Cushings dilemma - what to do?

[LeneHorse]

My 18 year old horse has had cushings for 4 years. She got her 6 monthly blood test at the start of March and it came back slightly raised (39 when <29 is normal for this time of year)so we upped her prascend from 1.5 tablets to 2 tablets. She was re-tested this week and it came back at 41. I have not yet discussed this with vet but I expect the options will be either to up the dose immediately to 2.5 tablets, or leave a couple of weeks and re-test. She looks well in herself and has lost most of her winter coat, does not have fat pads over her eyes and feet *seem* ok (I hate to write this down in case I am tempting fate).

I can't decide what to do - I would like to leave and re-test as she only recently got her dose increased but on the other hand the spring grass is coming through and all I can think about is laminitis

She is currently in at night on hay and out during the day. Normally around end of April I change this to in during the day and out at night.

Has anyone else had this dilemma? What would you do?
Deep down I am worried this may be the beginning of the end.

 

[JillA]

The ACTH test, if that is what she had, is notoriously unreliable. Levels can be raised by stress, and it pulses to you can get false negatives or positives. If there are no other symptoms, I wouldn't worry, maybe do another test in mid summer when the seasonal rise is just getting going and meanwhile watch her like a hawk for any footiness.

 

[paddy555]

I think it is very easy to play the numbers game with cushings. I don't as it didn't work for me. I didn't find the test results to be at all accurate. Mine tested at 17. I didn't believe this and retested a short while later and it was 11. The only problem was that I had a horse who was very seriously ill with every single symptom of cushings. So I am somewhat sceptical of the test results. I work on the symptoms. Mine went onto prascend, it dealt with the symptoms and he has stayed on a low dose for 4 years. I cannot see the point in increasing the dose as all the symptoms are under control.

As for laminitis I have one old laminitic mare. She cannot be tested but is on prascend. I dont find the prascend controls laminitis particularly. I find the only way to control it is vigilance and grass control/removal. So if your grass is coming through and you are worried about laminitis I would work out a way to restrict or remove from grass. I think that would be far more effective than increasing the prascend based on my own experiences.

 

[splashgirl45]

my mare was diagnosed in 2011 with levels of 172, so started on 1 prascend. over the next 5 years her levels gradually increased until she was finally on 4 tablets a day. unfortunately i had to make that decision in september as liphook didnt feel it was in her best interests to increase the dose any more, she became a bit footy so that made me decide to end it there and then as i didnt want her to go through full blown laminitis. i would just advise you to take notice of your horse's condition in conjunction with the test results and make your decisions re tablets and management based on the combination of both..i wasnt prepared to restrict my horses way of life so kept her turned out as normal while being careful with other feed. my view was that a shorter happier life was better than being kept in a stable or being muzzled ...i know other people will disagree but quality of life is paramount IMO..good luck with yours

 

[ester]

If she's only that much over and seems ok in herself I would probably treat to symptoms and carry on at current level.

 

[Boulty]

My horse had higher results than that and we still left his dose alone as he was ok in him self. (We did adjust when it came back over 400 but it hovered around the 40-60 mark for a few tests after this but as it was slowly dropping we opted to wait and see) Vet said at the time that you need to look at the whole horse and that unless the result is stupidly high then not to tinker with it if the horse is well and symptoms are controlled

 

[Fragglerock]

The ACTH test, if that is what she had, is notoriously unreliable. Levels can be raised by stress, and it pulses to you can get false negatives or positives. If there are no other symptoms, I wouldn't worry, maybe do another test in mid summer when the seasonal rise is just getting going and meanwhile watch her like a hawk for any footiness.

This.

One of my lads was only tested because it was free and it came back with a reading of 72 (cut off 47). Since then he has never been over and his March one was 18.

My other lad was 74 at the same time but 38 in March. We are only monitoring as the test is so unreliable and this is marginally over.

 

[LeneHorse]

Thanks for the replies everyone - you have confirmed my own gut feeling not to increase her dose any more at the moment.
We don't have a lot of grass - they are in the same field all year round and it is well grazed down. She is quite happy coming in off the grass during the day throughout the spring/summer so I will continue with this routine. She would hate being muzzled and I would prefer not to do this if at all possible.
I will let you know how she gets on next time she is tested.

 

[meleeka]

I wouldn't increase dose either. I have read that splitting the dose AM and PM sometimes works, so maybe try that.

 

[Tiddlypom]

Following with interest. My 16 yo mare has been stable and doing very well on 0.5 tablets per day for 3 years, but returned at 57 at end Jan, so was put up to 1 tablet, then was still at 55 two months later.

She suffers badly with the Prascend veil each time the Prascend dose is increased. My vet is happy for her to continue on 1 tablet daily for now, as I manage her as a lami suspect anyway and she looks well, and for me to continue to closely monitor her. Will see how it goes.

 

[Andalucian]

Given the levels, I think the dose is rather high already. I don't medicate for cushings unless above 50, I manage the diet up to this level. Higher than this I would only use Prascend if the horse had difficult symptoms. It's a tricky drug, for some horses it's a godsend, for others it's horrid. Use as little as possible, with older age you may need more.

 

[LeneHorse]

Thought I would give you an update. I had her tested again last week and the result has come back at 25 - 29 is normal for this time of year. So I am delighted.

 

[Billyandme]

Good news and no doubt a relief! Cushings is a bally awful disease but I do think sometimes playing the "numbers" game can prove to be a bit of a lottery in itself.

 

[splashgirl45]

great news, sounds like she is doing well...

 

[NOISYGIRL]

Does she get stressed when vet visits ? this can affect the test

 

[LeneHorse]

Does she get stressed when vet visits ? this can affect the test

not at all, she doesn't seem to mind getting needles stuck into her