In a catch 22 situation with my old retired mare. She has been cushingoid for about four years now, and is currently 23 years old. She started off on Pergolide (very hard to get her to eat it, a hard no in plain powder form and barely acceptable in a flavored compounded pill that we still had to work at daily to get her to eat) and has now been on Prascend (.5mg for the first year, currently 1mg) for about two years. Last year, she did well over the summer, then stopped eating anything but grass in September. We tried cutting the dose in half, which did nothing to improve her appetite, and I was nervous about her getting too thin going into winter, so we stopped the Prascend all together, and she regained a normal appetite, did fine over the winter (mild here last year). We resumed the Prascend in April, trying to go up slowly (1/2 pill every other day for a couple of weeks to 1/2 pill every day for a couple of weeks, finally to a full pill at the beginning of June). She did not shed well on 1/2 pill, has mostly shed now on a full pill, but her hair is definitely longer than a normal horse. Her appetite is very low and she has lost her spark somewhat and seems depressed at times (when on meds but her usual self when off meds). She is refusing all grain and hay, only eating grass again. Her mouth and teeth were just checked a couple of weeks ago and are fine, not a dental issue.
I would say that her body condition is currently about a three and at the minimum I’m comfortable with. I think she can maintain for the rest of the summer (turned out on nice pasture 24/7), but I’m at a loss for fall/winter. To at least maintain in the winter, she needs free choice hay and a minimum of 5lbs Ultium. Not to mention that she won’t be getting the meds without eating at least a handful of grain. She refuses it in a fig newton or hiding it in treats. If we stop over the winter again, she’ll still need it in the spring to shed, and the episodes of refusing food seem to be happening earlier each year.
Any suggestions? At this point, I’m leaning towards giving her a great summer, stopping the meds, and putting her to sleep in October or so. I don’t see her improving, and I want to let her go before she gets to a bad place. She is boarded with a friend of mine, who is lovely, and is trying everything she can to get 1 pill per day into her. Also relevant to the situation, I’m pregnant with my second child and due in January, so if she were to decline rapidly this winter/spring, it would be a bad time to deal with it. I’ve owned this mare for 18 years, and this is such a tough decision, but better a day too early, right? 
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