ACTH level - really really high

Just had vet out to do teeth and had her pull ACTH level in my older (early 20’s) TB gelding. Result over 1,000! His symptoms started this summer - sweating a lot, very itchy and weight gain. He was a little slower to shed out this spring too - but nothing drastic - he has always gotten a thick winter coat. Thinking back now - his coat might have been a bit curly last winter but again not obvious. But other than that he seems normal (knock on wood) chasing his pony companion around the field - full of energy etc. So obviously going to start Prascend this week - other options to help? He is at home on pasture at night - up during the day - I have grass but not a ton - one horse and a pony on right at 2 acres. He gets a handful of TC Senior once a day and 1-1.5 flakes of alfalfa outside at night and 1-2 small flakes of orchard grass hay inside. Also multi vitamin and omega-3 - thought the omega would help the itchy - can remove that easily.

Any and all ideas appreciated!!!

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'Tis the season to find this in our horses! Keep calm and do not get overwhelmed reading all about the condition on the internet. :slight_smile:

The Equine Cushings and Insulin Resistance site (ecirhorse.org) is probably the best place to start learning more about the condition and ways to manage it. Otherwise, some practical suggestions:

Prascend can cause a whole host of side effects that include lethargy and poor appetite. Many horses tolerate it better if they are tapered up onto the dose their vet recommends rather than starting it all at once. Talk to your vet about this- some taper protocols start with just 1/4 of a pill, some with 1/2. “Pergolide veil” can occur even in horses who have tolerated a dose for several months, so don’t be shocked if you start seeing it later on.

I feel like a broken record about this today, but a liquid adaptogen supplement called APF has given many of us good results in combating inappetance. If I were starting a horse on Prascend for the first time, I would just buy a bottle and start the horse on APF at the same time, too. YMMV.

The things he eats in his feed dish look appropriate. TC Senior is suitably low-NSC. Omega-3 fatty acids are associated with improved blood glucose regulation and can be helpful to horses who have Cushings. I have personally had really good results with marine-sourced (rather than plant based ex. flax) omega-3’s which were associated with much lower ACTH numbers in my horse. YMMV a lot on this one. :slight_smile:

You should know that fall and spring are the most challenging times to manage a horse at risk for laminitis because warm days and cool nights increase the sugar content of the grass. Those little short stubs of grass are deceptive- sugars are stored in the bottom few inches of the blade of grass, so it doesn’t matter that it’s a short stalk. Do talk to your vet about this before you change anything- depending on the rest of his clinical picture it may make sense to restrict his grazing, turn him out at a different time, add metformin to help him manage insulin, both, or possibly neither. Muzzles are part of life for many but not all Cushings horses. Not a bad idea to pick one up just in case- GreenGuard and Flexible Filly get good reports. Soaking his hay can be another way to reduce NSCs in his life.

Heading into winter, keep an eye on his temperature- Cushings can interfere with a horse’s ability to thermoregulate, so you may find him needing more blanket or less blanket than he used to.

He’s gonna be okay- it takes some management and trial and error, but it is all very manageable!

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Thank you! I’ve had this guy since he was about 1.5 and I am pretty sure we’ve had every medical issue possible over the years - he’s been happily retired for about 7 years now after a coffin bone fracture. I will certainly get the APF - he has a great appetite - but is very picky about any change to his feed. I will probably at least go ahead and swap to day turnout this weekend - I normally swap to days sometime in mid Oct anyway and we’ve already had mid to upper 30s at night. I will borrow a muzzle to try - the one time I put one on him years ago he had a melt down and almost ran through a fence - and this was after he wore it in his stall several times to get used to it. But he was also 8 at the time so maybe age has helped that!

Thank you so much - there is certainly no shortage of information online and it is a LOT to sort though!

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My TB tested with an initial level of 1253 at ago 20, so don’t worry too much about that. If you’re horse responds to the Prascend as well as mine did, you’ll find he’s back to normal levels withing a few weeks.

LIke Renn_aissance said, start with 1/4 tablet of Prascend and work up in 1/4 increments over the course of a week or two before you get to full dosage. If you start with the full dosage, your horse may experience what’s called “the veil” They become lethargic, go off their food, wet poop, etc. If you work up gradually, you’ll very likely avoid those things.

Soaking hay can help a bit with keeping the sugar content down and with any respiratory issues your horse might have due to the Cushings.

Try not to worry about the diagnosis. That little pink pill is magic.

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Talk to your vet before changing his diet. If he’s not insulin resistant, he may not need anything changed. I actually had to add more grain to my Cushing’s horse shortly after he started treatment because he lost so much weight. Don’t panic!

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Great post with lots of practical info. Getting the diagnosis is scary, so I agree with the “stay calm and carry on” attitude expressed here. You can do this, @luvmymorgan . Just don’t get too overwhelmed. Ease him onto the Prascend and understand that it isn’t an instantaneous fix. Deep breath and one day at a time. :kissing_heart:

Thank you all so much! I am taking a deep breath and not making any changes until I see how Prascend works. Thank you for the advise on starting slowly - I ordered a pill cutter this morning. I will talk to my vet about the IR - knock on wood I’ve not seen any evidence of it - no foot soreness - or anything he has been barefoot for years now. Farrier is coming this week so I will talk to her as well. Thinking with spring shots I just might pull this test on my other two as well - just to have a baseline…

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This is a great post. What marine sourced product did you use, and what differences did you see? Thank you!

@luvmymorgan I’m glad you’re approaching this in a measured way! I think it can be easy to get a Cushings diagnosis and hear “Your horse is going to founder and die!” but this has gotten to be quite a manageable condition. You may feel like his needs are constantly changing- part of that is the aging process, part of that is the disease, and part of that is the way that the hormonal stuff impacts the rest of his body. You get used to it. :slight_smile:

@NaturallyHappy I am using Mad Barn’s W-3 oil. I posted more about it here: Anecdata: supplementing marine source omega-3 fatty acids associated with lower ACTH in my one single Cushings horse who wasn't enrolled in a study
You can see from the thread title that this is not at all an academic study, so I’m hesitant to recommend this as a thing everyone with a Cushings horse should try, but I’ve got a 27-year-old horse who’s been on pergolide for 9 years- he sure isn’t getting better on his own, and the difference in his repeated ACTH tests on flax-based vs. marine-based omega 3’s (with no other deliberate changes in his lifestyle, medications, or anything else that were likely to improve his condition) was pretty remarkable.

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Thank you!

A Boehringer Ingelheim vet recommended dosing on alternate days for very small amounts. For example 1/2 a pill every second day vs 1/4 pill every day. In case you find that easier. The pills are scored to make breaking in half easy. B-I is the manufacturer of Prascend.

Yes, one thing at a time. Don’t fix what isn’t broken (yet). Many Cushings horses can tolerate grass; so if he’s not affected at the moment I wouldn’t assume he is at severe risk. And I would hesitate to change before Prascend because that can affect appetite.

Thank you all. One other question - I got his CBC back - very low platelets, and low WBC but very high RBC, hematocrit and hemoglobin. Obviously have a call in to my vet but can Cushing’s cause these readings? He’s had the low platelets for several years but the other changes are new. Thank you!!!