Wednesday, June 6, 2018

Caring for a show horse with PPID (Cushings)

T was diagnosed with Cushings (PPID) in October 2017. He had an ACTH level of 987, and the high end of normal is 110.

We immediately put him on Prascend, and in the last six months have since seen several dramatic changes. He went from being a lethargic horse to being much more energetic, often being rather exuberant at the trot and spooking for fun (which I’m glad about, because it means he’s feeling good). Whereas I struggled to keep weight on him all last year and some of 2016, this spring he’s gotten quite plump. His topline has filled back in, and he’s muscled appropriately for an almost-third-level dressage pony.

Even fancy fat ponies still love to get dirty

But… but. He struggles with regulating his temperature. He gets cold really, really easily. When I was at Nationals in November, I bought him a 400 gram fill blanket with a hood. I joked that I’d never use it… but it got used a LOT this winter, despite not having a particularly cold winter. He’d start shivering when the temps were in the 60s if there was a breeze and it wasn’t sunny. He now owns a very versatile wardrobe for weather conditions 70 degrees F and under.

I was hoping that we’d get a break this summer, but it’s actually worse – he’s started to overheat incredibly easily even though he’s getting body clipped regularly. He still sweats, but not as much as he used to, and even though he’s fit, trotting for 5 minutes has him breathing heavily. We’ve started doing a lot of walk work – mostly laterals – to work on suppleness and strength without doing him in. I’ve also started riding him before work, since it’s coolest then and sometimes we even have a bit of a breeze. We’re keeping our rides short and sweet, trying to make the work really count because I know I don’t have a lot of time to get it done.

At least our walk laterals are getting better. Imagine how good they'd be if I would STOP LEANING OMFG.

The heat sensitivity is also affecting our travel plans. We recently hauled to our usual clinic, a two-hour trailer ride. It was about 95 out, and by the time we arrived at the, he was colicking due to dehydration. Some banamine fixed him up, but by the next day symptoms returned and he ended up with an overnight at the vet’s for fluids. He’s fine now, but it’s clear that I’m going to have to limit our travel distance and make sure we only travel during the coolest part of the day. Since I have to haul to lessons, this means that lessons can only happen in early mornings, which means weekends. It also means that showing during the summer, and much of the fall, is off the table. 

Sometimes we just go for really long walks to improve fitness.

To attempt to address the dehydration issue, T is now on electrolytes. He’s always had free choice loose salt and a salt block, because I’m of the opinion that I’d rather let the horse self-regulate than force him to eat something he doesn’t need. I know the haffies use the lick, but I’ve never seen T try it. Anyway, do you know how hard it is to find electrolytes with no sugar? Because dextrose is the first ingredient in nearly every type of elytes… and guess what, PPID horses shouldn’t have sugar. The only option I could find was Summer Games, which was developed by several vets for the 1996 Olympic Games in Atlanta. It does have dextrose, but it’s the fifth ingredient, which is the best I could find. So far he’s actually eating them, which in of itself is a miracle. 

Magic stuff I hope

Because that’s another part of PPID… lack of appetite. We struggled with that before the Prascend, and it’s still an issue. He now refuses to eat the awesome flax-based Platinum Performance that he used to love  – he won’t touch it no matter what I mix it with. Right now, Triple Crown Lite (for vitamins), Renew Gold (for fat), and some soaked, rinsed beet pulp (for supps to stick to) is his mixture of choice. He’s quit eating carrots because I stuffed his Prascend pills in them (because I’m a horrible person, apparently), so now we have to dissolve the pills in water and pour it over the beet pulp. He’s also now on a vitamin E supplement to hopefully help his immune system, since PPID horses have a depressed immune response. Plus, since ulcers have been a thing, he’s trying GUT.  At some point I’ll see if he likes beer, because that’s good for anhidrosis and keeping weight on. If I can get him to eat the supplements without BP, I might take him off that, because there is some anecdotal evidence that BP may contribute to anhidrosis. At this point, I’ll try anything. In the meantime, I need a full kitchen in my tack room so I can prepare the right mix of All The Things.

T is unconcerned with my attempts to get him to eat, as long as he has his haffies to groom.

(Does anyone else try their horse’s supplements to see what they taste like, or is it just me? SG has a very mild flavor and no smell, so I think it’s well-masked by the other stuff in his feed. The vitamin E supplement also has a very mild flavor. GUT, however, has a strong sweet smell and a weird taste, so we may not be able to stick with that. Time will tell.)

Sooo… anybody else out there have secrets to share on keeping their PPID horse fit and healthy? I’ll take all the tips I can get!

24 comments:

  1. Dang, you've really went through the ringer! Also...yes he has a great spook at the trot now, ask me how I know :D

    No help here, but you're my inspiration behind switching Connor to low-starch treats since I suspect IR may run in the family. Everything else he eats is already low-starch, that was the one remaining high starch thing (bummer for him too because he LOVES Mrs. Pastures, but now he's on the Standlee Hay treats).

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    1. Honestly I don't think there's any reason to feed most horses the high-sugar/high-starch stuff that's on the market. Hopefully C at least gets an occasional Mrs. Pastures!

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  2. Ugh I only know second hand what a challenge it can be to manage cushings - esp in a performance horse. I do not envy your situation :( seems like you’re finding a good balance tho, even if it has taken absurd amounts of creativity. Bummer about the trickier lesson schedule too but it sounds worth it to avoid another serious colic episode.

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    1. Yeah we definitely don't want any more colic, TYVM.

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  3. Glad you got him diagnosed! I have had 2 PPID horses at once, both on Prascend. It dissolves pretty quickly in water, you can take a 3 cc syringe, put the pill in it, then add the water. With one horse I was able to just walk up to him and squirt the Prascend in his mouth. The other one got it squirted on her feed.

    Now I have 2 IR horses, one old and one young. The young one, a Peruvian, had an episode last year where his appetite fell off. Even though I am a vet, he needed hospitalization at an equine center for 5 1/2 days, then round their clock meds for a week at home.(Ended up being a 4800.00 vet bill). Shout out to Markel Equine Insurance, they covered about 3100 of it. Thankfully we didn’t have to use the mortality part of his policy!

    Senor Gordo now has to stay in a large pen mostly, he can’t handle the green grass. He gets coastal hay and a couple of cups of Safe Choice Special Care, plus occasional horsey Metamucil.


    The things we go through for our equine friends! Keep us posted on any and all equine health problems.

    I would love to come see Wyvern Oaks one of these days, have kinfolk in Austin.




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    1. The door is always open for visits! Drop me a line at jenjobst at gmail dot com.

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  4. Ugh, T! STOP BEING SO TRICKY. You could try mixing in aloe vera juice- Penn gets about a cup every day to wet down his powders so he'll eat them. So far, that's picky eater approved... but apparently there's Penn picky, and T picky!

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    1. Aloe vera juice is POISON. Just FYI.

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  5. Oof, I really feel this post on a deep level. A LOT of what you've gone through crosses over to Tristan as well.

    I can't remember - do you show recognized? Just be aware that pergolide is a prohibited substance, even if your horse is under the care of a vet. If you get tested you will fail. Some people work out the timing of the dose so their horse gets it right after a class/test, but that always seemed dicey to me. I made a unilateral decision not to show recognized anymore.

    Is Taran PPID and IR, or just PPID? If the former, you don't have to be as careful with the sugar/starch. IR is separate and though they often come together, they don't always. If he's not IR you can add in applesauce, mints, etc. into his food regimen to try to keep him eating grain. Thankfully that's not one I've had to cope with - Tristan eats anything and everything!

    I've definitely gone the route of syringing pergolide into Tristan - when he was still on the compounded powder - so that's a path you can take if you want.

    Immune system suppression has been the trickiest one for me to manage because it can pop out in so many ways. He got a cancerous growth on his tail, for no reason. Despite being a dark bay roan, he has a sarcoid on his chest. Last summer, he caught a weird virus that went through the barn and was very very sick for three days. Two summers ago he started breaking out all over in hives in reaction to something in his environment, so now he's on allergy meds in the summer. It's tough for me because you just never know what's going to pop out next. It could be anything.

    Good luck with Taran! I'd love to hear updates on managing PPID. I think there's a dearth of sensible, thoughtful conversation around it. (A lot of the email groups are way way WAY out there...)

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    1. I do show recognized, and plan to continue as long as possible. You have to pull them off Prascend 24 hours before, so we just time it carefully. He was actually on Prascend at Nationals... well, he'd been pulled off 24 hours before our first class, but he had it up to and right after he was done.

      He's not confirmed IR, but given the thin soles he's struggled with, we're assuming he is. Just makes things easier that way.

      Luckily we haven't had any issues with immune suppression yet. He's on high doses of Vitamin E, so I've got my fingers crossed that will help him some.

      And I definitely plan to keep updating, because as you said, there's a lack of good information out there about showing horses with PPID. And uh yeah, the conversations can be... tense. :D

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  6. I give Hampton Restore electrolytes from Kentucky Equine Research. They may have something that will work for T? https://ker.com/products/

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    1. I will definitely check them out, but currently he's eating the Summer Games without complaint so... if it ain't broke, don't fix it!

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  7. Don't know if you've heard about Dr. Eleanor Kellon before - she's a vet who runs a Cushings and ir group online that is SUPER legit and helpful. Tons of good info there. Good luck :D

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    1. Yes, I'm familiar with her, thank you for the link!

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  8. I’m no help but yeah, GUT smells strongly of marshmallows. I always disliked it but my dogs always begged for it when I was putting together supplement baggies and my barn manager thought it smelled amazing.

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    1. MARSHMALLOWS!!!! I couldn't put my finger on the smell but you're exactly right! T is suspicious.

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  9. We board a 27 year old with Cushings. My vet recommended 2/3 table salt and 1/3 lite salt instead of a commercial electrolyte. You might want to check with your vet and see if that would work for T. Just a thought.

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    1. Yes, I'm considering adding that as well as the elytes - IF he will eat it, since he doesn't seem to like salty-flavored anything. Ugh, horses!

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  10. This is a timely post. Harley is shedding his winter coat very slowly this year and losing muscle. The vet says it is steroid- induced Cushings. His COPD requires that he be medicated often. We are trying Triple Crown 30 ration balancer added to his grain-free diet. It is low starch\sugar. He also quits eating if we feed too much pelleted feed so I understand the struggle. I hope he does not have the temp issues you described. That sounds very challenging for a performance horse.

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    1. Yeah, T won't eat much pelleted feed either. As for the slow shedding, I just body clip all the time and then blanket as needed. They definitely lose condition quickly, so keeping them in light work (even stretches!) helps loads. Give Harley a hug for me, I miss hearing about him!

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  11. Oh man, this post brings back memories of my first year with Dino when he was first diagnosed! Figuring out the best management plan for these guys can be so challenging at first, since they all seem to manifest the condition differently, but once you get through all the trial and error to find what works it's really not a difficult condition to manage. Dino is currently on the KER Re-Leve feed which is high fat/low starch, plus loads of alfalfa (cubes and hay) and he THRIVES on that. I also give him SmartPak's pituitary senior supplement and DMG, though I don't know how much of a difference either of those makes. They just make me feel better, basically. I also find that making my Cushing's show horse OVER-fit is huge in keeping him happy and comfortable in work. They lose condition so fast, so it's really essential to work them to a higher level of fitness than what they need for the job at hand. I'm sure with your thoughtful and systematic approach (and that miracle drug, Prascend!) T will be back to his former glory in no time!

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    1. The problem with T is that what worked yesterday might not work today. So I find the right balance and then he decides he doesn't like something any more, so then we have to play the Elimination Diet game and figure out what the offending item is, then figure out an alternative. Keeps me on my toes, I guess?

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  12. My Cushings horse was also picky, picky, picky and a senior OTTB to boot, so weight was something I was always managing. I fed Triple Crown senior and as long as I didn't put any supplements in it, we were good to go. I fed soaked alfalfa cubes as well and hid any/all supplements in there, which seemed to mask any of the "poison" flavors I was feeding him. Bonus that the soaked alfalfa also helped with water intake. Have you had his levels re-tested? I had a postal shipping fail where my horse was off prascend for 1 week and that's when he randomly had temperature regulation issues. As long as he was getting his daily amount of 1 pill, we were good. Maybe Taran needs a larger dose? It's hard figuring out the right mix since each horse has different signs/symptoms, even harder for a horse that is actively in work. Best of luck figuring out the right program!

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    1. Oh, he loves TC Senior... right up until he doesn't. Then we switch to TC lite... until that's no good any more. Urgh.

      T actually needs to be rechecked and I'll have it done when the vet is out later this month for flu/rhino boosters. Thanks for the reminder!

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