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Would you test this horse for Cushing? Update and more questions!

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  • Would you test this horse for Cushing? Update and more questions!

    I have a 19 year old thoroughbred gelding that I moved from last Saturday from Southern Virginia to south west Pennsylvania. He has been on the thin side for the last month or so and the 11 hour trip up north seemed to add to the weight lost. He saw the vet, who has seen this horse before, on Monday for a post-trip check up and the vet was very concerned with how the horse looked. The vet felt that the weight loss and muscle wasting was pointing us towards Cushing’s or cancer. Now some things to consider with this horse:
    1) Vet had not seen the horse in a year and a half, and the last time he saw the horse the horse was in regular work.
    2) Horse has not been in regular work for almost a year, so I don’t expect him to have the muscle tone that he had the last time the vet saw him.
    3) Horse has lost weight like this before. He has really bad allergies and weight loss is also a symptom of that that he has always bounced back from.
    4) He does not have a very long coat over most of his body and the places he does have it, his neck and legs he is already shedding out.
    5) Horse does seem to be drinking a lot of water in his stall but I am not sure how much he is getting out in the field,.
    6) His teeth needs to be done and the vet will be doing that in about two weeks.

    I have been reading up on Cushing’s and while I think my horse may have some of the symptoms I don’t see him having any of the major symptoms. This is something that I would want to catch early but money is really tight right now so I don't want to test him for something if I don't have too.
    Last edited by Bearx2; Mar. 19, 2013, 06:36 PM.
    Ann
    ~\"Think today so you will be here to think tomorrow\" Burma Shave~

  • #2
    I would test for cushings, and do a short course of omeprazole for ulcers and see if you notice any improvement. The 11 hour trailer ride could've stressed him out enough to cause weight loss.
    "If you think nobody cares about you, try missing a couple payments..."

    Comment


    • #3
      Hmm...my TB mare is mostly retired. She is almost 18 and hasn't been ridden at all since last October; and over the last year was ridden maybe 20 times total at the walk and trot. She has no muscle "wasting" from not being in work; she looks fantastically fit. (She does have 4 acres to walk around on, but has hardly done more than walk on months).

      So, a TB with "muscle wasting" and on the thin side for a month or so; and the vet being "very worried" about how it looks? Yes, I would worry that something else is going on. Maybe not Cushings, but something.

      The blood test for Cushings is about $80. If you pull blood you might also want to test for Lyme and maybe a regular blood panel...

      I am sorry to say that it stinks to spend money just to see what's going on; naturally the treatment is another issue once the bloodwork comes back; but that might be what you need to do.... Maybe you can talk to your vet about a strategic process to start looking - e.g. maybe first do teeth and treat for ulcers, and if no improvement then pull blood? Or if the teeth aren't terrible, skip them for now and pull bloods first? Then do teeth in the spring?

      Comment


      • #4
        Can you get a second opinion from a friend who also hasn't seen him in a while on the muscle wasting and weight loss? Obviously not all vets are the same, but most of them don't get panicky about cancer and Cushing's for the type of weight loss and muscle wasting that I would expect from some stress and being out of work. Sometimes it is really hard to evaluate body condition when we see them every single day; is there maybe a friend who also hasn't seen him in a while and could give you an opinion?

        Cushings is one of those unfortunate things that catching it early can actually save you quite a bit of money, so if you can make it work it might make sense to go ahead and do the test. However, if he also needs his teeth floated, and just went through the stress of shipping, and finances are tight, I think you could certainly wait a few weeks to see if he starts picking up condition quickly. Just one thing to keep in mind with Cushings - if your vet wants to do the ACTH test, it is not accurate in the fall, so you do lose some flexibility on scheduling. I've had two with Cushings, and they don't always have that classic Cushings coat - one was a pony who just had a heavy, thick coat, but had always had tendencies that way. The other is a horse who doesn't shed great (he sheds a LOT early in the season, but he doesn't shed to a real summer coat), but his hair is super soft and not classic Cushings at all, so unfortunately the haircoat really doesn't rule it out.
        Last edited by Pookah; Mar. 11, 2013, 02:02 PM. Reason: typo

        Comment


        • #5
          I would test also, given his age. It's not terribly expensive and I would rather treat it than deal with laminitis or some other really serious side effect from undiagnosed Cushings.

          I have sporadically tested my 25 year old even though she doesn't really have any symptoms per my vet's advice.

          Comment


          • #6
            I would test for sure. We have a 20 yo TB, always a bit scant but nothing major, never had any coat issues, average water drinker, etc. Nothing about this horse said "Cushings" until he had a wound last summer that was taking a long time to heal. On that alone (and his age) vet tested for Cushings and he was positive. Horse is on pergolide and doing great.

            Comment


            • #7
              I have a 19 year old that has been out of work for 3 years with epm. He looks great, no muscle wasting at all yet he is not fit like he was when in training. Epm can cause muscle wasting and atrophy but I've been lucky he hasn't had those issues. I'd test him and also while pulling blood run a full panel. See how his kidneys are working also if you think he is drinking more than usually when in. That will show in a full panel.

              Also what is his diet right now?
              Horses aren't our whole life, but makes our life whole

              Comment

              • Original Poster

                #8
                Thanks for all the replies. I am going to talk to my vet when he comes out to do teeth in two weeks. I feel that I need to fix his teeth and get some other basic health care issues resolved and then go from there. I looked at his manure this afternoon and it looked like it had a lot of feed in it and he is turning his head to the side when he eats so I know his teeth need to be done.

                I am also monitoring his weight carefully and if he does not start to gain weight I will at least have a blood work done if not just go head and test him for Cushing’s .
                Ann
                ~\"Think today so you will be here to think tomorrow\" Burma Shave~

                Comment

                • Original Poster

                  #9
                  Update and more questions!

                  So an update and some more questions so I can have a productive talk with my vet. I contacted the vet ‘s office to find out more information about getting my horse tested for Cushing and about the cost. Heard back from the office and they say Vet wants to forego testing and go right to treatment. Tech also told me that he likes to test horses in the fall., which to be honest I find a little odd given what I have red online. So my questions are this:
                  1) Has anyone not done the testing and go right to the treatment and if so why?
                  2) If you did test what time of year did you test and why?
                  3) How much did the test cost you?
                  Ann
                  ~\"Think today so you will be here to think tomorrow\" Burma Shave~

                  Comment


                  • #10
                    Hi, you want to send the blood to Cornell and I'd go ahead and test so you have a baseline. You will pull blood more then once if you end up medicating to make sure the dosage is right. Check out Dr. Kellons yahoo group for Cushing and IR horses. Lots of great info!

                    Comment


                    • #11
                      If you test in the fall, most horses, including those without Cushings, will test higher than they would in the spring. A horse with Cushings will test much much higher.

                      Get the levels down now before fall so you're not playing catch-up. You may have to increase the dosage by then.

                      My horse's symptoms were a bit vague but the big tipoff that something wasn't right was the increased water consumption.

                      Comment


                      • #12
                        Originally posted by Bearx2 View Post
                        So my questions are this:
                        1) Has anyone not done the testing and go right to the treatment and if so why?
                        No, but my "free CL pony in need of an upgrade" was foundering and desperately sick so we tested for a bunch of things to find out what was wrong. Cushings was obvious after we figured it out; but since he was new to us we weren't sure. He had most of the classic symptoms.

                        Originally posted by Bearx2 View Post
                        2) If you did test what time of year did you test and why?
                        Tested in September about 3 weeks after I got him and his ACTH was super high (425 with normal range 9-35). Put him on 1/2 Prascend per day and retested at the end of January to see how it was working (new ACTH was 13.3) Not only did his ACTH numbers go down, but he became much sounder, gained a lot of weight - mostly muscle, and suddenly had a spunky little personality!

                        Originally posted by Bearx2 View Post
                        3) How much did the test cost you?
                        $80 (sent to Cornell) plus farm call fee.

                        I would not wait to test your horse in the fall. If you want to know if he has Cushings, it is better to test NOT in the fall, because even horses that are normal can have a ACTH rise in the fall that can put them above the "normal" range.

                        I also wouldn't treat without testing, for many reasons, including that medication can be expensive and has side effects. One of the side effects of pergolide (Prascend) is that it can cause loss of appetite. So it's worth dealing with and getting past if your horse truly has a metabolic condition, but if not, you might cause them to lose more weight. And obviously, if your horse doesn't have Cushings, you will still need to think about what might be causing his issues. Cushings is *one* possible cause, but it's certainly not the only one.

                        Comment


                        • #13
                          Its not expensive. Someone in the begining of the thread mentioned 80 dollars. And you DON'T treat without bloodwork because you have to use repeated tests to determine what kind of treatment and to adjust the treatment. There's no reason not to test; don't skimp on this. If he is negative, then you won't be spending the dollars for treatment unecessarily. If it is positive, then you have a baseline to compare the blood tests you will need to continue to do to check the effectiveness of your treatments and make adjustments. Good luck. Let us know how the blood tests come out.
                          My warmbloods have actually drunk mulled wine in the past. Not today though. A drunk warmblood is a surly warmblood. - WildandWickedWarmbloods

                          Comment

                          • Original Poster

                            #14
                            Thanks for the information ,please keep it coming. I will NOT treat him for Cushing’s with out some sort of testing for a lot of reasons, the main two being I want base line results if he is positive and I don’t want to treat him if I don‘t have too. This horse is so sensitive that I worry he would have some sort of reaction to the medication and I don’t want to risk that if I don’t have too.
                            Ann
                            ~\"Think today so you will be here to think tomorrow\" Burma Shave~

                            Comment


                            • #15
                              Even when we had a horse that was quite obviously cushings...my vet ran bloodwork because as others have said, you need to KNOW what you're dealing with, so you can approach the medication with the right information to determine dosage. Then, retest after an amount of time to see how its affecting the ACTH levels.

                              I would be concerned with your vet wanting to medicate willy-nilly on this one. He/she should know that bloodwork is needed as a starting point. You may find after the horse is on pergolide for a bit, you need more or less to keep the ACTH levels where they belong.
                              "If you think nobody cares about you, try missing a couple payments..."

                              Comment


                              • #16
                                I read your post and wondered about the allergies you mention? What are they?

                                Is your horse sound, how are his feet, is he sensitive on his feet? How are his eyes and nose, are they clean? Is he sensitive to inflammations of eyes/mouth/nose/skin? He drinks a lot, does he pee a lot too? Does he sweat without doing much? The thing is there is more to a cushing horse than long hair and a bad musle tone. You leave out much of the general picture ;-) Our horse Willy had cushings. I found out through the info on COTH and am still very greatful for that. He lived an additional 5,5 years and was put to sleep last June. He had a great life and lived to be around 30. He was never tested, his symtoms said more than enough.
                                Offspring of Ramiro Z clique,member TrakehNERD Clique Very proud and honored to be the human of Fargo (RIP) and Whizzard. Whizz what a true friend you are.

                                Comment

                                • Original Poster

                                  #17
                                  Some more info

                                  The horse had major hock surgery about 3 ½ years ago and has had some arthritis do to that, but has always been relatively sound. He did go through a period where we has some injuries and unsoundess but it was before we startetd treating him for allergies and once we started to get the allergies under controll this seemed to get better.

                                  As far as the allergies go I think it would be easier to just post a copy of his allergy report they it is to list what is allergic to.

                                  http://www.facebook.com/ann.jensen.5...type=3&theater

                                  Here are some pictures that I took yesterday. The hair you see on his neck and legs is the longest hair he has on his body. The girl I got him from said he never grew a coat and has always needed a blanket.
                                  http://www.facebook.com/ann.jensen.5...9885393&type=1
                                  Ann
                                  ~\"Think today so you will be here to think tomorrow\" Burma Shave~

                                  Comment

                                  • Original Poster

                                    #18
                                    Originally posted by SuckerForHorses View Post
                                    Even when we had a horse that was quite obviously cushings...my vet ran bloodwork because as others have said, you need to KNOW what you're dealing with, so you can approach the medication with the right information to determine dosage. Then, retest after an amount of time to see how its affecting the ACTH levels.

                                    I would be concerned with your vet wanting to medicate willy-nilly on this one. He/she should know that bloodwork is needed as a starting point. You may find after the horse is on pergolide for a bit, you need more or less to keep the ACTH levels where they belong.
                                    You have written just what I am thinking! To me this is not a “classic case” of Cushing’s in the fact that most people who look at my horse would not guess that he had Cushing’s. Now if he does have it maybe we can catch it early and start treatment, but if he doesn’t I don’t want to treat him for it!
                                    Ann
                                    ~\"Think today so you will be here to think tomorrow\" Burma Shave~

                                    Comment


                                    • #19
                                      I hate to say it based on secondhand information, but if I were in your shoes I would maybe think about switching vets. Possibly the office got the message confused? You very definitely do not want to test in the fall (the vets that I have worked with in the past for multiple Cushings horses/ponies consider fall results to be basically useless). And I would very definitely not ever start a horse on Prascend or Pergolide without a test, unless I guess MAYBE if it were actively foundering and really looked like classic Cushings, and we didn't want to wait on test results. But you really need to know where the horse is at without meds as a comparison point to know what dosage you need, etc. We just paid I think $89 for ACTH.

                                      I will say that the level of information available about metabolic disorders has skyrocketed in the last 5 years or so, and SO much more is known than it was even a couple of years ago. Unfortunately, it is a ton of (unpaid) work for vets to stay current on the latest findings, and some do a better job of it than others. Metabolic disorders, and also aging horses, are unfortunately both really difficult to manage without the help of a vet who is really dedicated to staying on top of the latest research. So, I wouldn't be quick to toss your vet, especially if it may be office admin confusion, but I would ask a lot of questions and make sure that he/she knows enough about Cushings to spend your money wisely in treating it.

                                      Comment


                                      • #20
                                        Originally posted by Pookah View Post
                                        I hate to say it based on secondhand information, but if I were in your shoes I would maybe think about switching vets. Possibly the office got the message confused? You very definitely do not want to test in the fall (the vets that I have worked with in the past for multiple Cushings horses/ponies consider fall results to be basically useless). And I would very definitely not ever start a horse on Prascend or Pergolide without a test, unless I guess MAYBE if it were actively foundering and really looked like classic Cushings, and we didn't want to wait on test results. But you really need to know where the horse is at without meds as a comparison point to know what dosage you need, etc. We just paid I think $89 for ACTH.

                                        I will say that the level of information available about metabolic disorders has skyrocketed in the last 5 years or so, and SO much more is known than it was even a couple of years ago. Unfortunately, it is a ton of (unpaid) work for vets to stay current on the latest findings, and some do a better job of it than others. Metabolic disorders, and also aging horses, are unfortunately both really difficult to manage without the help of a vet who is really dedicated to staying on top of the latest research. So, I wouldn't be quick to toss your vet, especially if it may be office admin confusion, but I would ask a lot of questions and make sure that he/she knows enough about Cushings to spend your money wisely in treating it.

                                        I agree with you on parts of what you say especially about vets not staying up on current information. I don't mind if they are not completely current what I do care about is if they are willing to read current research if I present it to them. However, you can test in the fall with accuracy. Labs will take into account the seasonal rise and give what the "normal" range is for that time of the year. That is why even if you are currently treating your Cushing horse with medication it is helpful to re-test in the fall to make sure your dosage is right and keeping the ACTH low enough.

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