Lethargy and Cushings Syndrome

I

iestynlad

Well-Known Member
Joined
4 September 2008
Messages
77
Location
Cheshire
Visit site
Anyone any experience of this? My pony just diagnosed is taking Pergolide with some good results so far. Have noticed lethargy when on hacks and schooling (initially reluctant to canter but does when really asked to)- seems to pick up when on fun rides and goes like a bomb! Am I going to cause him problems by "riding through" the lethargy?
 
Our old welshie has increasing symptoms of cushings - he's in his 30s and was a spritely little thing until this summer where his symptoms have got worse - one of them being lethergy :( We stopped him being ridden last year as we thought he was too old to be looking after the children - so he's retired now - but even so his lethargy has increased tenfold :(
Kate x
 
iestynlad said:
Anyone any experience of this? My pony just diagnosed is taking Pergolide with some good results so far. Have noticed lethargy when on hacks and schooling (initially reluctant to canter but does when really asked to)- seems to pick up when on fun rides and goes like a bomb! Am I going to cause him problems by "riding through" the lethargy?
Click to expand...

Hi,

I would be inclined to agree the Kate a bit. It is more likely that the lethargy could be due to Cushing's Syndrome progressing rather than be due to the pergolide.
I have used Pergolide in a lot of cases, but have never had owners report a problem with lethargy to me. I would be inclined to ask your vet for a repeat blood sample to check the Pergolide is at the best level for your horse. I find the best test currently is testing ACTH on a chilled or frozen blood sample. If the Cushings has progressed, then this level may be high and the Pergolide can be increased. If this is normal, then it is possible the Cushings is a red herring and the lethargy maybe due to something else entirely??:confused:

Hope that helps,
Imogen
 
Iestynlad, I've noticed exactly the same thing in my mare over the last week or so. She was diagnosed with cushings back in May and is now on 2mg Pergolide a day plus herbs for cushings. She really picked up initially and was back to her old self but have just been noticing shes quite lethargic when ridden and am a bit worried. I did speak to my vet who said it was unlikely her ACTH levels would have risen that dramatically in such a short space of time (she was increased to 2mg in July) to cause her to be lethargic so am just going to monitor her over the next week or so and then maybe ask for more blood to be taken. Her appetite is good, she's bright in herself and her coat and eyes are shiny. I have started adding red cell to her feed to see if that makes any difference.
 
nativepony said:
Iestynlad, I've noticed exactly the same thing in my mare over the last week or so. She was diagnosed with cushings back in May and is now on 2mg Pergolide a day plus herbs for cushings. She really picked up initially and was back to her old self but have just been noticing shes quite lethargic when ridden and am a bit worried. I did speak to my vet who said it was unlikely her ACTH levels would have risen that dramatically in such a short space of time (she was increased to 2mg in July) to cause her to be lethargic so am just going to monitor her over the next week or so and then maybe ask for more blood to be taken. Her appetite is good, she's bright in herself and her coat and eyes are shiny. I have started adding red cell to her feed to see if that makes any difference.
Click to expand...

WOW! That's a big dose - how big is she??? Have you had her ACTH levels rechecked?? :eek:
 
Isn't it correct that the ACTH levels rise at this time of year due to the shortening days?

My 16.2 warmblood is currently on 5mg Pergolide and his last blood test (5 weeks ago) showed that his ACTH levels had shot up to 90 (from 40 something). His clinical signs are good but he is being tested again next week although the Laminitis Clinic do advise that the ACTH levels can been all over the place at this time of year and we may not get a true reading for about another 6 weeks. However, the vets are concerned enough to consider putting his meds up to 6mg as the risk of another laminitis attack is our main concern.

The lethargy may be due to the time of year and the effect this has on cushings horses and ponies.
 
Lottie7 said:
Isn't it correct that the ACTH levels rise at this time of year due to the shortening days?

My 16.2 warmblood is currently on 5mg Pergolide and his last blood test (5 weeks ago) showed that his ACTH levels had shot up to 90 (from 40 something). His clinical signs are good but he is being tested again next week although the Laminitis Clinic do advise that the ACTH levels can been all over the place at this time of year and we may not get a true reading for about another 6 weeks. However, the vets are concerned enough to consider putting his meds up to 6mg as the risk of another laminitis attack is our main concern.

The lethargy may be due to the time of year and the effect this has on cushings horses and ponies.
Click to expand...

You are absolutely right about the ACTH having seasonal variation, but thanks to some lovely new research that's just been published - we now have seasonal normal range values too so the results are adjusted appropriately. the vets at Liphook wrote the papers so that's where I send mine chilled or frozen. now we can really rely on it as a fairly accurate indicator!!

I am worried about these high doses of pergolide....I've only ever prescribed 1mg max!!! I know that there is a mg/kg dose, but I've not needed to go higher TBH....6mg?????? I would be looking for OTHER contributing factors e.g. insulin resistance/metabolic syndrome concurrently....OR try another drug which also can treat Cushings....maybe he's not responding properly to the Pergolide? Just a thought.

If you're concerned about using the ACTH due to seasonal variation- try running it at Liphook, or even combine with trying another test e.g. low dose dex suppression test (some people don't like using steroids in the laminitics, but I've done this test repeatedly even in active cases without complication), or TRH stimulation test for example to back up you diagnosis....

Just my 2p.
Good luck.
Imogen
 
Just a suggestion, but the lethargy you describe is consistent with LGL, insulin resistance may be present, high blood sugar levels.

You may well have sorted the diet out, but I would certainly look at that.
 
AndySpooner said:
Pergolide is pretty vile stuff you know, it has many side effects and I think lethargy may be one of them.
Click to expand...

No, its not a vile drug.
Ive had 2 horses with Cushings. Pergolide is a life saver! Prior to taking the drug my horses looked like moth-eaten donkeys with thick curly coats of varying shades. They also had got lethargic (a symptom of Cushings) which had come on really gradually and was thought to be due to them getting older. Within 6 weeks of taking this drug both were like youngsters again - beautiful shiny coats and lots of energy. I think it also wards of laminitis so for that reason alone its great. My old horse had Cushings for many years and lived to 30, however, he was prone to colic all his life and finally had to be pts due to this condition otherwise I'm sure that he would have lived a lot longer.
Hooray for Pergolide!

p.s. My old horse was 15hh and was on 250 mcg and my current horse is 17hh is on 1000 mcg (micrograms) per day.
 
nativepony said:
Am worried now!!! She's 14.3 and not due to be re-checked until January. Have noticed she seems to be drinking a lot of water too.
Click to expand...

I was so concerned by the doses being told on this thread I actually rang an internal medicine specialist to check my views....he agreed that he's never needed to reach a dose above 1mg to control Cushings.

Apparently when it first was trialled the theory was to use it in increasing doses until effect and high doses such as you and others are describing were not uncommon. I can't say I have any experience of these high doses and even if you work out the bodyweight dose for 14.3hh horse at the highest end of the dose range it doesn't come close to 5mg.

I'm worried. I don't know why those doses are used....if ACTH is still high I was say the horse is either not responding to the pergolide (only about 80% of cases do) or there is another cause....ACTH producing tumour perhaps??

Don't know what else to say but recheck the bloods - I'd use Liphook, and then as a vet I'd speak to Andy Durham or Tim Brazil about medication and control of the problems.....

Hope that helps
Imogen
 
Now I'm worried! I was told my horses ACTH level was 583 and yet someone was worrying about it being 90 :eek: :eek: Are there different ways of measuring it maybe?

(Sorry to OP, a bit off topic here - its too early for me to tell about lethargy as my poor mare can hardly walk due to the laminitis)
 
I think often labs will vary the reference ranges so ask you vet what the usual normals are for that lab. Still as stated on the other cushings thread I think as long as it's decreasing you are seeing a response!
FYI one labs normalshttp://www.betlabs.com/insulin.html
Another test states <50pg/dL is normal in the horse and <27 in the pony, the mid range is equivocal and low if totally ok....

It varies a lot lab to lab.
 
A lot of interesting points here. I suspect my pony was missing his doses recently. Would not eat hard feed as mild lami and inappetance over the very cold period. I have managed to get him to take the Pergolide now in alpha beet and have immediately noticed a change within about two days from very sparky to just a bit dull. This is exactly how he was when he went onto the Pergolide in July (start of this thread). I am not contradicting Imogen but I have heard of other cases of Pergolide causing lethargy. I am not entirely happy with the dose at 1mg for 14hh as he is weeing a lot but the drinking I have monitored overnight (strict 12 hour period) has come down from 2.5 to 1-1.5 buckets since I have got him back on the Pergolide.
Another question? Hay - should I soak it to reduce lami risk?
I have an EMS case too and he will not eat soaked hay but does not appear to be affected lami wise by unsoaked although he got lami in the severe weather this year.
 
My horse had her blood checked at Liphook and is on 1mg of Pergolide a day, plus Danilon - still on box rest, havign farrier out today (14 days after first laminitis signs) - she has a beautiful coat already! Am reading these ocmments with great interest,as I am a newcomer to the world of Cushings/laminiitis - unfortunately. my horse is only 9 (well, 9 in July!) so any information regarding laminitis/Cushings and return to work is being avidly read. Research on both these topics is being regularly updated and reviewed whichis great.
 
Cob with attitude: very sorry to hear that your horse is just 9 with Cushings. I am also newish to the situation and having stabilised things since June when first diagnosed all up in the air again this winter (see threads from me re: severe weather). There is some good info on one of the threads from Bensababy in conn with herbal remedies. I am intending to try this alongside the 1mg Pergolide if my vet okay with this. I'll feed back.
My vets practice sends the bloods off to Liphook so the seasonal variations mentioned by Imogen Burrows are (hopefully) taken account of. Thanks for this Imogen as was not aware until I read your post. Wouldn't mind your 2p worth on the soaking hay sit please?
Once again I have seen mention in this thread of shorter daylight hours and effect on hormonal system (affecting Cushings and EMS cases) - there is some scepticism in other posts re: this but I have always maintained with my EMS pony that this was the causative factor (having removed all dietary factors and he is not ridden so no concussive issues and has gone laminitic even in warm winter weather).

On a good (very good) note: last year since my big pony recovered from lami (was of a few days duration only) he really gave the fun rides some stick! He is rising 21 and I can honestly say it was his most dynamic year ever. Unstoppable on occasions. So keep on keeping on, your horse will come right.
 
I had a mixed experience with this drug and my old pony. She wasn't worked but walked in hand regularly and enjoyed a lively quality of life. She went through a period of serious depression for about three weeks and then she was put on pergolide. Trouble was, she then lost all her inclination to eat anything other than hay (quite out of character), and so I was having to drench her with the drug which she was very good about.

The depression lifted and she seemed to suddenly turn a corner, but then her feet - oh! her poor feet - they had clearly become unbearable. I had to have her PTS inbetween Christmas and New Year. Altogether she was on the drug for about 6 months and in her case, I must admit, I wonder whether it was the right thing. Beyond about the end of October, I had really lost the pony I knew in all honesty.
 
You must log in or register to reply here.
Top