Newly diagnosed PPID (Cushings)- update asking for help administering meds; final update post 34

[demidq]

My mare has been lethargic off and on for a couple of years- pokey, really have to get after her to move out. Sometimes she is great for a few weeks at a time but it doesn’t last. I feel her topline isn’t what it should be with the frequency and type of work we do. We have also had a problem managing her “hay belly” and altho she isn’t really what you would call fat, this winter her neck became a bit cresty. Vet has not been concerned, routine screening lab work has been normal. This spring I pushed for more specific testing, and we did ACTH, insulin, glucose and thyroid. ACTH came back WAY elevated, like more than 10 times normal upper limit. The other endocrine stuff was normal. I am waiting to discuss with vet, but I think the diagnosis is pretty clear.

Interestingly, she has always been a ‘high shedder’ on her FECs, and she had a really wierd infection (Lawsonia intracellularis) in 2017. I know PPID can cause increased likelihood of infections as well as increased susceptibility to parasites., not sure if I can put these down to PPID or not. Her winter coat is heavy but she always sheds out. She drinks a ton (always has) and urine is consequently clear, always thought that was a good thing, but now wondering if that is also a symptom.

My question for COTH is how long does it take horses to respond clinically to pergolide? (Energy, muscle developement, crest reduction)? She is a picky eater- do yours’ prefer the liquid or powdered pergolide? Cost of treatment?

I am relieved to know her NQR was not my imagination, but feel sad that I didn’t push for this testing sooner.
Thanks for your input!

UPDATE July 9
Vet started mare on Prascend (agrees that compounded pergolide not as good).
We are having a MAJOR job to find a way for BM to give meds as I can’t get out every day. methods tried:
The first 2 days mare took pill in a handful of Senior feed then refused

I made delicious treat balls with carrot, oat flakes molasses and crushed peppermints and put pill in treat- she took pills 4 days in a row before refusing

I bought several kinds of human type treats to hide pills- chewy granola bars, fig newtons, fruit rollups, apple crisp bars- she won’t touch them. Barn friends are happy to use them up!

Dropped pills into feed (ration balancer with a handful of senior), ate for 3 days before saying "NO’ and now she won’t eat her meal.

Molasses, apple sauce, corn syrup with pills are 'No Go’s

stuck pill in carrot- she can obviously smell the pergolide and won’t eat the doctored ones.

The pills are bitter and box insert says not to crush. The only other option I can think of now is to dissolve in molasses and water and syringe. This is problematic because mare is awful with syringing and I am not that confident in BO/BM’s ability to do this effectively.
Yes, I have worked on this for 12 years with various delicious substances and I can usually get the stuff into her but she is a pain. It was really fun when she needed antibiotics 3 times daily for 2 months but at least it finished! This will be ongoing.
Does anyone have any other bright ideas? PLEASE?
Last update Aug 2: see post 30

[Dbliron]

Well. It’s not quite as simple as that, at least not for my two (19 and 22). Compounded pergolide did nothing for them, their ACTH levels climbed to what they’d been originally (we started with Prascend to establish the dose) so we went back to Prascend tablets and the numbers came down. Both responded reasonably quickly to Prascend, within a month, but had no response at all with the compounded version. I make a little hole in a carrot end with a flat head screwdriver and push in the tablet. Both take it really well. However, my mare developed terrible diarrhea and inappetence in the fall from the Prascend. It was easy to figure out, if I dropped the Prascend for a day the diarrhea stopped within 8 hours, but resumed within 4 hours if I started the Prascend again. What worked was halving the dose, so 1/2 tablet every 12 hours instead of one tablet every 24 hours. I did that through the winter, but she’s now transitioned to 1 tablet once per 24 hours. I also manage this horse with diet, she’s currently out on 5 acre pastures daily but with a Greenguard grazing muzzle on during turnout, and limited hay with no concentrates at night. She’s also on Mad Barn’s Omneity P. It’s entirely possible that the next time we do blood work, which would be late August, we may have to adjust doses on either or both, but they may be fine. Certainly their energy is great, and they both feel good in their work. The gelding’s also on a diet, but less restricted than the mare. Both of them work every day.

[demidq]

Thank you- mare is 15, out 24/7 and will be wearing a grazing muzzle come Mon. She gets a ration balance pellet and a handful of senior feed once a day to disguise her Previcox. That is excellent info re compounded pergolide vs Prascend. I hope mare responds as well as your horses.

[mlb722]

I wouldn’t mess with anything compounded—prascend is a tablet. My horse was diagnosed young and the medication never really changed her long hair coat and lack of topline. She did not have issues with energy. Her biggest issue is soft tissue injuries. Be very careful with conditioning, good footing and farrier care.

[jherold]

Don’t panic. You may not need to change her diet. My gelding has had Cushings for years, but he is not insulin resistant, so he’s out on full pasture with no issues. He actually lost weight within a few months of starting Prascend and I actually had to start giving him grain. Sounds like your mare isn’t insulin resistant so just start her Prascend and watch her. Some vets recommend starting with 1/2 tablet to minimize any side effects.

[RedHorses]

For each symptom there is a percentage of horses that will show improvement on Prascend. Irregular haircoat growth and shedding have a high success rate while muscle loss over the topline is only about 50%.

My horse’s only symptom at diagnosis was the muscle loss over his topline, and he is in the non responsive group. His numbers are good, and the Prascend is slowing the progression of the disease. He is 23 and has been on Prascend for six years. He started on half a pill per day for a year or two and bumped up to one pill when an ACTH test showed his numbers creeping over the normal line.

PPID does depress the horse’s immune system which results in more infections, more severe infections, and slowed recovery. As a horse’s worm load is affected by their natural resistance PPID can turn a low shedder into a high shedder. My two horses both got mud fever/scratches last fall. The non PPID horse healed up fairly quickly while my PPID horse had several very stubborn patches that would not heal until late April.

I put the pill in a 10cc syringe with 4-6cc of water and give it to him that way as he cannot be relied on to eat his grain and is pretty good about avoiding the pill when he does. 4-6cc is small enough that it just spreads through his mouth and can’t be spat out (provided his mouth was empty in the first place). My horse is very tolerant of syringed meds - good thing too as he gets 3-6 per day in the summer!

[Fiesta01]

I agree with RedHorse on putting Prascend in a syringe and adding water. My gelding would not eat his food if anything was added to it. With the syringe, you know that the horse is definitely getting the med.

[PaddockWood]

I would suggest tapering up on the Prascend. Some horses get depressed and go off their feed. My guy is very picky about his feed so I give the pill in a handful of ration balancer and watch that it goes down.

Our symptoms were like you describe - sluggish, infections etc and Prascend has him feeling like his old self.

We also muzzle.

[Calvincrowe]

I am blessed with two geldings who both eat their prascend pills wedged in a piece of carrot. After hearing so many horror stories of horses who refuse to eat it in any form, I truly am thankful. I’d start with offering it in a carrot or apple piece, in her feed, before trying other methods or forms. Monitor her so you can see if she eats it.

One of my geldings is IR and Cushings, the other is just Cushings. The IR horse is muzzled, on low sugar everything, and looks great coat-wise now that he’s on Prascend. The other is on pasture daily, eats the low sugar hay happily and has always responded well to Prascend. The IR horse recently had a laminitic episode after a mix up (gate left open) allowed him 12 hours on grass. Poor boy! My guilt is on overdrive! But we treated immediately-- icing feet, on sand bedding, SoftRide boots, bute, vet care, xrays showed very, very mild rotation that farrier is addressing with trimming.

[demidq]

There is an update in the first post

[Sdel]

Will she eat soaked food? In theory it shouldn’t matter if it is dissolved in a syringe or dissolved in the water used to soak food.

My current mare gets her pill tossed in while the alfalfa pellets are soaking and it seems to be working fine.

[S1969]

@demidq

Does anyone have any other bright ideas? PLEASE?

Sadly, no. It must taste very vile because I have to fight with my two every day.
Mine will flip any bowl or bucket that has a pill, whole or crushed in it.

I find there is some value in alternating between sticking the pill into the back of their mouth while eating their grain for a couple of weeks, and then syringing it in for a couple of weeks. I do crush it…I just don’t care anymore. LOL. But I do it in a mortar/pestle and try not to breathe any of it in.

I can get my herd to take just about anything else, and these are the pills that literally are keeping them alive. I won’t tell you how often I’ve told them “just die, then…see if I care!”

I spend a good 10 minutes sticking pills in their mouths, watching them skillfully spit them out and the picking them back up (out of the mud, whatever) and shoving them back in. It’s really not fun.

[demidq]

I can try in soaked alfalfa pellets- not sure if she will eat them with a pill tho. I will be pissed off if I buy a 20kg bag of A pellets and find she doesn’t like them!

Vet suggested cutting back to 1/2 pill for a week or so and syringing. That’s going to be fun but I don’t think that is a long term solution due to lack of BO/BM expertise and I can’t be there daily. I doubt he will be very keen on standing over her and continually sticking pills in her mouth as she continues to spit them out!

[Sdel]

@demidq

I can try in soaked alfalfa pellets- not sure if she will eat them with a pill tho. I will be pissed off if I buy a 20kg bag of A pellets and find she doesn’t like them!

Just soak her regular grain meal or pour the dissolved solution directly on the grain.

[PaddockWood]

In desperation, how about taking a carrot and shredding a small bit of it and hiding in there? Has anyone tried that?

[NaturallyHappy]

Mine will eat it if I give him a treat w no poison pill in it first, then a treat w the poison pill. The treat can be anything…a tiny bit of senior or ration balancer, a bite of carrot, or a bite of apple. I think the good taste first really helps. I thought about Vick’s Vapor Rub in his nose so he couldn’t smell it, but I haven’t had to try that yet.

[SusanO]

Prascend dissolves very readily in warm water. I put a small amount of warm water in a cup and drop in the pill. In a few minutes it is dissolved and I can suck it up into a 5mm syringe. My pony will NOT eat anything with Prascend in it. No feed, no treats, no molasses and he can find it stuffed into any sort of ruse. However he is fine with getting it squirted into his mouth. I let him eat his ration balancer and squirt it into his mouth before I turn him out into the pasture. He just stands there - I do not even put a halter on him.

You just have to make sure there is no hay or grass in their mouth. They can roll it around and spit it out along with the Prascend.

[jherold]

My gelding was difficult to get to take the pill. I finally figured out that hollowed out carrots work, but you can not preload the carrots. Th pill starts to dissolve and must taste bad. I stuff the pill in the carrot right as I’m handing it to him. I would have the barn manager start giving her empty carrots at feeding time to get her expecting them. You may have to take her off prascend for a few days. Then have the barn manager start back up with a 1/2 pill.

[starhorse]

My horse loves those jelly orange slices and jelly mint slices. Will take any pill shoved in there and then squeezed closed. I think the texture is also sticky so it’s harder for her to spit out. Takes her Prascend like that any day.

[jherold]

Jelly beans work too your horse likes them. Again, don’t preload.