Cushing's/IR in 4 Year Old? UPDATE: Positive for Cushings

[SLedbetter]

Would like to know your thoughts. Bean is a Shetland X, just turned 4. I've had him for two years. He came from a not so good situation, but don't know a lot of his background. He was in poor shape when I got him. I have always been very careful about what he gets fed, making sure he doesn't get too fat. His hay is weighed for every feeding so I know how much he is getting. He is basically fed an I/R diet due to the fact he is predisposed, but also because I have an oldie who is Cushing's and possibly borderline I/R.
Bean has terrible seasonal allergies, had had a couple bouts of mild laminitis we think due to steroid shots for the allergies, and seemingly diet changes. I always scratched my head when this occurred because I've been so careful with him.
Recently we've been treating him for colitis, from which he has recovered after over a month of treatment. Vet isn't sure what caused it, but thinks it may be due to pain medication for issues with his teeth and teething. Part of his treatment for the colitis was increasing alfalfa to help buffer his gut in addition to giving him Sucralfate 3x a day. I worked him up to 2 lbs of alfalfa per day of his 7 lbs total of forage. Bean typically gets 7 lbs of Bermuda grass hay per day over three feedings with a little alfalfa sprinkled on it. He also gets High Point Grass supplement.
When I took him in yesterday for his recheck, the vet noticed right away that he basically has a full blown winter coat. Now this isn't totally abnormal for him, because he does grow a triple coat every winter, but it did seem to come early this year. My Cushing's boy has just now started his winter coat. She also noticed he is a bit on the heavy side, and has developed a cresty neck. I did think he was looking a bit rounder, but thought it was either my imagination or the fact that he's so fluffy already.
After talking to the vet, and thinking back, I realized he didn't get as 'slick' this summer as the year before, also he has had at least 3 bouts of mild laminitis that we chalked up to different things, but also due to the fact that he is a pony. The vet did verify that my thoughts on his weight gain were correct.
I was shocked when she suggested testing for Cushing's and I/R. We went ahead and did that, should get results next week. I'm just flabbergasted that a horse so young could potentially have such serious issues. The thought had crossed my mind when I noticed his coat coming in so heavy, but right away dismissed it because of his age.
Bean has had extensive training and is such a good boy. My first training project, which I've enjoyed so much. I have to admit that I'm a bit frustrated with the fact that he's had so many issues despite my best efforts, as my other horse has had numerous health problems, and I was really looking forward to having a healthy horse for a change.
Does anyone have experience/knowledge of horses so young with these issues? Even horses well managed like mine is?

[JB]

It would be really rare for a 4yo to have Cushing's, but since there's at least 1 documented 5yo, not out of the question.

I would be shocked if he's not IR, given what you've described, and I would really think hard about any more steroids for him.

It also sounds like his hay needs to be tested sugar + starch < 10%.

[ChocoMare]

Total ditto to JB.

Pony = soooooooo prone to EMS/IR.

No more steroids. They're murder on hooves. Look for separation.

Until you can test the hay, start soaking it to pull the sugars.

[DinkyDonk]

My little red mare has seasonal allergies which presented when she was a four year old; MSM, and vitamins E and C control her coughing and sneezing quite well--she gets all 3 all year long. You might want to try them with your little guy to see if they work for him.

[SLedbetter]

JB: No more steroids. That's already been decided. I only have one reliable source for my hay, and it comes from a few different places, California and Arizona from what I'm told. I suppose that soaking should be something I start from here on out. What about alfalfa? Can I keep him on the two pounds and soak the grass?
I will check into the MSM and C. Bean has an issue with midges and its primarily skin issues we deal with. Smart Pak Immune supplement and spirulina helped a lot this year.

[SLedbetter]

Update: Got test results back today, haven't heard exact results. Vet called and left a message that due to Bean's ACTH levels we need to start him on Prascend. I emailed them, (they were super busy today), and got the response that the vet would call me Monday with a treatment plan for starting the medication. Results for leptin (I/R) aren't in yet, should be in early next week. Ugh. I just can't believe this is happening to me!

[4horses]

That is very odd especially so young. What would be the lifespan of cushings in a horse so young?

[4horses]

Would testing at this time of year even be accurate? As most healthy horses have elevated levels at this time?

[S1969]

Would testing at this time of year even be accurate? As most healthy horses have elevated levels at this time?

Well, I'd be curious of the number. If it was 50, for example (normal range of 9-35) I agree that might just be a seasonal rise. If it was 200….I think it would have been positive no matter when it was taken.

My pony is a metabolic disaster; I wouldn't be surprised if he had been + for Cushings at that age, since he was nearly dead at 12 when I got him. I wonder if some smaller ponies/minis have Cushings at a young age and are just thought to be "typical ponies" that need special diets.

[BWP]

Would testing at this time of year even be accurate? As most healthy horses have elevated levels at this time?

The reference range for the acth test varies throughout the year to take into account seasonal changes (at least the test we use here in the uk)

[SLedbetter]

The reference range for the acth test varies throughout the year to take into account seasonal changes (at least the test we use here in the uk)

Cornell University adjusts for the seasonal rise on testing done this time of year. According to my vet after speaking with them, there is also a difference in time frame for seasonal rise depending on where you live geographically. Here in the desert southwest, very short time period.
I will get actual numbers on Monday or Tuesday next week.

[SLedbetter]

That is very odd especially so young. What would be the lifespan of cushings in a horse so young?

I've read that horses can live an average of 5 years after diagnosis if they are treated, but I know some people on here have had horses live much longer than that. I think it depends on several factors, the individual, the severity, how early it was diagnosed, quality of care, etc etc. I hope my boy can live a long life.

[Gamma]

I have a big long thread about treating my horse-pony's allergies. I would hugely recommend getting the allergy test done at least... it gives you so many more choices with regards to treatment even if you decide against allergy shots. (Removing any allergens that you can, proactive antihistimine when you know an allergen is a about to spike, etc., I've written pages and pages about this before.)

Although for a young horse, the potential of allergy shots makes more and more sense--if you can potentially treat for 5 years and then "cured", vs having to manage every single year (with the disclaimer that allergy shots actually working can be hit or miss, but you can usually tell if it's working in 3-6 months, and when it does work it's magic).

[Gamma]

I've read that horses can live an average of 5 years after diagnosis if they are treated, but I know some people on here have had horses live much longer than that. I think it depends on several factors, the individual, the severity, how early it was diagnosed, quality of care, etc etc. I hope my boy can live a long life.

??? That seems way off to me, we have a lot of metabolic problems in my area (all that lovely grass), and a lot of horses are diagnosed, put on treatment, and still kicking it a decade on. I wonder if that number is skewed by more horses tending to be diagnosed towards the end of their natural life.

[SLedbetter]

Gamma: I will be looking into some different supplements for him once we know exactly what is going on. Bean we are fairly sure is sensitive to midges/flies. From my understanding there are two 'types' of allergy. One is an acute reaction such as hives, which will typically respond well to antihistimines, the other is a 'systemic' allergy which does not. Bean has what I believe is the second type, and does not get relief from antihistimines. He did much better this year, I started proactive treatment early in February. He has sheets, fans, and the allergy supplements which really did help. I do wonder if the immune system issue that goes along with Cushings could be part of the reason he has these allergies to begin with, and would they improve once we get the Cushings under control?

[SLedbetter]

??? That seems way off to me, we have a lot of metabolic problems in my area (all that lovely grass), and a lot of horses are diagnosed, put on treatment, and still kicking it a decade on. I wonder if that number is skewed by more horses tending to be diagnosed towards the end of their natural life.

That would be my guess. My other horse, also Cushings is 21, and is going on year 3 of treatment. He's doing better than ever. It's BYOG here, (Bring Your Own Grass), so my horses are on dry lot all the time. Which, in my situation is a good thing.
I think with the increased awareness of PPID, more horses are being diagnosed much earlier and living longer.

[fjordmom]

It's been a while since we PMed about Bean when you first got him. Sorry to hear he is still struggling with some issues.

I would strongly suggest looking into the MSM for his midge sensitivity. My Fjord with sweet itch has been on it for several years now and is doing better and better every year.

Also, look into Heiro. It is a supplement for IR/laminitic horses. Vit E and magnesium as well as some herbs in it. He is on that as well. Hard to say for sure if it has helped, but I'm taking the better safe than sorry approach since he had one minor laminitic episode early on. My chiro vet had high praise for its use. He's pretty old school but has used it personally for one of his and encouraged me to use it. I did see overall improvements in his coat and other subtle health and well-being areas. He has become very "talkative," more energetic (in a good way), and just seemed like a very happy camper this year. It's taken a long time (years).

This darn IR/Cushings/immune system thing is such a moving target. It is frustrating. I'm happy for every small gain I make. Hope you and Bean can get there too.

[JB]

??? That seems way off to me, we have a lot of metabolic problems in my area (all that lovely grass), and a lot of horses are diagnosed, put on treatment, and still kicking it a decade on. I wonder if that number is skewed by more horses tending to be diagnosed towards the end of their natural life.

What you're describing sounds like insulin resistance. That can be well-managed in most horses, and if done well then yes, most horses can live decades with a good career (and having a job helps the IR issue).

That is very different from Cushing's, which is a disease of a growing pituitary gland. You can't stop that, but pergolide slows things down and helps minimize life-threatening side effects like laminitis.

[JB]

I've read that horses can live an average of 5 years after diagnosis if they are treated, but I know some people on here have had horses live much longer than that. I think it depends on several factors, the individual, the severity, how early it was diagnosed, quality of care, etc etc. I hope my boy can live a long life.

You're right, a LOT of horses live much longer than 5 years, if all the right things fall into place, which really means early detection and early treatment, with regular monitoring and increasing doses of pergolide (Prascend) as necessary.

But I also think a lot of older horses aren't diagnosed early enough, with owners and vets brushing off some weight and muscle loss, and a heavier coat, as purely age-related So being older, already compromised for possibly quite a few years, they don't get as many years after diagnosis.

I'm really interested in the results!

[DinkyDonk]

I've read that horses can live an average of 5 years after diagnosis if they are treated, but I know some people on here have had horses live much longer than that. I think it depends on several factors, the individual, the severity, how early it was diagnosed, quality of care, etc etc. I hope my boy can live a long life.

My hinny was diagnosed 6 years ago this coming spring at age 11 and is doing great aside from the occasional hoof abscess. He does tend to grow and shed his hair continually all year so gets groomed a lot, but I've not had to clip him yet. He's not IR, so gets to go graze with the horses (and mini donks) but like the mini donks, never without a grazing muzzle. His blood is pulled every spring to make sure his numbers are staying good (was tested twice a year until we found the correct amount of pergolide to control his ACTH).. He was having some thrush issues, and after trying all the traditional thrush medications, tried a product with the active ingredient being benzalkonium chloride, and that has resolved the thrush. He's now on a 6 week trim schedule with my horses as opposed to being on the 12 week schedule of my donkeys. He really is no more maintenance than any of my other equines other than a little more grooming and spraying his feet to keep away thrush once or twice a week, and of course his daily dose of pergolide suspension.