Cushings - Odd symptoms - What's your experience?

[anon34661286]

I had to euthanize my heart horse last year due to Cushings. She had some odd symptoms and I searched for several years trying things to help her along until it couldn’t managed anymore and I needed to euthanize her.

I wanted to describe her symptoms/vet results with you guys and see if anyone else has seen similar things, or have your own experiences with classic cushings or bizarre cushings.

Background:
My mare was a QH/paint/draft cross. She was born at our ranch, I know both parents and have owned her since birth so I know her entire history. Both parents were healthy and never showed health issues. She was a healthy foal, bright and alert. She had all the proper colustrum at birth and lived a normal outside horse life. There are no possums where we live, so EPM was ruled out, no neurological syndromes.

She had plenty of room to move in pastures, she was never stalled. She was started as a riding horse at 4. She was 16hh, about 1,300 lbs. Super cool brain, easy to handle. Very sweet.

First symptom:
Even as a youngster, she had terrible flat feet. She had all white feet, and I know it’s not supposed to make a difference, but it clearly did for her. No matter what kind of shoeing/trimming we did for her (and believe me, I put a whole lot of time, effort and money into different farriers over the course of YEARS to try to help her), her feet would not stand up. She wasn’t sore on them, but her front feet would just flatten out and not stand up. She had thinner soles also.

Next series of symptoms over several years.
She was 6 years old and we were riding in a field. It wasn’t slick, we were going at a nice slow trot on a wide circle and her back legs slipped out from under her and she fell down. It didn’t worry her, she got back up and stood there like ‘whoa…what just happened’ The same thing happened when we were riding a couple years later when she was 8. Also starting at 8, every fall, she would blow abscesses out of her lateral heal bulbs from both HIND feet. Like clockwork, every August/September she would stock up on one leg and blow an abscess then a couple weeks later the other hoof would blow. She did this every fall from when she was 8 until I euthanized her.

When she was 9, she started to have reactions to being vaccinated. She would get a welt and be pretty lethargic. I spaced out the vaccines to see which one she would react to and it was all of them, but spacing out seemed to help. At 11, we vaccinated her in the spring and she had a violent reaction. She developed a HUGE welt on her neck and after 14 days, she blew her coat, but only the white fur. She shed out all of her white fur on her body and face. Her pink skin on her nose blistered and her feet went even flatter and she got sore (probably acute lami). I thought that was it for her, but I got the recovery boots and got a big uv sheet and sewed 2 fly masks together for her and moved her to a boarding facility that was outside, but surrounded by trees so she could be shaded all day. She spent the summer in recovery and ended up being fine once her winter coat grew in.

I didn’t vaccinate her for anything after that and did fecal counts for worms.
At 12, her feet stopped growing, so I put shoes on her so she wouldn’t wear her feet off. She would thrive in the winter, but suffer in the summer. I did test her ACTH levels, they were normal. We did try Prascend just to see if it would help. I would say I noticed a little better, but nothing significant.

At 13, she would get the big squishy fat balls above her eyes when she would eat or put her head down and they would stay for hours but eventually go away. She blew a heel abscess in the spring of her 13th year that was the worst I’d seen. When the foot did eventually grow out, more than a quarter of her hoof capsule fell off.
She had laid down and twisted to get up or something and ended up tearing her deep digital flexor tendon in her hind leg in half, her hock looked like it had a squishy soft ball inside of it, but she wasn’t really sore to mull in the pasture. The flexion test on the hock made her sore for a week though. She was not a candidate for surgery as the general anesthesia would have killed her, so I decided I should start thinking about putting her down. That same spring as the vet was looking at her she got a nose bleed at random. Vet was very concerned with that. I noticed after that that she would get random nose bleeds, one a week, then two, then three. I made the appt for her to be PTS at the end of July, I gave her 3 grams of bute every day for 14 days to try to give her some pain free time and she got lush pasture for a couple weeks, the we euthanized her and buried her in a peaceful place in my pasture.

I had 4 vets working on this horse. 2 agreed that she had cushings, but a weird slew of symptoms outside of the classic symptoms. One vet was convinced that nothing was wrong with her and told me to just give her away…I don’t recommend her services anymore and the other vet that couldn’t identify why she had such health issues but agreed she was a weird case.

One theory was that her particular brand of cushings caused her to be inflamed all the time, hence the feet and the tendon tear and the reaction to being vaccinated…and eventually the tumor was causing nose-bleeds. That in combo with the paint and all the pink pigmentation was a combo that complicated things for her.

That was a long post.

Does anyone else have a story of odd cushing symptoms? I did see a couple older threads on this, but wanted to bring it up again.

[Red_Barn]

I’d like to help, because I have a Cushing’s horse myself, but I don’t understand the question.

Are you suggesting that lousy feet in a youngster, and tripping in adult life, are somehow precursors of Cushing’s Disease? Or something like that?

If so, I highly doubt it. Cushing’s Disease is a specific, measurable condition, caused by a tumor in the pituitary glad. There’s really no way to tell ahead of time whether a horse will develop it - until it does.

[JB]

Is there more to this? It sounds unfinished.

Her feet being white is unrelated to them being flat. Lots of horses with dark feet have genetically splat feet, and all you can do is manage them. Sometimes diet changes will improve things, at least to the degree genetics allow - no soy, or no alfalfa, for example.

A horse is made up of more than just what their parents look at behave like. Looks and behavior from grandparents and beyond can show up.

Lots of horses do something to have a leg slip - slick section of grass for example - especially if they have flat feet which have less traction than concave feet. A slipping stifle can easily cause a hind leg slip.

When was she tested for Cushing’s (what age), how high was her number, and was she on pergolide/Prascend?

[anon34661286]

I hit enter before I finished typing. Sorry, I just added the rest of the history with that horse.

[anon34661286]

I hit enter before I finished typing. I just finished the post. Sorry

[Red_Barn]

Thanks for the update.

Actually, though, I still don’t see anything in your horse’s list of illnesses to suggest Cushing’s. The fact that Prascend didn’t help makes Cushing’s even less probable.

For several of these conditions, allergies do sound quite likely - to vaccines, insects, food, fly spray; it could be anything.

[JB]

@anon34661286

I did test her ACTH levels, they were normal

What date (month/day) was she tested?

@anon34661286

One theory was that her particular brand of cushings caused her to be inflamed all the time, hence the feet and the tendon tear and the reaction to being vaccinated…and eventually the tumor was causing nose-bleeds.

A gutteral pouch infection is more likely as the cause of the nose bleeds.

Also, what was her diet through all of this? Was there ever a time when she had no soy, no alfalfa, no part of any cereal grain at all?

The fact that Prascend (what dose?) didn’t help much would seem to indicate it wasn’t Cushing’s, but it’s possible that the dose wasn’t high enough.

PPID wouldn’t have caused her to be born with flat feet, or for them to flatten as she got to full adult weight (which is more usually the case).

Flat feet, chronic abscessing, those could easily be explained by insulin resistance, though to be fair, the hinds only is unusual, whether due to IR or PPID.

There are certainly a host of auto-immune issues horses can develop, or just be born with.

[Red_Barn]

I agree with everything JB has said thus far.

The thing I can’t figure out, OP, is the veterinary care. (No doubt I’m an idiot, so please humor me.) Who came up with the idea that all these problems could be traced to one underlying cause? Where did the Cushing’s theory come from? Were all these vets called in at once, or over the course of many years?

Just reading it as it stands, your story sounds like somebody trying to find a single reason for a bunch of obviously troubling, but ultimately unrelated medical events.

[anon34661286]

@JB

What date (month/day) was she tested?

She was tested late July of her 12th year. If the levels were elevated, it should have been then. They were 1 point above normal.

@JB

Also, what was her diet through all of this? Was there ever a time when she had no soy, no alfalfa, no part of any cereal grain at all?

I feed straight grass (brome, timothy, orchard) with mineral supplementation. The alfalfa here is extremely hot and I don’t feed it to horses. I did some magnesium supplementation for her as I thought she might be sore in the muscle, but nothing else.

@JB

The fact that Prascend (what dose?) didn’t help much would seem to indicate it wasn’t Cushing’s, but it’s possible that the dose wasn’t high enough.

We eased the dose from half a pill to a pill and a half over 6 months. At first I noticed a shift in her mood. She seemed happier, but after 3 months, none of the symptoms eased and at the end of the 6 months is when she tore her tendon in half getting up from laying down, so I stopped the prascend.

@JB

Flat feet, chronic abscessing, those could easily be explained by insulin resistance, though to be fair, the hinds only is unusual, whether due to IR or PPID.

Yep, that’s what the vets thought too. Odd to blow abscesses in the hind feet. She never blew an abscess in her front feet ever and they were WAY flat compared to the hinds. And she was balanced in the hind. She was a touch base narrow but not enough to produce chronic abscessing. And the timing without fail, was every fall every year no matter what she was doing (except for the one in the spring of when I euthanized her)

[anon34661286]

@Red_Barn

The thing I can’t figure out, OP, is the veterinary care. (No doubt I’m an idiot, so please humor me.) Who came up with the idea that all these problems could be traced to one underlying cause? Where did the Cushing’s theory come from? Were all these vets called in at once, or over the course of many years?

lol, you are definitely not an idiot.

So I had consulted with my regular vet, but she hadn’t seen many cushings cases to base my horses off of, she did think the mare did have some underlining auto immune deal, but it didn’t make sense that it was seasonal, and ended in hoof abscesses before winter. It seemed to be heat/sun related.

I called my old vet from another town who treats a lot of performance horses, and he had said that he had seen a couple other horses, one was also a paint with mystery symptoms similar to mine. That horse didn’t have especially elevated ACTH levels either, but with the other ongoing symptoms, they decided to euthanize him too. He told me that he did believe it was cushings based on all his other symptoms, but however the tumor was sitting in the brain affected that horse differently, and it seemed like mine was being affected that way too.
The 2 other vets in town that I consulted were the one vet that when suggested I just give my mare away and she refused to even think about the possibility of cushings, the other is a very experienced vet who agreed with my out of town vet. Three of the vets did agree that nosebleeds are a bad sign and typically mean whatever is wrong with the horse can’t be fixed and the end is near.

I had been talking to these 4 vets for about 4 years to get opinions and options.

I also thought it might be allergies…and I went as far to thinking the type of soil at my place was toxic to her, but she had the same symptoms even when I moved her 200 miles away for a time to test it at a friends place.

Her symptoms started just as flat feet and the occasional abscess to tripping, tightness in her tendons, abscesses in both hind feet every fall, reactions to vaccines, tearing the tendon, fat pads above her eyes that wouldn’t go away to chronic nosebleeds.

But, her symptoms would all go away in the winter (except for the fat pads above the eyes). She would bright and happy and sound. Then once the days would get longer, she would start to slide downhill when the weather got warm.

Who knows, she could have just been born defective and after time, whatever underling defect there was just became worse until I decided she shouldn’t live in a broken body anymore.

Whether it is cushings or that’s just the easiest blanket term to put on her case…who knows. Before I deleted facebook, I got hooked up with a cushing’s horse group and there were a couple other people with paints that had been experiencing the flat feet and abscessing/tight tendons thing too. Maybe it just presents itself a little differently in different horses?

[Red_Barn]

@anon34661286

But, her symptoms would all go away in the winter (except for the fat pads above the eyes). She would bright and happy and sound. Then once the days would get longer, she would start to slide downhill when the weather got warm.

Hmm.

~ The seasonal thing makes me think she must have had allergies of some kind - probably to a common insect or plant, so that moving didn’t help.

~ The abscesses in the hinds is odd, I agree, but there is such a thing as seasonal laminitis, so you never know. She might have been uncomfortable up front too, but didn’t show lameness because all four feet were affected.

~ Fat pads over the eyes sound like something metabolic, but I suppose an allergic/autoimmune response could cause that too.

~ Flat feet - I’d guess conformation. And I’d probably chalk the tripping up too poor conformation as well. Muscle tightness could be anything - including conformation and movement issues that worsened with age.

I’m getting a clearer picture, so thank you for all the info, but I still think you’re looking at multiple problems rather than just one.

[anon34661286]

What are your cushing horses symptoms, if i may ask? Are they classic? Elevated ACTH and such?
Cushing’s is such an awful disease, I’m sorry you have to go through it with your horse.

[Red_Barn]

It is an awful disease!

My horse first presented with a patchy, scaly, skin condition, which drove him nearly mad with itching. After trying everything else, the vet tested for Cushing’s, and his ACHT was very elevated. He was immediately put on Prascend, but he’d foundered badly before it had a chance to kick in, and he suffered terribly, for several months, with abscesses in both fronts. He also had the “classic” long coat that year, and I had to clip him in the spring. His ability to regulate temperate was pretty much nonexistent.

All in all, it took about 7 months for him to return to something close to Old Geezer Normal, and for his soles to fully recover. He’s doing well now, on one Prascend a day, and careful exercise for the sake of both his weight and his arthritis. We were lucky!

I’m terribly sorry you lost your horse, but it sounds like you did exactly the right thing. Without a diagnosis or a plan of action, watching them suffer just isn’t an option.

[JB]

@anon34661286

She was tested late July of her 12th year. If the levels were elevated, it should have been then. They were 1 point above normal.

1 point above normal at the very end of the normal levels could be early stages of PPID, or it may not be. It likely was, but it wasn’t very advanced to only be 1 above normal.

The diet sounds reasonable, though if she was IR, first compensated and then uncompensated, the grass may have simply been too much for whatever was going on. No idea, just something else to consider in the mix.

@anon34661286

she did think the mare did have some underlining auto immune deal, but it didn’t make sense that it was seasonal,

It isn’t unusual for an AI issue to be triggered by environmental conditions, such as allergies, to make them seasonal.

Keep in mind that PPID isn’t just from a tumor, it can be from the pituitary itself enlarging.

There may have (also) been a real tumor up in her sinuses somewhere.

PSSM also comes to mind. One or more of the Type 2 variants, possibly. Those horses tend to do worse in cold weather, but there are enough variants that aren’t well studied that there may be some combinations that are more heat-intolerant.

A conundrum for sure.

[Dbliron]

We have a PSSM 2 gelding, who definitely has a much harder time in summer than in winter. Any exposure to grass makes him worse, so he has “seasonal” issues. He is prone to hind hoof abscesses, and overall muscle soreness and tightness, as well as stumbling. The PSSM 2 diet along with 7 days per week exercise (not just cruising in a pasture) has made a remarkable difference. His ACTH was slight elevated when we first suspected something medical, but dropped to normal when his modified diet/exercise regime was implemented. He initially presented as IR/metabolic, but the dietary changes stopped all of that, and then the biopsy clarified the problem for us.

[anon34661286]

Very interesting! I wonder if my mare had that too. What was the diet that you did that helped him so much?