Cushings/laminitis advice

[MeanderCreek]

I’ve done a search, but many of the old links have expired so if you all could help out again it would be appreciated - I have no experience with Cushings.

My little sister’s old pony who is in his late twenties is retiring to my farm. He has Cushings and is a chronic laminitic. He’s pretty crippled, but still bright and carrying good body condition. He’s currently on Pergolide with Bute and/or Banamine as needed which of course I’ll continue. He’s currently barefoot so I think we can help him out there.

What else can I do for him though? My vets said that’s it, but my farrier is checking into a special diet that another customer swears by for her Cushings pony - something developed by some vets in CA I think.

This is a very dear old pony who I would like to keep as comfortable and happy as possible for as long as we can so any advice or information you could share would be greatly appreciated.

www.meandercreekstable.com

[Cherry]

A lot of what sbt78lw mentioned can be directly linked to a hormonal imbalance (long hair coat, excessive sweating, cold intolerance, laminitis); the rest to a weakened immune system (ulcerations and abscesses)… That’s why it’s so crucial to do everything you can to support the animal’s system…

My pony used to have problems with allergies too, which threw him into respiratory distress… When one of the vets did a sonogram he discovered my pony had fluid around his lungs–treatment with Lasix (and later, Naquasone bolus) and Azium helped him greatly and eventually the pony was placed on Thyrol-L… It was about five years before we finally figured out he had Cushing’s… He only lived a couple years after that…

Muscle wasting is also a big problem with Cushing’s; adding chromium piccolinate to the pony’s diet can help with transference of sugar across the cell membrane, but you’ll have to go to the Equine Cushing’s board to get a dosage on that…

“Everything looks good until you start to examine it!!!”, uttered by me on more than one occasion

[lilblackhorse]

cherry, thanks for fixing my link-hmmm, I’d have sworn that it used to be the whole name, not just dropin bucket…weird.

Anyway, that makes sense about the name-thank god, one of the few things I’ve not had to learn a ton about (aimee knocks on wood, because we’ve had to learn about way too many other maladies over the last 3 years!)

Elippses Users Clique…Co-Founder Occularly Challenged Equine Support Group, "I hate stall rest"and now the “Better riding through Chemistry Clique”

“What the fuh?” Robby Johnson

[SBT]

Hi cbv, I highly recommend getting insulin and T4 (thyroid) levels on your mare. These are fairly good indicators as to how the horse is doing hormonally, and the insulin level is often used to diagnose Cushings. I suggest the T4 because your mare’s symptoms, especially the cresty neck, are indicative of hypothyroidism (low thyroid) If nothing else, these tests will give you a baseline to work from. In other words, if you test her again in a few months, you’ll know whether she’s getting better or worse, and whether you need to adjust her meds. Even if her levels aren’t far off, starting her on a low dose of pergolide or cyproheptadine NOW, rather than later, will certainly help keep things from getting any worse.

Without these tests you’ll be working in the dark, just guessing what your horse needs. To run an insulin level can cost about $70. The T4 will add about $25. But honestly, once all is said and done, you’ll feel better knowing what you’re dealing with. Thyroid powder is VERY inexpensive ($25/month), and cyproheptadine is $40/mo. Pergolide is much more costly, at about $200/mo., but it all depends on what dosage your horse needs AND on your supplier. My darling pharmacist, a horse lover, gave me the Pergolide almost at cost.

But like I said, you just never know until you run the tests.

Good luck!

Heart in a horse is every bit as important as it is in a person. ~Jimmy Cruise

[slb]

It realy depends on what drugs you use and how much you have to give. If you are giving perolide or hormonize (evitex) then, I would say that the cost is around $.75-1.50/day. Hormonize is rather expensive for the first 6 months because you have to feed higher doses. It comes up to around $1.50-2.00/day. If you have to give thyroid meds, they are relatively cheap…maybe $.20/day. Not sure because I haven’t “shopped around” for prices in a while. If you need to feed chromium for insulin resistance that’s around $.50-1.00 per day.

Proud member of the * Hoof Fetish Clique *

[Xena]

Wow Slb - that’s a wealth of information - thank you. I’m actually waiting on the test results to post to the yahoo groups. It’s a lot to absorb - will let you know what happens! Thanks again.

[SBT]

xena, I think a horse would have to be on a pretty high dose of pergolide to make them go bonkers. I’ve known several horses that were on low doses, and NONE of them ever exhibited any aggressive behavior. Regained some pep, yes…but nothing abnormal or dangerous.

Remember that this is your horse, and you have control of her situation. If pergolide had a negative effect on her, you could simply take her off it (slowly) or try a different medication.

However, you need test results to work with before you make any decisions regarding medication or diet. Get the tests done and see what you have. Then work with your vet to determine the best course of action for YOUR horse. Pergolide might not ever come into the picture at all. So don’t guess, and don’t jump to conclusions; get the tests done!

Heart in a horse is every bit as important as it is in a person. ~Jimmy Cruise

[Xena]

I don’t know very much about Cushings, but have a 21 year old mare that we are contemplating getting tested. She has a very long coat and the last two years, has had a difficult time shedding it. I do have her on thyroid medication and her levels seem to be fine. I just leased her out to someone who is keeping her at my barn. I have noticed that since she’s been in stall board (previously I field boarded her) that on cool nights I do sometimes find her sweating in strange places. I haven’t clipped her yet because it is getting colder and I don’t think the girl leasing her will be riding her much so I wanted her to have as much of her natural coat as possible. Last year, I clipped her and she lost a bunch of weight, but there could have been other factors involved as well (we were in a new barn and she was the low horse on the pecking order for round bales)

Any info on the cost of drugs? Treatment? What to expect next?

She’s in a stall and is only getting 4 lbs. of feed daily - 2 pellets and 2 sweet. Her turnout has some grass but is fairly eaten down…at night she gets hay. What are feeding considerations at this point if all else looks good?

[Xena]

Cherry - The reason I haven’t had her tested yet is twofold - one I kinda don’t want to know because I’m so attached and two I’ve heard how expensive the cushings medication is although now I’ve heard that the prices are not as bad as previously. I have thought long and hard about the medications and don’t feel that I can afford the expense. She’s had a great life and I think if her situation got bad enough that I’d be making some difficult decisions. At the moment though, she is doing well other than a very thick coat and a few other minor symptoms. Those types of decisions are tough - how can you equate years of faithfulness on her part to money in her old age?? That’s the main reason I’ve been avoiding the “knowing”. Thanks for the info though!

[Coreene]

I got Pergolide suspension from my vet, $105 a bottle, and the bottle lasted about 2 1/2 months.

Having gone through this with Willem, and as we learn more and more about horses with Cushings and the diesease itself, I said when I got Oliver that I will test each of my horses annual for Cushings when they reach 15. I know that is on the early side, but I want an early baseline established as well.

Chronic founder and laminitis would be my worst nightmare. Our friend’s Walker rotated about 12 degrees in both fronts two years ago, but came through it. He foundered again in early March, and since then it has been the administration of meds etc every 12 hrs. It has gone up and down, time and again. A few weeks ago he was allowed to be ridden again, for five minutes at the walk. That was great - I cried of course, it was what I had so wanted for Willem - and now, for no reason but that it is chronic, it has turned again. The horse does not have Cushings. My heart breaks time and again for them, as I know what this rollercoaster feels like.

[SBT]

<BLOCKQUOTE class=“ip-ubbcode-quote”><font size="-1">quote:</font><HR>Originally posted by slb:
I personally am opposed to using pergolide to lower insulin levels. While it is sometimes successful, I feel that it is a heavy duty drug that can cause as many unbenefical side effects as it does good. Therefore, I prefer to first treat IR by lowing carbs as much as possible and mineral balancing. If this doesn’t work, or the horse is unstable with this treatment…check for insulin/glucose at least once/season as it may fluctuate with seasonal metabolic changes…then I add 5mg of chromium and retest in 4 weeks. From my experience, this is not always something that can be rushed…full stabilization may take up to 2-3 years to accomplish. However, if the horse is not showing any signs of improvement, then I would look into meds.

<HR></BLOCKQUOTE>

I’m rather surprised by your opinion of pergolide, since I’ve never seen nor heard of it causing any negative side effects whatsoever. Granted, it IS a human anti-Parkinsonian/CNS drug (dopamine agonist) that certainly must effect a horse’s neurochemistry, but I’ve never seen anything negative come out of its use; in fact, all the horses I’ve known that are treated with pergolide are markedly BETTER within weeks. No major side-effects.

As with nearly all CNS drugs, the action of pergolide is unknown. There are guesses (based on observation of patients, I would think) as to where and how it works in the brain, but those are, of course, just suppositions. We aren’t entirely sure why it works, we just know that it WORKS. For people (or, in this case, horses) suffering from terrible diseases, the end result is all that matters.

As I have said before, I wish I had known about Mg. supplementation and diet management when my mare was diagnosed with Cushing’s, but that information was not available to me. Additionally, my mare turned out to have one of the most aggressive cases my vet had ever seen. Literally, she went from normal to death’s door in 3 months. She lived only 2 years post-diagnosis. I would not have had the time for the mineral balancing and other treatments you recommend. FWIW, I did initially try an all-natrual supplement (I forget now what was in it) suggested by my vet, and it didn’t help. Tried the cyproheptadine (antihistamine), which SHOULD have helped…and it didn’t. I was quite literally left with NOTHING but pergolide. Were it not for pergolide, my mare would have been euthanized 3-4 months post-diagnosis.

All I’m saying is don’t knock pergolide because you don’t like it, or because you think your way is better. Your way MAY be better, but your way would not have allowed MY horse to live those 2 years. What works for one often doesn’t work for another. Right now, pergolide is the gold standard for treating Cushingoid horses. As we learn more about the disease, that might change; but at the moment it’s the best we have; and for my horse, it was the ONLY thing that could help her. It didn’t matter what I thought; if my vet had said LSD would have made her comfortable and allowed her to stay with me a bit longer, I would have hauled @$$ to the city and bought some. I did not have the luxury of sitting back and choosing a balanced mineral, low starch, seaweed/Mg supplemented diet, nor did I have years in which to experiment and perfect this diet. My horse was dying before my eyes, and had I read the above quote at that time, I believe I would have smashed my computer monitor with a baseball bat. I would never recommend that someone NOT use pergolide based solely on its possible side effects.

I’m not trying to flame you slb(honestly! ), you just hit a nerve. I’m also a bit disheartened that you would share this low opinion of the very drug that has allowed so many horses to live out their last years in comfort, and instead promote a diet therapy that is, compared to pergolide therapy, relatively new and unproven. Bottom line, as far as I’m concerned, is that you can’t rule out a therapy KNOWN for its effectiveness based solely on personal bias. To do so would be unfair to the horse. Sometimes, you just have to do what works even if you don’t like it.

I hope the original poster will not be discouraged from pursuing pergolide therapy if that’s what his/her horse needs.

Heart in a horse is every bit as important as it is in a person. ~Jimmy Cruise

[MeanderCreek]

Many, many thanks for all the information and links you all have provided. It has been a tremendous help!

Bobby - the pony came home Saturday and settled in well. We do test hay since we raise young horses, so I was able to immediately put him on an appropiate diet. He’s not exactly thrilled with the beet pulp - especially with his supplements in it so I have been syringing them into him until I can convince him to eat the dreaded beet pulp better. He’s eating his hay well though so that’s good.

Here’s a question I haven’t found the answer to anywhere yet though - is it okay to keep him under lights? SBT mentioned it, but I didn’t catch whether it was positive or negative. I have him in the bank barn now because its the warmest and I think he’ll be the most comfortable there. That whole barn is lights on 16 hours/day though. I’m thinking it should be okay but does anyone know for sure?

www.meandercreekstable.com

[This message was edited by MeanderCreek on Dec. 04, 2003 at 09:25 PM.]

[slb]

Ditto Sbt…
From my experience aggressive behavior is rare and probably has more to do with advanced tumor growth rather than medication. The worst case that I have heard of is a mare that was not responding well to Pergolide, so was weaned off to Hormonize and responded very well. She did very well for a number of years and then suddenly became agressive to other horses, then finally to people. Although it was rapid in a sense, there was a noticable progression. At that point they euthanized her as she was apparently becoming very advanced and things were deteriorating rapidly. She most likely was in pain or perhaps the meds no longer kept her hormones in balance.

Proud member of the * Hoof Fetish Clique *

[sweetnlo]

Get her off the sweet feed and have her checked by a vet and farrier who are experienced with Cushings and laminitis. I never had my pony tested because the outward symptoms were enough to convince the vet the test was not worth the risk, in those days the drug they administered to do the test could trigger laminitis. Again, diet is the most important factor in avoiding “Cushings Crisis” you want low protien and low sugar fed in small portions frequently. You should have frog supports and bute ready in case of a crisis. Another tip, if farrier suggests cold hosing to reduce any heat in the foot or soaking for thrush/abcesses, ask for a drier alternative like ice packs or a “sugar-dine” wrap, wetting the foot makes it even easier for thrush/abcesses to take hold.

[sweetnlo]

Xena, test or no test you will know and be able to make some less expensive changes than the meds ie diet, hoof maintenance, etc. From what I was told the meds had a 50 50 chance of being effective and once a “crisis” comes you still need to treat the symptoms with other meds. I was also told that once they show the outward symptoms of Cushings(coat, ‘polyurea’ excessive peeing) the ball is rolling and the meds are not powerful enought to stop it, just slow it, hopefully. So don’t feel as if you are hurting her to help your bank account, I put a little more faith in the “gut” instinct than a lab, they may be able to tell you what is wrong, but not when it is going to go wrong.

[Xena]

Thanks for all of the great info! I am planning on getting my mare tested. And I just found out that a friend of mine who does compounding at a pharmacy may be able to get me meds! Hopefully at cost. That would be great as I could use the break in costs…

[slb]

SBT…I hear ya and don’t feel that you are flaming me. You make a valid point and share your opinion as I did. While I caution that Pergolide should not be used to treat IR, I never indicated that it should be ignored for Cushings. IMO, drug teatment in Cushings cases should be left up to the vet and owner. My point is that it is the “big guns” and should be saved for such. In your horse’s case, there was nothing else you could have done. The fact that vitex (Homonize) can take up to 3+ months before improvements are noted (but generally doesn’t) would also have put you out of today’s options. The same is true of mineral balancing…although I noted that “full stabilization” may take a couple of years, in all cases where mineral balancing is applied, improvements in the horse’s condition are noted within 3 weeks. Additionally, those that take more than a few weeks to stabilize are generally recognized as severe cases. The thing that I warn against is that if you start Pergolid when you suspect IR, what do you give when there is full blown Cushings…will it still be effective? Pergolide is not IMO the “golden drug”, it doesn’t work on all horses, in some it simply presents its side effects and does nothing to help the horse. In others, it works for a while, but eventually fails despide increased doses. There are far better ways to deal with IR and other symptoms present in metabolic disorders. Humans with IR are not given Pergolide for treatment, yet it is IMO wrongly recommended for horses only diagnosed with IR. This is mostly because of a study done by a farrier that was told that chromium didn’t work, so it was not even compared and because IR is now consider part of the “Pre-Cushings” symptoms, vets often recommend or owners insist that Pergolide must be the answer. They (IR and Cushings) have been proven to be mutually exclusive and therefore, should be treated seperately. Since this study (2 years ago) treatment with chromium has been compared on the EquineCushings list and in my own barn. I successfully dropped insulin levels in a month with chromium. There are many horses with metabolic disorders of all sorts that have been helped over the last 4 years with mineral balancing and/or simply providing low carb diets. My farrier husband and my vet have worked together on approx. 50+ cases in the last 3 years and found that the vast majority of horses with metabolic disorders can be prevented from chronic foundering and their health and lives restored to “normal” (including riding) by simply restricting carb intake and supplementing with magnesium. My vet said that she no longer recommends Pergolide or thyroid meds until the dietary options have been tried. She only recommends Perolide in the case of diagnosed Cushings. Likewise, I am not recommending dietary “treatment” instead of for Cusings horses, but in addition to. I would only recommend that it be tried instead of on other metabolic disorders before going to drug treatment. Since the results will be noted within a month, what is the harm and it is far less costly to try than drug therapy which often fails also.

FWIW: The following side effects are from a drug handout sheet that provides information for horse owners using Perolide:

“Neurological (including movement disorders, hallucinations, sleepiness) are most common, then GI. We’ve had several reports of horses that had decreased appetite, possibly related to GI side effects. There are isolated reports of horses with seizures strongly suspected to be linked to pergolide (i.e. stopped when the drug was stopped). Whether these were really seizures versus hallucinations, movement disorderss, can’t really tell. May also see some problems with edema in horses, like stocking up.”

Given that the vast majority of Cushings horses are not similar to your horse’s case, I would carefully consider when it might be time to turn to Pergolid. As a society, we seem to think that we need to have instant gradification when we address a medical need. Most of these cases are not immediately life threatening. Most metabolic disorders exhibit far enough in advance to allow the owner the time to consider possible approaches and treatments. My suggestion/opinion is to treat the “whole” horse, not treat the smyptoms one at at a time…because eventually the owner will be treating many symptoms if the whole system is not addressed.

The “treatment” of dietary restrictions and mineral balancing are not just to address Cushings and I never recommend them as “the only approch”. What I do suggest is that you can give any meds that you prefer as needed and recommended by your vet, but that if you do not mineral balance or at the very least do the dietary restrictions, in the majority of cases, horses with metabolic disorders will not successful recover. While there is no “recovering” from Cushings, there is from all the other things that are attached to it. This, IMO, gives horses a “fighting chance” against the Cushings.

You’re right though, I do feel that this approach is better than others…I have personally seen far too many horses recover fully from long time health issues and chronic founder and read hundreds of testaments simliar in nature. My vet is also a firm believer since she is now able to successfully restore health to many horses that she previous couldn’t. She now believes that the majority of laminitis is the result of “treatable” metabolic disorders. So far, to the best of my knowledge, this approach has not failed to at least improve every horse’s condition…Cushings or not. This is the future and even in treatment of many human conditions is becoming less controversial and more accepted as it becomes apparent that you can treat with all the drugs you want, but if the immune system remains compomized or IR is not controlled, or other hormonal imbalances and system issues are not addressed, the body will have a difficult time healthing itself. The bottom line is, drugs help us, but our bodies must also participate in the healing. If the system is too weak or otherwise compromised, it simply cannot do that.

Just my opinionated 2 cents on the subject…

Proud member of the * Hoof Fetish Clique *

[slb]

I don’t think it will do any harm, but some have found that lights help with shedding and seasonal metabolic issues, others found that no lights help. So, it really depends on the horse. I found with my IR and other metabolic, but non-Cushings horse that lights didn’t help, but didn’t hinder either.

Proud member of the * Hoof Fetish Clique *

[Xena]

Yes…I’d have to say I’m jumping the gun a little. I am anxiously awaiting the test results which should be here any day. I had her tested last Wed/Thurs so hopefully I’ll hear something tomorrow.

Thanks for the info and I’ll update you on things when I hear.

[slb]

How was this pony diagnosed? Because he is old, I would suspect Cushings, however, it has been my expereince that if the Cushings tests are questionable, yet the pony exhibits Cushing-like symptons that it could be a magnesium deficency. We have had success with a couple of ponies that exhibited Cushings symptoms - one was younger (10) and one was older. The one had been diagnosed by sight at age 5, the other was tested, but test was not showing Cushings. Both responded well to additional magnesium and within 2 years both were “normal” with no more signs of chronic laminitis. So, my first suggestion would be to get a hay test done to see if you are magnesium deficient.

Some very good info here about diet and treatment…I only skimmed, so I may be repearing some stuff. The biggest problem with Cushings horses is that they generally suffer several other symptoms…insulin resistance, carb intolerance, compormised immune system. I would suggest that it is imperative that you get the pony checked for insulin/glucose blood levels. If insulin resistance is suspected, then the diet needs to be highly regulated. Generally an all forage diet is recommended. Some can tolerate commercial feeds that are beet pulp based such as Triple Crown Lite. However, not all cases can have even this. The best avenue is to feed a low quality grass hay (you will want to make sure the carb levels of the hay are under 20%), a good vit/min mix or a mix specially prepared to match your hay test, a source of protein (needed for healing tissues), and something to boost the immune system.

I feed my IR horses and Cushings horse a mix of beet pulp, alfalfa/mix cubes, blackoil sunflower seeds, flax meal, and a source of kelp. This is no more than 20% in weight of their total diet. Beet plup is generally safe as it has the lowest glycemic response (1). The sunflower seeds provide natural essential oils for good coat, feet and other tissue support. They also supply protien and essential min/vit. The flax provides essential omega 3 fatty acids plus support immune system…reduces things like rain rot, abscessing, urinary tract infections that are common in Cushings horses. The alfalfa cubes supple added protein and are good for keeping teeth in shape. Kelp (Source or plain kelp) provideds added essential micro-nutrients and supports thyroid function with iodine (lacking in most diets) plus provides support for the immune system. Feeding a probiotic will also help in adjusting gut pH and with digestion.

Ideally you will get best results with this pony if you have your hay tested and provide a complete balanced diet of minerals that commplement the hay. Here are the ratios that you are aiming for:

Ca:P - 2:1
Ca:Mg - 2:1
Zn:Mn:Cu - 3:3:1
Fe:Cu - 4:1

By following this method of balancing ratios as opposed to providing RDAs, you can compensate for excesses so that the mineral work synergystically and excesses are expelled rather than the body replacing one with an other.

If the pony is insulin resistant, then you may need to add chromium to bring its insulin levels down. However, many times a very low carb diet will do the same thing. Jus monitor and add chromium if you need to. However, if they need it, it is not something used as a “treatment”, it is a mineral deficency that needs to be addressed long term. Additionally, if you find that your hay is too high in carbs, you may need to soak it to help remove the sugars. We try to get year old hay to save soaking.

You can use any variation of diet that you want…as long as you keep the carb content very low. You can just offer a hay only diet with a little beet pulp to mix your supplements in. But, you must not forget protein support. You can also replace the kelp with iodized salt, but I feel that kelp provides much more than just adding the salt.

You will also find from reading Safergrass.org (I saw a link abve) that grazing may not be allowed…depending on each individual’s tolerance.

As far as the feet go…
If the pony is already barefoot, then I would recommend that he stay that way. You simply need a good farrier that knows how to address the rotation (to derotate) and keep the feet correctly balanced and aligned. This goes a long way in strengthening the internal structures and preventing further rotations. In truth, the shoes do little to help unless the feet are so bad that they need support for healing. It is better to allow them to have as much ground contact on the sole, frog and bars as possible to help support the damaged feet. This can be done in shoes, but often is done incorrectly and thus the shoeing application is more hinderance than help.

The medication also needs to be monitored carefully. Dr. Kellon and others can help you with suggestions at the EquineCushings group. I use Harmonize from Emerald Valley Botanicals, however, not every horse responds well to it…just as some do not respond well to Pergolide. Sometimes thyroid meds are also recommended. However, if you follow a good mineral balanced diet, this often takes care of itself…as do many other symptoms.

If you cannot get your hay tested, then there are some basic recommendations in the files section at EquineCushings.

While Cushings can be difficult to deal with…things have progressed recently in the field of treatment and the majority of Cushings horses can be maintained comfortably and free of laminitis and other issues. My Cushings horse is very ridable and full of life.

On bute…it has recently been discovered that long term bute use is not recommened and may in fact add to the laminitis. In the cases of chronic laminitic horses that we have seen bute removed from, all recovered in less time with less pain and have not had a bout of laminitis since (some had corrections to their diet also). Bute is an anti-inflammatory and not a pain reliver. While the intial use of bute (1-22 weeks helps to reduce inflammation and get the healing process started, the body needs to know where the inflammation is to continue healing. With bute, this can’t happen and little to no healing takes place…inflammation continues and thus pain continues…it becomes a vicious cycle that never ends and the feet never fully heal. Additionally, bute upsets the digestive system causing radical changes in the gut pH. This addeds to a die off of bacteria that results in toxin releases that are the same intitial causes for laminitis. Thus, long-term bute can add to the chronic laminitis issue.

You also need to be diligent with deworming, however, not overdoing it as too much can be too hard on a Cushings horse. Additionally, be careful of innoculations. I do as little as possible and stager them so as to not overload the system. I also do not do any in the spring as this is a very stressful time for the body. I also avoid any that are new or have resulted in problems in some horses. I stick to the basics.

Good luck and let us know how you make out…

Proud member of the * Hoof Fetish Clique *