PPID/Cushings diagnosis

[Fussymare]

Some of you may remember I posted recently about my mare lacking in energy. I decided to have her tested for Cushings as the lab fees are free at the moment, and I have to say I was quite shocked today when the vet rang me to say she does indeed have the early stages.

She told me her levels were about 135 - and went on to say that a "normal" level would be about 40. So I thought 135 sounded high in comparison, but she told me it's pretty low and she wouldn't recommend any sort of treatment at the moment. However she did say that she will now be more prone to laminitis.

I don't know a huge amount about PPID and wondered if anyone on here could share their experiences. Cariad is 22 next January, and in great health apart from this. She was more difficult to keep weight on last winter compared to previous years, but we did have some problem with hay making them scour and then the next batch they wouldn't eat, so I put it down to that. But she is definitely not holding her weight as well as she has previous years. She's also been a bit lethargic, but she often is during the summer months - and this month she has perked up. We have done rides in Rendelsham Forest and King's Forest these past weekends, and she has really been keen to canter and pretty forward generally.

She's currently on one feed a day of grass chaff without any added sugar (Top Chop Grass), Top Spec Senior Balancer and then just micronised linseed and glucosamine added. She has hay a couple of times a day.

Although the vet said she doesn't need any treatment, obviously I want to slow down the onset of further symptoms as much as I can. So anything I can do to make her more comfortable and manage the condition would be great. But I guess like most things it's not easy to predict how things will progress as each horse is so different. I am going on the internet now to do lots of reading but would really like to hear from all of you who have experience. Luckily my friend is doing her PhD at the RVC/AHT (Care About Laminitis study) so has access to some great information as it is part of her study - but in the meantime I really like real life experiences.

[janwilky]

Sorry to disagree with your vet, but 135 against a lab reference level of 40 isn't necessarily insignificant. Also, there's quite a lot of evidence that ACTH levels aren't always an infallible guide to how much a horse is affected by PPID symptoms. Given your mare's lethargy etc, if I was in your shoes I think I'd be asking to put her on a Prascend trial for a month or two and monitoring how she responds. If her symptoms improve then you have your answer, although we're coming towards the end of the seasonal rise now so that might be why she seems to be getting her energy back. Lethargy can, of course, be caused by other factors but given her age and the ACTH result I'd have thought it was worth trying her on Prascend. I know of people whose horses have had negative test results (i.e. well below the lab reference level) but Prascend has literally been a lifesaver for them.

FWIW my mare, Bambi, tested at 32 last November against a lab reference level of 28 - i.e. a borderline result, much lower than your mare's but Bambi was very unwell at the time. She was seriously lethargic and very ribby and had a slight pot belly and sore feet. Despite the borderline ACTH result my vet agreed to a Prascend trial and she went onto half a tablet a day. She got better and came back into work in the spring, and by June she was so well that I decided to give her a break from the Prascend just to see how she was, thinking if she was in the early stages she may only need medicating during the seasonal rise (some owners find this in the early years). To my surprise, she hasn't looked back and hasn't needed any medication at all this autumn and we haven't had the slightest hint of the symptoms she was suffering this time last year: in fact she's fit and positively bouncing with energy. I'm not sure why, it's possible she didn't have PPID at all but just had some kind of virus which got better by itself, or perhaps she had some kind of hormonal imbalance and/or stress response (she was new to me last year) which the Prascend helped with but she didn't need it long term. I don't really know, I can only keep monitoring her, but I've since come across several others who've had similar experiences including a friend who has a 35 year old pony who was on medication for many years but came off it last year and is unexpectedly doing brilliantly.

My other older pony, Coco, tested at 74 last year and he isn't on medication because he's perfectly healthy at the moment. The point is that you need to go on symptoms rather than attaching too much importance to the test results, which don't always seem to relate directly to how badly a horse is affected.

Anyway that's just my experience and probably isn't typical. I don't know if you ever visit the Phoenixhorse forum but it might be worth having a look on there as there are quite a few members who have PPID horses - either on the general board or there's a PPID support sub-forum which is worth a look.

How lucky to be able to ride in Rendlesham Forest

[Fussymare]

Thanks for the reply Janwilky. I said I thought that sounded high, but she said she would consider 600 high. My friend at the AHT will ask her vets there and hopefully I'll get a bit more info.

I really was surprised that she tested positive, as apart from a slight lack of energy this summer I really haven't noticed any other symptoms. She does drink quite a lot compared to her field mate, but she has no loss of weight and looks very well - shiny and well muscled. I only really had the test due to her lethargy, but it wasn't worrying me unduly.

Thanks for all the advice though - will check out that forum. Great to hear about Bambi doing so well. My gut feeling is to carry on as we are at the moment and perhaps put her on Prascend next year if she starts lacking in energy again. Out of interest, how expensive is the treatment?

Rendelsham Forest was lovely - about an hour from us so bit of a trek, but definitely worth it. But we loved King's Forest (part of Thetford Forest) more - lovely straight, long sandy tracks - had some fabulous canters and she was really up for it!

[marychick]

My mare was diagnosed with early stages of cushings at 12. She was lacking energy and drinking a bit more than normal (which actually turned out just to be a dry batch of hay). The vet and I agreed that Pracsend wasn't necessary at that point so we addressed her diet and lifestyle. She is now on timothy chop, forage plus hoof health balancer and a handful of soaked lucern nuts (to bind it all). If she has hay it's soaked for 12 hours. For her the trick is to keep the sugar intake as low as possible and feed good quality calories (if needed) through things like linseed. I also feed her chastberry (vitex equids) which a lot of people swear by for cushings. I'm on the fence about that but it doesn't do any harm.

I found the main thing for her energy and general wellbeing was to build up her fitness and make sure she stays in consistent work. This causes natural dopamine releases and she's now a different horse. That really made all the difference for us!

She's now 15 and hasn't shown any more symptoms (touch wood!). I know she will eventually need to go on Pracend but I won't give it to her until it is necessary. At the moment I can manage her without which is great.

Good luck with your girly!!

[Fussymare]

Thanks Marychick. Great news for your girl!

[specialized]

I would also disagree that a result of 135 is not significant, our vets would consider that to be highly significant. I would agree for a horse of her age a prascend trial would be useful, our one who was less than 50 responded really well to prascend - but only through certain seasons for the first 2 years, this is the first year he has been on it full-time. Our other boy was on a much higher reading from the start and again no symptoms other than 'not quite himself', once again prascend transformed him back to his old self - but this autumn his reading has increased again to over 200 and he has not responded as well to an increase in dose so we have started him on agnus castus which seems to be improving things.

[portiabuzz]

Best of luck with her x

Sent from my SM-G800F using proboards

[taklishim]

I have a PPID horse and agree with Jan and Specalized. There is lots of info on this site. If the test result was 600 I would be beyond panicing!!


www.thelaminitissite.org/ppid.html

[Catrin]

Further deterioration can be prevented with a herbal mix. Before and after blood tests show it has reversed ACTH levels and returned horses to clinical normality, as does homeopathic treatment. Lamined herbal mix can be obtained from jksshop.co.uk/JKs_Shop/metabolic.html More information here jksherbs.co.uk/JKs_Herbs/metabolic.html The homeopathic remedy abstract is here www.ncbi.nlm.nih.gov/pubmed/11212087?dopt=Abstract

[Leanne]

My 25 year old has just been tested for cushings of 71.9 which my vet has said is not really high but high enough for treatment. I've started him on restore and cush aid gold to see if that helps but if he detoriates will put him on pergolide next week.
He's ill at the moment but I don't know if its the cushings. Up until the past few days he's had diarrhea which i thought was maybe the autumn grass, but he's lost a serious amount of weight and isn't eating his hard feed. Now he's passed firm stools with blood in them. He's been blood tested and will be having a dung sample taken.

[cazd]

My companion pony has tested positive for cushings today. She's approx. 26 years old, maybe older. Last years ACTH reading was 45 - so just under the cut-off point against a lab reference of 46. This years reading is 352! I'm gutted. We start the prascend tomorrow and the vet is going to do another blood test in six weeks time. My vet is lovely - but quite a realistic bloke - and has already warned me that laminitis is inevitable at some point and that I may have some difficult decisions to make in the not too distant future. I've had the pony five years and she arrived in a near feral and dangerous state after being abandoned by someone. Its taken me those five years to gain her trust - and now this!

[Fussymare]

Thanks for all the info. I'm seriously confused about what to do. She's not unwell. She looks really good at the moment - shiny coat, good weight, and working nicely in her lessons. Happy in herself. My gut feeling is just to carry on as we are for the moment. That's what we would have done if we hadn't had the test done I guess?

Second opinion from another vet at AHT felt her result was not insignificant. They have suggested getting her retested Nov/Dec to see if levels drop after the "autumn peak" and also get her insulin tested. I've owned her for 7 years, but when I bought her she'd done very little for a couple of years and was very overweight. She also used to be fed doughnuts by her previous owner!

I think I am going to have her retested but can't decide whether it is worth getting her insulin tested also? Have others on here done this?

I'll look in to those supplements. I don't think I will start her on Prascend now she's picked up, but it is something to consider if she gets lethargic again.

[janwilky]

You know your horse best.... but if she's looking well and has plenty of energy now, at the end of the seasonal rise, then I'd probably not be in a hurry to put her on Prascend but perhaps go with the option of re-testing in a few weeks to see if her levels have dropped. I intended to do that with Bambi but to be honest, she's been so well all of this year that I couldn't see the point in re-testing: would it help me to know what her ACTH levels are or would it just confuse me? Looking at the horse in front of me, who can't wait to overtake all her friends out on a fast hack, tells me all I need to know. Of course if that changes at any point then I know what to check first and can have her re-tested and on Prascend in a jiffy if needs be.

Re the insulin testing, I think a lot of people opt for treating the horse "as if" it's insulin resistant rather than going for the testing, as the treatment is dietary management anyway. It's quite likely, given her history (doughnuts, for goodness sake!!!) but it sounds like you're giving her the best possible chance of staying healthy by keeping her active and fit and not overweight. She's a lucky girl

[portiabuzz]

Well said jan x

Sent from my SM-G800F using proboards

[Fussymare]

Thanks Jan. She's definitely picked up. She is striding out on hacks, without me using any leg, and my friend's Haffy had to trot a few times today to catch up! She's not bouncy and silly, but definitely heaps better than during the summer.

My gut feeling is not to put her on Prascend, but perhaps get her re-tested when her levels would be at their lowest. But friends keep recommending that I either have her re-tested or ask vet to put her on Prascend because it's a progressive disease. I'm wondering if they are seeing things that I can't, or whether they are just speaking from personal experience,.

Re diet, I've spoken to Top Spec who recommend staying on existing feeds - with option of moving to Top Chop Lite and a lite balancer if she puts on too much weight. Her weight is perfect now, but I wouldn't want her losing much more going in to winter. I haven't worried too much about the hay she is on - it's meadow hay, but I'm not soaking it. (I know - couldn't believe it when she told me she loves doughnuts! She certainly has never had one in the past 7 years!!) Do I need to worry about cutting out apples and carrots, as she always has one or the other in her daily feed?

I asked about a herbal supplement on another forum, (was considering putting her on Cushy-VX) but someone mentioned that it can be counter productive by decreasing dopamine levels. Still feeling quite confused by all the conflicting advice on the internet - lots of people out there seem to have good results with Agnus Castus.