Prioritizing Care for Seniors

[MNDressage]

How do you prioritize what you do for your senior horse? I have a 26 year old gelding that I need help prioritizing what to do for his upcoming vet visit and coming up with a plan of what I will do to support him in his old age.

He is being tested for PPID/Cushing’s for the first time and I anticipate he will need to be put on Prascend, so I am trying to factor the cost of testing and then the initial purchase of medicine for him shortly after when we get his blood work back.

I’m more torn on what to do for joint support. He lives outside 24/7 but is an energy conserver who does not take the initiative to get moving more than he must. It’s great in the summer when he has grass and meanders all day, but isn’t so great in the winter and just walks between his round bale, shelter, and water when needed. I go out to the barn every day and try to get him moving when I’m there. I have him doing ground poles a couple times a week, going on trail walks to get in some hills and uneven terrain while the weather is nice (not when we have 3 feet of snow), hand walking in the arena when the weather does not cooperate, and 1-2 short walk (maybe a little trot) rides when he’s feeling good.

I have him on a joint supplement and have done Adequan and joint injections in the past, but I’m trying to decide what to do/prioritize for joint support going forward. I’m considering whether to do Adequan or hock injections but can’t afford to do both if he tests positive for PPID and needs medication which I’m guessing he will. He last had his hocks injected in June 2023 and it helped until we were in the dead of winter and I noticed he was losing range of motion and becoming more uncomfortable so decided to do Adequan in March to hopefully help provide some joint support and get over the winter hump since I couldn’t afford to do injections again at that time after having an expensive bill with the dentist a few months prior to get his remaining incisors removed. I can’t totally say how much the Adequan helped vs the change in weather and the more he was moving around throughout the day in his pasture. He did improve going into summer and has been doing well this summer for short rides 1-2 times a week. The hock injections will be about twice the cost of Adequan but I noticed a bigger difference. I could do neither I guess, but I feel like it would help with his comfort this winter.

I’m looking to hear what others do for their seniors and at what point you cut off doing more. I absolutely adore him and have had him for nearly 10 years so he deserves the best care, but I can only afford so much and am trying to decide what other extras to do (or not do) for him.

[beowulf]

Hi there MNDressage, welcome to the community.

Fingers crossed that you will not need Prascend, it is costly, but if you do, there are many threads on it. First thing I want to tell you that took some hard earned experience to learn is, the pill tastes terrible and it’s not uncommon for them to become suspicious of treats. I use treats to mask it and mix up the delivery method. Sometimes it’s Fig Newtons, sometimes it’s an apple, sometimes it’s in their grain. Fig newtons are great pill disguisers, but I’ve also been using Pill Pockets to completely disguise the pill when it’s dropped in grain. It’s not my preference to feed in grain, as I have had some go off feed completely because they’re suspicious of it. Consider buying APF Pro to help with the “pergolide veil”.

For joint support, depends. Is he sound? If he is sound, there’s really no need - but MSM is cheap. Sounds like you don’t like that he is on economy mode? It could be physical - some horses conserve their energy when they are not feeling well. See how he is post Prascend (if he is Cushings).
Hock injections are much more costly, and are short term, but this is more a question for your vet.

Have you tried MSM? Cheap, easy to feed, and it helps arthritic horses.

You are already doing good keeping him out 24/7 and in light work. My opinion is this is very beneficial for them - even if they are creaky. The motion is the lotion, keeping the body fit and healthy keeps them sturdier and prolongs senescence, to some degree.

[MNDressage]

Thanks for the tips on Prascend! I’m hoping that he doesn’t need it, but with how he’s been doing lately I don’t feel that the odds are in my favor. He does have EOTRH and all incisors have been removed now. The way I understood when the equine dentist was explaining to me is that there’s a correlation between EOTRH and PPID, but not necessarily proven causation with the studies done. He’s been sweating more than his normal and had a terrible time with summer allergies which is more what is driving my increased suspicion that he’ll need to be medicated.

As for soundness, it depends on the day for how great he’s feeling. This summer he’s been doing really well with the warmer weather and slowly walking around for the majority of the day eating grass. He does have a history with navicular disease/caudal heel pain issues and general arthritis. When it flares up I notice it that most with his hocks and shortly after he will become a bit sore in the low back. His feet are much healthier so the navicular problems aren’t the #1 concern like they were for a long time. Come winter time I know that he will not be as sound as he has been since he will no longer be walking around to eat grass and the cold weather makes him extra creaky.

He has been on a handful of different joint supplements over the year. Currently he gets SmartPak’s SmartComfort pellets which contains MSM, yucca, Devil’s claw, turmeric, and a few other herbs.

[Amberley]

If I had a 26yo who was having a hard time getting around and it was fall in MN I’d talk to my vet about putting him on Previcox and I’d consider if I could alter his living arrangements to help him manage better and move more. If you get him on a painkiller/ anti-inflammatory now you can see if he tolerates it and if it helps him stay pasture sound before winter. If he’s not getting staying pasture sound and holding his weight on the Prascend and Previcox later this fall going into real winter then I think you are looking at end of life care unfortunately.

[GoodTimes]

On an older horse I would probably go with something like equioxx/previcox (firocoxib) over joint injections. He more than likely has arthritis going on in multiple places, sore muscles day to day, etc.
More bang for you buck compared to just making the hocks happy for a few months.

[luvmyhackney]

So the company that makes the cushings meds offers rebates which is helpful. Hopefully the test is negative.

I don’t do joint injections unless I have to, prefer adequan, msm, equinox or something more long term.

[cayuse]

Like others suggested I’d put him on previcox. If I did that and he responded well, I’d stop the SmartPak supplement and probably the adequan, that would save a little $ to make up for the previcox and also the Prascend if he needs it.

[MNDressage]

Thanks for the suggestions! In the spring we went with Adequan because he has a history of ulcers and has a sensitive stomach. I’ll discuss equioxx/firocoxib with my vet again and using that for him or if we should continue sticking with Adequan. It does make sense to prioritize something that helps multiple joints rather than one.

[CowgirlCoffee]

MNDressage, are you in the northern hemisphere ( I assume Minnesota?). If so, I would hold off on testing your horse right now for PPID because of the seasonal rise in ACTH. https://www.ecirhorse.org/seasonal-rise.php .

My senior horses have since crossed the rainbow bridge, but I cared for their needs for about a decade between them and these are some of the things that helped their quality of life.

Anti-Inflammatory Diet. As much as possible, I avoided feeding inflammatory ingredients such as various cereal grains, rice bran, corn oil, etc. When my horses lost the ability to eat hay, I fed them a soaked mix of alfalfa/timothy cubes and pellets, beet pulp (soaked and rinse to remove iron/dirt), and a vitamin/mineral supplement. I used to feed a ration balancer, but I noticed a huge improvement in their comfort level, hoof quality, and coat and reduced stiffness when I made the switch. I know I sound crazy, how could 1lb of a ration balancer have such an effect on them? I can only surmise that some of the “filler” ingredients were not agreeing with them. I also fed ground flax for a source of omega 3 and noticed additional improvement in their comfort and skin/coat, along with natural vitamin E. My oldies had PPID, so fresh green grass was out of the question.

• I want make a caveat here. One of my oldies would not eat enough of the aforementioned mash to keep up his weight, so I added 3 lbs of Triple Crown Senior Gold for extra calories. This was about 1/2 of the recommended amount, so I fed him 1/2 serving of the V/M supplement. It’s grain-free and low NSC.

I also fed Cosequin ASU Plus for joints. It’s the only feed-through supplement that ever worked for my horses. It is pricey, but in my opinion worth it.

I know I sound hippy-dippy, but I truly believe that the diet plays a huge role in the overall health of the horse. Sometimes, we feed our horses into problems ( I know I used to!), or there are problems which can be addressed by tweaking the diet a bit.

[lintesia]

My senior horse lost quite a significant amount of weight when he went on Prascend and we had a hard time getting it back on him even after reducing the dosage. What finally worked was syringing the Prascend so that he got the full dose no matter what. He then starting feeling better overall and regained much of the weight. To keep him comfortable in his late 20s (he was fully retired) he was on daily previcox. He lived to be 30 and was galloping periodically almost to the end.

[RedHorses]

My senior is 26 and we just tried Osphos on my vet’s recommendation. We are about 5 weeks from the injection (it takes up to two months for full effect). He’s been on Prascend for nine years, Prednisolone and Hydroxyzine (in heaves season) for ten years, and Previcox for almost two years. I bought him a Bemer two years ago.

His diseases are PSSM, PPID, and seasonal allergy induced heaves. Each of these have management practices that are necessary to maintain his quality of life. Those who know something about PPID may be twitching at my use of the steroid Prednisolone, but my first priority is keeping my horse breathing (and since deliberate attempts to induce laminitis with Prednisolone failed, I accept the risk of using it part of the year) because if he can’t breathe everything else is irrelevant.

When it comes to adding things to the house of cards that is the management he needs, I ask questions about potential treatments. How does it work? What benefits are we realistically likely to see? What side effects are possible, and how common are they? Is it a course of treatment, or a forever until the end thing? How much will it cost?

I also (go away from the discussion with the vet and) consider the horse’s current quality of life. Will his quality of life improve? For how long? Will there be any conflict with current required management practices? Is the cost worth the potential benefit? Can I afford it for the duration?

The answer depends on all the factors, including costs. I did Osphos to help with arthritis. Whether or not I do it again will depend on the results we get.

BTW go ahead and test for PPID now. The preferred time for testing is during the seasonal rise currently.

[MNDressage]

I have heard conflicting opinions on testing in the fall due to the seasonal rise in levels and whether it’s the best or worst time to test. From what I’ve read and heard from others you can test, but need to compare to a different baseline range to account for the season change. There’s another horse with PPID that will be tested to check levels when the vet is there, so I’m going to go ahead with testing.

He is no longer at the boarding facility I originally had him (I moved a couple hours away so had to find a new place for him) and he has benefitted immensely from a smaller, quieter boarding barn that has grass pastures. Through lifestyle changes he has done much better with more room to move around, hay/grass in front of him 24/7, and less stress. I used to consider him a hard keeper where I’d be lucky if I could get him to eat 6 lbs. of food across multiple feedings when he really needed the calories. Looking back he probably had ulcers that I didn’t know enough about at the time. Fortunately, for the last couple years he’s been doing much better and I’ve had to drastically cut back on what I feed. Removing the painful incisors has helped a lot as well and everyone has been impressed to see how well the horse with no front teeth does at eating grass. He’s currently only getting 1.5 lbs. of Triple Crown Senior Gold with a vitamin/mineral supplement to help balance out that he’s not eating the full recommended amount (6 lbs.) and 0.5 lb. of alfalfa pellets.

[Texarkana]

I’m another “less is more” person when it comes to veterinary support. My seniors all get 24/7 turnout, an appropriate diet for their needs, and only get arthritis management if they are showing discomfort. MSM is one of my first go-tos if needed. Then equioxx.

[SmlHpy1]

How is your guy doing without incisors? I’m taking my guy in 2 weeks for xrays as he has EOTRH as well. I’ve been unable to commit to pulling the teeth unfortunately. It’s been such a mental road block for me. Does your guy eat grass well?

[Pepsy]

Not to hack this thread but I had my horses incisors all removed in August 2019 and he recovered extremely fast and was eating grass right away.

[MNDressage]

Great! Pulling the teeth is one of the best thing I’ve done for him and you’d never know he is missing those teeth watching him eat except for how he holds his tongue sometimes.

The longer version - He was originally diagnosed back in 2019 and at the time only 4 needed to be removed, the others were fine still. Those 4 were removed within a few months. I then moved and was out of the practice range for the equine dentist and didn’t have a trailer myself to haul him (nor the money at the time) to regularly check on his remaining incisors. He did have his teeth checked in the meantime annually by the vet, but they only floated. In 2023 after I moved again back into the practice range I got on the schedule for him to be seen by the dentist again. I could tell that they were bothering him because he was slower to eat and more cautious about taking bites of his grain. The remaining 8 were in bad shape when he got x-rays and it was advised all should be removed at that point. January 2024 he had them removed and has done amazing since. The recovery was quick and as soon as he woke up he was eating hay just fine. Once grass started to pop up this spring it took him no time to figure out eating grass, but he can’t get the extremely short grass really well.

[SmlHpy1]

Thank you for the back story. My guy was diagnosed in May 2019. We had xrays in May and Dec. We consulted with a few equine dentists. We were staged early in the disease (stage 2 of 6) and told it can progress very slowly. Then covid hit and we didn’t get annual xrays. So here we are now - he lost a tooth last month. And I’m hauling him to the university for xrays. We will likely need to pull. They will do half and then the other half 2 months later I think. We don’t have the appt to actually do extractions this month. So I’ll have to schedule that out. My guy is 29 and I’m so afraid this will be a the wrong decision. I watch him eat grass now and all he does is eat the very short stuff. The really short stuff. Since I board him, I worry tremendously about the grass access/quality. It’s not lush pasture for sure. I think if i had lush pasture I’d stress less.

[MNDressage]

Wishing you the best of luck at your appointment!! I was beyond stressed about him going through with the extractions, recovery, and how he would do with eating afterwards. He wasn’t phased after and he was able to go right back out with his friends the same day.

With a bit of time he has become quite adept at the shorter grass until it’s about an inch or two long then it’s more of a struggle. He certainly tries and does get some, but he can’t grasp it as much as he could with good teeth. The grass isn’t growing as much for the last few weeks and most of the areas I find him eating are short even when he has the option to eat taller grass nearby.

[RedHorses]

Back when this was a newer test there simply wasn’t the knowledge of normal baseline numbers throughout the year. It was easier to be sure a high number was PPID when the numbers ought to be low. There’s been a lot of research done in the many years since, and the seasonal rise has become the preferred time for testing.

If your vet thinks your aged horse might have PPID contributing to his issues, the last thing you want to do is wait four months to test. PPID is a degenerative disease, constantly causing additional damage in the body. Prascend slows the degeneration so the earlier the disease is treated the healthier the horse will be.

[SmlHpy1]

The seasonal rise is the preferred time? I haven’t heard that