Cushings induced laminitis

[Maisy]

Evening all...sorry if this is long or confusing....I tend to babble!!

I have a 12 year old pony, diagnosed with cushings about 18 months ago. Put on 1/2 mg prascend to start with, which was then doubled to 1mg about a year ago as her levels continued to rise.

Since then, she seems to have been controlled well.

In the last 6 weeks, she has been confined to her stable and a big indoor barn as she is keeping her friend company whilst on box rest.

She is fed as a laminitic, even though she has never had laminitis before....she has a tiny amount of fast fibre and speedi beet as well as about a 2 inches long piece of carrot to give her her prascend tablet in. She has hay which is off a really old meadow, so its not fertilised and has lots of different plants/weeds in....not just grass. I haven't been soaking her hay.

She is not overweight imo. You can see her ribs fairly clearly, she has no fatty pads on her bum, but she does have a crest....although it isn't solid, and as a shetland x I don't think it would/will ever go (she's a chunky pony, not section A stamp or anything!!).

Yesterday, she was diagnosed with laminitis :-( I am absolutely gutted, especially since neither the vet, nor I can come up with a reason why. The vet has just said it is the cushings, and not a management issue.

The plan from here is for her to have xrays done on Wednesday to see if there is any pedal bone rotation. (She has her feet padded, is on a full bed and complete box rest, soaked hay with danilon and sedaline). When she is out of pain, they will test her ACTH levels again to see if they are not being managed by the dosage of prascend she is currently on.

I wondered if anyone had any similar experiences? A cushingoid horse/pony who gets laminitis despite careful management....Is this likely to be a never ending battle of box rest to keep her sound? How much of a pedal rotation is significant? I am very much of the opinion that quality of life is much more important than quantity, so if she's never going to be able to graze in a field (albeit muzzled!) with the others, she won't have much of a life....

I know the vet would probably be able to answer some of my questions, but I would like to hear some real life experiences if possible!

Thanks in advance

 

[be positive]

It sounds as if you were doing really well controlling the cushings, there will be more you can do now, soaking the hay will make a difference to reduce the sugars she is getting, they may be high as it was a very good year for hay last year, it is not just about the grass type or quality but how it was made, when the weather is good the hay is more full of sugars , if you have caught the laminitis early there may not be any rotation and she may recover quickly.
I suspect that the cause will be lack of normal movement, even though she has been in a barn it is not the same as being out in a muddy paddock moving about looking for every blade of grass, the calories used up moving around are probably far more than in the barn and that could have been enough to tip her over, unfortunately these things do happen however hard we try, hopefully she will recover and be able to get out again, I agree that they need quality of life and access to some time out, being cooped up is not fair if that is all they have day in day out forever.

 

[vanrim]

I have a mare that had 6 bouts of laminitis and numerous ACTH tests that came back "normal" before she was finally put on Prascend. My vet did another test that has only recently come available apparently and this test showed very high levels so my mare does have Cushings. I am therefore of the opinion that the ACTH test is very hit and miss and even my vet says that it is only reliable at certain times of the year. I could be that your pony needs a higher dose of Prascend than the ACTH test is telling you. Since my mare has been on the correct dose she has not had laminitis even in circumstances that would have set her off previously. I can't remember what the new test is called sorry - something like "thyroid response test" I think but I am sure your vet will know if you ask.

 

[Maisy]

Thank you for your reply. I *think* it was caught early. The vet had to dig around a fair bit to find some specs of blood on/in her white line, and she had only been pottery yesterday. It was the vet who suggested xrays though....I have never actually had experience with laminitis, only trying to guard against it, so I don't know how quickly rotation can happen.

I feel very stuck with regards to her being in the barn. The other horse has completely knackered her DDFT and gets very upset/jumpy if my pony leaves her sight....even if my others are in view. The vet said her tendon is "about as bad as it gets" so getting excitable is not a good idea at all.

 

[OLDGREYMARE]

If she has laminitis she will be insulin resistant(ems)I recommend you look at the Laminitis Site and join their facebook group,Andrea and Karen will help you with all your queries.They are very knowlegable and helpful.Mean while soak all her hay 3hrs plus in plenty of cold water and make sure she has daily vits and minerals such as Spillers lite balancer.

 

[be positive]

If she is only "pottery" you will probably be ok, regarding the barn it is the best place now she needs to be restricted anyway until the laminitis settles maybe once she is well again you could give her a little exercise each day to make up for being less active until the other horse gets better. You are going through a rough patch with 2 patients to care for, DDFT injuries are not great, hope she improves but that will be a long haul.

 

[Maisy]

OldGreyMare....I had her tested for EMS (I think!) a while back because of the way she looked...but it came back negative....does the onset of laminitis change that? Shs doesn't have a balancer, but I think she has about enough fast fibre to give her what she needs. She's a fussy little thing, and refuses vitamin/mineral powders!

Be Positive....the other injured horse isn't mine, and yes, it will be a very long process with the best case outcome being field soundness....

If rotation *is* an issue...how much is substantial?

 

[Orangehorse]

It is the Cushings disease, not your management. I had a pony PTS in the autumn. Looking back, I must have done a reasonable job of keeping it under control, although I didn't know he was suffering from it until the very end. I was distressed that he had gone down with laminitis and the vet said that autumn onset was typical, that he was a good weight and it wasn't anything I had done, or not done. He had other health issues, and was in quite a state, so vet advised PTS.

Sorry this isn't what you want to hear. I know that many people have lots of success with keeping Cushings ponies well with the help of medication and management.

 

[OLDGREYMARE]

If she has rotation it can be corrected by trimming ,you will find all the answers if you join the ppid and ems facebook group,they helped me and my ems mare last year,please don't despair she can be helped.

 

[Maisy]

It is the Cushings disease, not your management. I had a pony PTS in the autumn. Looking back, I must have done a reasonable job of keeping it under control, although I didn't know he was suffering from it until the very end. I was distressed that he had gone down with laminitis and the vet said that autumn onset was typical, that he was a good weight and it wasn't anything I had done, or not done. He had other health issues, and was in quite a state, so vet advised PTS.

Sorry this isn't what you want to hear. I know that many people have lots of success with keeping Cushings ponies well with the help of medication and management.

What other health issues did your pony have? Molly has something 'wrong' with her breathing, although the vets can't figure out what it is and how to cure it....she sounds very hollow and sometimes takes very odd breaths (not easy to explain!). She also has some swelling on her nose....again, the vets have no idea why, and suspect inflammation of the false nostrils....

She is very much 'not herself' which is why I insisted they test for cushings in the first place. She is much less depressed since being medicated, but is still, for want of a better word, joyless. (Does that make sense?).

I suppose I hope that her ACTH levels have gone astray and I can alter the dosage of medication and all will be well again. My fear is that it isn't that simple, we potentially undo any damage done this time, only for her to be hit with bout after bout of laminitis for no apparent reason.

I would almost rather that I had been feeding her something I shouldn't have been because then I would be able to cut it out!

 

[Micky]

Second old grey mare...se the lamintis site and facebook page link...Also start her on a small scoop of magnesium oxide, that will help get rid of that 'crest' and any other fat pads...I am nearly a year on since mine was diagnosed with PPID and he is absolutely full of it. It is manageable and all about diet, exercise management plus keeping in contact with your vet regularly ( even by phone). Dont worry, it will be fine. Check out the site and gem yourself up

 

[Maisy]

Ok....so small update and if possible I would love to hear about any experiences....

So the vet came last week to xray hooves.....there is a small degree of movement in one hoof, but nothing that they don't think can come right with trimming. The farrier came on Friday to trim away the excess toe, as per xrays that the vet sent him.

The vet also took bloods which came back yesterday....her ACTH has gone from 33 in December to 132, despite being on 1mg prascend. Obviously, this explains the laminitis attack, but I am very concerned about the speed at which her levels have gone up, especially considering she is only 11 (12 in May) :-(

She is completely not herself....she is ravenous, and in a really bad mood....ears back etc etc. I am hoping that once we can get her prascend level right again then she will be happier.

Does anyone else have experience of 'controlled' levels increasing so rapidly, especially outside of the 'ACTH peak' time of the year?

I am very concerned I am going to enter into a never ending cycle of laminitis attacks, where I lose sight of the quality of life my pony has....:-(

 

[amandap]

She is completely not herself....she is ravenous, and in a really bad mood....ears back etc etc. I am hoping that once we can get her prascend level right again then she will be happier.

May I ask if you are soaking her hay? Even meadow hay can be high in sugars so I would definitely do that if you aren't.

Sorry, I can't help with the prascend questions.

 

[Maisy]

I was soaking her hay....but tbh, she doesn't like it, and the vet said since she has always had unsoaked hay before, and the laminitis was due to the cushings, we have decided that for quality of life she can have hay that she enjoys.....

 

[Silverfire]

Ok....so small update and if possible I would love to hear about any experiences....

So the vet came last week to xray hooves.....there is a small degree of movement in one hoof, but nothing that they don't think can come right with trimming. The farrier came on Friday to trim away the excess toe, as per xrays that the vet sent him.

The vet also took bloods which came back yesterday....her ACTH has gone from 33 in December to 132, despite being on 1mg prascend. Obviously, this explains the laminitis attack, but I am very concerned about the speed at which her levels have gone up, especially considering she is only 11 (12 in May) :-(

She is completely not herself....she is ravenous, and in a really bad mood....ears back etc etc. I am hoping that once we can get her prascend level right again then she will be happier.

Does anyone else have experience of 'controlled' levels increasing so rapidly, especially outside of the 'ACTH peak' time of the year?

I am very concerned I am going to enter into a never ending cycle of laminitis attacks, where I lose sight of the quality of life my pony has....:-(

My 21yr old horses ACTH hasn't been tested since Aug last year when it was down to 23, he is on 1.5mg prascend and he was tested last Thurs and i've had the results today which is 105 which is higher than when he was first tested this time last year (91.4). He had never had laminitis and does not have any fat pads but 3 weeks after starting on prascend last year he became very footy and sore turning - cushings induced laminitis. He was on one tablet then and his ACTH was down to 57 so dose was increased half tablet and eventually the footiness/soreness turning went but it took a couple months. I do not treat him as a laminitic, his feed is low sugar but he has adlib hay and haylage un-soaked. At end Dec i cut his dose down to one tablet for ten days to improve his appetite which it did but he also went very footy which disappeared again after a couple weeks back on normal dose. He is not footy at moment but 2 weeks ago he had a funny seizure type thing in stable and he has been really nervy/spooky since (he was spooky this time last year) so thought i better have him re-tested. Vet has said to increase dose by half tablet and re-test in month. He will probably need more than another half but i would rather try half first.

 

[amandap]

I was soaking her hay....but tbh, she doesn't like it, and the vet said since she has always had unsoaked hay before, and the laminitis was due to the cushings, we have decided that for quality of life she can have hay that she enjoys.....

Fair enough. I just mentioned that as IR often accompanies PPID.

 

[Maisy]

My 21yr old horses ACTH hasn't been tested since Aug last year when it was down to 23, he is on 1.5mg prascend and he was tested last Thurs and i've had the results today which is 105 which is higher than when he was first tested this time last year (91.4). He had never had laminitis and does not have any fat pads but 3 weeks after starting on prascend last year he became very footy and sore turning - cushings induced laminitis. He was on one tablet then and his ACTH was down to 57 so dose was increased half tablet and eventually the footiness/soreness turning went but it took a couple months. I do not treat him as a laminitic, his feed is low sugar but he has adlib hay and haylage un-soaked. At end Dec i cut his dose down to one tablet for ten days to improve his appetite which it did but he also went very footy which disappeared again after a couple weeks back on normal dose. He is not footy at moment but 2 weeks ago he had a funny seizure type thing in stable and he has been really nervy/spooky since (he was spooky this time last year) so thought i better have him re-tested. Vet has said to increase dose by half tablet and re-test in month. He will probably need more than another half but i would rather try half first.

:-( The seizure thing sounds scary....it's a massive minefield isn't it? I have fed her low sugar everything (apart from unsoaked hay) since I bought her 7 years ago. She was massively overweight when she arrived and slowly but surely she has lost about 150kg and now looks on the 'slim' side. She is muzzled 24/7 when out during any time but mid winter, not put out on frosty grass etc etc etc but *still* she is going to suffer from the cushings induced laminitis, and other than have her bloods tested monthly, there is *nothing* I can do to prevent it....gutted doesn't come close....

 

[Jsye]

I wish this horrible disease didn't exist! I know how you feel about it as my 9 year old TB was diagnosed a few weeks ago with levels of 96 :-( it's even worse when they're young isn't it! I've never known a horse diagnosed as young as mine

He is currently on 1mg prascend per day, unsoaked hay, happy hoof with turmeric & agnus castus. He seems okay at the moment but vet will be back soon to retest his levels and *hopefully* theyve gone down. You're right when you say it's a minefield and i've only just begun with mine - the thought of him getting lami no matter how i manage him is really disheartening and truly gutting.

Does anyone else think that recently there are a much higher quantity of horses being diagnosed with cushings? Surely it shouldn't occur in SO many - makes you think whether it's something that we're doing/have done .. hmmm..

 

[Micky]

As said before, please see the laminitis site for more information you are requiring. There is also a facebook page you can join, where you could probably get your questions answered by people who have PPID horses/ponies and are up to date with all the tech.
My horses ACTH levels have risen in the last 2 months and have upped his Prascend to a pill and a half, with sucess. The high rise ( as i understand it) is worse during winter, lamintis risk is higher during spring, summer and the second flush in autumn. however, please ask on FB page, am sure they will help you on there, as they have helped me and countless others.
PS I would persevere with the soaked hay, your pony will eat it eventually

 

[Menolly]

Maisy I really feel for you, having had a horse with cushings it's very stressful and heart breaking.
As others have said I found the yahoo group, Facebook page and the forum search history really helpful.
My mare was 26 when she was diagnosed and I had the opposite problem of most - She was a light weight Arab who we really struggled keep weight on her.

Without being all doom and gloom we had to say goodbye after 2 years as after upping the prascend a few times, corrective shoeing and very careful management of zero grass we just couldn't control the laminitis bouts and regretfully apart from her last night she spent the last few months in a stable.

Her ATCH level maxed at 94 and the lowest we got it was 54. She was increased up to 1.5 mg of prascend in the last few months and our vet advised they didn't recommend for it to be continually increased as the same outcome would eventually occur. We also struggled every time the prascend was increased as her appetite would just disappear and more weight would drop off.

Her age was against us really so please don't let my experience dishearten you.
Do you think your mare would happily live in grass free turnout? If your yard situation can cater for this I'd defiantly try this long term.
I was able to electric tape off the gateway so mine had a dirt paddock about 20ft x 20ft and she could still see and touch her friends. This defiantly helped in her having some normality and kept her less stressy.
I've read lots of success stories where people have been able to keep the laminitis under control this way and there ponies are still going strong and enjoying life xx

 

[Orangehorse]

If you have been managing the pony up to now and it hasn't had laminitis, then it is nothing to do with you. It is the cushings disease. My vet gave me a good explanation when my pony went down with it last autumn, it is basically a disease of "old age" even if your pony isn't that old.

So you can give medication and keep to the "laminitis diet and management" regime, but utlimately it is probably a life limiting condition.

 

[Heidi1]

I have a TB x Welsh D 15 year old mare, that was diagnosed with Cushings last December, her first set of bloods came back 158, she went on to 1 precend tablet (1mg), 6 weeks later bloods taken again, came back 36.7, carried on as we were and then last set of bloods taken and she is down to 12.5, sound, shod fronts only and back in work, fingers crossed we are going the right direction, she gets turnout too, we fought lami for 3 years with her, slight rotation, farrier did a wonderful job, so fingers crossed we are going the right direction, but please join the facebook groups, they are so supportive. Good Luck..x

 

[Maisy]

To all those advising the fb group, I have joined it, and I have posted, however, other than the original reply, I haven't had any feedback, nor can I find the answers to my probably-unanswerable questions.

My yard is suitable for no-grass turnout....we are very lucky to have a big yard inside, and a big yard outside, but I still maintain that that is no kind of life for a pony. If I can't control the laminitis then I will have her pts.

For those who have lost horses to cushings/laminitis because of cushings, could you tell me the timescales of increase in medication? Ie Molly has been on 1mg of prascend for 12 months and now we are trying 1.5mg....?

Thank you so much for all your replies....any experiences are interesting and useful to read....

 

[splashgirl45]

mine was diagnosed with cushings august 2011 with levels of 172 started on 1 tablet daily..tested again in nov and was 50.5 so still too high so increased to 1 1/2. tested feb 2012 levels 48.9 and should be under 29 so up to 2 tablets.tested june 1012 levels 52 and should be under 29 so up to 2 1/2 tablets. tested feb 2013 levels still to high at 45 but kept on same dose for now.tested june 2013 levels now 53 so up to 3 tablets..tested dec 2013 levels 61 s/be under 29 so up to 3 1/2 tablets....hope this helps, my mare gets grumpy and depressed and cribs alot when her levels have increased so i just try and get her tested as soon as i suspect a problem...i give her a small feed of fast fibre,formula4feet and baileys light chaff..she has wet as opposed to soaked hay at night and is out on grass all day..i feel her quality of life is the most important and am not going to restrict her to no grass..if she gets laminitis i will PTS as she is now 23....she is stillbeing hacked out regularly and seems to enjoy her life...