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Discussion on Possible Cushings - test and medicate or manage?
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Member:
kaarina
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Posted on Monday, Jun 15, 2009 - 6:17 am:
Hi all,
My 18yo arab mare (whose founder last year has been discussed quite a bit on these boards) has just been seen by another vet and in her opinion my mare is a classic case of quite advanced cushings. She thought it likely my original vet had never come across a case like this (he rejected cushings when I asked because my mare is thin not fat and instead put her on thyroid medication). She pointed to the severe unexplained founder last year, excessive urination, inability to keep weight, cresty neck despite being ribby, and her lack of complete shedding this year as symptoms and is currently putting numbers together to do proper testing and treatment. She is concerned however, because the cost of peroglide where I am is apparently astronomical and the mare seems to have responded extremely well to the changes in management we made this year. A little bit of, if it ain't broke why fix it. The mare is 18 now and (knock wood knock wood knock wood) doing well. She is sound as can be despite founder with huge rotation last year (I could see the bone through the sole on her left fore when we first started treatment), jolly and affectionate, and seems without pain. The only evidence is her strange neck and thin body (though the new vet told me her weight is bang on for her conditions and to keep her right there). I am therefore terrified to make any changes to anything in her care.
I would like some opinions from folks with experience and DrO regarding continuing to manage without medication other than the levothyroxine (which I am now wondering if she needs but scared to remove) - assuming the tests are positive and she is advanced cushings - if I continue on the path I'm on instead of medicating, am I pretty much guaranteeing another laminitic incident? I was told I could wait for symptoms to worsen and for management to stop working but I'm worried that means waiting until another founder incident and frankly I'm not sure she would survive another bout that serious. I will obviously be discussing further with the vet but some additional outside opinions or experiences would be very much appreciated.
Thank you!
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Member:
scooter
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Posted on Monday, Jun 15, 2009 - 7:12 am:
Hi Tamara, glad your mare is doing better
My arab gelding also started showing signs of cushings about 6 yrs. ago he too was 18 yo. I am still managing him with diet. He did founder the first year it became apparent he was cushings. I have to be very careful with his diet, exercise seems to help him too.
At this point I clip him in the spring, and watch for any signs of "footiness" he did start to founder this year when I gave him some hay with alfalfa in it. He has to be closely monitored in the spring and fall he gets "weird acting" I don't know if it is caused by the grass or because cushings horses have a hard time at that time of year.
Dr.O. can give you better advice about the pergolide. I am just giving you my experience. Along the cushings journey with Sam I have found out through experience and careful monitoring what he can and can not handle. If he even starts walking a little slower on hard ground my management immediately changes, I have been able to avoid another bout of founder that way.
He can not tolerate clover, alfalfa, spring/fall grass. I believe he is IR too tho so that might make a difference. He has the weird body too, when ribby, his crest remains and so do the strange fat lumps. My vet said as long as he is manageable without pergolide there is no sense in giving it...so far so good...but every horse is different!!!!
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Moderator:
DrO
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Posted on Monday, Jun 15, 2009 - 8:32 am:
Hello tamara,
You answer your own questions in your post so I will pose the following questions to you as the best way to illustrate this:
1) If your horse is classic for Cushings: why do you need a test to say she has Cushings?
2) If weight loss is a problem why do you continue a medication which increases metabolic rate (the thyroid medication) and therefore exacerbates the thinness and for a disease (hypothyroidism) that basically does not exist in older horses. The article on Hypothyroidism explains more on this.
3) If the disease can be well managed without medication why do you feel the need to add medication?
Remember this is a progressive problem so any decision you make on management or treatment may need modification in the future.
DrO
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Member:
kaarina
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Posted on Monday, Jun 15, 2009 - 9:26 am:
Diane - thanks for the experience, that is very helpful and encouraging.
DrO - Thanks very much for the response. It is all about affirmation I think. I want to do the best thing for the horse and it feels strange these days to NOT use the medication everyone prescribes!
Vet 2 said the same thing on the test, she would only test if I want to medicate to confirm her suspicions.
The levothyroxine is a big, BIG question mark for me. Vet 1 told me that if I take her off I am asking for another founder but, as you remarked, this medication seems highly counter productive in the weight battle. I will review the Hypothyroidism article as well.
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Member:
erika
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Posted on Monday, Jun 15, 2009 - 11:13 am:
Tamara, if you eventually decide to use Pergolide, I have a pharmacy that send it to me by mail. My vet phones in the prescript. I and other people that I have recommended them to have found them very reasonable. You can call and ask for a price quote.
Todd's Harvard Park pharmacy 303 733-3755.
They are located in Denver.
Erika
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Member:
kaarina
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Posted on Tuesday, Jun 16, 2009 - 9:48 am:
Thank you Erika, anything is cheaper than Quebec I think. And I had always heard prescription drugs are cheap in Canada!
DrO - with regard to the Levothyroxine, do you see any danger, in your opinion, with taking her to a half dose at this point. The article makes it seem like retesting to decide this is fairly worthless, though my original vet based his prescription on her levels during her last founder (when she was on Bute) which indicated levels of near 0.
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Moderator:
DrO
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Posted on Wednesday, Jun 17, 2009 - 8:26 am:
Hello tamara,
The article Treatments and Medications for Horses » Miscellaneous Drugs » Levothroxine gives a regimen that has worked in some cases. However you should discuss this with your veterinarian to determine the amount and how safe this might be for your horse.
DrO
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