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Cushings questions/thoughts

So the vet looked at my 20 yr old retired mare today. Based on fat deposits above her eyes, a more cresty look to her neck, her suspicion is Cushings and we will test early next week. I have also noticed that she fairly suddenly looked fatter in the barrel, and is a bit lethargic. She has a nasty summer sore are on belly that is being treated but not healing very fast. More background - diagnosed maybe 4 years ago or so with suspensory branch desmitis, both hind legs. Some drop in fetlocks but not too bad - she is in special $upport $hoes.
Here are some questions/concerns I have:
She is currently on 12 hour turnout, over night and will switch to daytime next month. Lots of grass…This is a retirement type place so if the diagnosis is correct, it seems I will need to substantially reduce her grass - is this a correct assessment in light of laminitis risk?
I have also read that cushings can adversely impact the desmitis. Something to do with cortisol, I think? Anyone heard this?
She has had a history of colics (and 2 surgeries) over the years - though no recent events. I am wondering if the cushings could change or impact this?
Any move option for her would result in significantly less turnout, and she is not sound for any work, so it seems that she is more likely to be stiff, uncomfortable in hind end. Leading to more meds…
FWIW, my vet, who knows her very well did mention that sometimes as things pile on, and the costs mount, its not unreasonable to think about euthanasia.

I would try to manage her by muzzling if you can before you change anything drastic.

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My 24 year old gelding was diagnosed with Cushings last year. His levels are low and my vet put him on daily Peroglide and switched his hay to alfalfa. No other change. Same grain and turnout and work (which is pretty light). I’ve had him on Probios for years.
The only thing I’ve noticed is he shed out a little later than usual but he shed all the way.

I agree with trying a muzzle first. Yes, her recent history of weird, slow-healing wounds ,and injuries, are very suspicious of PPID.

most PPID horses aren’t also IR. Being PPID, there is an increased risk of developing IR. But I’d rather see a non-IR PPID horse turned out in a muzzle, less stress, more movement, than stressed in a dry lot or stalled most of the time.

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agree with @JB’s thoughts on knowing both PPID and IR/EMS status. When your vet pulls blood, you can also run the metabolic panel (insulin/glucose/leptin). Those results will help you make informed decisions about turnout.

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