior, but it freezes in the winter and I got tired of messing with it). For the winter, this is working pretty well. She's thin, but looks good.
In the summer, she gets ~15 hrs per day of grass pasture and a pound of ration balancer (Tribute Essential K). I haven't muzzled her because she has never had a problem eating grass, doesn't gain a bunch of weight (just maintains well), and the BO will put them in a dry lot with a run in during the hottest parts of the day, so it breaks up the grazing into smaller chunks.
I used to have a 22yo western pleasure Quarter Horse who had cushings/insulin resistance. We actually maintained him really well, and we still showed him. We soaked his hay and kept him on the supplement "Natural Glo" for his coat. As for medication, he got Prascend, Equine Metabolic support , and Thyro-L. Doing this combination everyday was EXPENSIVE, but it worked, we never had any problems in 4+ years.
Horses with Cushings are very likely to have ulcers, according to a paragraph from The Horse Journal. If anyone is interested in it, I'll copy it in another post.
My 28 yr. old was noticeably losing weight this winter, and slightly off his feed in Jan. Checking his calendars (I keep notes on him every year), I noticed that he was the same in Jan. the past two years as well. My vet, who is younger than the usual vet from the practice, said that sometimes Pergolide causes ulcers. It can, but the appetite problems are usually due to starting/increasing the dose. I didn't think he had ulcers, and he didn't respond to the common acupuncture trigger points for ulcers, but I started him on UGard pellets just to be sure. And sure enough, his appetite came back within 3 days, he's eating his TC SR enthusiastically (hay was never a problem). Eventually he would eat his meals, but still was losing weight, so while he was eating the usual amount, it wasn't keeping weight on.
Just to increase his weight gain a bit more, he's on two scoops of Buckeye UF 100 too. I'll also be switching from UGard to Uckele G.U.T. And most days he gets a very small snack of soaked alfalfa pellets to mix his extra powdered sups.
He didn't show any other typical ulcer symptoms. I feel bad that he may have felt off for the past two years, but he's on his way to feeling better now.
The TC Senior is low in NSCs but the first ingredient is alfalfa, which is a laminitis/founder and sometimes just foot-sore trigger for a lot (not all) of Cushings & IR horses. Unless you know your horse does not get foot-sore or laminitic etc. from alfalfa, I would avoid it.
If you haven't already, join Dr. Kellon's Equine Cushings & Insulin Resistance group on Yahoo--they have the best, most up-to-date info on everything related to the care & management of horses with either disease.
If weight is an issue, I would start by upping the hay. Make sure it's tested & low NSC, though, or soak/rinse to get rid of some of the sugars.
Thank you very much for all the responses. I wasn't expecting this diagnosis when the vet was out. Now, I can ask better questions about how to regulate him. He is pokey about eating his grass hay but loves grain of any kind. I forgot to mention that our hay is low in protein (coastal hay) so we feed Enrich to supplement the horses. My Cushings boy gets 1 pound of Enrich, 2 pounds of low starch feed, and 1/2 pound of Strategy (I'm transitioning him off the Strategy still since he was just diagnosed). He should be on just Enrich and the low starch feed soon. Our pasture, even at it's peak, couldn't founder a greedy pony if he gorged himself.
The vet says the medicine will cost about $1 a day so that would probably be the peroglide, right?
I started my gelding on Prascend in October and he is doing fantastic! He is on 1 mg a day, which is $60 per month. His ACTH levels have gone from 121 to 15.
He had lost some top line and between the Prascend and increased work he has gained it all back. He is much more energetic than he was and looks great. I am hoping he will shed out faster this year
He had a bout of laminitis last year, and we tested him then, but his ACTH levels were normal. We re-tested this year and got the high numbers. He was also having trouble with being sore even after the most conservative trims, and that has completely stopped with the Prascend. He had no side effects when starting the medication.
ETA: I feed LMF low-carb complete for his snack (it's really just a base for his supplements). Both horses really like it.
I personally wouldn't go with the compounded pergolide if you can afford the Prascend. The compounded versions aren't as stable and from what I've read, people end up using a much higher dosage so it doesn't really seem to save any money. The Prascend is a tiny, tiny, little pill so it's easy to feed.
My gelding is on straight orchard grass and a small amount of a low-carb complete feed each day as a snack. My gelding is not insulin resistant at this time, so diet is not quite as crucial. You should have his insulin/leptin levels run if you have not already, because not all horses with Cushing's are IR.
I have my pony on Safe Choice Special Care, top dressed with canola oil and he keeps his weight & muscle GREAT on that, in addition to lots of grass hay. He also gets 1 Prescend tab/day, and it's seriously been a wonder drug for him. If there is grass in the pasture, he's muzzled. Always the muzzle. He hates it, but it keeps him healthy.
Proud member of the "I'm In My 20's and Hope to Be a Good Rider Someday" clique
My cushings pony is eating Triple Crown Senior, which is a low starch feed. Most feed companies have their nutritional info online, so you can check the starch, NSC values.
He's also on Prascend, which runs me about $2/day. I can just toss the pill right into his feed and he'll eat it with no hesitation. It's especially helpful for my pony in the summer, because when he's not on it, he drinks and urinates excessively.
My cushings horse gets tc sr, alfalfa cubes with alfalfa pellets soaked and grass hay,a cup of oil, pergolide and in the winter I throw in a feeding of beet pulp. She gets 4 meals a day.She is at least 35 years old and has few teeth. I have trouble keeping weight on her. I found that it was actually cheaper for me to just put her on pergolide rather than have her on a million supplements to control her insulin resistance. At her age I am frankly not so concerned about founder, I will not do anything stupid but she has no teeth, has trouble keeping weight and I refuse to starve her at this point. If she founders I will put her down rather than cut back on feeding her. When she was younger and had no problem with weight I was more aggressive with her treatment. She has never foundered.
I have two horses with Cushings in the barn right now. We recheck ACTH every spring at the same time that we pull Coggins, plus ~60 days after a dosage change, so I have documented evidence that Prascend is more effective than compounded pergolide for both of my guys.
#1) Pony, age 29, easy keeper on grass with the big horses until he foundered at age 27. Didn't bother to test for IR -- he has all the symptoms. Year-round dry lot turnout with a round bale in the field, free-choice orchardgrass hay in his stall. Teeth are adequate but he eats hay very slowly, so free-choice tends to be less than 10lb overnight in his stall. For extra fun, he switched from life-long total air fern to hard keeper last winter.
Currently eating (per day): 7 lb TC Senior, 2 cups Legends Omega Plus, 1 "flake" Standlee compressed alfalfa, free-choice grass hay, 2.5 mg Prascend. I just added the alfalfa as he is thinner than I would like.
2) 20 year old TB, diagnosed two years ago when I noticed slight changes in winter coat plus an increase in thirst/urination. He's a massively picky eater, but fortunately an easy keeper. No signs of IR when last tested, so he is out on grass and muzzled as needed for weight control.
Currently eating (per day): ~1 lb TC Senior, SmartHoof Ultra, 1 mg Prascend, ~20lb orchardgrass hay in stall, round bale or grass in turnout.
I wish he would eat TC30 or vit/min supplement, but neither are currently on his chosen menu. :-/
My 30-yr old Arab gelding was dx'd with Cushings in the fall of 2010, when he was 26.
Over the last 3 years, I've been thru many different feed regimens with him, and Pergolide/Prascend dosages.
Since September 2013, he has been OFF Prascend/Pergolide, and won't be going back on it. I never could get him to take it consistently, and he never ate well on it. We also could never get his levels right. He was miserable.
He is now back to his normal pre-Prascend self, and eats every bit of his feed. He's keeping weight on better, too. Since December 2012, he's been on Triple Crown Sr., Timothy Balance Cubes, Smartpak Combo Senior, and unlimited pasture/local grass hay.
My management of him is unconventional, but.... He's 30. I have a family and a budget I need to stay within, which doesn't allow for expensive micro-managing of his condition. He has been my horse for 27 years, and honestly, *I* am happier seeing him frolic in the field and clean up his meals each day than I was seeing him depressed and refusing to eat. He's 30. *Something* is going to end his life in the near future. Who knows when, but until then, I want him to be gloriously happy, not miserable. I want to give that to him.
Yes, he does look like a yak. I do have to shave him, even in winter - I am going to have to shave his head to get his halter to fit.
If he were a younger horse with Cushings, I probably would not be so laid back about handling it. I would likely be aggressive about it, and micro-managing it to prolong the time I had with the horse. But my guy... He's 30.
That Equine Cushing's Yahoo group had a comparison chart of cost per dose from various online pharmacies for Pergolide and probably for Prascend now too. IF you can get your vet to write a script for you that you can fill at your choice of pharmacies (mine fills all his prescriptions in house. Period.) then there are some good choices for the budget conscious.