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PPID/Cushings.... another thread

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  • PPID/Cushings.... another thread

    Vet has tested my horse for PPID, tests came back normal, however, I'm convinced my horse has issues and needs treatment.

    For the past 3 winters he has gotten hind hoof abscesses, bad ones that take months to resolve. He has a thicker winter coat and the hair on his legs have become curly in winter. This is a horse who barely grew a winter coat 5 years ago. His topline is non-existent and he is losing muscle.

    Vet will not prescribe medication until the bloodwork shows something. I don't know what to do but feel my horse is going downhill more and more every year. He is a 15 year old 17h warmblood cross.

  • #2
    Do you have another vet available? Some are more proactive than others.
    You have to have experiences to gain experience.

    1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

    Comment

    • Original Poster

      #3
      Originally posted by quietann View Post
      Do you have another vet available? Some are more proactive than others.
      Yes, I already had a second opinion and was told the same thing that they cannot medicate until the horse tests positive.

      Comment


      • #4
        It's so frustrating! Mine is similar, although her symptoms are very mild. She has the fat pads (especially over her eyes), hangs onto her winter coat a bit late, and her topline isn't quite as nice as it used to be (but we are not doing dressage anymore, so it could be because of that), but has not had the hoof issues other than being footsore last year due to poor shoeing.

        She's been tested for Cushings (and IR) multiple times and only once has she had a value even slightly out of range. I did have one vet who, about 4 or 5 years ago, said she "looks like" a Cushings horse, and had I not moved her out of that vet's practice area, I suspect she'd be getting treated regardless of test results. She is a now 21 YO Morgan, and they are SO prone to metabolic issues. My current vet did prescribe Thyro-L for her to try to get her weight down a bit, and it helped, but she may need a higher dose. (Vet comes tomorrow and we will see what he says.)

        I am actually hearing about more vets not relying completely on the test results in diagnosing Cushings, especially, because the tests themselves can be influenced by so many things. Some are willing to do a trial of pergolide/Prascend. There are also, as I am sure you know, a lot of herbal supplements that are supposed to help, but the data on those is anecdotal. Heiro for IR, chaste berries for Cushings.
        You have to have experiences to gain experience.

        1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

        Comment

        • Original Poster

          #5
          Originally posted by quietann View Post
          It's so frustrating! Mine is similar, although her symptoms are very mild. She has the fat pads (especially over her eyes), hangs onto her winter coat a bit late, and her topline isn't quite as nice as it used to be (but we are not doing dressage anymore, so it could be because of that), but has not had the hoof issues other than being footsore last year due to poor shoeing.

          She's been tested for Cushings (and IR) multiple times and only once has she had a value even slightly out of range. I did have one vet who, about 4 or 5 years ago, said she "looks like" a Cushings horse, and had I not moved her out of that vet's practice area, I suspect she'd be getting treated regardless of test results. She is a now 21 YO Morgan, and they are SO prone to metabolic issues. My current vet did prescribe Thyro-L for her to try to get her weight down a bit, and it helped, but she may need a higher dose. (Vet comes tomorrow and we will see what he says.)

          I am actually hearing about more vets not relying completely on the test results in diagnosing Cushings, especially, because the tests themselves can be influenced by so many things. Some are willing to do a trial of pergolide/Prascend. There are also, as I am sure you know, a lot of herbal supplements that are supposed to help, but the data on those is anecdotal. Heiro for IR, chaste berries for Cushings.
          Yes it is super frustrating for sure. How is your mare doing on the Thyro-L, any improvement?

          My boy is a hard keeper and is on the slimmer side - not crest etc... which is why vet is hesitant.

          Comment


          • #6
            My horse did not have wow numbers but we started her on half a tablet. Many of her symptoms disappeared. She had a tendon injury (PPID horses are predisposed), numbers creeped up and we increased the dose again. From what I understand numbers can be deciving if there are other symptoms. May be time for a different vet.

            Comment


            • #7
              Did you do the TRH stim test or just ACTH? The TRH stim/response test is supposed to be more sensitive. We've done both and both were normal but I've put the bug in my vet's ear about possibly still treating with a low dose. We will revisit in a few months if we have more cellulitis flares and other strange symptoms.

              Comment


              • #8
                I am a big cheerleader for the SmartPituitary supplement by SmartPak and suggest it anytime someone brings up Cushing's. I noticed a big difference in my Cushing's mare when I started her on this and I'm convinced it gave her a few extra years of quality life. As a bonus it's very affordable. May be something to check into if your vet says the horse isn't quite bad enough for meds yet.
                *Wendy* 4.17.73 - 12.20.05
                *Missy* 2.2.88/89 - 9.3.18

                Gone but never forgotten.

                Comment


                • #9
                  19 year old Mustang here. Has always tested normal. Has all the same symptoms. Started Prascend two years ago this summer. Big improvement. My vet consulted with Cornell U. Their recommendation was to medicate. Find a vet that will give the meds a try.

                  Comment

                  • Original Poster

                    #10
                    Originally posted by SLedbetter View Post
                    19 year old Mustang here. Has always tested normal. Has all the same symptoms. Started Prascend two years ago this summer. Big improvement. My vet consulted with Cornell U. Their recommendation was to medicate. Find a vet that will give the meds a try.
                    Your had all the same symptoms as what I described?

                    Comment


                    • #11
                      There's a supplement called Heiro that works pretty well for a lot of horses. I'd try that first. A bunch of horses at a dressage barn I worked at were on it and I was impressed at how effective it was for a non--Rx. What really sealed the deal for me was when the pony foundered and we took her in to one of the best farriers in the mid-Atlantic and she recommended the Heiro as well.

                      Pergolide frankly scares me. It was originally developed as a drug to treat Parkinsons. In 2007 it was withdrawn from the U.S. market for human use after several studies revealed a link between the drug and increased valvular heart disease. Soon after being started on the drug, the pony suffered several unexplained episodes where her heart and respiration rates spiked through the roof. I've never seen anything like it and hope to God I never see it again. The first time, 20 seconds into a canter in a group lesson my daughter pulled the pony up crying that she was worried about her breathing. The trainer is a timber jockey/trainer and no doubt has seen horses red-line before. She went pale as a ghost and leapt into emergency mode. The vet chalked it up to being "out of shape". I called BS. The pony's workload hadn't changed. She had been doing 3-4 moderate-to-heavy lessons weekly for as long as I'd known her. Soon after, the pony collapsed while being wormed (we think she got lightheaded) and suffered a near-fatal incident of heat stroke while at rest in her stall. I don't doubt that there are cases where Pergolide is absolutely indicated. In borderline cases I personally would avoid it. The pony was asymptomatic other than heavier hair growth. She ballooned up and got the fatty crest AFTER starting Pergolide. It was the Heiro that seemed to bring relief.

                      IMO, drastic calorie restriction like some vets recommend is incorrect for Cushings horses that are in work. Severely limiting calories is linked to weight retention/weight gain in human dieters. Not that big a leap of logic that it could have the same effect on horses. High fat low starch diets have been used for the last decade as a means of getting sufficient calories into EPSM-prone draft horses. (We originated the whole vegetable/coca-soya oil thing) A low-starch feed like Triple Crown Senior with some flax seed, a mineral supplement, and a few pumps of oil was what I got good results with for my big pulling horses. For Cushings, I would then do either bagged forage or grass hay that has been soaked.

                      Comment


                      • #12
                        As the last poster suggests I would definitely get onto the resources for feeding metabolic horses and figure out the recommended diet and supplements immediately even while contnuing to pursue the pharmaceutical end of things.

                        Comment


                        • #13
                          Which test was done, when, and what was the number?

                          If you are dealing with pre-Cushing's, no amount of messing with the diet will address that, you need pergolide (Prascend).

                          If his coat is just old age, and you're dealing with rising insulin resistance issues, then while testing is a nice thing to have so you can monitor progress, you can still feed a horse as if he's majorly IR even if he's not, without any harm.
                          ______________________________
                          The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

                          Comment


                          • #14
                            I can't imagine working with a vet that "can't" prescribe a trial of medication for my horse based on symptoms and not test results. "Can't" - why not? Who is stopping them? It sounds like you are a teenager and they need your parent's permission.

                            What is the vet's explanation and recommendation for 15 year old horse with muscle atrophy, hoof abscesses and changes in coat? Is the vet recommending something else - e.g. other diagnostics - and not willing to just treat for Cushings before other things? Or is there no recommendation, no further testing, and no medication?

                            When did you test and what were the results?

                            I feel like we might be missing out on more of the conversation. Or, the vet is really bad. I just can't imagine my vet clinic telling me there is nothing to do, and unwilling to do a medication trial, sorry...nope!

                            Comment


                            • #15
                              Originally posted by S1969 View Post
                              I can't imagine working with a vet that "can't" prescribe a trial of medication for my horse based on symptoms and not test results. "Can't" - why not? Who is stopping them? It sounds like you are a teenager and they need your parent's permission.
                              Maybe because there are standards and rules to follow to prevent abuse of prescribing medication unnecessarily?

                              https://www.fda.gov/forpatients/othe...el/default.htm

                              I know that there are posters here who feel they are more knowledgeable than educated and credentialed experts, but there are valid reasons for refusing to prescribe a medication off-label, mainly unanticipated side effects.

                              "It is important to know that before a drug can be approved, a company must submit clinical data and other information to FDA for review. The company must show that the drug is safe and effective for its intended uses. "Safe" does not mean that the drug has no side effects. Instead, it means the FDA has determined the benefits of using the drug for a particular use outweigh the potential risks."

                              Comment


                              • #16
                                Originally posted by Pocketpony View Post

                                Your had all the same symptoms as what I described?
                                Yes. With the exception of the hoof abscesses. He didn't shed until late June, started winter coat in August. Curly hair in weird places, horrible loss of topline. He has had on and off hoof issues, laminitis, foot sore. Muscle wasting, increased drinking/urination, runny eyes. We always thought he was lazy, but in hindsight, I think he also had some exercise intolerance. My vet was hesitant to treat as well, but Cornell University said that they recommend a trial period on Prascend to see if symptoms improve. The medication helped, it took about a month to see a noticeable change. Vets words to me: 'If it walks like a duck, quacks like a duck.......'

                                Comment


                                • #17
                                  Originally posted by Palm Beach View Post

                                  Maybe because there are standards and rules to follow to prevent abuse of prescribing medication unnecessarily?

                                  https://www.fda.gov/forpatients/othe...el/default.htm

                                  I know that there are posters here who feel they are more knowledgeable than educated and credentialed experts, but there are valid reasons for refusing to prescribe a medication off-label, mainly unanticipated side effects.

                                  "It is important to know that before a drug can be approved, a company must submit clinical data and other information to FDA for review. The company must show that the drug is safe and effective for its intended uses. "Safe" does not mean that the drug has no side effects. Instead, it means the FDA has determined the benefits of using the drug for a particular use outweigh the potential risks."
                                  This has nothing to do with approved or not, on label or off. Many vets have looked at a horse and used common sense and experience instead of relying 100% on numbers to tell them what to do.

                                  MANY vets have looked at the horse in front of them, not the numbers on paper, and said "if it's walking and talking like a duck, let's try this and see if it really IS a duck", especially when the treatment will have no harm for the relatively short duration of the trial period.

                                  Many vets have absolutely prescribed Prascend for a trial period when the horse is presenting all the right symptoms, even in the face of a test saying "no". We have learned a great deal about Cushing's and its presentations and how some horses are showing external symptoms long before their test results are showing issues. It's not like this would be uncharted territory. It's not like guessing wrong is going to kill the horse or cause a whole different set of serious complications. We know this, because this has been done before. Many times.

                                  And if the horse has no improvement of symptoms? No problem, wean off the Prascend and regroup.

                                  And please note, I am NOT saying this horse MUST be put on Prascend to see what happens. We all still need to know which test(s) were done when, and what the results were.


                                  ______________________________
                                  The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

                                  Comment


                                  • #18
                                    Originally posted by JB View Post

                                    And please note, I am NOT saying this horse MUST be put on Prascend to see what happens. We all still need to know which test(s) were done when, and what the results were.

                                    Good thing since you are not a veterinarian and learned everything via an online home study program. Hopefully the OP is getting recommendations from real people with real credentials instead of online anonymous posters!

                                    This is how the anit-vaxers succeeded in spreading their misinformation regarding the necessity and safety of childhood vaccines. They do not have formal educations and are self-educated proclaimed experts and said things that made enough sense to some people that they did not get their children vaccinated. Please, people, if you have a real medical condition, consult with professionals who truly know what they are doing. OP, if you want a second opinion then get one, but take what you read online with a grain or three of salt since few people here have the expertise or credentials to tell you whether or not your horse needs medication right now.

                                    Comment


                                    • #19
                                      Originally posted by Palm Beach View Post

                                      Good thing since you are not a veterinarian and learned everything via an online home study program. Hopefully the OP is getting recommendations from real people with real credentials instead of online anonymous posters!

                                      This is how the anit-vaxers succeeded in spreading their misinformation regarding the necessity and safety of childhood vaccines. They do not have formal educations and are self-educated proclaimed experts and said things that made enough sense to some people that they did not get their children vaccinated. Please, people, if you have a real medical condition, consult with professionals who truly know what they are doing. OP, if you want a second opinion then get one, but take what you read online with a grain or three of salt since few people here have the expertise or credentials to tell you whether or not your horse needs medication right now.
                                      You are the one who states things shouldn't happen. If you can read for comprehension, I have never said "do it". I have never said "oh that horse has Cushing's even though I've never seen him and am not a vet". You're the one who makes blanket statements, maybe based on personal experience, maybe based on things you read.

                                      And yet, all around you, there are situations that disprove your blanket statements.

                                      My vet was hesitant to treat as well, but Cornell University said that they recommend a trial period on Prascend to see if symptoms improve. The medication helped, it took about a month to see a noticeable change. Vets words to me: 'If it walks like a duck, quacks like a duck.......'
                                      All around you, and right on the threads where you make those "this is how it's done in my world therefore that's how it must be done everywhere", you are proven wrong.

                                      Tell me again where I've spread misinformation. You keep making these accusations of things I say, yet when asked to point out specifics, so that I can either admit I was wrong (and really, isn't that your whole goal, find out why and where I'm wrong?) or to make clarifying statements, it's crickets. Every time. So tell me, where have I "anti-vaxxed" this thread? Where have I not asked questions? Where have *I* said "why isn't your vet doing a trial treatment for Cushing's just to see"? Where have I said "your horse has Cushing's?"

                                      You make the argument that unless the numbers are definitive for X issues, a vet should not prescribe Y medication. Thank goodness good vets don't subscribe to your theory of medicine. And right on this thread, there are examples of good vets who did just what clearly freaks you out, and the horses are better off for it. Medicine is never an exact science, and thank goodness there are vets and doctors who understand that.

                                      I hope the OP DOES seek other professional opinions, and that will ( hopefully) happen in large part because those on this thread have urged her to. I would hate to think her horse may continue to suffer the consequences of unchecked Cushing's until the numbers blow up in everyone's face just because a vet is a "by the book" person who won't prescribe without absolute facts.

                                      And despite the fact that you believe only vets can have the knowledge of certain issues, there are non-vets who have been around enough horses with that issue that they know more than the vets, and help educate vets. How about that. Book learning is not the only game in town.
                                      ______________________________
                                      The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

                                      Comment


                                      • #20
                                        It's usually a big red flag when someone with no credentials claims that those who have taken the time - years of time in many cases - and money to obtain the education and degrees to make their livelihood out of caring for people or animals, don't have as much knowledge as the self educated. Unfortunately, when you are self educating online, there is no structure of what to learn and when to learn it, so you are putting things together piecemeal. You don't know what gaps are there, and since you are not getting tested, or have no professional assistance, you don't know what gaps are in your knowledge, or even that you might be wrong.

                                        People, please be very wary of what you read online, unless it is from a reputable source, and especially when the health and welfare of you, your family or your animals is at stake. Some people mean well, but when you are self educated, you simply don't know what you don't know.

                                        Comment

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