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Discussion on Boosting immunity in Cushings horses?
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New Member:
micki
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Posted on Friday, Apr 3, 2009 - 1:05 pm:
Is there some way to boost immunities in a Cushings horse? I have a 34-year old Cushings mare who has always received regular vaccinations, worming, etc. However, she's become more prone to infections over the past three years. Aside from treating the infections, is there anything additional we can do to boost her immune system?
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Member:
pattyb
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Posted on Friday, Apr 3, 2009 - 8:08 pm:
Hi Michelle....and welcome.
I'm sure DrO can give you a more detailed answer but I wanted to add that when my now deceased (33) Arab/Saddlebred cross was diagnosed with Cushing's at the age of 27, she went immediately onto Pergolide with chromium added. I never had any problems with her being sickly, either before or after, but I did noticed that she stopped having hoof abscesses from that point on. She went from two a year after the age of 23ish, then none after she went on meds.
I don't know if that helps any but I wanted to share it with you just in case.
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Moderator:
DrO
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Posted on Friday, Apr 3, 2009 - 8:18 pm:
Welcome Michelle,
As Patty says Pergolide is the answer for serious complications that are secondary to Cushings, check out the article for more. However it would also be important to evaluate how or why these infections are penetrating the horn, often there are preventible causes that if not addressed all the immune boosting in the world will not help. For more on this see Diseases of Horses » Lameness » Diseases of the Hoof » Hoof Abscesses, Bruises, and Gravels.
DrO
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New Member:
micki
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Posted on Saturday, Apr 4, 2009 - 12:35 pm:
Thanks to both of you. Pergolide doesn't work for Tawnee. Her appetite completely DrOps off -regardless of the dose - to the point she was starving herself. We finally transitioned her off Pergolide and onto Evitex and she does much better on that - sheds, eats (!) and doesn't get depressed. We wish we could use the pergolide, but...
The infections haven't been hoof infections, but rather mammary gland and skin. I noticed in several postings and in the articles that often times horses with Cushings are deficient in immunities. So, I wondered if there were other supplements (Chromium perhaps?) that would help her?
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Member:
3chip
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Posted on Saturday, Apr 4, 2009 - 1:59 pm:
I am curious about your mare. How did you determine that she has Cushings? Was she tested properly (ACTH)? Or did her long coat convince someone she has Cushings?
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Member:
erika
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Posted on Saturday, Apr 4, 2009 - 8:09 pm:
Micki, I just read an article today in Equus about vitamin E deficiency causing slow-healing wounds and frequent infections. In fact a lot of the symptoms sounded to me to be similar to Cushings.
You might ask your vet, or our own Dr. O, about the possibility. Just a thought.
Erika
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New Member:
micki
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Posted on Saturday, Apr 4, 2009 - 10:09 pm:
Thanks 3chip and Erika L. I'll talk w/our vet about vitamin E. We tested Tawnee for cushings and she was diagnosed w/having it. 
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Moderator:
DrO
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Posted on Sunday, Apr 5, 2009 - 9:26 am:
3chip you should note that there are no tests for Cushings that give results that are as reliable as clinical symptoms, see the article for an explanation of this.
Concerning nutritional management, we have specific vitamin E recommendations in the article. Follow the link in the article for product and dosage recommendations. The article also discusses chromium and its use in Cushings.
Besides pergolide there are a few other medications discussed in the article that have helped some but it may be best to deal with the specific problems: what type skin and mammary infections have you had?
DrO
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Member:
3chip
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Posted on Sunday, Apr 5, 2009 - 10:41 pm:
Well, I believe this issue is still under a lot of study. The reliability of clinical symptoms is indeed a key factor in determining if a horse is possibly suffering from Cushings. I have never owned a horse that suffered from PPID but I have read extensively about it. As you know, pergolide use in humans was outlawed because of its side effects. (Heart Valve problems). Its counterpart is hardly effective. After outlawing the sale of pergolide in humans the FDA permitted the compounding of pergolide as a special use granted to veterinarians. I just have an uneasy feeling about the use of pergolide, especially its indiscriminate use which seems to occur more and more often without establishing a definite need. I agree, clinical signs are very, very important in diagnosing cushings but were I treated to all the clinical signs I would still opt for a final diagnostic procedure, endocrinological testing.
In 1999, Messner published some guidelines about how to diagnose PPID. Diagnosis should be based on clinical signs and dynamic endocrinological testing. The main clinical sign is hirsutism (extremely long hair coat which is not shed) among others like lethargy and decreased performance, dental abnormalities, deposition of fat (along the neck, over the tail head, above or behind the eyes (Pic.2)), infertility, loss of muscles in the back and in the hindquarters and chronic laminitis and infections (McGowan 2005; Schott 2006). According to Messner (1999), females are more affected by hirsutism; but again no research is done yet to back this thesis up.
Just my opinion expressed here. There is a lot of research going on right now that should shed some more light on these issues.
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Moderator:
DrO
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Posted on Monday, Apr 6, 2009 - 8:38 am:
Hello 3chip,
as this is the most common disease condition seen in older horses I have seen cared for what must be around several hundred PPID horses over the last 2 and a half decades and care for many at this time now.
It is widely accepted now that the early (including 99) Cushings research overestimated both the sensitivity and specificity of the tests for PPID and did not recognize the seasonal variation effect on response. This is why testing became so wide spread. At the 2008 AAEP meeting just 3 months ago an equine endocrinologist concedes clinical symptoms remain the best diagnostic tool. As you say research goes on but remember our articles are constantly edited to contain all the latest published information and we review hundreds of journal entries every week. Certainly the newest test Domperidone Response Test, just published 3 months ago holds promise as a test but requires further testing. You can read about the procedure in the article.
DrO
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Member:
erika
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Posted on Monday, Apr 6, 2009 - 11:03 am:
Micki, first of all, sorry if this is becoming a hijack of your thread, but this is very much of interest to me as my mare, Sugar, has PPID and is on Pergolide.
3chip, I understand your concern that so many horses are diagnosed, that weren't in years past. One thing that pops to mind is that the horse population in the US is aging. Many horses are living much longer than they used to in the past, thanks to good nutrition, worming, and medical care. I think, like Alzheimer's in humans, as a population ages there will be more individuals suffering from geriatric diseases.
I agree that there may be some horses treated that are falsely believed to have Cushings, but I doubt that Pergolide is the worst of the two evils for a horse that does have it. IMHO, even if there is a small possibility of heart valve damage, quality of life--at least in Sugar's case--is a more important factor. Sugar acts like a horse with zest for life again. She looks and acts much better since we treated.
Dr. O, we did the Domperidone test on Sugar to back up the clinical diagnosis. I understand the seasonal variation of the hormone. Therefore I wonder whether it may be a possibility that the Pergolide dose optimally would also fluctuate seasonally? I realize there may not be research on this yet, but it kind of makes sense to hypothesize, doesn't it? Do you think that in the future there is a good possibility of that being the common recommendation?
Erika
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Moderator:
DrO
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Posted on Tuesday, Apr 7, 2009 - 8:23 am:
It is an interesting thought Erika. Clinically I don't see, nor have I read, of a variation in symptoms or response to treatment that waxes and wanes with the seasons with the possible exception of founder. Currently we attribute this to the seasonal changes of nonstructural carbohydrates (NSC's) in the pasture.
DrO
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