Update post 49: he’s gone (was Heaves management: inhalers? nebulizers? other ideas?)

[pompeiii]

@Pehsness I already own a steamer (my late gelding also had heaves so we purchased the steamer for him —every horse I’ve owned has loved steamed hay, especially in the winter). So budget is not an issue here since it’s sitting in the barn. The issue is that he is IR. My vet requested that I stop steaming and soak his hay instead. He prefers steamed hay to soaked hay but soaking removes more sugars and I have to balance 2 conditions…

We got more hay on Saturday. My hay guy told me to that there shouldn’t be any dusty hay but if anything is remotely dustier than I’m comfortable with, put it aside and he’ll swap it out. So far the hay is gorgeous, and I’ve also swapped out bad bales, but it’s nice that any amount of dust is OK to swap now too.

[Pehsness]

Well… good you have a steamer at least?? Sorry, that sucks that it isn’t a simple solution.

I haven’t done the allergy testing either but wish I could. I know that is the problem for my guy (and it extends to his eyes as well) so we just muddle along and mitigate as best as possible.

[pompeiii]

Just thought I’d post an update.

We’ve been using the nebulizer now for a couple of weeks and it’s wonderful. I have the pony mask now and it’s made a huge difference. I’ve been using the Colloidal Silver though my vet suggested we try the Eucalyptus Colloidal Silver so I’ll order that. I have the winner’s choice nebulizing solution as well but, for whatever reason, he’s less of a fan of that one. We’re also going to add liquid albuterol to his nebulizing routine because he’s pretty much over everything else.

I will say, he’s doing decently. He’s breathing harder than I’d like but isn’t distressed like before. Slow and steady progress?

On a different note (I could create a new topic) he’s lost a ton of weight that he didn’t need to lose between his IR and cushing’s management (he was always the perfect weight). Between the Prascend and the Ertugliflozin, he definitely doesn’t have the biggest appetite. At least a big enough appetite to make him inhale his soaked hay that he hates. He eats it, most of the time, but leaves some of it so upping his hay isn’t an option. Going into winter, I likely will need to add more calories which is a scary prospect. I just need to find the safest way to do this. Right now he’s still cleaning up his soaked cubes so at least there is that!

Excuse the mess in the photo… Someone managed to knock over the entire wheelbarrow outside the barn and hadn’t properly cleaned up yet…

[pompeiii]

I figured I’d just use the same thread and continue to chronicle the disaster that is my mini rather than start a new thread.

His heaves is sort of under control. It is better than before. Managed enough.

If I sound super optimistic right now? Yeah.

Here’s an overview/recap because I can’t remember what I’ve covered. Rough timeline (everything is mid month)

August he was diagnosed with Cushing’s. Insulin levels were high but we elected to just treat the Cushing’s initially and soak hay with plans to retest to see if insulin levels improved. Heaves flareup that was treated with equihaler.

September - Insulin levels were sky high (but ACTH levels massively improved). Vet put him on ertugliflozin. Retest in a month. Added in ventipulmin. And nebulizer (with Colloidal Silver and albuterol as needed)

October - Retested. Lungs started to sound better (upped ventipulmin which made the most difference). Nebulize occasionally. Discontinued all inhalers and allergy meds.

November - Insulin levels still sky high but improved slightly (results were delayed from October test-- long story). Added pioglitazone. We’ll test in 3 weeks.

At this point, I feel like giving up. He gets a tiny amount of soaked hay and hay cubes/soaked fibre beet (if you’re not familiar with fibre beet, it’s very low NSC and a beet pulp/hay pellet feed that is 8% ish NSC and is considered safe for laminitis prone horses – he gets 2 cups/day). He has no weight to lose. We’re building him a run on Saturday so I can ensure he gets just what he needs (he’s dry lotted anyway) and my TB can have unlimited hay. My vet mentioned we can consider moving him to just cubes if necessary (he’s a mini, he doesn’t actually eat that much), but the run gives us options.

Anyway, I just am frustrated and ready to give up. There’s more, but this is where I’m at and comfortable sharing today.

[cayuse]

I have a metabolic pony who is 27. He’s on Metformin and Insulin Wise, soaked hay. Still has high Insulin levels. My mini was also on the above regime and his levels were elevated so we started him on steglatro 2 weeks ago, he’ll have bloodwork monday. It’s a battle and I sympathize with you.

About the nebulizer, I did get one like yours for my mini with the sinus issues. I used it 3 weeks with the colloidal silver and he then had his scheduled scope/xrays to check on his infected sinus (very long story, extensive history with him) and the last of the infection was gone! Not sure if it was the neb that got him over the last hump or not, but gut says it helped.

Hang in there with your little one. Sending jingles!

[IPEsq]

Is the ertugliflozin you are using a compounded paste? I’ve read some people are not getting results with that. If that is the case, you could try switching to the human medicine or the related pill canagliflozin and see if that can bring the insulin down. The drugs also don’t work as well if Cushings is out of control, but it sounds like yours is doing better as far as Cushings management.

[pompeiii]

It is the compounded paste. I’ll keep this in mind and ask my vet when we do the next blood draw. Obviously we shouldn’t change anything until then so we know if the pioglitazone is making a difference. But this is something to consider. The paste is a pain to deal with as I have to use a syringe to pull from the large tube due to his size. And it’s not like the ertugliflozin hasn’t helped, it’s brought his numbers down significantly (Cut in half almost), they just were so dangerously crazy high. Now they’re just dangerously high? Ugh.

His Cushing’s is controlled (numbers in normal range) with the half tab of prascend so at least there is that?

[Pico_Banana]

I don’t have anything to add but just wanted to send you some virtual support. Sometimes it can be exhausting and close to heartbreaking to deal with all of this stuff. Big hugs.

[pompeiii]

Just finishing out this thread. We said goodbye to our boy today. He was in too much pain and likely foundered again. It didn’t seem to matter what we did. So, we spent about an hour stuffing him with all the things he never got to eat, gave him lots of hugs and a good grooming (which he loved) and said goodbye.

His emotional TB is still calling on and off but I’m sure will settle eventually. I hate this.

Be free Jiminy. Be free.

[Kyrabee]

{{{{Pompeiii}}}}

[trubandloki]

So sorry for your loss!

[endlessclimb]

I’m so sorry for your loss. What a cutie he was, and you guys did everything you could.

[ThreeWishes]

Huge hugs. I’m so sorry. Rest easy sweet Jiminy.

[PaddockWood]

Jiminy was loved. I’m so sorry. (HUG)

[MorganSercu]

You gave it your all and when it was too much for him, you released him. That was the ultimate act of love.

[luvmyhackney]

So so sorry for your loss. You did right by him.

[BrownDerby]

You left no stone unturned. Your little guy is at peace now.

[glitterless]

So sorry that you lost your boy. He was so lucky to have you. Hugs to you and his TB friend.

[SLW]

((Hugs)) on the passing of your sweet Jimmy. I’m so sorry.

[quietann]

Thank you for doing right by him, poor fellow. It’s heartbreaking.