Cushings bloods results - A WWYD?

TwyfordM

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So mysti has been on the bova paste for about 5 months now, 1ml a day was tested again and bringing her levels down to normal range during the seasonal rise. All good. Vets happy. No symptoms nor reaction to meds. Win win scenario.

Had bloods taken yesterday when I wasn’t present, told by yard staff who assisted vet that vet was absolutely useless. Broke 10 needles and caused a huge amount of unnecessary stress to everyone involved (you get one chance with this horse, after that she fights - this is on her record) while I appreciate that the vet persevered. Had I been present. Vet wouldn’t have had a second chance. I’m doubtful we will actually be able to get bloods at all next time ? so this has potentially caused me a huge issue. Neck was red and covered in blood by the end of it.

Just had a phone call from the vet with results, she’s at 40.
Last results were 33. No stress caused during that blood test as vet heeded advice and didn’t faff, boom needle in before even saying hello. Done. As far as I know (I’ve been told on previous times that she’s fought vet -) stress can elevate the ACTH level.

Vet has said to put her on 3.5mls. No advice on gradual increase, no asking about how she’s been in herself/any symptoms. She wasn’t even going to tell me the results until I asked. She said she’s in the grey area between 30-50 not a positive result but not a normal result either.

Looking up the cut off for levels on months, she’s barely above the high as we’re only halfway through November end it isn’t an instant cut off on the 31st of Oct according to the studies I’ve read.

I’m really not happy with how the vet acted on the appointment (yard staff and mum who know pony well present as I couldn’t be) yard staff who see lots of vets and horses, not happy and told me under no uncertain terms not to allow this vet near madam again. Or the treatment plan moving forwards, will be calling vets tomorrow to ask for second opinion from resident cushings expert. Who is the reason she’s on the paste (half a tablet too high for her, 3.5mls is the equivalent of half a tablet)

I do my research, so I’m aware that results are slightly too high. But not dangerously high. Had vet suggested moving forwards to 2mls slowly I may have just given it a go but the attitude that says to me she has definitely not read my horses notes (I have full copy for insurance reasons) is a red flag for me. She also wants to retest in 6 weeks. All other retests with dosage adjustments have been after three weeks?

Honestly baffled about the whole situation ? and dreading the fact that we had just got her to the point where twitching, headlock and 4 people were no longer required for bloods .. just a walk in and boom needle in before she’s noticed was all that was required. The retest is going to be near on impossible and I’ve worked so flipping hard to find a way that works for her ?

I know vets mess up - it happens, animals will be animals. But I feel like this is a massive balls up, that if I just blindly follow, I’m going to live to regret it.

I was upset that she had been stressed yesterday but accepted that I just wouldn’t use the vet again. After phone call today I’m really questioning the treatment plan.
 

Gloi

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We are getting past the peak so I'd keep her on the current dose or up it by 0.5 ml , monitor any symptoms and if none noticed test her again next year. If there are changes try and test earlier.
 

MuddyMonster

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I wouldn't up the dose either. I'd be having a chat with another, more senior vet at the surgery too.

But (and I appreciate this may not be a popular opinion) I would also work with an fully qualified equine behaviourist between now & then to overcome the needle phobia or dislike. I appreciate she does sound opinionated but there's so much more that can be done (desensitisation, positive reinforcement etc) instead of twitching and headlocking or pinning down to make it a nicer experience for her & get a more accurate result. But if she had blood everywhere and ten broken needles, I'd be getting professional help at this stage rather than trying to fix it alone.

The blood tests aren't going to get any less frequent and it won't be nice for her, either.
 

fankino04

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I wouldn't change her dose either I would go by the horse in front of me, if they are doing well on the current dose then why change it. Many years ago my dog was diagnosed with an underactive thyroid, the bet medicated her according to her "numbers" and she ended up with a dose too high, I took her back for her check up and told him I thought it was too high, he redid the bloods and said her numbers were still too low and wanted her on a higher dose, she ended up with a heart condition and we lost her a month later.
 

View

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But (and I appreciate this may not be a popular opinion) I would also work with an fully qualified equine behaviourist between now & then to overcome the needle phobia or dislike. I appreciate she does sound opinionated but there's so much more that can be done (desensitisation, positive reinforcement etc) instead of twitching and headlocking or pinning down to make it a nicer experience for her & get a more accurate result. But if she had blood everywhere and ten broken needles, I'd be getting professional help at this stage rather than trying to fix it alone.
.

I agree that help is now needed to repair the damage done by this particular vet.

BUT the OP had already done enough work that the twitch, headlock and 4 people was no longer needed.

OP, trust your instincts.
 

MuddyMonster

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I agree that help is now needed to repair the damage done by this particular vet.

BUT the OP had already done enough work that the twitch, headlock and 4 people was no longer needed.

OP, trust your instincts.

Yes, sorry I may have worded my first post badly - I appreciate they didn't need to do that anymore, but given her history & the recent events, it would probably be in everyone's best interests to help her overcome her latest trauma.
 
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SEL

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I have had to ask the practice not to send me a particular vet because her injection technique is brutal. I'd worked long and hard clicker training my draft and I had to twitch him for her. When I had to twitch the easy pony I knew she was never coming back. Your mare may be ok with a different vet. I warned the new vet my draft was difficult but I clicked once and he stood like a rock - so thankfully the training wasn't undone by one person
 

Tiddlypom

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10 broken needles ?!!

ACTH levels shoot up when a horse is under stress, so that result is pretty low, actually, but in any event can be completely discounted. The vet should have stopped trying much earlier on, especially as the result was always going to be useless once the pony got so upset.

ACTH results are now compared to a daily reference range, rather than weekly or monthly levels, which is much better
 

meleeka

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I’d keep the dose the same. I think symptoms are far more important than the numbers. I’ve both increased and decreased the dose without the opinion of my vet based solely on symptoms and how my mare was.

I’d probably just make a point of not having that vet again. The last vet I had asked for some treats and used them sparingly, but very well timed to make friends with my scatty pony. A different vet came yesterday and the work the previous vet had put in was still evident. The pony was calm and the blood was taken quickly with no fuss. Levels were fine, as I thought they would be.
 

TwyfordM

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How did they break the needles?! I’ve never accidentally broken even 1! Bent maybe, but not broken!

Honestly, not a clue ? She has a habit of rearing just as you get the needle in, just got told she “broke” 10 needles, may well have just bent, who knows! Tried to get answer out of vet tonight and got nowhere..
 

Mary3050

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I would also keep the dose the same or up ever so slightly if she got symptoms. Also maybe get a different vet or speak to a more senior vet . As I would be telling them to repeat it for free since they caused stress and may have effected the results
 

NinjaPony

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Similar results to mine, discussed with the vets and I’m keeping him on half a tablet of prascend a day and monitoring him for symptoms. I’ll test again early next year and see how we go, any worries and I’ll put him on half 1 day followed by a whole the next day and then retest. He is also a total pain with bloods and needles so that’s my worst nightmare - definitely wouldn’t be using those vets again!! Mine took two tries as he went up when the first needle went in despite me holding him as firmly as possible but second time we managed it…. Distressing to hear about it second hand too. So I’d keep doing what you are doing and watch closely for pulses, filled eye sockets and excess thirst.
 

TwyfordM

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Sent vets an email as easier to explain full situation and they’ve acknowledged it and said they’ll be investigating. I’m waiting to hear back before even considering changing dosage.

They are a pretty large practice of vets I have full trust in usually, this is the exception to the rule unfortunately. I’ve said under no uncertain terms this vet will not be treating her again, it may well be down to inexperience or just a bad day, but I’m not risking it happening again.
 

Boulty

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Would tell that particular vet to F off! That's really not that big a rise esp as they majorly stressed her out taking the blood. Would discuss with the vet at the practice who actually knows her & listens to you but gut feeling would be to leave dose as is if symptoms all under control & recheck in a few months (or try her on 1.5ml if after discussion it's decided that there's any subtle little signs you'd like to try & improve or if her bloods have been slowly creeping up)


I feel your pain as the orange one was very much a 1st stab or not at all horse & he also ran into a slightly useless vet who persevered & was a lot worse afterwards... I started requesting the male vets as they were better at being sneaky & speedy with no faffing! I also had a few battles about dosages with him as he used to go zombified if we got it wrong & was awful for stopping eating
 

TwyfordM

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So the vet that knows his stuff about ACTH/cushings and metabolic issues is having a look into it ?? He pretty much mirrored what I thought, which is a relief. Having a chat on Monday to see where we go from here.
Madams still a bit uptight about neck being touched and we are back to the turning her backside on anyone entering the stable other than me (not ideal when you really need the help) ??‍♀️ But she’s fine in herself, going out for nearly full days now no symptoms whatsoever which is fantastic when you consider in June I honestly thought we wouldn’t be able to go out for longer than a few hours or on no grass turnout.
 

TwyfordM

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Spoken to vet, he agrees best course of action is to stick with current dose and monitor closely her symptoms and behaviour etc. Getting farrier to keep an eye for any hoof changes too. He’s not particularly concerned if she’s happy in herself and I’m not noticing anything alarming

Glad I trusted my gut, the option is there to slightly increase dose if I notice anything moving forwards but he’s happy to retest in 6months to a year ?
 
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