New to PPID with some specific questions

[Seven]

My 29 y/o OTTB is probably getting an ‘official’ PPID diagnosis. He does not appear otherwise EMS or IR but the vet is coming tomorrow to discuss our treatment options and management. He has a good diet, turnout, buddies, and no demands but I’m still worried about the unknowns. I read a lot of the posts and advice here as wells as linked resources, searches with some vet med websites, and some books I have at home.

Some things I can’t figure out yet:

1. There is a seasonal component to the testing so is there a seasonal component to the PPID horse’s health? Are they better spring/summer and more challenged in the fall/winter? Or is is the shoulder seasons? Or just no connection at all?
2. Does the typical treatment increase immune function generally or is there more that I can do? Lately he gets occasional nasal discharge and has some slow healing wounds since this all started. He’s also itchier than usual and his coat is more oily and dandruff-y (in addition to the patchy shedding).
3. He’s had no lameness issues and is very sound right now (knock wood). He is barefoot. Are there any tips, tricks, or management strategies to avoid any laminitis or long-term lameness issues? I want to keep him as healthy as we can and I really don’t want him to be in any pain (or have to make a euthanasia decision because of a very painful event, if it can be avoided).
4. I’m a bit worried about his mental state and what I’ve read about the treatment. He’s currently got what I would describe as a “low mood.” I’ve read the treatment can make them more depressed - has anyone had good outcomes improving the mental state while on the medication? Do the mental changes eventually go away? I’m also worried because even though he has good teeth that were floated this spring, he’s not a super enthusiastic eater and is already somewhat of a hard keeper. I’m concerned about treatment protocols that might make this worse and if the treatment doesn’t offset the challenges it creates.

Thanks for any experiences or thoughts on this topic that will help me navigate this.

[JB]

@Seven

There is a seasonal component to the testing so is there a seasonal component to the PPID horse’s health? Are they better spring/summer and more challenged in the fall/winter? Or is is the shoulder seasons? Or just no connection at all?

Definitely a connection. The northern hemisphere is ramping up the seasonal rise now, peaking mid-Sept to mid-Oct. This causes ACTH to rise in all horses. The PPID horse has an abnormal rise. Sometimes they need an increased dose from around June 1 (to get a bit more drug into them before the rise really starts), to around Dec 1 (when seasonal starts going, ending 6 months after the peak of the rise). OR, the horse has a normal dose of, usually, 1mg (average horse), and for the Dec-June he may be quite ok on 1/2mg. Sometimes they need the full dose (for their stage, age, individual need) year-round, sometimes they can go lower during the low 6 months and/or higher during the higher 6 months

@Seven

Does the typical treatment increase immune function generally or is there more that I can do? Lately he gets occasional nasal discharge and has some slow healing wounds since this all started. He’s also itchier than usual and his coat is more oily and dandruff-y (in addition to the patchy shedding).

Absolutely, getting a handle on ACTH levels does help the immune system, healing, all that. You’re describing common symptoms of unmanaged PPID. Will medicating fix all the things? It really depends how advanced the disease is and how well the drug controls it

@Seven

He’s had no lameness issues and is very sound right now (knock wood). He is barefoot. Are there any tips, tricks, or management strategies to avoid any laminitis or long-term lameness issues? I want to keep him as healthy as we can and I really don’t want him to be in any pain (or have to make a euthanasia decision because of a very painful event, if it can be avoided).

Treat him more like an IR horse than not. PPID does seem to predispose the horse to also becoming IR, and there’s some thought that the IR horse is more prone to developing PPID. This doesn’t mean you have to keep his entire diet < 12% or < 10% NSC, but I wouldn’t feed 10lb of a 20% feed either if you have other options. Managing PPID helps manage any tagalong IR, but nothing’s guaranteed

@Seven

I’m a bit worried about his mental state and what I’ve read about the treatment. He’s currently got what I would describe as a “low mood.” I’ve read the treatment can make them more depressed - has anyone had good outcomes improving the mental state while on the medication? Do the mental changes eventually go away? I’m also worried because even though he has good teeth that were floated this spring, he’s not a super enthusiastic eater and is already somewhat of a hard keeper. I’m concerned about treatment protocols that might make this worse and if the treatment doesn’t offset the challenges it creates

His mood can be due to high ACTH which can make them miserable. Medication can cause a “veil” where they can get depressed, anorexic, and the way to all but eliminate that is to start his desired dose (usually 1mg) very slowly. Like, 1/4 dose for a couple weeks, then 1/2 dose, then 3/4, then full. Sometimes adding the extra 1/4 dose is done at a 2nd dosing so they get a steadier intake of the drug, rather than all at once. That’s not always possible especially if you board, but if it can be done that way and that slowly to get things started, that may help a lot. Just know the veil can also come on months after starting.

The veil can definitely affect appetite. A lot of people have good results with APF Pro, so you might want to get a bottle or 2 to have on hand when you start medicating

The ECIR Group has been around a long time, both as the FB page (not a group) and their website www.ecirhorse.org. They are quite black and white about what is and isn’t “allowed”

This FB group is fantastic, very science-based. They do follow the info from the Equine Endocrinology Group (EEG) which is the leading research-based group on all this, AND, they allow that horses don’t always read the books and it’s not always as black and white as ECIR wants things to be. Both are excellent resources

I personally use the Equine PPID (Cushings) group (the 2nd one I linked to) for most things

[Seven]

Thanks very much, JB. I’m sure I’ll learn a lot tomorrow too but I appreciate your feedback as it helps me organize my thoughts. When the vet was out in April, we discussed this as a possible diagnosis but both wanted to see if it was just the cold, rainy, erratic spring weather or he was really showing symptoms. Just in this month everything seems to have changed to become quite a bit clearer.

All his grain is considered low starch. I checked it all when I started thinking about this. We board so I can’t control the hay source.

And yes, we’re in NY so now I know June to October is going to be worse rather than better.

I hope he responds well to the medication! Fortunately, even tho we board, it’s only a few miles from home so I can do the medication myself. I would like to see his personality back.

[SMF11]

I board retirees and always have a Cushings horse or two on the property. All horses that have been on prascend eat it in their feed. I soak the feed to mush, add the prascend immediately before feeding, and feed in feedbags. That way, a tiny half a prascend tablet, eg, can’t be dribbled out of their mouth if they are a little sloppy.

[NaturallyHappy]

I have four on Prascend. Only one exhibited the Pergolide “veil” when his dosage was increased to 1 pill. We reduced his dosage to 1/2 - his ACTH is well managed on that dose. All are cheerful and energetic.

[Demerara_Stables]

Mine girl was diagnosed a couple years ago. She was on 1 tab for about 18 months then last summer/fall got 3 (4?) abscesses within a month. We re checked her ACTH and she was still high (can’t remember the exact number) so we bumped her to 2 tabs last fall. She is pretty depressed right now so I think we’ll re check and hope I can scale back. But! Not one abscess knock wood since we increased the dose, so I’d say it’s definitely helping with the immune system.

Thanks for posting this - would love to hear what others say about the veil.

[Seven]

Thanks everyone - it is good to read positive stories! And SMF11, I’d be so happy if he eats it in his feed. I may change his feed to see if I can find something he wants to eat regularly, and along with the medication he’ll get his appetite back. Maybe that would work for us too.

Lots of info on ecirhorse - I don’t think I’d found that website yet. I don’t use FB but had read the information on the Equine Endocrinology Group, Boehringer Ingelheim, Michigan State and some other vet school info. I also liked the content on https://myseniorhorse.com/ and not just for PPID.

Also good news - it was about 25 degrees cooler today and low humidity and while still not his “old self” he was definitely perkier.

For those that manage this in some of their horses - did you start routinely testing others? Or wait until there are signs?

[jherold]

Tested my gelding when he was 13 because he was foot sore after pulling his shoes for the winter. He’d never had a problem before. Started him on 1/2 tablet. Within a few weeks his feet no longer bothered him and he lost weight. (He was your typical easy keeper quarter horse before prascend). He was not and now at 26 is still not insulin resistant so no change in diet was necessary. He’s on full pasture and his vitamin/mineral supplement and looks great. His dose has increased over the years and he is now on 3 mg. Fortunately, he quit taking prascend so we get the compounded pergolide (it’s a lot cheaper) in capsules and he let’s me pill him with a dog pill gun with a carrot chaser. He had an increase this spring because I noticed that he wasn’t totally comfortable on rough ground. He’s even shed out pretty normally this year. Other than issues getting him to take the pill, he’s been easy to manage.

[ladipus]

1. Yes …seasonally they are going to be more susceptible to laminitis in the spring and fall just as an EMS/IR horse would be …so you need to manage them with careful attention to diet -low starch & sugar feed and generally a tested low sugar or soaked grass hay is ideal…you might also find that you need to body clip when warmer weather approaches because many have trouble shedding their coats.

2. Immune function typically starts to decrease as the PPID increases over time -you might find delayed healing and more prone to soft tissue injuries and even skin infections ….APF - a liquid adaptenogenic liquid helps with that.

3. Your best way to avoid laminitis is going to be with dietary management…follow ECIR guidelines and feed tested low sugar grass hay or soaked grass hay …avoid pasture/grass especially in spring & fall …the only way to be the most careful would be to turnout in a dry lot with tested hay only.

4. The best thing you can do when starting Cushings treatment is if giving the Prascend pill to start with 1/4 pill and increase it by 1/4 every 4 days until target dose is reached -if you start larger than that or don’t increase in small intervals your horse will very likely go through the “Pergolide veil” which is the undesirable side effects of losing appetite /going off feed completely , dull/depressed , etc ….i have found that my thoroughbred and more sensitive types do better on the compounded Pergolide liquid vs Prascend. APF is also very helpful to combat side effects when starting this medication…it also has many other health benefits as well.

[JB]

@ladipus

seasonally they are going to be more susceptible to laminitis in the spring and fall just as an EMS/IR horse would be

Do you have some info for that? Most PPID horses aren’t also IR, and Spring is the seasonal low for ACTH (northern hemisphere). And while managing PPID with secondary IR does tend to manage the IR pretty well, if not entirely, there’s definitely still the diet aspect and any PPID + IR horse should be dietarily managed just like the IR horse

there are so so many PPID-only horses who are on full time grass, untested hay, etc, without any laminitis issues, because they aren’t also IR.

[Demerara_Stables]

@JB

there are so so many PPID-only horses who are on full time grass, untested hay, etc, without any laminitis issues, because they aren’t also IR.

I have two!

[SMF11]

Agree. Every single Cushings horse here over the years has not been IR and they’ve done fine on 24/7 turnout in big grass fields.

(If a horse is insulin resistant I won’t take them as my farm is not set up to properly care for them).

[ladipus]

I suppose it depends on how well the ACTH/PPID is controlled… If ACTH levels are not within the normal range then that will drive insulin and glucose higher, regardless if they are IR or not at baseline is the way I understood it, which then puts them at greater risk for laminitis… So I just always air on the side of caution and treat and manage them as EMS/IR

[treebeard]

My miniature mare is Cushing’s positive but not IR. I had a dear little miniature gelding that was IR. Poor little guy had any and all symptoms ever associated with IR and I lost him last year.

My mare was fine with green leafy hay and pasture up until last year. She’s 18 now. She now cannot handle a lot of pasture and I had to find a low sugar hay. Thankfully I have a hay supplier that routinely tests his hay, and he has a lot of choices.

Sarah had laminitis for months and off pasture until it was under control. She’s not the typical fat mini, either. She’s a slender gal naturally. This year she’s sound and free of acute laminitis and can go out on pasture for a limited time every day.

I guess what I’m trying to say is to know your horse and keep an eye out and expect that the Cushing’s may give you some surprises over the years.

[JB]

@ladipus

I suppose it depends on how well the ACTH/PPID is controlled… If ACTH levels are not within the normal range then that will drive insulin and glucose higher, regardless if they are IR or not at baseline is the way I understood it, which then puts them at greater risk for laminitis… So I just always air on the side of caution and treat and manage them as EMS/IR

This is really the key - how well is the disease being managed. Many are managed to have levels very much in normal range, or at least very close, with very normal glucose, insulin, and just as importantly, G:I ratio numbers

[Demerara_Stables]

For those of you who have had good luck with the compounded pergoide (especially in regards to less of the veil) have you checked levels after you went on the compounded version? My vet said in her experience of one other patient being on compounded, it was not as effective as the prascend. She thinks because the compounded is less regulated that maybe the dosage isn’t exactly correct.

My plan is to recheck Dora’s levels now, then order the compounded pergolide, then check once more after she has been on it for a month or two (still waiting to hear back from the vet as to the ideal time frame here).

[JB]

Pharmacy matters a lot. I know of quite a few people who have test proof that their compounded works as expected. Others, not so much.

[Renn_aissance]

@treebeard

I guess what I’m trying to say is to know your horse and keep an eye out and expect that the Cushing’s may give you some surprises over the years.

Try every 6 months. It’s a condition of management and change is the only constant. Absolutely agree with Treebeard’s point here- expect that the horse’s needs will change with time and the seasons, and don’t panic when what worked in the spring doesn’t work in the fall, or vice versa. You’ll get used to it.

OP, you mentioned your horse’s mental state. If your horse doesn’t perk up in a couple of months after he starts to respond to pergolide, and you haven’t checked this already, check his thyroid. Cushings can cause secondary hypothyroidism and that can cause depression. For my horse, every single time I thought “oh no his Cushings is getting worse” or once or twice “he’s getting tired of this mortal coil,” it was his thyroid, and he perked right back up in a week of appropriate medication or dose adjustment. But you might get good results by just getting him on the right pergolide dose. (Have you seen Chicago? “You know some guys just can’t hold their arsenic”? I’m getting T-shirts made for me and my horse. “Some folks just can’t hold their cortisol.”)

About eating- I want to second or third those who have suggested supplementing with APF at the same time you start titrating up on pergolide. My vet calls it a magic potion, as in we aren’t entirely sure what its mechanism is but it seems to work. I’ve had really good results for it combating inappetance when adjusting the pergolide dose.

[ladipus]

Yes …exactly …it’s a balancing act. My aged wb gelding had Cushings only and never had to be muzzled or off grass and never had laminitis either luckily.

[jherold]

You do have to be careful with your compounding pharmacy. I use Wedgewood. My vet uses them for other compounding needs and the quality is good.