Never simple is it? Lami/cushings

[TwyfordM]

So, Mystis gone down with Lami, again.

This will be her 9th bout in her lifetime and she's now nearly 20 with first bout occurring as a youngster before I took her on aged 4.

Some have been fairly quick to resolve, some have taken longer and caused minor rotations/dropping of pedal bone, the last bout she had causing the most amount of damage and taking months to heal fully.

She's had cushings since the age of 9, regularly tested and put on the pergolide paste. Last year was in the autumn during the seasonal rise and dose adjusted. Seemingly no issues since, she's moulting normally, not drinking/peeing excessively etc

She has not seen grass since Oct and has been on school turnout. Carefully weighed hay/low starch/sugar feed for meds. Weight has remained within 5kg on weigh tape throughout the winter, she's been lunged/free schooled regularly, gone for walks etc

The weight she's at now, you can see
3/4 ribs, vet agreed shes not at all overweight.

Talked through everything with the vet, and the only thing I can change is soaking the hay again and I'm weighing it out to 1% of her body weight (weight bridge not weigh tape)

So she's going to lose further weight that she doesn't have to lose

Bout came on acutely, no warning so we are going to try and cushings test in a week if she's improved at all.

Beyond a sudden rise in ACTH levels since the last seasonal rise, we are all baffled.

It's taking a fair amount of pain killer to keep her comfy, and I've padded and booted her feet to try to relieve some of the pain. So she's comfy and eating/drinking and happy enough at the moment.

But I'm at a loss on what to do, I said another bout and I'd call it a day, discussed with vet too. She said that they would completely understand if that's what I choose, given her history and not wanting her on another long stretch of box rest. So we agreed on a week of keeping her as pain free as possible and assess it next week and see if we are able to test ACTH then.

Feel physically sick at the thought, but I also don't want to keep her going if she's going to have no quality of life.

So so tricky. Any words of wisdom?

 

[Errin Paddywack]

No words of wisdom as you are already doing everything I could think of. Just wanted to express my sympathy, she is such a charismatic little pony, one of my favourites on here. I do love little ponies with character. Everything crossed that things start to go in the right direction and give her a reprieve.

 

[Supercalifragilistic]

Nothing to add, I just wanted to offer support as I am also struggling with a cushings pony, and like you I soak and weigh every gram that goes into his little mouth. It’s exhausting and stressful and it’s ok to feel a bit overwhelmed. She’s really lucky to have you as her owner.

 

[splashgirl45]

None from me either. I can only tell you that I had my cushings mare put down at 25 as her levels were rising and she was already on 4 tablets daily, which is a lot for a 15.2 lightweight horse. She became footy and vet thought she was low grade lami so I made the choice to end it rather than curtail her life by being in a stable and not allowing her to graze with her friend. Although I miss her I’m sure that it was the right decision for her. You know your mare and know if she is happy so that’s the choice I think . I was pretty sure mine would have been very unhappy kept in.

 

[Pearlsasinger]

I had a Shire mare pts aged 6 with what I now think was undiagnosed Cushings. You have been managing Misti's Cushings for years and doing so very well. As the last bout was the worst so far, I don't think I would put her through it all again. It's much easier to make the decision when it's not your horse though.

 

[tda]

I also had to let a pony go, as not matter what we did, he was having relapses / lami episodes despite not being overweight or on grass. This was 20 years ago
You have to think about their quality of life, but it's a hard decision to make

 

[holeymoley]

I really sympathise , they're very hard to keep and a constant worry.

Have you tried anything from Trinity Consultants? A constant dose of their P45 may just keep a build up of toxins away enough to keep her levels down. Although I appreciate another monthly cost. My guy is EMS laminitic, not cushings yet, and I give him their P45/ L96 regularly to flush anything out.

 

[Slightlyconfused]

Have you tested for EMS as well?

Sending hugs. X

 

[Gamebird]

Have you tested her for EMS? That could easily be destabilising her, and if she had that as well then treating it could make all the difference. They don't have to be fat either - I have had several clients with really quite skinny ponies test positive for it.

 

[TwyfordM]

Have you tested her for EMS? That could easily be destabilising her, and if she had that as well then treating it could make all the difference. They don't have to be fat either - I have had several clients with really quite skinny ponies test positive for it.

Yep, been ruled out several times over

 

[Alibear]

Your plan sounds excellent. As you say, assess the next step once you get the results.
You've done the very best for her all this time, and quality of life is a more prominent factor as they age.
I let my old boy go last November because treatment would have severely and permenantly changed how he could be kept, and he'd never been one that could cope with change.

 

[SO1]

I am so sorry you are going through this especially as she is off grass turnout. Could it be a different batch of hay with a higher sugar content? Maybe her Cushings has worsened and her medication needs adjustment.

It is a hard decision to make. I don't know what I would do in your situation. Laminitis is such a cruel disease.

 

[ILuvCowparsely]

So, Mystis gone down with Lami, again.

This will be her 9th bout in her lifetime and she's now nearly 20 with first bout occurring as a youngster before I took her on aged 4.

Some have been fairly quick to resolve, some have taken longer and caused minor rotations/dropping of pedal bone, the last bout she had causing the most amount of damage and taking months to heal fully.

She's had cushings since the age of 9, regularly tested and put on the pergolide paste. Last year was in the autumn during the seasonal rise and dose adjusted. Seemingly no issues since, she's moulting normally, not drinking/peeing excessively etc

She has not seen grass since Oct and has been on school turnout. Carefully weighed hay/low starch/sugar feed for meds. Weight has remained within 5kg on weigh tape throughout the winter, she's been lunged/free schooled regularly, gone for walks etc

The weight she's at now, you can see
3/4 ribs, vet agreed shes not at all overweight.

Talked through everything with the vet, and the only thing I can change is soaking the hay again and I'm weighing it out to 1% of her body weight (weight bridge not weigh tape)

So she's going to lose further weight that she doesn't have to lose

Bout came on acutely, no warning so we are going to try and cushings test in a week if she's improved at all.

Beyond a sudden rise in ACTH levels since the last seasonal rise, we are all baffled.

It's taking a fair amount of pain killer to keep her comfy, and I've padded and booted her feet to try to relieve some of the pain. So she's comfy and eating/drinking and happy enough at the moment.

But I'm at a loss on what to do, I said another bout and I'd call it a day, discussed with vet too. She said that they would completely understand if that's what I choose, given her history and not wanting her on another long stretch of box rest. So we agreed on a week of keeping her as pain free as possible and assess it next week and see if we are able to test ACTH then.

Feel physically sick at the thought, but I also don't want to keep her going if she's going to have no quality of life.

So so tricky. Any words of wisdom?

Feel for you as I learnt the hard way with loosing my mare, courtesy of my vets lack of checking. currently I have 3 who suffer laminitis

 

[94lunagem]

I don't have any words of wisdom, but I also have a lami-prone little one with cushings so I know how much of a worry it is and I just wanted to offer all the hugs and support I can.

It sounds like you are doing everything within your power to give her the best quality of life you can but I'm a great believer that when it is time to call it a day, you know it in your gut. And it doesn't sound like you're quite there yet.

Nobody will judge however you decide to go forwards.

I'll be routing for her

 

[meleeka]

No help here, I’m in the same boat . The only difference is that mine did overdo the grass at the beginning of the year and her levels were tested ok a couple of months before. I’ve upped her dose anyway as she tolerates it well and I figure it won’t do any harm. The weather has sort of helped as she was quite happy in her stable, but now she’s ready for limited turnout, it’s still a swamp. She might be 30 but doesn’t remotely look or act it and I know she will go mad when she’s allowed out. Shes currently got boots on and allowed the run of the yard and we are just waiting for the field to dry a bit then i’ll let her have a small mud patch and increase very gradually.

Is yours on Paracetomol as well as Bute/Danilon? It made all the difference to mine when she looked comfortable in her stable but her pulses just wouldn’t come down.

 

[TwyfordM]

No help here, I’m in the same boat . The only difference is that mine did overdo the grass at the beginning of the year and her levels were tested ok a couple of months before. I’ve upped her dose anyway as she tolerates it well and I figure it won’t do any harm. The weather has sort of helped as she was quite happy in her stable, but now she’s ready for limited turnout, it’s still a swamp. She might be 30 but doesn’t remotely look or act it and I know she will go mad when she’s allowed out. Shes currently got boots on and allowed the run of the yard and we are just waiting for the field to dry a bit then i’ll let her have a small mud patch and increase very gradually.

Is yours on Paracetomol as well as Bute/Danilon? It made all the difference to mine when she looked comfortable in her stable but her pulses just wouldn’t come down.

Yep on paracetamol too, hasn't made a difference with pulses/heat as of yet

 

[southerncomfort]

I also had to let a pony go, as not matter what we did, he was having relapses / lami episodes despite not being overweight or on grass. This was 20 years ago
You have to think about their quality of life, but it's a hard decision to make

Me too.

She was on prascend, all bloods completely normal and nowhere near grass. Still had regular bouts of laminitis. Bute/paracetamol didn't control the pain.

It was a horrible decision but she couldn't go on like that.

 

[Bellalily]

Lots of support, but despite also having a Cushings horse, he’s doing ok atm. You sound as tho you’re doing everything possible, so as I’m sure you’ll make the right decision.

 

[deepblue]

Apologies if you have mentioned it previously, but has she been tested for EMS?

 

[ihatework]

You have managed this for longer than I would have. I’m sorry

 

[Boulty]

Random thought but if you haven’t done so already maybe consider running general bloods on her when you retest ACTH to see if there’s anything else systemic going on. My PPID horse destabilised when he had raised liver values (we never really found the cause but suspect environmental as several other horses at same yard also had raised liver enzymes).

Tbh if ACTH still showing good control and no other obvious cause then unless she improves drastically in the interim I would consider PTS as it honestly doesn’t sound like you’ve anywhere else to go management-wise unless you’ve got a grass free track livery nearby where she could get extra movement which may help as if mainly stabled with arena turnout she won’t be moving as much as she could be (my PPID horse was at his most stable when in a lot of work (obv not possible for you) & in a living environment where he moved a hell of a lot)

 

[TwyfordM]

Random thought but if you haven’t done so already maybe consider running general bloods on her when you retest ACTH to see if there’s anything else systemic going on. My PPID horse destabilised when he had raised liver values (we never really found the cause but suspect environmental as several other horses at same yard also had raised liver enzymes).

Tbh if ACTH still showing good control and no other obvious cause then unless she improves drastically in the interim I would consider PTS as it honestly doesn’t sound like you’ve anywhere else to go management-wise unless you’ve got a grass free track livery nearby where she could get extra movement which may help as if mainly stabled with arena turnout she won’t be moving as much as she could be (my PPID horse was at his most stable when in a lot of work (obv not possible for you) & in a living environment where he moved a hell of a lot)

Yeah will be, it's something I've already discussed with vet as she's had high liver enzymes before which resulted in an impaction colic. There's no external signs of it, but given she's on a lot of pain meds, I want to be sure that her liver is handling it ok

 

[marmalade76]

Mine was 19 when we went through similar and I called it a day, so very upsetting.

 

[scats]

Honestly, I wouldn’t judge you for calling it a day. I think when they get to the point that it’s just happening without any obvious reason for them ‘falling off the tightrope’, it becomes too difficult to predict or manage.
Theres obviously some internal reason for it, so running full bloods might show something.

If Polly goes down with it again, I’ve already made my mind up that we’re done. She is the slimmest she’s been in probably 5 years, but I cannot shift that last bit of crest so I’m aware that we’re living on the metaphorical tightrope and probably always will be.

 

[julesjoy]

Offering my sympathies, been there too unfortunately and pts in the end, as it got to the point where she was still getting it despite doing everything possible and it didnt seem fair on her. It's really hard, I'm sorry, I hope you get more time.

 

[Highmileagecob]

I've been there too, with an Arab cross who was thought to be about 15 years old. I read everything I could lay my hands on, and found links between Cushings, diabetes, EMS and daylight length. The pituitary gland is involved in Cushings and PPID and responds to daylight length to trigger coat shedding and increased protein uptake in the gut. Pain is often uncontrollable, no idea why. You are doing everything you can, but may be reaching the tipping point. It's heartbreaking. Hugs to you.

 

[GemmaRuby]

I'm so sorry you are experiencing this with your mare. I was in the same situation with my own a few year ago. Despite a full surfaced track and good hay, the prascend no longer controlled her hormones, I couldn't get her confortable and I had to call it a day. Still heartbroken, she was wonderful and only 18, I thought I had years left

 

[ycbm]

Any words of wisdom?

So sorry, T, absolutely none. It's clear you adore her and have done everything possible for her. It’s a very cruel disease on the horse and the owner.
.

 

[TwyfordM]

How we are looking weight wise at the moment. Fat pads on shoulders/crest just don't shift. Coats very thick so hides how slim she really is

Quick couple of steps to the tie up ring to assess this morning, still very sore turning and she's got some thick sponge padding in her hoof boots.

Hooves still hot, pulse still going strong.

 

[TwyfordM]

So sorry, T, absolutely none. It's clear you adore her and have done everything possible for her. It’s a very cruel disease on the horse and the owner.
.

She's got me through so much over the years, I owe her so much. I wouldn't be where I am, or the person I am today without her. I'm not even sure I'd still be here to be honest, which is why it's so hard, but I know I owe it to her to make sure she's not suffering.

Doesn't make it any easier though

Trying to remember better a day too soon, than a day too late.