Making a decision to PTS when it's not clear cut

[acw295]

I'm wrestling with what to do with my just turned 24 year old beloved pony. She's a very young 24, no signs of ageing really but last year she developed EMS and had laminitis. After 5 months in she resumed work and has been doing great, her weight is low (ribby thanks to an expensive course of levothyroxine) and her insulin/glucose results are pretty much perfect. Just low adiponectin which is strange and unexplained as that goes with obesity and she is not in the least fat.

She went slightly pottery again so has had 2 weeks in on bute and bloods retested. All fine. But she looks no better to me off the bute today. We are going to re-do her TRH Stim test for PPID again as last year it was normal but elevated, but if it is not that then I don't know what to do from here. She is miserable in and getting a bit aggressive with me and other horses. It's no life to be stabled so much especially at her age and on a very limited diet so she is often hungry. But when do you decide enough is enough? If she were in pain, or obviously distressed it would be a no-brainer but as she is "ok" I don't know what to think. Before going pottery she was out for 5hrs muzzled and ridden lightly 4-5 times a week and I felt her quality of life was reasonable.

I feel an extra pressure as we are struggling a bit financially as we have a toddler and costs of everything are rising (our nursery bill is going up 8% this year plus there's the utilities and NI). She costs me 25% of my take home pay now I am part-time (£600ish a month as I need part livery and she has all sorts of special feed and shavings) and is now uninsured. Although my husband would never say a word, our life will be much easier when she is no longer here. I feel devastated to admit that though, but the honest truth is I can't really afford her now with her health needs and I have so little time. But I love her so very, very much and only want the best for her. Although I say I can't afford her she never goes without and I give up all other luxuries to give her what she needs, so to that extent I can pay, it's just tight. I do feel emotionally exhausted by it all though, with that awful stomach knot every time I go the yard at what I might find.

I knew I'd have this decision one day but I wish it was an easier one to make. What would you do?

 

[Gloi]

? I'd decide what to do when I got the PPID results. If they are slightly raised a Prascend trial may make a big difference to her and she could get back to doing some work.
Otherwise only you can decide what is enough for both her and you. It's horrible when they age.

 

[honetpot]

She may not that old in years, but old in body. Even with humans, they withdraw treatment and let nature take its course, fortunately for us, we can speed the end for animals. Try and chose a sunny day, and make your last memory of her a nice one.

 

[TPO]

I would say that if she is "miserable" and turning aggressive them she is in a degree of discomfort.

My gentle as a lamb Arab started being narky with her neighbours when in, totally unlike her, there were other factors that on their own weren't much but added up so vet out. She had a slow growing cyst or tumour in her head/upper nasal passage. Vet thinks it would have caused her varying degrees of headaches. Inoperable and I wouldn't have put her through it anyway so she was pts a few days later.

Not the same as your mare, although mine was a "young" 21 too, but just that there is usually always a reason for temperament/personality changes.

Even if you had all the money in the world it can't fix everything. Don't blame yourself for considering your finances. Even if a decision to pts is purely financial its often still the right/not a wrong decision.

It does sound like there is something going on and I wouldn't consider pts the wrong course of action at all. Thinking of you, it's never easy

 

[Crazy_cat_lady]

I've just made the very same decision. He went peacefully to sleep for the final time this week. I could have written your post.

Finances were also a factor of my decision so I absolutely won't judge you for whatever you decide. People at work gave me wonderful advice "it is your horse and your money"

Massive word of advice - try not to discuss your decision with anyone, as much as possible...

More than happy to chat via pm in more detail

 

[meleeka]

? I'd decide what to do when I got the PPID results. If they are slightly raised a Prascend trial may make a big difference to her and she could get back to doing some work.
Otherwise only you can decide what is enough for both her and you. It's horrible when they age.

This. It’s highly likely she’s got cushings by the sounds of it.

 

[windand rain]

I never consider PTS as wrong especially for an old/older horse. What ever the reason it is never wrong what is wrong is putting it off to both your detriment. I won't be using pracend for mine as I simply cannot afford to so if old and uncomfortable they will meet their maker. I would also make the same decision based on my ability to pay even if they were old but healthy. I do not believe in selling old horses or loaning any horse so I am afraid my pragmatic self is to do what is best for both owner and horse or one or the other

 

[ester]

Personally I’ve always said I wouldn’t put my oldie through lami.

 

[Carrottom]

In the situation you describe I would pts.
Out of character aggression is most likely caused by pain. Quality of life is more important than quantity imo. One can spend a fortune on investigating and trying different things but it is an ageing equine and quite likely to have more than one issue. It is a horrible decision but I believe it is the right one.

 

[Equi]

24 is a great age. Yeah she can go longer with more and more help from medicine etc but for who’s benefit hers or yours?

I too could have written a similar post and in the end when I was faced with a 6month boxrest and 2-300 every month vet/medicine bills I said enough is enough we’re both miserable and I can’t do it anymore. He didn’t know any different and spent his last day totally high as a kite on drugs so for him, being beyond pain free was the best day I could have given him.

 

[Highmileagecob]

This. It’s highly likely she’s got cushings by the sounds of it.

If Cushings is implicated, be aware that for some reason either the painkillers don't work or the pain level is such that it breaks through. I went through exactly your situation years ago with a fifteen year old. He was medicated with Prascend and Danilon, in the days when Cushings was a new, emerging diagnosis. He went down after a two weeks of laminitis, and could not stand despite three Danilon twice daily - massive dose for a 14.2 Arab X Welsh. I called a halt, and it wasn't the happy ending that we would have wished for. Do the right thing. You are a caring owner and you will know when the time is right. It may be up and down, three steps forward, one step back, but discuss likely outcomes with your vet and be prepared to call a halt if no progress is being made. Old age is crap isn't it? My remaining oldie has just had a full blood profile done today so that I can tailor his retirement. I am dreading any abnormal levels.

 

[acw295]

I’d love it to be Cushings as at least I can then actively try something, her last TRH Stim test result was 110 which was considered normal but high end (seasonally adjusted, it was in May).

She doesn’t have any Cushings indicators (normal coat, no fat pads, no crest, no puffy eyes) apart from the laminitis. Her Insulin Resistance was pretty huge when she had the EMS diagnosed, but insulin is normal now.

I’ve put her back on bute tonight, she’s clearly not right. Will call vets Monday and see if we can bring the test forward. The aggressive behaviour is around food and/or her feet. Directed at me if I want to lift her feet up or at other horses if she thinks they are anywhere near her food but it’s not all the time but it has definitely got worse though.

I think if it’s not Cushings I’d try and get her some field time in the sun dosed up for a few days then call it an end. If it’s Cushings then try the Prascend and see if there’s any improvement.
I know it’s always better a day early and all that but I feel I need to have tried to answer the “why” first.

 

[Gloi]

When my oldie was diagnosed with Cushing's it was less than a week of 1/2 a tablet a day before I noticed big changes. (No longer sweating and peeing a lot and brighter)

 

[acw295]

When my oldie was diagnosed with Cushing's it was less than a week of 1/2 a tablet a day before I noticed big changes. (No longer sweating and peeing a lot and brighter)

She definitely doesn’t drink a lot, her hay is soaked so she only drinks a small amount and her pee is fairly light as a result. She does sweat easily ridden but she’s always done that as she’s a tad hot headed (aka crackers) but she doesn’t sweat at the moment. Sadly there’s not much to suggest it will be a Cushings result but I know some have it without symptoms.

 

[Gloi]

Always worth testing I think. I suspected mine when he started peeing when ridden which he never did before. Good luck.

 

[milliepops]

Personally I’ve always said I wouldn’t put my oldie through lami.

Same. My old girls will be allowed to slip away if they had any condition that meant they couldn't keep to their normal lifestyle. They have no concept of their age after all, but I decided when they were retired that if I needed to stable or otherwise restrict them for any reason then I'd call it a day.

I generally think that if a caring owner is starting to think PTS might be on the cards then it's not a wrong decision. We all have to be realistic about what's fair to the horse, and what's fair to the owner (finances come into that).

Sounds like you have a good handle on this OP, i would also want to know what the issue was if it was possible to find out, and then you can begin to come to terms with your decision.

 

[tiga71]

I don't think it would be wrong to pts with her issues and apparent unhappiness.

My boy is 24 and I won't keep him going when can't enjoy his current lifestyle. If he needs box rest for any real length of time or restricted grazing, I will call it a day.

At that age they have had a good life and I don't think it is fair to keep them going without a good quality of life.

Sounds like you have a good plan to find out what the immediate issue is and go from there.

 

[ester]

Fwiw I completely support you getting bloods to check first and would be doing the same unless horse critical but agree do ASAP.

 

[nagblagger]

If you need to do blood tests first to get a diagnosis then do them sooner, its you that has to make the decision and sometimes it is easier with all the facts. I used to be like that and cost me a fortune, but i could then accept that I had made the right decision as I had the evidence.
However, now I am similar to Windand Rain, if any of mine have long term issues they will be PTS, with no regrets as they will only get worse. (maybe except the donkeys!)

 

[Highmileagecob]

It may help if you can treat EMS as type 2 diabetes. High insulin is known to send horses into laminitis, but high insulin is a response to high blood sugar, which causes circulatory defects and lower limb changes. It is absolutely pointless to lower insulin without tackling the high blood sugar. Allocate a normal daily allowance of food and forage, and devise ways of making it last to replicate trickle feeding. If you can slow down the amount going in, then the blood sugar and insulin will balance out.

 

[Errin Paddywack]

Before going pottery she was out for 5hrs muzzled and ridden lightly 4-5 times a week and I felt her quality of life was reasonable.

So at her best, her quality of life is only 'reasonable' therefore if anything is going to drop it lower for me that would be too low. For some horses 24 is still young but they are the lucky ones, for many 24 is 'old'. I have lost 3 at 23. 2 couldn't have been saved. the 3rd could have been if I had been able/prepared to throw money and time at him. He was the last of my homebred horses and much loved but I opted to let him go. My very sensible vet once told me. 'don't bankrupt yourself keeping old horses'. Wise words but not always easy to follow. You have my sympathy.

 

[V&F]

I’m in a fairly similar situation, my late twenties mare has Cushings and also found she had EMS last year after a lami episode.

She’s also got severe separation anxiety with my other ridden pony, to the point where I can’t hack him out or take him anywhere. If she is on box rest then he has to be on box rest with her (he then gets stiff and irritated). She’s been retired for over 2 years, and also arthritic.

I am also worrying about struggling financially, it’s getting harder and harder to get by each month!

I too had thoughts about how things would be easier if she wasn’t around anymore (feel awful for saying it!)

I just about manage her at the moment with grazing muzzle, soaked hay etc however her insulin level was showing fairly high on her bloods we had done a couple of weeks ago.

I can’t bring myself to make any decisions as of yet, I feel emotional turmoil about it most days - I think if she has another lami episode it might be time to make the call.

 

[acw295]

Small update- vet has been today and we’ve started her on the Prascend anyway. She’s not moving too badly on the bute but obviously not right. Bloods taken for the basic ACTH test, vet feels that she’s too sore to recommend either test just now, so we will leave the Stim Test for now and see if the drugs work. But we’ll have the ACTH result as a baseline, even if it’s inaccurate.
If it’s a clear negative on the bloods, and the Prascend makes no difference at all then we will pts. So another month or so of action to see if it works and then reconsider where we are. Vet is in agreement that if she can’t cope with any turnout then quality of life is unsatisfactory-so that’s our aim, get her fit enough to be out for a decent amount of the day (muzzled, but she’s been muzzled for 15 years and isn’t bothered by it) or call it a day.
If there is progress on the Prascend we’ll have new xrays done to see if any more damage. But we won’t do it if there’s no progress as it won’t help anything.
My yard owner, yard staff and close friends are fully onboard with that at least so that’s helpful.

I feel better now we are trying something new, it feels less like giving upon her. She was absolutely lovely with my toddler today and the thought she will not be in her life makes me beyond sad. But I know that the odds are not in out favour and I have accepted the likely outcome. I think I will have done all my crying before it happens at this rate.

 

[Apizz2019]

I’d love it to be Cushings as at least I can then actively try something, her last TRH Stim test result was 110 which was considered normal but high end (seasonally adjusted, it was in May).

She doesn’t have any Cushings indicators (normal coat, no fat pads, no crest, no puffy eyes) apart from the laminitis. Her Insulin Resistance was pretty huge when she had the EMS diagnosed, but insulin is normal now.

I’ve put her back on bute tonight, she’s clearly not right. Will call vets Monday and see if we can bring the test forward. The aggressive behaviour is around food and/or her feet. Directed at me if I want to lift her feet up or at other horses if she thinks they are anywhere near her food but it’s not all the time but it has definitely got worse though.

I think if it’s not Cushings I’d try and get her some field time in the sun dosed up for a few days then call it an end. If it’s Cushings then try the Prascend and see if there’s any improvement.
I know it’s always better a day early and all that but I feel I need to have tried to answer the “why” first.

We had a Cushings pony. The fat pads and puffy eyes you describe are most often symptoms of EMS, not Cushings. Coat changes are often in the advanced stages of Cushings.

Our Cushings pony was at the higher end of normal when tested and he had a tiny cut that wouldn't heal, and a super high worm count. Despite the vet saying to test again in a few months time, I chose to medicate. It did make a difference within a few weeks but sadly we lost him a few months after due to dropped suslensories. I didn't know then that Cushings also affects connective tissues, so what we could see on the outside was likely only a small part of what was going on.

If I were you, I'd medicate, if I could afford to but if you feel you're at the end of your journey, both financially and emotionally, you're doing absolutely the right thing by saying goodbye. It's the hardest, most heartbreaking decision we have to make for our wonderful friends but absolutely the right one in these circumstances.

You have to think of your family, and you too. She's lived a wonderful life and is obviously dearly loved and cherished.

What a lucky little girl she is!

Hugs

 

[ester]

That sounds like a very sensible plan and helpful that everyone is on board. Thanks for the update.

 

[acw295]

Bad news. It’s not Cushings, not even close, 12.6 result.
My vet isn’t in, a different one called me with the update so waiting to talk to her next week.
I think my options are Xrays to see what’s happening in her feet, or end things now, or get her ok to be back out and wait to see if she goes downhill again.
I think I need a few days to work that through in my head. The poor vet that called thought he had good news, but I burst in to tears on him.

 

[nagblagger]

What you have to ask yourself is 'is she happy' or just 'ok'?
Xrays - what will that show that will change your plan (except cost more money)? Painkillers and turn her out to see what happens, but realistically is she comfortable?
Sometimes we don't get a diagnosis which would make decisions so much easier - but you have to look at her quality of life, she is not going to be cured. Unfortunately, although i sound hard, it is 'when' not 'if' the time has come to ease her suffering.
Discuss with your vet next week to get the facts and a clearer picture, but i feel you will have to be strong to do what is best for her.
We are all here for you...

 

[ester]

Trust that you know your horse and as such know how well she is or isn't coping with the current situation/well enough to continue the prascend.
Re xrays I think it is what info you want/need to make a decision on which is quite personal, might be helpful but you might decided just on the horse/situation in front of you. Hopefully can have a good chat with your vet. Keep posting we can be a pretty good sounding board even if just to get your own thoughts in order.