It’s not 100% though, because my Old Man has been tested 3x for cushings and it’s negative. Get the test to be sure, though!
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In the case of the pony at my stable he was negative for Cushings but he sure has full-blown Equine Metabolic Syndrome. Great idea to insist on testing.
Another sign in the pony here is that he has developed a copious amount of smegma with his condition. Something to watch for with a swollen sheath.
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My senior regularly had some degree of edema in his sheath for much of his life. Grape sized swelling on each side of the opening was normal, and they could get up to plum sized. He has PSSM, and I did see more sheath edema around the days it was causing trouble. It reduced as the excess glycogen was used up, but there’s no definite determining that it was the reduction in glycogen or the exercise that shifted the edema. He also has PPID, diagnosed very early and kept well controlled with Prascend. There was no change in degree or frequency of sheath edema that I noticed after he started Prascend.
Interesting to note is that I have seen virtually no sheath edema in the past couple of years. The exceptions being when the PSSM was an issue again. This matches up with the timing of my use of the Bemer on him.
I did exactly that – emailed the pics. 
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My friends gelding has a very swollen sheath. Not sure if it’s related but the mares love him and he comes to my farm whenever I need to tease the mares. They will ignore other geldings but swoon over him. 
She told me it was from a botched gelding. Not sure she really knows what caused it?
This happened to our elderly QH gelding. His bloodwork was borderline Cushings, he had that classic Cushings coat, cresty neck/fat deposits. We got his Cushings managed and all was good, but the puffy sheath with the tiny “nipples” remained until he died (several years after dx).
UPDATE – after vet visit today:
We’re going with Lyme as a co-infection that didn’t resolve after successfull treatment for anaplasmosis. Pulled blood + starting back on antibiotics Cushings seems very unlikely at this point as horse’s ATCH levels were normal in the spring, but will re-test this coming spring and yearly thereafter.
Reason we settled on Lyme is because his sheath edema (likey lymph node issues) occured so soon after stopping treatment for anaplasmosis + he has some behavior issues that aren’t part of his normal personality.
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Interesting about the lymph node issue. My gelding that I referenced had some other very strange issues including a swollen infected lymph node under his chin. It would drain and sometimes refill but never completely went away. We did 30 days doxycycline and aspiration. It was cultured and was not strangles but some other bacteria (started with an a) that I can’t recall. He also had some funky skin issues with odd areas of rubbing and irritation. He would get a course of dexamethasone for the skin stuff and it always cleared up.
I was never able to get a good answer as to why he had such odd issues. As I said I had planned to do the thyroid stimulating hormone test in spring but he ended up being PTS due to some nasty coffin bone issues instead.
I am pretty sure he had Cushings though.
What symptoms did he have that made the vet think he had anaplasmosis?
Just now seeing this thread and don’t have time to read all responses, expect others will have touched on this.
Our teenage Cushings gelding, when he needed more Prascend, one sign was his sheath would swell.
We upped his Prascend and in a few days it was back to normal.
Also know of another horse a friend had with same problem.
All the usual symptoms: high fever, not eating, lethargy + unusually warm fall temperatures = ticks were out in force.
Others did mention Cushings – so I talked to my vet about it. We ruled it out as horse had normal ACTH this spring and shows no other signs, but he is overweight.
We’re waiting for Lyme test to come back. But in the interim she ultrasounded the lump in his scrotum area – nothing definitive; nothing she’s ever seen before. She she said it looks like stringy, spongy fat.
Anyway, were putting him on Thyro-L for a bit to see if things ‘down there’ go back to normal.
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Just cause it’s normal in the spring doesn’t mean he isn’t impacted by the fall/winter rise.
Hopefully Thyro-l helps trim the weight off.
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FYI…my gelding had a normal ACTH test…but his stim test came back exceptionally high. My vet said they are seeing more and more cases where the baseline test is normal but the stim is crazy high.
My gelding was very obese at the time, and had the swollen sheath and exercise intolerance. Coat was normal.
After the stim we start prascend, his weight came back to normal, exercise tolerance improved. Eventually we cut his prascend dose in half and he’s been doing fantastic.
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UPDATE: Lyme tests came back negative. Putting him on Thyro-L was a good move. Hopefully his weight will decrease though more exercise is looking grim due to horrible NY weather. Thankfully his pasture buddies (two very active OTTB’s) keep him moving.
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