Cost of Cushings, Drugs, Thyrol-l experiences & some nutrition info


Eclectk1@...
 

Hi Donna,

The cost and medication necessary to treat Cushings can be quite variable
depending on the horse, how they progress, and what their symptoms are. My
mare was diagnosed symptomatically -- without testing. Several veterinarians
have stated that for her this is totally appropriate because her symptoms are
so obvious -- this often isn't the case and testing is necessary. For her,
however, she had a fabulous foal for me when she was 23 (she's 29 this year)
and then didn't catch when rebred. I only tried one cycle then decided to
wait until spring for several reasons.

First she had never had uterine cysts before this colt, and suddenly had
several, one large enough to palpate as tho it was a 30 day pregnancy (this
may not be Cushings related, but I think considering the timing and how
strange it was and that Cushings really affects their hormonal balance, it
quite likely was). The vet felt that the cysts may have been causing the
embryo to fail to properly implant. In January the following spring, when
she came in heat, I took her to the vet for an ultrasound and D&C. He felt
that scraping the uterine walls to pop the cysts might allow those spots to
heal and her to conceive. He particularly wanted to pop the one large cyst.
Well, on ultrasound we were both totally amazed -- all but the huge cyst were
totally gone, and the huge one was now tiny. No treatment necessary.

Unfortunately, that was also the last time I know of that she ever came in
heat, even with leutilase and regumate, we couldn't get her to cycle again
and we tried for several months into early summer. Next symptom, by early
summer with all my other horses shed out fully for a month or more, she'd not
even started shedding. She was also too fat and living off of virtually air,
but it was "patchy fat." Patchy fat is when it is unevenly distributed.
Typically (and her's was/is) it goes to the crest which will be much larger
and also harder than a normal crest on a fat horse, it also goes around the
dock of the tail, it may also be behind the elbow and up around the withers.

When palpated, the vet said that her ovaries were very small and 'mushy' and
that he'd never palp'd ones that felt like that. Additionally, the previous
spring just a few weeks prior to foaling, she had had a very minor bout with
laminitis. Another common problem with Cushinoid horses. She also had
gotten a bit ribby that winter, but still had tons of patchy fat, and I
noticed that she had no muscle between her hind legs (muscle atrophy)... With
these clear symptoms, particularly the failure to ovulate and the failure to
shed (even tho well and regularly wormed) the vets said Cushings is the only
possibility.

We put her on thyrol-l, starting at one scoop a day. You can, with a
veterinary script, order 10 lbs of thyrol-l for about $145 + shipping from
Omaha Vaccine. It lasts a LONG time (roughly 6 months). Here, getting one
pound bottles from the veterinarians direct costs about $32 (huge savings to
mail order the 10 lbs).

To this day I feel somewhat guilty, because the vets had asked me for several
years if she was sluggish or lethargic and I had always said no. I thought
that she didn't play with the other horses, come running up when called, got
a little irritable when brushed and so on just because she was getting older.
When ridden she didn't FEEL sluggish (2nd level dressage, trail riding,
etc.). Well, to my amazement, within literally a day and a half she was like
a 4 year old again. She RAN with the other horses/babies when they played,
she CAME running up when called -- it was such an amazing and distinct
difference.

Over a few months and under the vet's direction I slowly increased the
thyrol-l. Each increase would be about 1/2 a scoop, then wait two or three
weeks, then 1/2 a scoop more... After being at about 2 scoops for about 2
weeks she began shedding and shed out fully within a few weeks. In my
experience, you have to wait a good two weeks to see how the thyrol-l will
affect the hair coat. If the dosage becomes too low, about two weeks AFTER
its too low, the winter coat will begin growing back, even in 115 degree
weather (I'm not exaggerating, I'm in Las Vegas, it gets OVER 115 here and
its not uncommon). If the thyrol-l is boarderline, the hair will grow winter
hair (long) AND shed at the same time (you could make mattresses with the
massive amount that can be grown and shed), with no net difference to how
much coat is there.

The thyrol-l did several other things... the patchy fat began to come off,
the crest softened some to feel more like normal fat on a crest, but at the
same time she put muscle and normal good thin fat layer on all over. The
muscle was particularly noticable between her hind legs.

One thing VERY important about thyrol-l -- I have discovered (and tested)
that if you mix the thyrol-l in with a vitamine/mineral supplement, the
thyrol-l may NOT be absorbed properly. With Tina, I have to literally DOUBLE
the amount of thyrol-l if I feed it at the same time as a vitamine/mineral
supplement. It was pretty clear too, since I could gague it by her starting
to grow a full winter coat in or shedding it based on the amount of Thyrol-l.
Interesting thing is that I ran across a medical article about human
Cushings and they specifically stated that you should NOT take thyrol-l with
any other supplements as they can strongly interfere with proper uptake of
the thyrol-l!! Three vets I've worked with now were not aware of this at all
(and they're pretty decent vets).

Anyhow, the vets had me keep her on this for several years. With time, I had
to increase the thyrol-l until she was getting 3 scoops a day. Eventually,
one summer the patchy fat & crest began building up again literally over just
a couple of months, she got downright ribby at the same time and had no
muscle between her hind legs...

So I got Cyproheptadine. At the time I got quotes for a 1000 pill bottle
that ranged from $192 to $15. Yes, $15. That pharmacy told me that they got
1000 for $10, and since it was for a horse they'd mark it up to $15 and we'd
both be happy. This was about 4 years ago. I started her on 26 tablets a
day (she's about 900 lbs, 14.1 hands, built like a HORSE tho). Carefully
adjusted the thyrol and eventually settled on 26 tabs of cypro and 1 scoop of
thyrol l. This worked beautifully. Good haircoat, good muscle, minimal
patchy fat, happy horse.

After about 3 months, however, I could tell that it wasn't working as well.
On vets orders, increased the cypro to 39 tablets a day. That worked for a
couple of months, and then the cypro didn't seem to be making any
difference... I had to increase the thyrol-l back up to 3 scoops a day. When
I took her off the cypro I couldn't tell that it made any difference. But
she seemed to hold ok with the 3 scoops, whereas before the cypro 3 scoops
thyrol wasn't enough. (the vet has told me not to go over 3 scoops
regardless).

Then I moved to Las Vegas (I was in Virginia and Maryland). Believe it or
not, the massive amount of sunshine or SOMETHING that is different in the
environment (low humidity?) seems to very much agree with her. She's been on
3 scoops of thyrol-l since I've been here and it seems sufficient for the
most part. Problems occured twice, when the barn owner forgot and started
feeding supplements WITH the thyrol-l -- 115 degrees and my poor mare was in
massive winter coat!! Got that squared away, then the barn owner decided
that maybe the thyrol-l was "keeping her from gaining weight" and she cut it
back to one scoop without telling me. Several weeks later (I still didn't
know) I was getting quite concerned because her winter coat was coming back
in the middle of the summer... found out that she'd decreased the thyrol-l
and had her increase it again. Right about that time Tina foundered and
rotated about 2 degrees. She had been barefoot, now she has special shoes.
Eventually she'll probably be back to regular shoes or possibly even
barefoot... but we are being quite conservative and taking time. She's
pretty sound.

By the way, I found out thru this experience that there is a fairly new
method of treating a laminitic or foundered horse in the acute (when it first
starts) phase that is amazingly effective, but that's for another email and
only if you all haven't heard of it -- you use styrofoam blocks on their
feet...

The vet also had me take her OFF of ANY alfalfa (too much calcium, too high
nutrition, too likely to contribute to founder) OFF any sweet feed (too much
sugar, Cushinoid horses may be not be dealing with sugar and may be insulin
resistant) and put her on a combination of grass hay (very difficult to get
here, more expensive than alfalfa believe it or not), rice bran (high fat to
provide the nutrition and energy needed), and purina Eq. Senior (round out
the diet). This seems to be working fairly well, or at least her weight is
ok and she's not continuing to have laminitis problems at this point in time.

For the past year, she's been a bit ribby and under muscled again -- not
badly, just not as good as before either -- and I probably need to put her
back on the Cyproheptadine. Late last year I got a quote of $50 for a
formulated version that would last the same length of time as about 1000
pills. I haven't had a chance to really price it out and get her started on
it. I'm also concerned that it will quit working again after a few months,
as it did before. If so, and she gets much worse, then I will have to
consider getting pergolide mesolayte (sp?) and my understanding is that it
will cost somewhere between $100 to $300 per MONTH. Right now she's ok with
just the thyrol-l, but not optimal...

I have been extremely lucky, however that she has not progressed into
diabetes. This is quite common and something you have to watch closely for
with all cushinoid horses. The main symptoms to watch for are drinking more
than normal or more than other horses of similar size at the same facility,
and excessive peeing. A simple blood test can check sugar levels and see if
they have diabetes. I'm getting basic blood panels pulled on her
periodically just to be sure that nothing of that nature is occuring. The
last set showed that she's a touch anemic, not unusual for a 29 year old
horse. Older horses also often don't utilize or need more Vitamine B (just
as older people) and this can cause anemia. I'm going to get her some
Brewer's yeast (excellent source of B vitamins) and possibly some red-cell.
But then I've got to get the barn owner to feed those separate from the
thyrol-l. I need my own place again!

Well, I know this has been very long, but I hope that relaying my experiences
will help some of you...
Robin

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