To give Prascend or not?

[Shilasdair]

Hi
One of mine has been diagnosed with Pituitary Pars Intermedia Dysfunction (PPID) or 'Cushings', and I have duly been given Prascend for her.
I do not want to give her Prascend, however, as she doesn't show any of the symptoms of PPID (with the exception of laminitis which I suspect is more due to her EMS).
The laminitis is under control with diet.
I also believe that the side effects of Prascend will hit this horse particularly hard.

So convince me to obey the vet and give her the 1/2 pill she's been prescribed, please.

 

[EllenJay]

Why bother to get vet advice if you don't want to follow it. If you know better than the vet, then don't give the treatment

 

[Pearlsasinger]

I suppose it depends on why you don't want to give this particular horse Prascend but if mine had Cushings related laminitis, I would certainly want to give the one drug that can make a huge difference. If you don't give the medication, I think you should be prepared to pts before long, as it is likely that the horse will soon have another bout of laminitis.

 

[poiuytrewq]

Yes. My little old pony has had a new lease of life.
He was a bit awkward the first year, he’d take it one way then decide not too but now has a handful of chaff, a handful of nuts and eats it easily.
He’s back to his bouncy jig Joggy self.
After a year or so I’ve just had to up from half to 3/4
I couldn’t ever consider not giving it
It’s given him a happy life

 

[Shilasdair]

I suppose I didn't give enough information about the horse for you to give any helpful responses regarding experiences with Prascend- my fault.

 

[MuddyMonster]

The difference in my boy on a low dose of Prascend is amazing.

He didn't test positive (was borderline) but he did have LGL - his only obvious symptom but we trialled Prascend and have not looked back.

I've got my boy back and he's fitter, healthier and happier than ever. He's quite young to be on it I think, but super pleased we tried it.

 

[Shilasdair]

Thanks Poiuytrewq and MuddyMonster - that's helpful to know.
I have read a blog by a vet who says she doesn't prescribe Prascend because the blood tests (taken in the autumn) are often incorrect...

 

[paddy555]

So convince me to obey the vet and give her the 1/2 pill she's been prescribed, please.

I don't understand your post. Your horse, you have employed a vet and got a professional opinion, your decision. . Perhaps it would be better if you attach a poll to your post then we could vote. That would probably be the best way of deciding how to treat a horse.

In fact we could do it for all animal illnesses. Far more exciting than employing the boring old vet.

 

[Shilasdair]

I don't understand your post. Your horse, you have employed a vet and got a professional opinion, your decision. . Perhaps it would be better if you attach a poll to your post then we could vote. That would probably be the best way of deciding how to treat a horse.

In fact we could do it for all animal illnesses. Far more exciting than employing the boring old vet.

I wish I believed that vets were infallible and able to see the future. In humans now, they can determine what drugs will work with which genetic make up you have inherited - shame we can't do the same with horses other than by trial and error.

 

[Pearlsasinger]

Thanks Poiuytrewq and MuddyMonster - that's helpful to know.
I have read a blog by a vet who says she doesn't prescribe Prascend because the blood tests (taken in the autumn) are often incorrect...

If either you or your vet think that the ACTH test result is incorrect, do the TRH-Stim test,which is much more accurate. Our mare was tested several times and came back within normal range but slightly increased readings each time. We were suspicious of her symptoms (fortunately not laminitis) and had the TRH-Stim test, which came back as *8 times* the normal max; 800 while max should be 100.
I don't understand why your vet didn't suggest the alternative test.

 

[Scarlett]

I have one who was borderline Cushings who's been on a half a prascend for 3 years now. He's TB and barefoot. Whilst he didn't have any real issues other than the odd bit of footiness and drinking a lot it certainly seemed to pick him up and gave him a new lease of life. We've not had any side effects.

 

[Shilasdair]

If either you or your vet think that the ACTH test result is incorrect, do the TRH-Stim test,which is much more accurate. Our mare was tested several times and came back within normal range but slightly increased readings each time. We were suspicious of her symptoms (fortunately not laminitis) and had the TRH-Stim test, which came back as *8 times* the normal max; 800 while max should be 100.
I don't understand why your vet didn't suggest the alternative test.

I should have explained - I asked the vet to run bloods for EMS and other issues as I was suspicious she had it hence the odd laminitis she had earlier this year. The tests came back with PPID too - but the horse doesn't show a single other symptom of PPID.
Horse does however have issues with colic, and one of pergolide's side effects can be colic.

 

[AdorableAlice]

It is a simple question you can answer yourself really.

1. Do I want to prolong the life of the pony and ensure it has every chance of having a nasty and progressive disease effectively controlled, thereby giving quality of life and preventing suffering.

2. Do I NOT want to prolong the life of the pony and let a nasty and progressive disease take its course which will result in suffering of various types and stages.

I have a very old horse on the drug, one and half pills for him, but he is 17.2. He is a picture of health at rising 28, full of life and happy. Yes it is a considerable cost but I choose to give him quality of life.

 

[Shilasdair]

It is a simple question you can answer yourself really.

1. Do I want to prolong the life of the pony and ensure it has every chance of having a nasty and progressive disease effectively controlled, thereby giving quality of life and preventing suffering.

2. Do I NOT want to prolong the life of the pony and let a nasty and progressive disease take its course which will result in suffering of various types and stages.

I have a very old horse on the drug, one and half pills for him, but he is 17.2. He is a picture of health at rising 28, full of life and happy. Yes it is a considerable cost but I choose to give him quality of life.

I would have to pick
2. I'm not sure I want to prolong the life of a horse at all costs.

I don't care about the financial cost (I have the drug already) but I would rather she had a nicer quality, shorter life, than a long, colicky one. It won't be the PPID that gets her, incidentally - she has other life-limiting conditions.

 

[MuddyMonster]

Thanks Poiuytrewq and MuddyMonster - that's helpful to know.
I have read a blog by a vet who says she doesn't prescribe Prascend because the blood tests (taken in the autumn) are often incorrect...

It's my understanding that labs now adjust the levels to take into account the natural ACTH rise.

Mine tested borderline to both the ACTH and the TRH stimulation test but we wanted to trial the Prascend as he had winter laminitis. If I have waited for a positive result, he may not be with us now - who knows?

If you have any concerns, can you speak to your own vet about them? They know your horse and ultimately want what is best for them.

 

[Caol Ila]

Try giving her 1/4 tablet. Then after a week, build up to 1/2. Or you can give her 1/4 in the morning, 1/4 in the evening. When Gypsum was diagnised with Cushings, I spent a lot of time on the PPID Facebook group, and their suggestions for owners worried about side effects was roughly that -- reduce dose, and/or spread the dose out. Gypsum lost her appetite, which was sort of an on-and-on off thing whether she was on Prascend or not, but the Prascend did not help. I moderated the dose accordingly.

 

[RHM]

It depends I think on why you tested for cushings to begin with.
What symptoms was the horse showing? If it was purely lami related and the horse was well and non symptomatic apart from that then I would consider not treating. The evidence for it reducing lami episodes is poor. And trials show that diet and exercise is just as effective.
HOWEVER - pracend can be a life changer for those that have been symptomatic of PPID. And in many cases the horses appear to be feeling profoundly better for it.

 

[Laurac13]

My elderly pony had mild laminitis years ago tested positive for Cushings and been on half a tablet of prascend for years and hasn’t had laminitis since it’s been a godsend. If you don’t think the results are right retest, but If positive please do give prascend as per your vets recommendation as it really does help Cushings equines

 

[AdorableAlice]

I would have to pick
2. I'm not sure I want to prolong the life of a horse at all costs.

I don't care about the financial cost (I have the drug already) but I would rather she had a nicer quality, shorter life, than a long, colicky one. It won't be the PPID that gets her, incidentally - she has other life-limiting conditions.

That is a sensible way to look at, maybe winter her without and see how she goes. The main issue I had with my lad was persistent abscessing in his feet. The drug stopped all of that. Colic is not fun, I have a mare who colics for fun and managing her is a nightmare and very stressful.

 

[Tiddlypom]

ACTH levels do rise sharply in the autumn in PPID horses. The reference range (above which a horse is deemed to need medication) is duly adjusted upwards to take this into account.

Maybe your tame vet is unaware of this.

A untreated PPID horse will deteriorate and end up very sick. PPID is a lot more than laminitis and a curly coat. The sooner they are stabilised on a suitable dose of Prascend, the longer their subsequent healthy life is likely to be.

I have two on it. One needs her dose titrated up very carefully if the dose is increased, the other has been grand on it from the start.

 

[poiuytrewq]

My pony was from the Blue Cross, he was already diagnosed but doing fine without treatment and he did at first, for quite a while.
I have friends who have ponies they are hesitant at giving prescand too, I just can’t say enough, it’s been like a wonder drug to my little chap. He’s almost 30 and has a bounce in him, it’s really lovely.

 

[paddy555]

I should have explained - I asked the vet to run bloods for EMS and other issues as I was suspicious she had it hence the odd laminitis she had earlier this year. The tests came back with PPID too - but the horse doesn't show a single other symptom of PPID.
Horse does however have issues with colic, and one of pergolide's side effects can be colic.

what PPID test did they do and, when and what was the result ie the number.

 

[Auslander]

Speaking from my experience, which isn't entirely relevant as it isn't with a horse that has the problems yours have. My vet said that giving Prascend to a symptomless horse would massively reduce the risk of it getting laminitis, that, without treatment, a PPID horse WILL at some point get laminitis, and laminitis in a PPID horse is far more complicated to manage than in a "normal" horse.
The ppid horse here has 2 a day, and her levels are stable at 75, she has no side effects, and leads a pretty normal life, albeit with my beady eye on her all the time!

 

[Shilasdair]

Horse's bloods were taken when she was trying to die by wrapping her intestines round her spleen.
They were just into 'positive' territory.

 

[Auslander]

Horse's bloods were taken when she was trying to die by wrapping her intestines round her spleen.
They were just into 'positive' territory.

I think I'd be inclined to hang fire for a bit, and keep an eye on levels with regular testing

 

[Shilasdair]

Try giving her 1/4 tablet. Then after a week, build up to 1/2. Or you can give her 1/4 in the morning, 1/4 in the evening. When Gypsum was diagnised with Cushings, I spent a lot of time on the PPID Facebook group, and their suggestions for owners worried about side effects was roughly that -- reduce dose, and/or spread the dose out. Gypsum lost her appetite, which was sort of an on-and-on off thing whether she was on Prascend or not, but the Prascend did not help. I moderated the dose accordingly.

I like this plan.
Horse stops eating at the drop of a hat, but if I sneak a tiny dose at first...I can review if it has a really bad effect on her.

 

[Shilasdair]

I think I'd be inclined to hang fire for a bit, and keep an eye on levels with regular testing

Yes, I'm swithering between giving a low dose of 1/4, and then retesting. Or giving no dose, waiting until she's healthier all round, and retesting.

 

[SO1]

Difficult one that. I suppose it depends on if you know why the horse is colic prone.

My pony is 19 as that is the average age of onset for Cushings he is now going to be tested every year. My vet is of the opinion to medicate before symptoms rather than waiting for them to occur if he tests positive for Cushings. He also is colic prone. Vet also believes all horses get Cushings if they live long enough. If he does get Cushings I probably will medicate but start at very low dose.

 

[paddy555]

Horse's bloods were taken when she was trying to die by wrapping her intestines round her spleen.
They were just into 'positive' territory.

I'm a bit lost. Was the blood drawn when the horse was stressed and or in pain? One may assume so if she was trying to die at the time.
ETA I suppose the other question is did she have any sedation at the time for her presumably colic illness?

 

[MuddyMonster]

I'm fairly certain I've had a discussion with my hoof care practitioner that some of their clients give Angus Cactus as a herbal alternative. I never looked further into it as medication suits mine, but could be worth looking at?