Cushings test

Birker2020

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Sorry for long post. Got a call whilst we we were away on holiday on the Monday of last week from Y.O to say Lari had gone quite footy when they brought him in from overnight and she was letting me know. We agreed on continued overnight turnout with stabling during the day and by Wednesday morning there was significant improvement. I'd noticed he was very slightly ocassionally foot pointy before we went away but it was very intermittent.

When we got back off holiday on the way home we called in to see him and he was about 1/10th lame. Carried on giving him bute but reduced it from 2 to 1.5 a day. He's been on two because of his gum issue, until the specialist dentist at the horspital sees him but I was hoping to cut him down a bit before then as its not really giving any wiggle room.

Anyway I got a call yesterday morning to say he was very lame, like abscess lame when staff brought him in. Got there to find him throwing his head up when moving in the stable and putting weight on that foot, very very lame, like broken leg lame but obviously weight bearing, foot pointy again. He'd had breakfast already at this point about half an hour before i arrived. Rang vet as assumed abscess (he was shod on 28th August and assumed slow nail bind. Vet came out at around 3pm, he was only about 2/10ths lame by then but very hoppy on turn to the right. Vet said definitely not laminitis, negative on hoof testers, no increased pulse, no tendon/ligament issue. He was xrayed Jan this year as he had the same issue, little bit of change on coffin joint, no rotation of pedal bone, navicular dandy. The vet felt the changes to the coffin joint was insignificant.

He was shod on fronts on the 18th June as prior to that he'd been barefoot. He's been shod a further twice since then. He's been very good, much sounder than when barefoot, running around the paddock and never showing a single lameness or footiness all this time but definitely heavier on that off fore. Video 21st July

So the vet still thinks its either coffin joint arthritis or insertion point of ddft into coffin joint and I've all along I am not paying for an MRI so long story short going to get his coffin joint injected next week to rule this out. Vet says in his favour there is no enlargement at the back of the heel somewhere that is normally present when there's issues with the DDFT.

He hadn't been hoolying around the paddock, as I checked it and no canter footmarks. No skid marks, nothing.

I know a number of you were putting pressure on me to have him tested so whilst the vet was there I asked him to be tested for cushings. She took bloods and I've just had a voicemail to say the results are back and he is negative which I'm delighted about.

Is it really possible for a horse to go from broken legged lame to hardly noticeable except on a circle on only 3/4 of a bute? Surely that wouldn't happen if it was an issue with the DDFT would it?

Thoughts? Please keep comments pleasant, I'm doing my best for my boy and this will be the last attempt by medicating the coffin joint. He had this done last in 2022 but it was more to help him with his other issues ,(KS/neck arthritis) than anything.

His symptoms are foot pointing, toe resting. Very hoppy on turn to the right. That's it. Oh and when you push him backwards or to the side when he is footy and has one of these episodes he leans back on his heels dramatically.

Just turned him out for an hour, he cantered off, brought him in and he looks sound.
 
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If pressure builds up with an abscess he will be very lame. If he is turned out and allowed to walk/canter etc movement may relieve some of the pressure as the pressure of moving allows some of the abscess to drain. That, miserable contribution, is all I can think of as to why he goes from more or less sound to broken legged lame.
If you stable him for several hours is he very lame ie pressure built up. If you then turn him out for a few hours does he come in more or less sound.
I had an abscess that went on for months. X rayed, 2 vets and 1 farrier couldn't find it. No one had any ideas. Then a couple of months later he came sound and the tell tale line appeared on the hoof. I had poulticed it endlessly, vets and farriers considered cutting but nothing obvious.

sorry can't be more helpful, hope you can come up with something, :):)
 
I've poulticed for up to five days previously, as well as the retirement place having done so when he also got this mysterious lameness again in early January, they did this twice previously with nothing coming out. Their farrier/trimmer found nothing either and visiting barefoot trimmer kindly looked for me when I happened to be there and was chatting to her and mentioned it, she also found nothing to indicate presence of abscess He did have a nasty abcess that came through his coronary band but this was his first winter at retirement so a year prior and was on the near fore and not the foot in question.

In January this year when I called the vet out to retirement with this very bad lameness and pointing of the toe I'd made up my mind retirement didn't suit Lari where I'd sent him. It was that dreadful winter where it rained for months on end and we were in a sea of mud. He'd had a whole cacophony of issues ranging from mud fever, rainscald, being kicked which ended up costing me 1k as it had been infected as well as being bullied and injuring his DDFT and SDFT significantly the year prior. He'd had his rugs ripped to shreds and had lost weight. I wanted to hold fire on buying a new horse and bring him home but wasn't going to do so unless I'd had him xrayed first because if anything major had been found, as it had with Bailey, then i was going to pts.

Nothing was found in the foot on scan, xray, palpitation or hoof testers, she pared away the sole, no reaction whatsoever. He was nerve blocked that day which blocked the coffin and navicular. He came up sound. Vet suggested (although felt very unlikely to be an abscess, it was more a 'clutching of straws') to poultice it. In the end we treated for sulcus infection in frog as both me and y.o at retirement felt that was more likely at that time and again . nothing had come out on the poultice. He came 'home' to me around 4th Jan where he's been ever since. Within days he became sound with sulcus being treated for infection (this was probably another clutching at straws), farrier disputed there was anything wrong with foot or sulcus as he really put pressure over whole of foot with testers and also pared sole deeply and no reaction. And so he remained sound until around early June this year where he presented again with foot pointing, lameness which again came on overnight, no evidence of hoolying around in paddock.

Vet came out as i was naturally assuming either abscess or lami, we had a long and frank discussion. Again no laminitis, no tendon/ligament issues. No reaction on hoof testers. Went onto one bute a day and was shod on fronts with standard shoes the following week. Lameness resolved as quickly as it had come on, almost overnight.

It's such a weird thing. Vet says she'd love to get him MRI'd but agrees with me totally, re: prohibitive due to cost, but she finds him a fascinating case as does my farrier. I guess time will tell after he's had his coffin joints done.

As he was so improved and he really benefits from being out and vet said a few hours here and there won't hurt he went out for an hour yesterday (we moved house yesterday so that's all i had time to do) and he cantered a few strides but came in an hour later looking about 1/10th lame. The difference from 32 hours previously is incredible. And so, so strange.

Again happy for any further contributions as long as it is civil, would certainly appreciate some comments from those posters who were very much in favour of me having him tested for cushings. Cantering carrot, Field Ornaments, Horserules 2009, Sandstone who was very vocal at the time about me having the test (ignorance is bliss comment mentioned) and Crazy Cat Lady to name but a few. Now the test has ruled out cushings, which i said he didn't have all along, please give me the benefit of your knowledge. I'm glad i had the test done but I would love to hear what you might think is wrong with my horse. Again in a civil way is best. Thank you x
 
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Mac tested negative for cushings a couple of times on the blood test. Vet was happy to do a prascend trial anyway, and the difference in just a couple of weeks was amazing.
please don't take offence at this B but unfortunately Theresa is right. The ACTH test is not that accurate and can give incorrect results. Equally vets, farriers and x rays saying there is no abscess is also not totally accurate. I have had both. My horse tested negative twice for cushings, in fact he had excellent results. Unfortunately he had abscesses which were one of the clinical symptoms. I insisted on a prascend trial and bye bye abscesses. The prascend showed he did in fact have cushings even though the test said no. That is my knowledge based on fact as to what happened to me.

If you don't get anywhere with injecting or anything else then if he was mine and I didn't want to PTS if that was the only choice (obviously depends on how much you want to continue spending) I would either do a TRH test which is a much more accurate test for cushings or I was ask the vet for a prascend trial for say 3 months to see if there were results. Pergoquin the current cushings drug is a pound a tablet, dose probably one a dayso you would be looking at 90/100 quid max. if you wanted to try that.


please don't take this as arguing I am just giving you info. based on what happened to me. if it doesn't help OK and if it does then great. :):) I hope the house move went well.
 
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I wonder if Agnus Castus would help? Non proven herbal supplement for Cushings type symptoms. A couple of people I knew weaned their ponies off Pergolide and moved on to the supplements, with good results. This was after they had stabilised though. It does sound very abscess like - Old Dobbin got a bad one a few years ago, and he looked like he had a wooden leg. It burst at the heel, above the frog, and a year later a track appeared next to the bar which took another six months to grow out. Watch for stinky, black, tar like discharge. You won't forget the smell....
 
please don't take offence at this B but unfortunately Theresa is right. The ACTH test is not that accurate and can give incorrect results. Equally vets, farriers and x rays saying there is no abscess is also not totally accurate. I have had both. My horse tested negative twice for cushings, in fact he had excellent results. Unfortunately he had abscesses which were one of the clinical symptoms. I insisted on a prascend trial and bye bye abscesses. The prascend showed he did in fact have cushings even though the test said no. That is my knowledge based on fact as to what happened to me.

If you don't get anywhere with injecting or anything else then if he was mine and I didn't want to PTS if that was the only choice (obviously depends on how much you want to continue spending) I would either do a TRH test which is a much more accurate test for cushings or I was ask the vet for a prascend trial for say 3 months to see if there were results. Pergoquin the current cushings drug is a pound a tablet, dose probably one a dayso you would be looking at 90/100 quid max. if you wanted to try that.


please don't take this as arguing I am just giving you info. based on what happened to me. if it doesn't help OK and if it does then great. :):) I hope the house move went well.
Hey thanks for that info, I'll try the coffin joint injection first and look into the TRH test if that fails. I doubt my vet will prescribe prascend/pergoquin based on lack of diagnosis but if the TRH test came up positive then they would do so.

This was him coming straight out of his stable this morning. Monday you could barely turn him on that right circle he was so, so lame. This is why it's such a mystery. Nothing makes sense. Been on box rest since effectively Monday morning with one hour out yesterday afternoon, where he cantered and looked like he does on the above video coming back towards the stable.
 
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Unfortunately a friend of mine had her horse tested for Cushings several times (including the times where it would be at its peak in terms of diagnostics) and it came back negative.

She did a 3 month trial of the Cushing meds and within 2 weeks, she had her old horse back.

He was prone to abscesses, cuts got infected easily, he dropped a ton of weight, ended up getting mud fever a few times and generally wasn't his usual chirpy self.

I would ask the vet for the TRH test as that is what eventually led to my friends horse being diagnosed with Cushings.

Regarding the video you've posted - my lad Baggs who has arthritis in his hocks and stifles often has difficulty turning when he is having a flare up and usually half a sachet of bute sorts him right out. I am looking into injections as I'd rather those than the Bute (he's a smart cookie and can sniff out meds in a massive mash of feed!), but I would deffo look at getting Lari injected and seeing how things go from there. Baggs sometimes presents as minor-ly lame if he's been out and about moving around, but he can present as quite a severe lameness if he's been stabled for a long period of time.

Keeping everything crossed for both you and Lari - it's awful when our babies aren't right :(
 
Unfortunately a friend of mine had her horse tested for Cushings several times (including the times where it would be at its peak in terms of diagnostics) and it came back negative.

She did a 3 month trial of the Cushing meds and within 2 weeks, she had her old horse back.

He was prone to abscesses, cuts got infected easily, he dropped a ton of weight, ended up getting mud fever a few times and generally wasn't his usual chirpy self.

I would ask the vet for the TRH test as that is what eventually led to my friends horse being diagnosed with Cushings.

Regarding the video you've posted - my lad Baggs who has arthritis in his hocks and stifles often has difficulty turning when he is having a flare up and usually half a sachet of bute sorts him right out. I am looking into injections as I'd rather those than the Bute (he's a smart cookie and can sniff out meds in a massive mash of feed!), but I would deffo look at getting Lari injected and seeing how things go from there. Baggs sometimes presents as minor-ly lame if he's been out and about moving around, but he can present as quite a severe lameness if he's been stabled for a long period of time.

Keeping everything crossed for both you and Lari - it's awful when our babies aren't right :(
No that's fine I will rule out coffin joint first then do ACTH test if it fails. Thanks.

Trouble is it's so intermittent, he could go another three or four months and be fine and then be crippled again. That doesn't follow anything we are guessing.
 
nothing to do with Birker but it is interesting how many are coming back with false negatives on ACTH.
Mine was the same. Only tested positive with the STIM (sp) . I'd had the standard test a couple of months previously which said levels were OK. Then she suddenly lost weight and went footy so I knew something was up. Now on 1 prascend a day and 🤞much better.
Hope you find the cause Birker - horses are never straightforward lol x
 
What do Lari’s central sulci look like now? Can you post a current pic? I know that I’m on UI but I’ll mention it anyway.

They were deep and highly suggestive of a likely thrush infection a while back, though the OP didn’t agree. A deep set thrush infection aggravating the soft tissues can make a horse very footy indeed, so it ‘could’ be that if the infection is active.

I’m a big believer in getting joints medicated and have had coffins done successfully previously, but when the horse presents broken leg lame on occasions even on 2 bute a day I think that the issue is too far gone to respond to joint medication.

Agree it could also be a long standing abscess.
 
I’m a big believer in getting joints medicated and have had coffins done successfully previously, but when the horse presents broken leg lame on occasions even on 2 bute a day I think that the issue is too far gone to respond to joint medication.
Agree, but could try next time he's shod in front asking your farrier to put pads on with DIM underneath if you don't get an answer to the cause in the meantime.

Also, is he worse on the hard and better on the soft or no difference?
 
From your threads, it appears to be seasonal, which is why Cushings has been mentioned. Symptoms get worse as the hours of daylight shorten. Hope you find a solution. :)
Barometric pressure in weather means that coffin joint pain is worse in the Autumn and this is in part due to expansion of tissues and less lubrication due to colder weather making synovial fluid thicker. This reduces effectiveness and leads to more friction abd inflammation.

 
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No that's fine I will rule out coffin joint first then do ACTH test if it fails. Thanks.

Trouble is it's so intermittent, he could go another three or four months and be fine and then be crippled again. That doesn't follow anything we are guessing.

I'm guessing you already are - but have you got notes/ a diary of what the weather was like, how Lari presented, what he was fed, what his routine was etc to try and pinpoint a specific trigger or triggers that could be causing it? It might help lead you to an answer and also help regarding his management going forwards?

With it being intermittent, I'd certainly do the ACTH test first and then go for the coffin joint injections, as you could end up with a case of the coffin joint injections working, but it showing as not working because of the Cushings causing something going on in the background that needs sorting first....

Also I've just been going over what's been previously posted and noted that he is better out than in - could he have pulled a muscle somewhere and is compensating? It would explain why he is worse when stood in but better when out and about moving around. I know it's not the same, but I've pulled a muscle and keeping moving through helped it more than being still. Also it would go through stages where I'd be fine for a while, twinge it slightly and then set myself back a bit.

Might be worth getting a chiropractor/physio out to give him a once over and see if they can find any sore spots that relate to where he is going lame? x
 
I'm guessing you already are - but have you got notes/ a diary of what the weather was like, how Lari presented, what he was fed, what his routine was etc to try and pinpoint a specific trigger or triggers that could be causing it? It might help lead you to an answer and also help regarding his management going forwards?

With it being intermittent, I'd certainly do the ACTH test first and then go for the coffin joint injections, as you could end up with a case of the coffin joint injections working, but it showing as not working because of the Cushings causing something going on in the background that needs sorting first....

Also I've just been going over what's been previously posted and noted that he is better out than in - could he have pulled a muscle somewhere and is compensating? It would explain why he is worse when stood in but better when out and about moving around. I know it's not the same, but I've pulled a muscle and keeping moving through helped it more than being still. Also it would go through stages where I'd be fine for a while, twinge it slightly and then set myself back a bit.

Might be worth getting a chiropractor/physio out to give him a once over and see if they can find any sore spots that relate to where he is going lame? x
Yes will get a physio out in next few weeks.
I am still going ahead with the coffin joints injections next Thursday as I've booked him in and paid and it might be my last week I'm available as hoping to be back at work the following week. I can ask her to test when she comes out though.

Physio might be worthwhile but the issue is in the foot as its below the fetlock as he's been blocked higher up. Its either coffin joint, or ddft insertion in foot, it's been proven to be the foot. He's also being blocked again next week. She did say she could medicate the navolucular bursa but that's already a
shown on imaging to be fine.
 
My warmblood had a real bad run with abscesses a couple of years ago, one took 3 months and multiple x rays to finally get it to drain. Asked vet to test for cushings, she said she doesnt look like she has cushings but happy to test. ACTH came back in the grey zone. TRH stim came back very high. Been on one prascend for 2 years, no side effects and havent had an abscess since.

A few years prior to that she also had on/off lameness in a front foot that blocked to the coffin joint, x rays were unremarkable. We injected coffin joint with steroid , she was sound for 4 weeks then the lameness returned twice as bad. I then took the shoes off and turned her out for 9 months and she came back sound. Vet reckons collateral ligament or ddft injury as a coffin joint block includes those two structures
 
We injected coffin joint with steroid , she was sound for 4 weeks then the lameness returned twice as bad. I then took the shoes off and turned her out for 9 months and she came back sound. Vet reckons collateral ligament or ddft injury as a coffin joint block includes those two structures
To put it into perspective he's had two abscesses in 4 years, both at retirement when it rained non stop for five months, the fields were in a sea of mud, the river burst its banks and he was out 24/7 (which is how he got mud fever on his legs and rainscald on his face too). Only one of those 'abscesses' was a definite abscess, the other was a 'possible' as has been the one I treated for until the farrier found a crack and when that was rectified he was fine, so no abscess there. It is really extremely unlikely he has an abscess. Horses that have abscesses do not go from 10/10ths lame or whatever the grading is now to 1/10th lame in under 6 hours. They don't canter off down the paddock and execute an almost sound trot 24hrs after being 'broken legged' lame. Does the video of him look like he's crippled with an abscess? Yes he's stiff when he first comes out the stable but that dissapears relatively quickly and ties in with all his other issues (K.S, neck, hocks and SI). I appreciate he does that very strange turn on a tight right but that points to coffin joint as does the toe pointing. He doesn't shift weight from foot to foot, he certainly is not pointing his foot since Monday afternoon, he has no increased pulse.

Vet is certain it is one of three things

1. where DDFT inserts into pedal bone
2. Coffin joint inflammation
3. Inflammatory navicular bursa (we had a horse that would go from crippled to sound in hours- something to do with pressure in the bursa I believe)

This is an interesting read as it explains about on/off lameness and toe pointing, also toe landing first, also the reason why it doesn't show on the xrays taken in Jan where it showed a perfect navicular bone on xray

""It is worth noting, however, that some horses’ X-rays show changes to their navicular bones and yet have no symptoms or lameness, while others who do have navicular syndrome show no evidence of this on X-ray"


I do appreciate your comments and will get his ACTH level done on Thursday but I know 100% what it will reveal and is am additional expense I could do without.

Thank you.
 
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It's not the same but my horse has got a DDFT injury and when it first happened he would go lame and then appear to be sound again very quickly. Not as extreme as what you're describing though as he was never all that lame on it, possibly 3-4/10 max when it was at its worst, and it was probably more an improvement over a day or two rather than overnight. I can see an argument though for a soft tissue injury which is waxing and waning, and now I think about it I know somebody whose horse had "navicular" who would go form sound to 9-10/10 lame after a ride and then recover. I can't remember now which way round you said it was with Lari but both of these horses were worse after exercise and improved with rest.

If it's something along the soft tissue lines then obviously you're not going to know without an MRI and I completely understand why you're not going to do one of those. I think then it just becomes a case of working on that assumption and seeing if you manage it satisfactorily. Did you say the vet offered a jab of the navicular bursa as well as the coffin joint? If so and if you can afford it I might be tempted to do both just to throw everything at it and give it the best chance. I'm not sure if the two are thought to communicate with each other though in which case it's probably either/ or. Sorry, I'm just musing out loud a bit.

I'm not sure about the abscess theory either but I do think in the case of weird lamenesses it's sensible to keep all options in mind as anything can be possible! My horse also has Cushings and honestly if I had to choose between that and soft tissue for Lari I'd definitely go for the Cushings. At least then you could just give him the medicine whereas with a soft tissue injury it feel like you'd be looking at managing it until you can't. So I do understand that the TRH test is additional expense for you but I think it's worth doing because it might just give you an answer and if it's not that then you can definitely rule it out.
 
I was thinking navicular

Diagnostic is lameness present and x ray confirmation

I would try blocking the foot that is lame and see if it's bi lateral

If possible block the bad foot low as possible and x ray from different angles

Get x rays looked at by 2nd opinion from specialist

It's odd though how it comes and goes

Only suggesting this cos had one years ago who's major symptom was erratic under saddle and diagnosed as bi lateral navicular
But only lame visibly on one front hoof on a circle
 
Horses that have abscesses do not go from 10/10ths lame or whatever the grading is now to 1/10th lame in under 6 hours. They don't canter off down the paddock and execute an almost sound trot 24hrs after being 'broken legged' lame.
I really hope you can figure out what's going on here but I just wanted to say that there is a pony here who presented like this - on and off lameness. Hopping one minute, sound the next. It baffled me. I had poulticed too with no result. Eventually the vet said she thought it was a really deep-seated abscess and it would likely work its way up & out through the coronet band, especially if I were to poultice that area rather than just the bottom of the hoof. So I did and we had a pus eruption and great celebrations all round. I only mention this to say although an abscess looks unlikely here, don't rule it out. It could be one, but very deep in the hoof.
It took weeks to get him sorted, so I hope it's a quicker process for you.
 
I’d favour a positive diagnosis for Cushing’s over a serious soft tissue injury within the foot any day, too.

Struggling to see how he can be that lame on and off if it’s the coffin joint, but appreciate that’s just based on my own experience with my mare. Her coffin joint arthritis was caught early and responded very well to joint medication.
 
The acth test is the same as the free Cushings test - so if you have done the free cushings then no point doing another.

Unless this specific lameness is an abscess (could be, might not be!) then it doesn’t sound Cushings/lami and your vet is probably somewhere in the right ballpark.

Doesn’t mean Lari isn’t still ticking a number of potential Cushings boxes. But I’m not going to labour that point.

If you are dealing with a non-abcess, and it’s a soft tissue/orthopedic thing, it’s just another in a long line of his unfortunate issues. Whilst not immediate, I would start preparing yourself to have to do the inevitable
 
I was thinking navicular

Diagnostic is lameness present and x ray confirmation

I would try blocking the foot that is lame and see if it's bi lateral

If possible block the bad foot low as possible and x ray from different angles

Get x rays looked at by 2nd opinion from specialist

It's odd though how it comes and goes

Only suggesting this cos had one years ago who's major symptom was erratic under saddle and diagnosed as bi lateral navicular
But only lame visibly on one front hoof on a circle
Hi Tristars thanks for your viewpoint. We did xray all this in January. The xrays are attached. She seemed to think that the xrays showed only slight changes and of no real significance. As you can see the navicular bone looks very good, in fact you'dbe hard pressed to see better I think. She xrayed slightly higher over the fetlock and found the chip that no one knew he had. That was a shock!

Senior vet said in view of the fact Lari had nerve blocked positive to the foot (and it was a veey clear positive) he felt the chip was either an old injury or he was born with it as does sometimes happen.

Vet is going to nerve block next week to see if it is the foot still positive to the block as a very kind freebie. She says in order to inject into the navicular bursa he'd have to go into the clinic as there's an increased danger of infection but she says she's happy to do so in order to rule it out. If i can combine this with the visiting dentist to look at his gingivial hyperplasia/possible tooth removal, hopefully he can have both things treated at the same time. The vet is excellent.

This morning when i scampered over to the yard (in between house moving) he came out of the stable completely sound. It seems the box rest coupled with the short turnouts have really benefitted him although I'm hoping he can return to going out overnight in a couple of weeks until the end of Oct.
 

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