Cushings - interesting blood test results

[9tails]

Hi all

Horse was diagnosed with Cushings with an ACTH reading of 165. After a month on one tablet a day, results dropped to 89 so dose was increased to 1.5 tablets a day. This time, the blood test showed an ACTH reading of 115. Vet has advised increasing the tablets to 2 a day for a month which I'll do.

My question is whether this is something that anybody else has experienced because the vet seemed flummoxed by the result. The dosage had increased but the reading rose rather than fell. The horse is living out 24/7 during summer, the field is mostly brown with some small green shoots and you could play bowls on it. One meal a day, senior balancer with senior chaff and a carrot with her tablets in it. A section of hay daily because there's not much to eat out there. I know she's getting her dose, I watch like a hawk to make sure she eats them.

She seems fine in herself. Her appetite is great, she's bright and lively, she's a bit bigger than my ideal but not a blimp. Her energy level for hacking is good, she get excited about doing some work. Apart from the crazy coat she grew over winter, you wouldn't know she had anything wrong.

 

[SEL]

I know ACTH readings can be distorted if the horse is in pain or otherwise stressed - so could there be anything else going on?

 

[Pearlsacarolsinger]

I would ask for the TRH-Stim test, its muc h more reliable.

 

[TheBigPony]

ACHT levels rise naturally at this time of year. As the hours of daylight decrease ACHT levels increase.

Your level is still above what the cut off is for this time of year.

I have also had unexpected ACHT levels and it turned out there was a problem with the test and on retest the ACHT levels were lower.

 

[meleeka]

I've gone by symptoms, rather than numbers with my mare. She's been on Prascend for many years and I've yet to be wrong when I've felt I needed to increase the dose. Blood tests always say it's well controlled, despite me seeing differently, so the opposite problem to you.

 

[PinkvSantaboots]

The blood test are not very accurate so many things can affect the results.

My vet says to treat the horse infront of you and doesn't insist on regular blood tests, Louis is on half a tablet as was just borderline and symptoms have stayed the same and his doing fine.

I would be wary to keep upping the dose, if your horse seems to have improved on the 1 tablet I would be inclined to just carry on.

 

[Mahoganybay]

I've gone by symptoms, rather than numbers with my mare. She's been on Prascend for many years and I've yet to be wrong when I've felt I needed to increase the dose. Blood tests always say it's well controlled, despite me seeing differently, so the opposite problem to you.

Can I ask what symptoms you use as a marker to increase your dosage?

 

[meleeka]

Can I ask what symptoms you use as a marker to increase your dosage?

Footiness, that's the only symptom she's ever had. She's been on Prascend for 10 years or so, now on 2.5 tablets a day and currently defying her years.

 

[9tails]

The blood test are not very accurate so many things can affect the results.

My vet says to treat the horse infront of you and doesn't insist on regular blood tests, Louis is on half a tablet as was just borderline and symptoms have stayed the same and his doing fine.

I would be wary to keep upping the dose, if your horse seems to have improved on the 1 tablet I would be inclined to just carry on.

I think that's where we're having an issue. Her level dropped with one tablet a day, but not enough to bring her down into acceptable parameters. So it was increased to 1.5 tablets and it's risen! I'll give it a month on two tablets, hoping that the level drops otherwise it may just be worth treating symptoms rather than worrying about the numbers I think. She's 24, you wouldn't know it, she's not footy and my farrier says there's no sign of anything sinister there. The only sign of anything untoward going on is her funky coat, though she looks reasonably ok at the moment. Just a bit like she has short baby fuzz rather than a nice smooth shiny coat.

 

[PinkvSantaboots]

I think that's where we're having an issue. Her level dropped with one tablet a day, but not enough to bring her down into acceptable parameters. So it was increased to 1.5 tablets and it's risen! I'll give it a month on two tablets, hoping that the level drops otherwise it may just be worth treating symptoms rather than worrying about the numbers I think. She's 24, you wouldn't know it, she's not footy and my farrier says there's no sign of anything sinister there. The only sign of anything untoward going on is her funky coat, though she looks reasonably ok at the moment. Just a bit like she has short baby fuzz rather than a nice smooth shiny coat.

Just like Louis his coat is weird he looks like a leopard at the moment, his only been footy once when he got in the rested field and gorged himself, I kept him off grass for 5 days on soaked hay and he was fine.

 

[Gloi]

Can I ask what symptoms you use as a marker to increase your dosage?

Increase in amount they are drinking too.

 

[santas_spotty_pony]

Sorry to jump on the post but does anybody know what the cutoff actually is for the ACTH levels?

 

[Tiddlypom]

Sorry to jump on the post but does anybody know what the cutoff actually is for the ACTH levels?

It varies seasonally, being higher during the autumn rise. The lab will assign a specific cut off level for the date that the bloods were pulled.

ETA The cut off can be over 50 at its highest point during the autumn rise.

 

[slimjim86]

My girls bloods came back a few weeks ago at over 330, vet was astonished as her only symptom was muscle wastage and feeling the cold more. He thought 1 tablet a day wouldn't be enough but I didn't want to start her too high and risk too much side effects / changes. She has her retest on Monday and I'm wondering if the results say her numbers are coming down but not where they should be do I up her dose or keep her on 1 and give it more time? She seems really happy in herself.

 

[santas_spotty_pony]

It varies seasonally, being higher during the autumn rise. The lab will assign a specific cut off level for the date that the bloods were pulled.

ETA The cut off can be over 50 at its highest point during the autumn rise.

Ok, I had my boy checked recently but even at this time of year he was 19 so I just wondered what the cut off was but it sounds like he is well below the threshold!

 

[9tails]

Sorry to jump on the post but does anybody know what the cutoff actually is for the ACTH levels?

I was told 45 at this time of year, 30 usually.

 

[9tails]

My girls bloods came back a few weeks ago at over 330, vet was astonished as her only symptom was muscle wastage and feeling the cold more. He thought 1 tablet a day wouldn't be enough but I didn't want to start her too high and risk too much side effects / changes. She has her retest on Monday and I'm wondering if the results say her numbers are coming down but not where they should be do I up her dose or keep her on 1 and give it more time? She seems really happy in herself.

I've only been giving it for a short time, about 2.5 months, but the vet told me that they usually see really quick results. Mine started on 1 a day and the reading dropped to half the original reading so the vet wanted to do 1.5 for another month. It seems 2 is the highest dose as anything more than that doesn't make any difference, he said. Well, in my case, 1.5 didn't make a difference. I'm hoping 2 tablets does the trick but if not, I don't want to see any side effects either and will probably drop back to 1 a day.

 

[Tiddlypom]

Good luck.

My vet also recommends a maximum of 2 tablets per day for any horse. If 2 a day isn’t controlling the ACTH levels she says that there’s something else going on in addition to the PPID.

Senior mare was on 2 tablets/day, but after a while (years) she began reacting to the Prascend and I have now had to take her off it completely.

 

[meleeka]

I've only been giving it for a short time, about 2.5 months, but the vet told me that they usually see really quick results. Mine started on 1 a day and the reading dropped to half the original reading so the vet wanted to do 1.5 for another month. It seems 2 is the highest dose as anything more than that doesn't make any difference, he said. Well, in my case, 1.5 didn't make a difference. I'm hoping 2 tablets does the trick but if not, I don't want to see any side effects either and will probably drop back to 1 a day.

That's not strictly true. Here is the dosing table for the manufacturer

 

[9tails]

I'm not a vet, I'm just quoting what I've been told by my vet. I hope 3 tablets aren't recommended, that's over £1k per year just in tablets let alone all the blood test costs.

 

[2 Dragons]

The cut off for ACTH varies each week and is at its highest at the moment as we in near the peak of the seasonal rise. Different labs also have different cut offs depending on how they measure the ACTH levels. There is also a grey area, where it is unclear if the Cushings is under control. The Laminitis Site website explains this well.
I always get a copy of the lab report from my vet so I can track my boy's levels.

Last year my vet took C's blood while he was in the field, this gave his lowest result ever.

 

[Slightlyconfused]

I would wait for the stim test to become available again, currently there is a supplier issue.

The other test is not totally right, said mine was low grey area, stim test supposed to be under 250 was 1,050.

 

[Tiddlypom]

Prascend is off licence now and I buy the cheaper generic version Pergoquin directly from my vets without having to pay for a prescription. I get a box of 200 at a time.

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[9tails]

Prascend is off licence now and I buy the cheaper generic version Pergoquin directly from my vets without having to pay for a prescription. I get a box of 200 at a time.

I'm already using Pergoquin, sadly my vet only supplies Prascend so I need to buy a prescription to get it.