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At what point do you medicate when you don't have a definitive diagnosis of Cushings?

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  • At what point do you medicate when you don't have a definitive diagnosis of Cushings?

    Approximately 25 yr old Welsh pony, tested on 6/1/19 for Cushings. ACTH came back 36 (35 is cut-off if I remember correctly). Also tested for IR at same time. That result was 56 (don't remember range on that test). Prior to having him tested, we've been treating him (low starch/sugar diet, limited access to grass, hay tested, etc.) for the past several years as if he might be PPID and probably IR.

    Vet has offered to start pony on Prascend, even though she's not convinced he has Cushings. So there is no reluctance on my vets part. I'm just trying to decide what is best for the pony.

    Pony currently has no symptoms, except the fat pads around his dock. No laminitis. No thick coat this summer (did shed completely, albeit oddly). No thick cresty neck. Not obese. Was an air fern until this past Feb, when he was dropping weight as his winter coat was both shedding and growing at the same time. He ended up with like 6" long hairs under his jaw and on his lower legs (that did shed out). It was very bizzare. And why I finally decided to have him tested.

    I worry about my little Bud pony. And like I said, want to do what is best for him. Don't want to put him on medication if he doesn't need it. But don't want to not start the meds if it will help him. So, what to do? TIA

    Pictures taken in August of this year. Of course, now he looks like a fur ball in his winter coat.
    ~~ How do you catch a loose horse? Make a noise like a carrot! - British Cavalry joke ~~

  • #2
    I'd save the money for now and recheck the ACTH over the winter and before the seasonal spike in the spring. I have one that was started on Prascend without testing (prior owner) and am using testing to wean off Prascend. This stuff is pricey and for some (not mine) have side effects.

    Comment


    • #3
      I'd treat him now; actually I would have treated him initially. June should be the point of the year where the pituitary is least affected by sunlight - you tested during the longest possible days of the year and he was still technically positive. And already had clinical signs - fat pads, weight loss, coat changes.

      Cushings does not go away or get better. It is a degenerative disease that affects the whole body and continues to get worse with time. There are only a few reasons NOT to treat - cost, and potential for lack of appetite. Aside from those, MOST horses don't have other side effects, and some have none (including no loss of appetite.) So it's really just cost.

      I have a pony with advanced Cushings. I got him this way, and he will never be normal. With what I know about the disease NOW, I would advise people to treat immediately upon a positive test. If you are unsure, retest and see where you are now. At this point in the year you should expect the ACTH to be higher, but with Cushings horses, it will be higher than unaffected horses.

      You really don't want to wait until the clinical signs are worse. My pony will never have normal feet again, and the trim cycle for all my horses is scheduled around his feet because I keep them at home. He's always walking a fine line between being ok and scheduling euthanasia. It's a good thing I like him, because he's a very high maintenance, unrideable little dude.

      Comment


      • #4
        Originally posted by 4LeafCloverFarm View Post
        Approximately 25 yr old Welsh pony, tested on 6/1/19 for Cushings. ACTH came back 36 (35 is cut-off if I remember correctly). Also tested for IR at same time. That result was 56 (don't remember range on that test). Prior to having him tested, we've been treating him (low starch/sugar diet, limited access to grass, hay tested, etc.) for the past several years as if he might be PPID and probably IR.

        Vet has offered to start pony on Prascend, even though she's not convinced he has Cushings. So there is no reluctance on my vets part. I'm just trying to decide what is best for the pony.

        Pony currently has no symptoms, except the fat pads around his dock. No laminitis. No thick coat this summer (did shed completely, albeit oddly). No thick cresty neck. Not obese. Was an air fern until this past Feb, when he was dropping weight as his winter coat was both shedding and growing at the same time. He ended up with like 6" long hairs under his jaw and on his lower legs (that did shed out). It was very bizzare. And why I finally decided to have him tested.

        I worry about my little Bud pony. And like I said, want to do what is best for him. Don't want to put him on medication if he doesn't need it. But don't want to not start the meds if it will help him. So, what to do? TIA

        Pictures taken in August of this year. Of course, now he looks like a fur ball in his winter coat.
        There is a definitive to way to test him ...you need to have your vet do a TRH stim ...he will take a pre stim sample..give the TRH stim injection, wait 10 minutes ...then take a post sample ...that is the only truly accurate way to actually test the acth for Cushings...also being fat, obese , cresty necked and furry aren’t the only signs of Cushings ...they can also be the opposite side of things and lose weight/topline and condition ....it’s important to get an accurate diagnosis ...and if your little Bud does have Cushings ...start off at 1/4 pill and increase it by only 1/4 every 4 days until target dose is reached ...this helps to avoid the side effects with Prascend called the Pergolide veil
        R.I.P. "Henry" 4/22/05 - 3/26/2010 We loved you so much....gone but NEVER FORGOTTEN...i hope we meet again

        Comment


        • #5
          The seasonal rise is now, not in the spring. I think an ACTH of 105 is baseline for a horse with Cushing's this time of year.

          After dealing with Cushing's in my previous horse for many years, I would treat sooner rather than wait, especially with the IR symptoms yours is showing. It affects them in so many ways and hard to keep up with.

          Comment

          • Original Poster

            #6
            I have been reading all the Cushings/PPID threads that pop up on CoTH. Its one of the reasons I came back, after a long absence. I'm amazed at how prevalent this disease seems to be. I'm guessing that has to do with advances in diagnostics, vet care and ponies/horses living longer lives.

            I had been leaning toward treating Bud at a small dose. Wanted to see if that sounded like a good idea, or if we should wait. Sounds like we should give it a go.

            I know from my reading that when Prascend is first administered, that the pony may loose his appetite and may be lethargic or seem depressed. Are there other major side effects that one needs to look for or are concerning? Do they usually diminish as they continue to take the meds?
            ~~ How do you catch a loose horse? Make a noise like a carrot! - British Cavalry joke ~~

            Comment


            • #7
              I'm in your shoes with a 22 year old Paint--- he too tested negative for PPID but in April. Vet opted for no medication but instead low sugar/limited grass diet changes. We thought we'd nailed it, but when ringbone reared its ugly head and he was off behind (diagnosed with xrays), we also discovered he'd had a mild bout of bilateral hind laminitis---absolutely no signs he'd had it! None. Just seeing the evidence in his hinds when farrier came to do regular trim. It blew us all away, and his situation is complicated by two lameness causes behind. He is now working through an abscess that seems to be the source of his worst lameness. (again, visible on xray).

              Vet is opting to still not treat with prascend at this point until we see how the abscess resolves. There was no rotation visible. We will continue to reduce caloric intake (he is still a bit overweight), keep vitamins and joint supplements going, and adding a grazing muzzle. Additionally, we are shoeing behind for support.

              But...I'd like to add prascend sooner than that-- the laminitis scare is making me sick. If I were you, I'd push for prascend.
              Proud member of the "Don't rush to kill wildlife" clique!

              Comment


              • #8
                If you'd like to do something additional, but not use medication yet, you can give chaste tree berry a try.

                Comment

                • Original Poster

                  #9
                  Originally posted by Simkie View Post
                  If you'd like to do something additional, but not use medication yet, you can give chaste tree berry a try.
                  I am unfamiliar with that herbal remedy (though I have heard of it). Is this something where if you find the human version cheaper, its the same as something specifically marketed for horses? Guess I'll go look that up and see where I can get it.

                  And here is the stupid question of the day.... if the Prascend or Chaste Tree Berry is working as intended, should his fat pads around his tail start to dissipate? I mean, since he has no other symptoms/issues, how do you know it is working as intended?
                  ~~ How do you catch a loose horse? Make a noise like a carrot! - British Cavalry joke ~~

                  Comment


                  • #10
                    Originally posted by 4LeafCloverFarm View Post

                    I am unfamiliar with that herbal remedy (though I have heard of it). Is this something where if you find the human version cheaper, its the same as something specifically marketed for horses? Guess I'll go look that up and see where I can get it.
                    I use it to even out my hormonal older mare and buy the liquid from Gateway. Get it directly from them, two gallons has lasted maybe 9 months and shipped free. It's quite inexpensive, and palatable. Smells like cherry snocone syrup.

                    Comment

                    • Original Poster

                      #11
                      Originally posted by Calvincrowe View Post
                      I'm in your shoes with a 22 year old Paint--- he too tested negative for PPID but in April. Vet opted for no medication but instead low sugar/limited grass diet changes. ...
                      Bud was supposed to be tested in April. But his mother (me), had a senior blonde moment the morning of the farm call, and I FED the pony his breakfast. Oops! So it took another month to get back on the farm call route. Spring is very busy with their practice, as they aren't just equine vets (they treat all farm animals, which came in handy when we had goats).

                      Sorry to hear about your Paint. Hope that abscess resolves quickly for him. My 28 yr old Draft Cross is "Mr. Abscess". I'm a champ at wrapping his salad plate sized hooves from all the practice. My other two have never ever had an abscess, even the one with Laminitis.
                      ~~ How do you catch a loose horse? Make a noise like a carrot! - British Cavalry joke ~~

                      Comment


                      • #12
                        This timely for me, with my 24 yr old TWH that was diagnosed IR in 2012 but has been in remission since 2015.

                        He has the early subtle indicators of cushings, plus his ACTH last March was at the top of the high/normal range. I didn't find that out until October (nor did I get the bill for the tests until October, which is its own Tee'd me off story.

                        Anyway, I have nothing to offer, just wanted to add that I have a horse with early indicators but I'm the only who seems concerned.

                        Comment

                        • Original Poster

                          #13
                          Originally posted by walkinthewalk View Post
                          Anyway, I have nothing to offer, just wanted to add that I have a horse with early indicators but I'm the only who seems concerned.
                          I understand completely. My vet thinks I'm a bit of a hypochondriac where my horses are concerned. Vet thinks I'd be wasting money on the Prascend, but offered to write the script anyway. Hence my dilemma.
                          ~~ How do you catch a loose horse? Make a noise like a carrot! - British Cavalry joke ~~

                          Comment

                          • Original Poster

                            #14
                            Simkie - okay, I can't find Gateway. When I do a Google search, this is what comes up - is this it?

                            https://www.su-perstore.com/m7/sfech...ry-liquid.html
                            ~~ How do you catch a loose horse? Make a noise like a carrot! - British Cavalry joke ~~

                            Comment


                            • #15
                              Originally posted by 4LeafCloverFarm View Post
                              Simkie - okay, I can't find Gateway. When I do a Google search, this is what comes up - is this it?

                              https://www.su-perstore.com/m7/sfech...ry-liquid.html
                              Yeah. That company is Gateway.

                              Comment


                              • #16
                                I'm usually on team "treat early and often" when it comes to Cushing's, but for a 36 and no other complaints, I think I'd wait for February and do the TRH stim as ladipus mentioned. You'll get a more definitive answer and can make a treatment decision from there.

                                Comment


                                • #17
                                  Chaste tree berry might resolve the symptoms, (which you don't have yet) but not slow down the disease. I've used it with Prascend to keep his coat a bit more normal looking. Fall is the time for laminitis due to IR/Cushings and is sometimes one of the first signs of Cushings.

                                  Comment


                                  • #18
                                    Originally posted by 4LeafCloverFarm View Post
                                    I have been reading all the Cushings/PPID threads that pop up on CoTH. Its one of the reasons I came back, after a long absence. I'm amazed at how prevalent this disease seems to be. I'm guessing that has to do with advances in diagnostics, vet care and ponies/horses living longer lives.

                                    I had been leaning toward treating Bud at a small dose. Wanted to see if that sounded like a good idea, or if we should wait. Sounds like we should give it a go.

                                    I know from my reading that when Prascend is first administered, that the pony may loose his appetite and may be lethargic or seem depressed. Are there other major side effects that one needs to look for or are concerning? Do they usually diminish as they continue to take the meds?
                                    You need to start at 1/4 pill and increase by 1/4 tab every 4 days until target dose is reached ...this helps reduce the side effects
                                    R.I.P. "Henry" 4/22/05 - 3/26/2010 We loved you so much....gone but NEVER FORGOTTEN...i hope we meet again

                                    Comment


                                    • #19
                                      My Cushings mare is on Prascend and also Chasteberry powder - I get mine though Horsetech. It's not on their website so you have to call them to order it. A one pound bag lasts about five months and it's about $26 for it (with free shipping). My mare is ridiculously picky and she'll eat this without issue - sticks nicely to her TC Senior.

                                      As said above - it'll help the symptoms but not slow down the Cushings progression.
                                      "When a horse greets you with a nicker & regards you with a large & liquid eye, the question of where you want to be & what you want to do has been answered." CANTER New England

                                      Comment


                                      • #20
                                        Originally posted by findthedistance View Post
                                        I'm usually on team "treat early and often" when it comes to Cushing's, but for a 36 and no other complaints, I think I'd wait for February and do the TRH stim as ladipus mentioned. You'll get a more definitive answer and can make a treatment decision from there.
                                        Not sure I'd say there are "no other complaints" - this horse has outward signs of Cushings already:

                                        - Fat pads around his dock
                                        - Was an air fern until this past Feb, when he was dropping weight
                                        - Winter coat was both shedding and growing at the same time.
                                        - 6" long hairs under his jaw and on his lower legs

                                        Fat pads, weight loss, abnormal hair growth.....those are classic signs. If the pony had laminitis, everyone would agree that it was time to treat. Do you really want to wait until then?

                                        I don't disagree that a re-test could help prove it if there is doubt. But a result of 36 in June is good enough for me with those symptoms.

                                        If you wait another year or two, it is likely that the test results will be strongly positive. Is that better or worse?

                                        Comment

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