ihatework
Well-Known Member
I'm coming at this as a fake biochemist (ie I have a degree in it and can barely remember anything!) and currently working in the clinical/medical side of drug development.
I am not an expert in PPID and quite frankly have done little to no research on it, so my DISCLAIMER is to take everything I say with a pinch of salt. But my very little brain does have a little pocket somewhere that muses about a variety of things and cushings is one of those. I'm sure some proper scientists have done research that either supports or refutes my musings, but quite frankly I'm too lazy to look it up
We all remember those (often white) old ponies with curly coats, often looked a bit ropy in winter, were on lammi watch through summer, but they kept plugging on in the riding school like the little stalwarts they were ....
Fast forward on many years and we are getting younger diagnosis and a much wider variety of horses diagnosed, and from seemingly a vast array of non-specific symptoms. Why?
Well in part the sales and marketing genius from Boehringer Ingleheim (or whatever they are called) ..... because it was free a large cohort of equines that possibly never would have been tested previously, were indeed tested. The more sales income generated, the more research gets funded, the more we start to know, blah blah blah
Roll back the clock, dear god, going back over 20 years. I had a cast off event horse given to me. 7/8th tb. He was a cool dude but truth be told was always a bit off in his feet, even at a relatively young age. Started with being footsore after being shod, progressed a bit to not wanting to go off drops xc, had a navicular syndrome type diagnosis despite not much to see. We managed him, he was happy. Then he tweaked a ligament, went out for rest on good grass and fairly soon after presented to me as laminitic. Vet poo-pooed it, said he was just footsore without shoes, but I treated him as if laminitic anyway. Fastforward a couple of years, the malingerer hadn't come back into any serious sort of work and was eventually retired. Again a bit footy and had a couple of abcess'. We are at this point about 15 years ago and even then cushings in a mid-teens tb type was not at the top of any vets radar. I'm not even sure what prompted me to get him tested, quite possibly something I had read on here, but I did. ACTH over 500. He was managed really well for the final few years on prascend, he responded super and his quality of life was good. He had a fairly rapid decline whereby he started to get footy with repeat abcess plus rainscaldy skin and that was when I called it a day for him.
Bearing in mind horse above had me quite well primed for cushings in a non typical horse. Horse 2 - young (7 at diagnosis), mixed breed horse. Again something not quite right that I couldn't put my finger on. Different initially, fluctuating lethergy primarily. Tried all sorts, pretty much gave up and turfed him in a field to give me some headspace. Weight piled on in weird distribution and come spring he also got repeat abcess. When I asked my vet to test my 7yo for cushings they virtually laughed at me, but did humour me and doing it .... then came back grovelling in surprise.
That said, this horse did not respond to pracend, at least not back than. He got extremely depressed, it made no difference to his symptomology so he eventually came off it.
I actually don't think that horse had cushings. At least not at that stage of his life although maybe he had a genetic disposition towards it, as I know more recently as a late teenager he is being managed successfully with a small dose of prascend. Back then it wasn't quite as well known, although seems pretty common knowledge now, that an ACTH rise can be caused by chronic stress. I'm pretty convinced that was true for this horse and I do wonder if the side effects he had on prascend were as a result of not actually having PPID. So these days I'd always confirm an ACTH with a TRH-stim.
But my horses aside, the interesting things I've seen or discussed
When horse 2 was initially diagnosed and we were treating, I was working in the field of prostate cancer. Being a dutiful employee I was right up to speed on various endocrine pathways and the various hormones in play. As I was randomly recounting this to my vet, I mentioned the potential for a rise in testosterone in cushings horses (don't ask me why, I can't remember now). She thought this was fascinating as ancedotally she was observing, in her words, those rude bargy cobby types with cushings start behaving a bit better on prascend. Testosterone reduction link?!
Uveitis - friends horse had it recurrently. Once it independently got treated for cushings, the uveitis resolved!
Where am I going with this? I'm not really sure, but from what I've observed its more like a syndrome. An element of genetic susceptability, quite possibly some environmental input. Stress has to be a big component (physical and/or mental) - shift the body out of biochemical equilibrium and you start seeing the subtle signs - footiness, abcess, infection, auto-immune stuff. All things that are vague and non-specific. Things that have plenty of other potential diagnosis. These horses may or may not have an underlying piturity issue, probably don't have full blown cushings, may or may not respond to drugs. But IMO it's a sign all is not well and the patterns would always lead me to test, because the genius at BI made it free ....
I am not an expert in PPID and quite frankly have done little to no research on it, so my DISCLAIMER is to take everything I say with a pinch of salt. But my very little brain does have a little pocket somewhere that muses about a variety of things and cushings is one of those. I'm sure some proper scientists have done research that either supports or refutes my musings, but quite frankly I'm too lazy to look it up
We all remember those (often white) old ponies with curly coats, often looked a bit ropy in winter, were on lammi watch through summer, but they kept plugging on in the riding school like the little stalwarts they were ....
Fast forward on many years and we are getting younger diagnosis and a much wider variety of horses diagnosed, and from seemingly a vast array of non-specific symptoms. Why?
Well in part the sales and marketing genius from Boehringer Ingleheim (or whatever they are called) ..... because it was free a large cohort of equines that possibly never would have been tested previously, were indeed tested. The more sales income generated, the more research gets funded, the more we start to know, blah blah blah
Roll back the clock, dear god, going back over 20 years. I had a cast off event horse given to me. 7/8th tb. He was a cool dude but truth be told was always a bit off in his feet, even at a relatively young age. Started with being footsore after being shod, progressed a bit to not wanting to go off drops xc, had a navicular syndrome type diagnosis despite not much to see. We managed him, he was happy. Then he tweaked a ligament, went out for rest on good grass and fairly soon after presented to me as laminitic. Vet poo-pooed it, said he was just footsore without shoes, but I treated him as if laminitic anyway. Fastforward a couple of years, the malingerer hadn't come back into any serious sort of work and was eventually retired. Again a bit footy and had a couple of abcess'. We are at this point about 15 years ago and even then cushings in a mid-teens tb type was not at the top of any vets radar. I'm not even sure what prompted me to get him tested, quite possibly something I had read on here, but I did. ACTH over 500. He was managed really well for the final few years on prascend, he responded super and his quality of life was good. He had a fairly rapid decline whereby he started to get footy with repeat abcess plus rainscaldy skin and that was when I called it a day for him.
Bearing in mind horse above had me quite well primed for cushings in a non typical horse. Horse 2 - young (7 at diagnosis), mixed breed horse. Again something not quite right that I couldn't put my finger on. Different initially, fluctuating lethergy primarily. Tried all sorts, pretty much gave up and turfed him in a field to give me some headspace. Weight piled on in weird distribution and come spring he also got repeat abcess. When I asked my vet to test my 7yo for cushings they virtually laughed at me, but did humour me and doing it .... then came back grovelling in surprise.
That said, this horse did not respond to pracend, at least not back than. He got extremely depressed, it made no difference to his symptomology so he eventually came off it.
I actually don't think that horse had cushings. At least not at that stage of his life although maybe he had a genetic disposition towards it, as I know more recently as a late teenager he is being managed successfully with a small dose of prascend. Back then it wasn't quite as well known, although seems pretty common knowledge now, that an ACTH rise can be caused by chronic stress. I'm pretty convinced that was true for this horse and I do wonder if the side effects he had on prascend were as a result of not actually having PPID. So these days I'd always confirm an ACTH with a TRH-stim.
But my horses aside, the interesting things I've seen or discussed
When horse 2 was initially diagnosed and we were treating, I was working in the field of prostate cancer. Being a dutiful employee I was right up to speed on various endocrine pathways and the various hormones in play. As I was randomly recounting this to my vet, I mentioned the potential for a rise in testosterone in cushings horses (don't ask me why, I can't remember now). She thought this was fascinating as ancedotally she was observing, in her words, those rude bargy cobby types with cushings start behaving a bit better on prascend. Testosterone reduction link?!
Uveitis - friends horse had it recurrently. Once it independently got treated for cushings, the uveitis resolved!
Where am I going with this? I'm not really sure, but from what I've observed its more like a syndrome. An element of genetic susceptability, quite possibly some environmental input. Stress has to be a big component (physical and/or mental) - shift the body out of biochemical equilibrium and you start seeing the subtle signs - footiness, abcess, infection, auto-immune stuff. All things that are vague and non-specific. Things that have plenty of other potential diagnosis. These horses may or may not have an underlying piturity issue, probably don't have full blown cushings, may or may not respond to drugs. But IMO it's a sign all is not well and the patterns would always lead me to test, because the genius at BI made it free ....
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