Yeah we were doing that but it wasn’t enough
So wanted to update a bit. Got back tests today (still waiting for PSSM1 though) and he’s borderline insulin resistant, but the kicker is his ACTH came in over 500. It’s high enough (and was normal last year) that we’re going to retest. But if it is indeed that want to thank @Critter because you pushed me to have the vet test again!
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Oh man this is so interesting. My old lady mare started Prascend last year, and was at a full tab. I never saw a pergolide veil. Then this spring she just looked like hell–wasn’t shedding (wasn’t ever an issue before!), lacked muscle, and I just couldn’t get weight on her. Nothing looked amiss on bloodwork.
Finally, after trying everything else, I cut her back to a half tab. And damned if she didn’t immediately start shedding, gaining weight, and gaining muscle. I could see changes in her daily, it was wild.
I think your story is the first I’ve heard of another horse needing to cut back!
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Bartonella? Since you know there have been tick exposures. An outlier but when you can’t make a diagnosis, you have to think about uncommon presentations of common diseases. The following comes from this article: https://www.equineshivers.com/bartonellosis.html.
Horses display subtle symptoms early in the course of infection, for example, muscle cramps, sore ribs, chronic fatigue, fibromyalgia, ‘stiff legs’, urinary discomfort (standing parked out), respiratory problems, hypersensitivity to anything that touches the skin, sore soles, patchy sweating, ulcers, heart valve insufficiencies (heart murmurs), and eye problems (conjunctivitis, uveitis, dry eyes and/or distorted vision).
Glad you tested again and maybe have some answers! I rode my guy for the first time in 2 months (as we had some anhidrosis this summer and I didn’t want to stress him) and he felt awesome! I was keeping him doing very light work since he’s been on vacation…he was so ready to go and wanted to do more.
@Simkie yes, my guy never had the veil in the beginning…but this this spring was really odd. He’s still on the 1/4 tab (lower) dose and feels and looks amazing. I am watching him close since this is the seasonal rise time and I am not sure if I might have to bump him up for a few weeks, but so far he seems to be good on that lower dose.
So I did bump my mare back up to a full tab for…I think ten days?..at the “seasonal rise” point, and all that happened in her hay consumption dropped by about half. So I took her back down, and she’s been a okay there.
But I totally had that same concern!
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I’d be curious to see what his heart rate and respiratory rate / recovery is in work. Your trainer is riding him daily on top of you riding? Does this persist if he’s not ridden twice a day?
He sounds like he’s on economy mode. Two rides a day in theory isn’t objectively bad for a horse - in some ways it can be very positive - but if he’s struggling, I’d wonder if there’s something else at play. Not wanting to move forward could be anything from suspensory to footsore to heart issues. In your position I might dial back the work and revisit.
He gets 2 rides a day 1-2 times a week. And when I’m the second ride, their rides are typically a walk around the field not true training rides. OR if they did a true training ride, my rides are a walk around the field. I’m riding after 9-10 hours at a desk during the week, you are not getting my best!
However, it does look like he’s got PPID, which basically explains everything, if a bit annoying for a 10yo to have it.
Did you already retest? It is not uncommon for some readings (including ACTH) to be higher in the fall, it is why many vets prefer to test around this time for a good marker.
It would be annoying for a 10 y/o to have it. The more experience I have with the disease the more varied the symptoms seem. For my own guy, the earliest symptom he had was he went from being barefoot his whole life, to suddenly needing shoes. Then about 6 months later, went from air fern to needing a lot of roughage. He never had any form of exercise intolerance, but he did lose his topline over the winter. There’s been some other competing issues too – he lost all his molars, went off his food many times as we worked on dosage, etc. Good luck. He’s 29, I think he was diagnosed at 22.
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We’re just about in the middle of the month of the peak of the seasonal rise, so all horses test higher this time of year, relative to their own normals. But there are reference ranges for each week or the year to take into account what’s normal for that week. The lower level PPID horses often test above the normal range during the seasonal rise, where they might test as normal at other times of the year, which is what makes this the ideal time for the ACTH test
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No the retest just got pulled this morning. But with a level at 545 I would imagine even if the other comes back lower it’s probably not gonna come back below 90. It’s more a how aggressively do we need to treat it. Unless there was some real mix up at the lab and it’s a different horse!
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ANOTHER update. Secondary results came back at 86. Sooo not sure where we go from here. 86 is in the high equivocal range and that plus his symptoms makes me think we are indeed in the early stages. Vet is coming out on Tuesday and going to discuss in more depth.
On the plus side if we keep work at/under 20 min. He’s great. But certainly doesn’t do a lot for his fitness.
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For comparison…my guy was tested mid-September 2 years ago.
His baseline ACTH was 41 pg/ml (which was equivocal for that time of year).
The ACTH after the Stim part of the test was 239 pg/ml (during Sept, <100 PPID unlikely).
Yes, there is a chance of false positives…but given the whole picture my vet was very comfortable going ahead and treating him. And I can honestly say he looks so much better now than he did 2 years ago.
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yeah I think I’ll feel better after the stim test.
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I skipped straight to posting, so apologies if I missed anything apart from the PPID discussion, but this is very much like how my horse’s asthma presented at first. Start off great, then just hit a wall after 15-20 mins. Only when we had some serious wildfire smoke in the area would he maybe cough once or twice on warmup. Which is not normal for him. He also stopped sweating. It took doing a BAL to figure out the diagnosis and type of asthma. Getting that under control and doing some acupuncture, and he sweats great now. It was the first summer after I bought him and he had a huge change in climate from where he came from. My vet also said that asthma and sweating issues are not causative as far as we know, but they often occur together.
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I think the no coughing is what stopped me from going down that route, but if the PPID doesn’t get us there, I’ll do this next. Actually how do you test for asthma in horses?
He showed symptoms for a long time before he ever coughed, and then it would only be 1-2 coughs in the warmup, occasionally. Which is normal for some horses. Not him apparently!
We did a static airway scope and dynamic scope first, which did not show any abnormalities. A BAL was the main diagnostic tool (Bronchoalveolar lavage). A scope is put down the airway, and the lungs are lavaged with saline. Then the saline is sucked back up and taken to the lab. The lab looks for mucous, blood cells, immune cells, other particulate material, etc. in the sample. You need a fairly big sample to be able to judge the amounts/ratios of cells. From there, you can determine if it’s “mild equine asthma” (“severe” asthma is heaves), and what the potential triggers are. My horse is mast cell type, which indicates it is largely allergy triggered. He does have some significant environmental allergies.
The BAL procedure is not the most pleasant to watch, but they do handle it well, and it’s really the best way to do the diagnosis. My horse was scoped without a camera, on the farm. My friend’s horse we took to the hospital, and they did the BAL also with a camera scope. Which was fascinating because he had all kinds of junk floating around in there (not normal). Allergies were a factor for him, but he had a different type of dominant cell, and so he sometimes has to be managed with steroids and such, which I’ve been able to avoid. I am doing allergy shots (while friend is not) because my horse also had horrible skin allergies develop as well.
we do have significant skin allergies, we had to take him off straw bedding and put him on zyrtec.
Update: We started Prascend today. I will come back (for future people) to update on any symptom remediation and/or how it all goes!
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