Cushings test result of 60 - start treatment

P

Polos Mum

Well-Known Member
Joined
22 September 2012
Messages
6,372
Location
West Yorkshire
Visit site
Had vet out to 90% retired ( couple of hacks a month) 21 17.1 irish mutt.

Turns out he was sweating in his light weight rug as this year I've not clipped him at all and had a bit of rainscald

But we did full bloods to check liver as he was so itchy. Only think in them was the cushings marker which came back as 60, normal level is 30 so a bit high but vet said not massive

No other symptoms, happy in himself. Vet said treatment might be worth is for a month to see if it gave him more energy (which he doesn't need) and help him put on weight (again absolutely doesn't need and he wore a muzzle all summer to keep his weight down!) Slightly worried by the vet (don't know her as just moved to area) about weight as he's spot on to me - he could lose more if he was fit.

Would others treat at this level/ situation. I don't want to start pouring pointless drugs into him and the vet has a slightly vested interest.
Do we think all older horses would have slightly raised levels if we tested them all??
 
A bad case of rainscald due to sweating , which he had never had before, was the first sign of Cushings with our old Fell Pony. His level when tested was 65, he has been on 0.5mg/day for the last 2 years (now 26) has had no more problems and looks great. I'd do a trial with him, probably for longer than a month, as there are sometimes lots of subtle symptoms which you don't notice or put down to ageing until treated. Our other 26 yo had a level of 90 and is also better after being treated though his symptoms were increased thirt/urination. I do think most older horses will have raised levels but I also think they are better for being treated.
 
Last edited:
Two of mine are now on Cushings meds - the most recently diagnosed just had a very thick coat, but I had a feeling he might have it, and his results came back around 147! :eek:
Personally I would use the meds even with a relatively low reading to try and avoid the dreaded lami.
 
60 is double the normal ACTH level, so is more than a little raised IMHO. We started treating my mare when her level was 31, up from 10 the year before (vet was worried by the sharp rise).

I would start him on Prascend at a low dose, perhaps 0.5 tablets per day. It can take a little while to tweak the amount to suit the horse. Blood tests are taken fairly frequently, say every 6 weeks, until the ACTH levels have stabilised, then 6 monthly is ok. The horse often goes a bit dull and inappetent at first, but they pick up in a few weeks.

Although Prascend is not a cure, I believe that horses which start on it early fare better than those who start it with very elevated ACTH levels (though I can't remember who told me that).
 
Thanks all, how high can the readings get? I guess if I compare to worm counts low is 100, so 200 is twice the 'normal' level but I've had a horse with 1,600 count (not a good worming history !) so for the ACTH what is a 'high' level ?

Roughly what is the cost of the prascend 0.5 a day so 15 tabs a month? - I guess if it's a few pounds no harm - but I'm not keen on drugs without clear benefit - hence all the questions!
 
My son's loan pony had a reading of 678. My friend's pony is on one tablet a day. I think she said 50 tablets cost her £80 but I think if you shop around you may get them cheaper on-line?
 
I pay about £1.15 per tablet direct from my vets. I agree that no one wants to give their horse unnecessary medication.

Some symptoms of Cushing's include laminitis, loss of condition, excess coat, excess thirst, excess urination, skin irritations. ACTH levels can get very elevated, but that doesn't mean than 60 is too low to bother with. Reducing the level will benefit your horse's general health. If I had a Cushing's horse that I was unable or reluctant to medicate, I would PTS rather than let it bumble on with a condition that can be alleviated (but not cured) with easily available medication.

I suggest that you speak to a decent horse vet. My vets (very experienced equine practice) would definitely be pushing to medicate at an ACTH level of 60.
 
Thanks all, he has no classic symptoms and I do question the vets knowledge when she suggested the tablets would help him put on weight when he's already borderline tubby now anyway - the last think I want him to do is put on weight!

I've had him at home for 7 years and there is absolutely no change in drinking, coat, condition - better if anything on this new grazing. since I took his rug off completely his rain scald has cleared up

I'm not sure how I will judge whether the tablets are making him feel better when there is nothing apparently wrong with him now.

I am quite cynical and am very sure vets would be pushing to medicate anything they think they can! Same as most farriers recommend shoes even though many would be better off without.
 
Please see thelaminitissite for loads of info regarding PPID (cushings) plus feeds, management and facts plus a link to facebook where andrea can advise you...very helpful.
If your vets dont charge too much for a prescription, then it can work out cheaper to buy meds online ( vet medic and the like)...Mine charge £20 but it still works out cheaper for me to buy online and my lad is on x2 tabs a day...saying that, i have my old spirited horse back and its just a case of changing your management and keeping an eye on your horse for changes...
 
my only comment is...why risk laminitis for the sake of maybe 60p per day if on 1/2 tablet? and before you say money is tight, mine is on 4 tablets daily and I am on a pension and still have a mortgage so have to continually use credit cards to exist. however mine is nearly 24 and I feel that while her quality of life is good I will continue as I know that the max dose is 5 tablets so she is really on borrowed time..her level is currently 37.5 and should be under 29 so still a bit higher than it should be......hope this helps you to come to a decision..
 
splashgirl45 said:
my only comment is...why risk laminitis for the sake of maybe 60p per day if on 1/2 tablet? ..
Click to expand...

Thanks - it's not a money issue just that I don't want to pump him full of unnecessary drugs. Everyone is saying it'll help his symptoms and help his quality of life but he has no symptoms and is happy and perky so how should I judge whether it is necessary/ effective.

I suspect if you tested me I'd be a bit iffy, in fact I know what it is - I always have blood in my urine have for years doesn't cause any problems but always makes Drs raise an eyebrow. I wouldn't want to take something/ do something just to get rid of a test result that had no effect on my life whatsoever

I will do some more research into side effects, how long they can take it, whether (as it sounds like) you're forever increasing the dose so is starting sooner/ later better etc. Taking anything over a long time must risk liver damage?
 
Having just been through the exact same thing with a pony who is just 9yrs old I'll tell you my take on it.

My pony has suffered last 12 months with EMS & induced lammi. Last 6 months lame and on box rest. Eventually tested for Cushings. Results came back at 96%. Advised prascend for 1 month. My initial reaction was no way. I would change the feed again and manage it that way and if not sound would PTS.

So, my farrier comes 3 weeks later ( been on 4 weekly visits) I tell him the results and my thoughts. His simple reply was this, "at the end of the day this pony has a tumour whether you like it or not, you will never ever cure it but you can suppress it, the choice is yours!!"

I immediately treated with prascend and retested after 4 weeks, results came back at 21%. We are now 6 weeks on from there, pony is sound, looking well and going for bloods again in the near future. Farrier is now doing 6 weeks refits, hoof growth has slowed and is growing evenly.

I would say that if you are not prepared to treat then PTS. You are sitting on a time bomb and if the lami does arrive I think you'll find its with a vengeance. I'm devastated about my pony and was in denial as she was only 9 but the bloods don't lie.
 
Not all Cushings sufferers will get laminitis btw.

Treating with Prascend will not just improve symptoms but may also help slow down the progression of the disease and it will progress because it is degenerative.
If you do decide to medicate then start on a small dose and build up slowly to the full dose...this will help with side effects such as inappetance and depression.

This is a very useful site
http://www.thelaminitissite.org/ppid.html
 
My pony is currently on 2.5 prascend a day, she is 11.2 hh so it is a high dose. The dosage has gradually increased since she was diagnosed over 10 years ago, but the current dosage has maintained her levels for nearly 2 years. She is now 22 years and (fingers crossed that I'm not tempting fate) is looking very well and hasn't had a lami episode in 2 years. She hasn't shown any side effects of being on the Prascend for this length of time.
We have another pony aged 26 who was tested a couple of years ago, she had no symptoms as such she just didn't get her summer coat as well as in previous years, lost her winter coat but the texture was slightly different on her summer coat. She was just over the normal level and was put on a very low dose , .25 of a 1mg tablet although she is now receiving 1 microgram tablet of human pergolide as it is easier to administer. Her summer coat last year was back to normal .
 
It is definitely better to treat sooner. Don't leave it until his levels start to rise, which they will. PPID causes a whole range of horrible problems when it becomes advanced so nip it in the bud. My old girl was pts when her level was 525 on the last test, despite Prascend. Vet said she'd have needed 5-6 tablets a day to try and control, plus she was starting to show early signs of respiratory failure.
The old girl before that had a level of 130 when first tested which was comparatively much lower, though still high. But a couple of years on, one day she just told me she'd had enough. Vet thought she'd probably gone into some kind of organ failure.
ETS liver damage I'm not sure about but I can assure you the PPID will cause far more if left untreated. You are lucky in that you have a diagnosis before symptoms are obvious so you have a time advantage. Untreated, it will progress faster.
 
Last edited:
_HP_ said:
Not all Cushings sufferers will get laminitis btw.

Treating with Prascend will not just improve symptoms but may also help slow down the progression of the disease and it will progress because it is degenerative.
If you do decide to medicate then start on a small dose and build up slowly to the full dose...this will help with side effects such as inappetance and depression.
Click to expand...

This is my view too - I have two teenagers on Prascend, neither with obvious symptoms - they were both diagnosed because I get the free test done each year at vaccination time. For them, it's the slowing down of the degeneration I'm interested in. I think Animed are the cheapest online source of Prascend at the moment.
 
Just a quick question for those of you with horses on prase nd .do you still Compete? I believe it's an illegal drug for competing but if your horse is still to young what do you do?
 
My mares results came back at 72, no outward signs (or so i thought) at the time. On half a tablet a day (53p a day) she's like a totally different horse! I hadn't noticed her getting lethargic/down as it was such a gradual thing, but after 6 weeks into the treatment it was obvious how bad she had been before
 
I've kind of changed my mind about medicating. I felt like the OP, that I didn't want to medicate unless it was necessary.

So we went down the route of agnus castus instead. Worked really well. Pony got spark back, coat improved, etc etc. Fast forward to last year and I struggled to keep her weight up all through the Summer, she looked ribby and even though her coat had a beautiful shine, she'd lost her spark and just didn't seem quite right. Towards the end of Autumn she suddenly went very downhill, very fast.

We are still not entirely sure what was wrong with her but suspect she contracted a nasty virus due to her immune system not functioning as it should because of the Cushings. I had her ACTH levels tested which came back at 135. In short, the agnus castus was NOT controlling her Cushings at all!

The point is that with Cushings, if left unmedicated, you won't know that is has reached an advanced stage until your horse becomes very poorly. And that may be a virus as with my pony. Or it may be full blown laminitis.

Either way, I have completely changed my view. Pony is now on half a Prascend daily and is back to full health. At the end of the day, I adore her and want her around as long as possible and compromising my views on medicating is a very small price to pay to keep her happy and healthy for longer. :)
 
I think if I was in doubt I would get another test done in a month, you should still be in time to avoid a spring flush of grass. I am sure I heard that results can fluctuate but I could be wrong.
 
Polos Mum said:
Had vet out to 90% retired ( couple of hacks a month) 21 17.1 irish mutt.

Turns out he was sweating in his light weight rug as this year I've not clipped him at all and had a bit of rainscald

But we did full bloods to check liver as he was so itchy. Only think in them was the cushings marker which came back as 60, normal level is 30 so a bit high but vet said not massive

No other symptoms, happy in himself. Vet said treatment might be worth is for a month to see if it gave him more energy (which he doesn't need) and help him put on weight (again absolutely doesn't need and he wore a muzzle all summer to keep his weight down!) Slightly worried by the vet (don't know her as just moved to area) about weight as he's spot on to me - he could lose more if he was fit.

Would others treat at this level/ situation. I don't want to start pouring pointless drugs into him and the vet has a slightly vested interest.
Do we think all older horses would have slightly raised levels if we tested them all??
Click to expand...

My donkey came back as 99 and 30 days on prascend and it went way down below 29. She is on 1/2 tablet she no longer drinks the amount she was
 
Polos Mum said:
Thanks - it's not a money issue just that I don't want to pump him full of unnecessary drugs. Everyone is saying it'll help his symptoms and help his quality of life but he has no symptoms and is happy and perky so how should I judge whether it is necessary/ effective.
Click to expand...

Your pony's ACTH level is higher than normal. The medication will help control it and stop it progressing as quickly.

Alternatively, you could do nothing and just wait for your pony to develop symptoms - but that will mean he is suffering.

If it's not a money issue - surely you've got nothing to lose?
 
MileAMinute said:
Your pony's ACTH level is higher than normal. The medication will help control it and stop it progressing as quickly.

Alternatively, you could do nothing and just wait for your pony to develop symptoms - but that will mean he is suffering.

If it's not a money issue - surely you've got nothing to lose?
Click to expand...

Absolutely. Why anyone would let their horse/pony go without when they've got money to buy other stuff is beyond me.
 
Moomin1 said:
Absolutely. Why anyone would let their horse/pony go without when they've got money to buy other stuff is beyond me.
Click to expand...
I agree with Moomin,

My donkey showed no symptoms until I realized her coat had not shed (which never shed early like the horses) only this year it had not shed in end Aug.

I had spoken to the vet *S* on a routing call for the others to look at her as I wanted her opinion on my donkeys skin which looked amazing after vet *N* had recommended her to go on soya oil. It had looked like this last year
diamond%20002_zpsvtxywxek.jpg
pus oozing out with big blotchy red pustules continuously.
Months of washing - improved with washing every 2 days as per vet instructions. After soya oil it looked like this a few months after
20131006_164249_zps0ch1hy91.jpg
. The vet listened to all we did and what N had suggested and was please with the improvement. She then suggested a cushings test which older equines are prone to, I said go on then and the bloods came back as 99. Vet said you have two options 1. leave it 2. treat it.

She said leaving it would make her more prone to Laminitis I lost my mare of a life time 2 years ago and 1 1/2 years nursing her, I could not go through that again. It made no sense at all leaving it when a tiny 1/2 tablet a day could put her in a better position and healthier life. Second bloods came down to around 25 which was amazing, the only issue is her not wanting her donkey chaff ( balanced feed for donkeys ) as she just wants hay but needs her feed with all the vits and minerals and her pill.

I suggest you treat her condition, I think when your given a lifeline of treatment you should take it and treat the horse instead of leaving it and later down the line horse gets worst or laminitis claims another victim.
 
Last edited:
Still stuck, can anyone provide links to some science based descriptions of prognosis and side effects of treatment.

I had another vet out today to do vacs (same practice) and he also said as horse is symptomless and only reading 60 he wouldn't start to give drugs as unnecessary !
 
See Thelaminitissite...all the science based information on there ( PPID, EMS and Laminitis) plus a link to a very good facebook page, where Andrea will answer any questions you may have ( based on ongoing scientific research i may add!)
You may find there are symptoms but not the ones the vets are aware of, not all vets are totally up to date with PPID ( Formerly known as cushings) much the same as owners, referring to 'cushings as a tumour' when it is simply not the case!
Good luck
 
There is no scientific evidence with regard to the hypothesis that the drug may slow progression of the disease rather than just halt symptoms, but it would be a logical outcome given the effect that Prascend has and how the disease progresses without treatment (it's a positive feedback loop that Prascend inhibits). I think Boeringher (sp?) are looking at doing long term studies but obviously it takes years and you would need a large number of treated horses and controls, which are difficult to find.
I don't know about evidence-based studies of prognosis, presume there are some, but there is a huge amount of anecdotal evidence where horses who do have symptoms have improved dramatically when given the drug.
 
You must log in or register to reply here.
Top