|
|
Discussion on Differential diagnosis of possibly cushingoid horse
|
| Author |
Message |
Member:
klowe
|
Posted on Monday, Aug 18, 2008 - 4:04 pm:
My 17ish horse, Paint, has been given a diagnosis of Equine Cushingoid SynDrOme by a new vet. My original vet, Vet #1, is a neighbor who is retired, no longer has much equipment and doesn't do emergencies etc. I trust him absolutely. He did mention the possibility of pituitary dysfunction when he first saw Paint, due to his furry coat, but didn't suggest any treatment.
The new vet, Vet #2, I called mainly because I had heard she had a portable x-ray, and I wanted X-rays to confirm the ringbone diagnosis of Vet #1 and to have baseline x-rays.
Vet #2 (whom I admit I didn't particularly like and therefore have trouble trusting, although that doesn't mean she isn't competent) made the rather offhand diagnosis of equine cushingoid synDrOme. This appears to be on the basis of his coat, which is indeed rather long and which doesn't shed completely, and on palpating his sheath. She recommended the new, pricey Purina Wellsolve low sugar/low starch feed in place of alfalfa pellets. He gets free choice grass hay. She gave me a Pergolide rx only because I requested it.
After this, the more I thought about it, the harder time I had with just beginning medications without some confirmation. Being a medical technologist (needing some hard, scientific evidence), and being lucky enough to have a boss who likes horses and gave the go-ahead, I decided that at least some basic bloodwork was in order.
Paint's CBCD and chemistry panels, for which we do have equine normal ranges, were unremarkable. His glucose was 88 (72-114 mg/dL range). His thyroid function tests, on the other hand, were profoundly abnormal:
Free T4 = 0.600 mg/dL (3.0-9.0)
TSH = 0.005 uIU/mL (2.3-4.5)
Total T4 = 1.38 ug/dL (2.5-4.5)
Total T3 = <40.0 ng/dL (30-115)
I also ran cortisol and insulin tests even though we have no equine ranges for them...my thoughts were that at least I would have a baseline for comparison. If he were human, his results would be in the normal ranges...cortisol, 2.98 ug/dL (a.m) and insulin, 4.93 uIU/mL.
His body condition score is around 5-6. He doesn't have obvious neck or tail fat deposits. He appears very high- withered and quite swaybacked, which I have read elsewhere may be a result of loss of muscle fiber due to equine cushingoid synDrOme. His coat is indeed long and doesn't ever shed out completely, although it doesn't look like the published pictures I have seen of the long, wavy cushingoid horse coats.
Just to round out the picture, the x-rays confirmed intra- and periarticular arthritis of the RF pastern, with the good news being there is 1 degree or less of rotation in both front hooves. However, his front hooves appear to be growing extremely slowly. After 12 weeks the farrier felt she couldn't trim them without causing soreness.
To ask my actual question, are these test results/symptoms sufficient reason for a trial of Pergolide? I have read elsewhere on this site that true hypothyroidism is very rare in horses. At what point would repeat bloodwork be indicated?
I love this boy to pieces and want to take care of him as best as I can, but I am rather at the financial limit at this point in terms of anything I can't do myself, barring true emergencies. Guess I'm going to learn some horse phlebotomy...
Any advice would be much appreciated.
Thanks, Kathy
|
Member:
scooter
|
Posted on Monday, Aug 18, 2008 - 4:44 pm:
Hi Kathy, my arab gelding Sam is the same way, he hasn't completely shed in 6 years, his coat doesn't appear to be the "typical cushings" either. It gets very long, but it is shiny and healthy, he sheds like crazy, then just stops! Before it gets to hot I shave the rest.
I had blood tests done on him also, everything was WNL except his glucose was just a tiny tiny bit elevated. The vet said he thought he was probably a cushings horse, he has foundered once with slight rotation, but that was because I let him get too fat. He has had some weird changes with his body....BUT he is energetic, healthy, and very happy.
Being a concerned owner I asked the vet about starting pergolide. He said if I wanted to spend the money fine, but what did I think I was treating??? Really there is nothing wrong with him other than a few body changes, and I have to clip him once a year...big deal.
Well when the vet put it that way, I thought , he's right! Sam is still doing fine after 6 years, he is around 22 years old now and feisty as ever. The vet did say to watch his diet, so he and the old mare, both are on pretty strict diets with Hank. Sam did get a little thin last winter, but beet pulp took care of that.
So after that book, my question is exactly what do you want to treat with the pergolide? Does he have problems other than the non-shedding and ringbone?
|
Member:
kshayden
|
Posted on Monday, Aug 18, 2008 - 7:39 pm:
Pergolide can be purchased very reasonably via the internet. I got my last batch for $ 135.00 for a 6 mth supply. For all you ever wanted to know about IR and Cushings - there is a yahoo support group.
Kathy
|
Moderator:
DrO
|
Posted on Tuesday, Aug 19, 2008 - 10:09 am:
Hello Kathy,
In my opinion no the tests are not. The article explains a reasonable straightforward indication for medication.
DrO
|
Member:
klowe
|
Posted on Tuesday, Aug 19, 2008 - 1:10 pm:
Ok, you all have addressed some of my confusion.
Vet #2 seemed to think that sometimes ringbone responds well to attacking the metabolic problem. I thought at the time that she was possibly lumping the cushingoid synDrOme with EPMS, but of course there is a part of me that wants to believe that there was something I can do for his lameness ...He is on naprosyn for that, which seems to work better for him than bute on a once per day (or every other day if he's doing well) dosing schedule. Vet #1 felt this is all right...said we shouldn't argue with success.
His rate of hoof growth seems to have slowed dramatically over the past year. Last year, up until October, he was trimmed every 8-10 weeks without ever having been sore. I switched farriers after the April trim this year, because the 1st had no time to talk to me about his hooves/ringbone. He was trimmed in mid-June and was very lame thereafter, though I like the 2nd farrier a lot, and at the end of July his front hooves were still too short to be trimmed again.
Other than the shagginess and the high-withered, swaybacked conformation, Paint is not having any other problems that I can connect to being cushingoid. Both my horses have free run of the property, and I can watch them from all my windows...something I spend a lot of time doing. He doesn't appear to drink or urinate more than the other horse, who has DJD in one knee but is otherwise healthy. He does sweat more, but it appears to me primarily related to the black areas of his coat which absorb more heat (in our hot climate with not a lot of shade); sometimes he sweats in a line where black meets white. He doesn't sweat all over.
The only other problem we've had is an episode of possible photosensitivity earlier this year. He suddenly got very itchy and rubbed some of his white spots so badly he started to get bald patches and huge sores. Vet #2 called it photosensivity, at any rate. I have been keeping him covered as much as I can and he seems fine...liver function tests were completely normal. (I am ashamed to admit there are vast numbers of poisonous weeds in the yard; if I killed them all I would have mostly dirt.) I watched them both carefully the first year, and they seem to leave them alone. He is generally an itchy horse, very disturbed by flies, gnats and mosquitos.
So, Dr. O, you don't think the grossly abnormal thyroid function tests warrant any further concern at this point?
If not, my plan is to continue to give him his joint supplements, naprosyn and biotin (to see if it helps the slow-growing hooves). As I said earlier, he gets pretty much free choice good-quality grass hay and 4-6 lbs of alfalfa pellets w/supplements etc. And obviously I need to find a vet who isn't retired whom I like and trust.
Anyone need a month's supply of (obviously too expensive, given what you paid, Kathy!) from SmartPak? I ordered it and then started having 2nd and 3rd thoughts, thus the bloodwork and all my questions...I could trade for some clippers!
This site is wonderful, thank you all for your time and thoughts. Better to have spent money once unnecessarily than to keep doing it and to give this guy meds he doesn't need.
Kathy
|
Moderator:
DrO
|
Posted on Wednesday, Aug 20, 2008 - 6:14 am:
Kathy, lets first address the osteoarthritis of the pastern joint. It is not going to be responsive to treating a potential Cushings horse for more on ringbone see Diseases of Horses » Lameness » Diseases of the Lower Limb » Ringbone.
The accuracy of your labs results remain unknown as they do not have equine normals. However even if accurate the significance becomes a problem. It is known you cannot measure equine thyroid function this way, for more on this see Diseases of Horses » Endocrine System » Hypothyroidism in Adult Equines.
In general the grass alfalfa mix hay is a diet hard to beat and the most significant statement in your post are the references to his good overall condition and that he feels well. We would recommend you include methionine in the hoof supplement, for dosages see Diseases of Horses » Lameness » Diseases of the Hoof » Wall Cracks and Thin Sensitive Soles.
DrO
|
Member:
klowe
|
Posted on Wednesday, Aug 20, 2008 - 12:51 pm:
Dr O, sorry if I wasn't clear, my lab does have equine normals for all of the chemistry panels, the CBCD and the thyroid function tests, which I included in the parentheses. The only equine normals we don't have were for the cortisol and insulin results, which I ran because I thought at least if I ever needed to do it again, I would have a baseline...
I have read the ringbone article many times. I think I just succumbed to wishful thinking due to Vet #2's offhand remark...
I will however, read the thyroid article again. As people have often noted, when it is your horse, it can be hard to absorb all the information! I believe my hoof supplement does contain methionine and a couple other things, I read the hoof articles when choosing it, but I will check again.
And as everyone has pointed out, if Paint looks good and feels as good as possible, then I must be doing some things right...partly due to this website. Thanks for the support and input.
Kathy
|
|
|
