Cushings or EMS? Confused....

Jericho

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My 17 yr old mare has just been tested for ACTH and the levels were way way high at 384 (although this was after a night grazing) and vet has prescribed pergolide saying she has cushings.

These are the signs she is presenting - very good doer, is overweight, pot belly, muscle wastage across back (sway back), is always quite warm, points her front feet when resting indicating soreness in feet - she has always done this in 6 yrs I have had her and X-rays, lameness work ups, bute trials didn't stop it and farrier investigations have not showed any laminitis issues but I manage her for this anyway (tiny amount of straw/hay based chop, with vits/mins plus linseed and speedibeet in winter as necessary. She is on restricted grazing out 24/7 usually but is currently in overnight on 1.5% of bw of soaked hay.)

She doesn't have an abnormal coat, looses it well in the spring, nor she does have fatty pads over her eyes (her orbitals are v sunken), doesn't have fatty pads, doesn't sweat, doesn't drink or urinate excessively. She looks and behaves generally like a normal horse albeit one with a slighty dipped back and pot belly. Vet has said treat for her cushings and carry on riding as normal (although we only hack out and school once or twice a week). I don't feel comfortable riding her at the moment because the way her back is dipping and because I know the pointing feet at rest must indicate pain or something.

Don't know if this is related but she is very aloof in nature and generally seems to dislike life unless she is grazing or doing xc. Not grumpy or pulling faces but rather dead or fearful look to her eye, just doesn't want much interaction with humans and almost seems to have no personality, like she has shut down :-( unless there is food involved. She hates quick movements, head and ear shy ( suspect this was due to the fact she was worked hard and without much gentleness at a pro eventers yard during her youth). Makes me so sad, I love this mare - she is amazingly brave and gentle and loves children but breaks my heart that after 6 years I can still panic her by being a bit quick putting head collar on or she moves away everytime I go to touch or pat her. Sorry I digress...

I have read so much on the various groups and Internet but am now just confusing myself. Does she has have cushings or ems? Does anyone have any advice, nuggets of wisdom, experiences to share ?
 
based on your ACTH reading and vet consultation then cushings. However it is often not a case of EMS or cushings but of both together. You say she is a good doer and you are obviously restricting her grazing, feeding her accordingly so I would guess that she may well have both.

My lad had a lot of these problems before he went on prascend. In your position I would just walk away from her for 6 weeks. Don't try to attach too many explanations to anything and after a month or 6 weeks on prascend you may well find you have a very different horse. If you are not happy riding (and I wasn;t) then take her our for a long walk in hand. I did that daily for an hour and it made a lot of difference getting exercise into the horse but without the stress of being ridden.

Some horses are aloof due to their earlier unpleasant lives but I found that cushings did make the horse "shut down".
 
At an ACTH level of 384 (normal up to around 50 or less) there is definitely PPID (Cushings) and it should respond well to pergolide (Prascend). The symptoms can vary, my old mare just mainly showed the symptoms of IR but when tested recently had an ACTH level of 700!! She was never laminitic, always shed her coat, didn't have unusual fat pads but the proof is right there in the ACTH levels, and depression/suppressed appetite are quite common with it I am told. If you don't treat for PPID you will probably have laminitis in the not too distant future, regardless of the food and obesity if any, simply due to the high levels of ACTH.
 
Thank you that's helpful to understand others have experienced similar. I guess you are probably right with a bit of both going on - maybe the Cushings is only mild at the moment but the seasonal rise in the ACTH reading caused it to be very high?

She has been on the Prascend for nearly 2 weeks now and other than keeping her settled in a routine going out during the day and coming in for groom, pick out feet, feed and put away for the night that's really all I am doing. Hopefully she will start to perk up soon :-(
Thanks again
 
The effects of the Cushings might seem mild to you at the moment but with a reading of 384 you can't say the Cushings is only mild because that not a low reading. Mine only had a reading of 90 at his highest but the tablets have made a big difference to him. Hopefully you will soon see a difference in your pony.
 
My mare has ems and cushings and she is only 14, Rossdales did a test that can tell them if she is controling the cushings herself which she is so she is not treated for that at the moment I have been advised to test in spring, her first test was negative because her levels are fairly low and she does not have many symptoms, no lethargy infact quite the opposite with her I think some horses have all the symptoms some may just have a few. Agree with the others maybe just give the drugs a while to work and hopefully she will be better in herself.
 
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