PPID, Inflammatory Bowel Disease, Corticosteroids


Tracy H
 

Hello All,
Am a regular reader at ECIR Horse but have come here in case anyone has had a similar experience. 20 year old warmblood, very healthy and sound until late July of this year. Horse has always been excellent drinker with non stop appetite. Not super easy keeper, but well maintained on primarily pasture/hay and small amount of lowish 15% NSC grain. 

In late July, weight loss, starting to lose topline, slight lethargy, but big problem with thermoregulation. Significant sweating during both exercise and turnout. Water consumption way up but with sweating, probably good. No signs of laminitis inc. x-rays. Full blood chem, tick borne disease and ACTH bloodwork done 1st week August. All normal except ACTH at 99. (Cornell Lab) Run Insulin and Leptin (both come back at very bottom end of normal. Start on Prascend. Horse is know to be hyper sensitive to meds so slow titre over 10 days to 1mg. No adverse effects. Appetite excellent as always, and water consumption is normal. Improvement noted in thermoregulation after four weeks, energy level better, gained back a little weight. At 6 weeks of 1 mg (late Sept), retest ACTH. Result is 49. Plan is stay at 1mg thru December and then retest. 

Late October, horse begins to show odd drinking behavior. "Testing" or "playing with water" before he drinks.Has also stopped dunking hay which he does about 50% of meals. This is new behavior. Check mouth, try bottled water, etc. Nothing. Since consumption amount is fine, will discuss with vet at next visit. 

Three weeks ago, horse is still eating well but a bit more slowly, and water consumption stops overnight. Manure is a little dry. Call vet; to thwart possible impaction, feed and hay pulled, Prascend stopped, and three days of IV fluids and enteral fluids via nasogastric tube. Horse is only allowed small handfuls of wet hay as manure is still coming thru. Third day, oil passes. Horse is STARVING (at least in his mind) and finally at least drinks 1 gallon on his own. Day four restart Prascend at 1/2 dose and small small amount of hay. Horse is drinking on his own. Plan is stay 1/2 dose Prascend for four days and then go back to 1 mg. Two days later horse is exhibiting spasmodic colic during eating. Off to vet hospital. Abdominal ultra sound shows moderate to significant inflammation of small intestine. Scope shows no sign of ulcers, problems with esophagus, etc. but inflammation of of first part of small intestine is visible. Biopsy performed. Result show esinophils, likely caused by immune response to something, diagnosed as Inflammatory Bowel Disease. (explained as similar to what happens to people who have celiac disease if they consume gluten). Hard part is figuring out what the something is? Horse is now eating soaked timothy pellets, still on .50 mg Prascend and drinking at hospital.  Bad news is treatment is Corticosteroids. Obviously contra-indicated for PPID horse, but potential impaction due to inflammation is more dire problem. Decision to go back to 1mg Prascend and start steroids. Three days IV Dexamethasone then switch to oral prednisolone as it has a slightly lower risk for inducing laminitis. Horse comes home  doing okay and drinking, although with 6 soaking wet meals of timothy pellets, not enormous amounts. Then drinking stops. Attending vet is concerned that end of seasonal rise, Prascend dose might be the problem. Stop Prascend for two days. Day two horse drinks a little and is as bright and alert and famished as he's been for whole ordeal, scarfing the pellet soup down.  Restart Prascend at .50 mg. Next day, no drinking and eating slowly again.

FYI - When they were scoping him, I asked for a full check of his teeth, gums, etc. they didn't find anything.

Sorry this is so long but I am wondering....
1. Does anyone have experience with Prascend where drinking is more of a problem than eating? Whatever is going on, the drinking stops and he still eats but not the scarfing it down he usually does? I should say that this horse is as food motivated as they come. Eating is his life.

2. Like causes of the IBD are protein sources in grains or some other thing he ingests in hay or pasture....but could be medication. Has anyone had a horse with inflammation of the bowel related to Prascend dose?

3. Is it possible or likely that at this time of the year, he just needs less Prascend?

Thank you all so much in advance. Any insight is most welcome.


Maggie
 

Hi "silversnaffle",

Welcome to the group!  You've sure been through the wringer with your warmblood!  Sorry you are having so much trouble!  Since you are a regular reader at our website, ECIRhorse.org, I won't go into the basics of the DDT/E, since the website covers all of that.  To get the best answers to all of your questions, we need you to fill out a CH on your boy.  To do that, you will need to join our sister group called ECHistory8, a filing cabinet for current CH's.  It should not take long to get approved and then just follow the instruction on the main page to fill out a CH on your boy.  Here's a link to that group:  https://groups.yahoo.com/neo/groups/echistory8/info  In addition to the "fill in the blanks" on the CH form, at the very end is a "comments" section that you may want to use to copy and paste the information you have provided in your post.  This will put all the important facts in one easily accessible place for the volunteers.

Meanwhile, I had a couple of thoughts when I read your post.  I am sure others will chime in with their thoughts as well.  

I do see that you weaned onto the pergolide, but did not see mention if you used APF.  Did you try that?  APF is an adaptogen that can really help with the symptoms related to the "pergolide veil".  You might be able to pick some up at a local tack or feed store.  It's also available in online catalogs, and on their website:  http://www.auburnlabs.com/html/eqProdGen.html   I'm sorry, but I have no experience, nor do I remember reading about any horses on the list where decreased water consumption is a veil symptom, but I haven't been around as long as many of the other members.  You did also mention that he wasn't eating as enthusiastically.   If that in combination with the decreased water consumption your warmblood is experiencing are his veil symptoms, the APF should be very helpful.

I also see that you weaned onto the pergolide, which is good, but it may be that you didn't wean on slowly enough.  We recommend that you start with 0.25mg for 3-4 days, and increase by 0.25mg every 3-4 days until you reach your target dose.  Since Prascend is scored to be broken in half, but not recommended to break into quarters, you can dissolve 1/2 tab (0.5mg) in 10cc water, administer 5cc (0.25mg) and save the other 5cc in the fridge for administration the next day.  May be that your boy needs this slower wean onto the drug.

The other thing that jumped out at me is the ACTH of 49 in late September after 6 weeks on 1mg of Prascend.  Since you mention the "seasonal rise", I'm guessing that you may have already read that section on the ECIRhorse website.  If not, here's a link to that part so that you can read the details:  http://ecirhorse.org/index.php/cushing-s-disease/seasonal-rise   The seasonal rise is period of the year (fall in the northern hemisphere) when all horses have a natural rise in their ACTH, but PPID horses can have an exaggerated rise over an extended period of time.  Many (most) horses need an increase in their pergolide to get them through the seasonal rise.  We like to see their ACTH down in the middle of the normal range (Cornell 9-35, so mid teen's to low 20's).  Since your boy was doing well on 1mg of Prascend in late September, but his ACTH was still high at 49, it makes sense that he would have benefited from an increase in his pergolide at that time.  Many PPID horses don't peak their ACTH until October (or even November), so it's possible that his ACTH continued to rise after the late September ACTH of 49, causing him the problems that started in late October.  Some early PPID horses do need pergolide only during the seasonal rise.  The only way to know is to test again.  We recommend that the horse be on a set dose for 3 weeks before testing to see if that dose is controlling the ACTH.  

Those are my thoughts as I read your post.  Hopefully others will chime in with their knowledge/experience.

We ask members to sign each post with their name (first is fine), date of joining, and general location, which helps us to help you source products.  Also, once you get your CH done, please add a link to it in your signature as well.  It really helps us to find it faster and to answer questions faster.  Thanks for your help with that!  And keep us posted on your boy!

Maggie, Chancey and Spiral in VA



Tracy H
 

Thank you Maggie. Have submitted request to join to add case history. Re: APF, will check with my vet. Due to the IBD, he is currently restricted to his meds, the timothy pellets and NOTHING else without vet's okay. We did try weaning him on. Started at .5 for five days, the .75 for five days, then 1mg. No adverse effects at all. On 1 mg dose for almost 12 weeks with only excellent response. That's when the weird water "testing" before he'd drink started.  Didn't think it could be related to the Prascend at the time. And maybe it's not related at all. 

Re: upping his dose, vet's preferred protocol is 6 weeks at new dose before retesting. In late Sept at 49, we had discussion about upping it. Given his excellent response at the time, the decision was to wait. It was based on the fact that the excessive sweating had abated. He was gaining back weight, his topline looked much better, his energy level was improved and he was bright and happy. Vet's thought was that symptoms were looking very well controlled with marked improvement. If we increased, and not knowing anything about his seasonal rise pattern....there was the possibility that by retest time in mid-November - the dose could be too high and that we could end up inducing the "pergolide veil" effect. If he wasn't responding so well, we'd probably have done it. Do some horses who seem to have no adverse effects at the beginning, develop signs of intolerance at 12 weeks in? One odd thing about the not drinking is that if he was under dosed  wouldn't the symptom be more likely to a resumption of the excessive drinking we saw before? Then again, maybe the water issue doesn't have anything to do with this but we can't find any other reason.

Tracy H (RI)
2015


Eleanor Kellon, VMD
 

To answer your questions about Prascend, I am unaware of any reports where drinking was affected rather than (or worse than eating), or of pergolide causing an enteritis.

While it's impossible to completely rule out a role for Prascend, it is at least as likely if not moreso that what you are seeing is really related to abdominal discomfort.  A short trial of no Prascend while increasing feeding should give you more answers.

Eosinophilic enteritis is a relatively newly appreciated problem in horses and may be localized (e.g. small intestine only)

Idiopathic Focal Eosinophilic Enteritis (IFEE), an Emerging Cause of Abdominal Pain in Horses: The Effect of Age, Time and Geographical Location on Risk


This form has **not** been linked to an allergic reaction and does not require long term steroids but often does need surgical resection of the isolated lesion (s).


More generalized forms have also been described:


http://vet.sagepub.com/content/19/5/486.full.pdf


I have personally had good results in a few IBD cases using oral bovine colostrum, starting at 200 mL/day.  Human article here:


http://ajcn.nutrition.org/content/72/1/5.full.pdf


and a Pubmed search will yield many others.


Eleanor in Pa

www.drkellon.com

EC  Co-owner

Feb 2001






Lisa S
 

<<Does anyone have experience with Prascend where drinking is more of a problem than eating? Whatever is going on, the drinking stops and he still eats but not the scarfing it down he usually does? >>

No, but my IR gelding experienced something very similar when he was NOT on Prascend. 

Like yours, he had always had a voracious appetite. He had always been a good drinker, too, and liked to dunk his hay, at least he always did so prior to his IR diagnosis and subsequent management changes. 

His episodes of not drinking happened maybe 18 months or so into his laminitis rehab. He was doing well otherwise, but suddenly stopped drinking. I went through all the steps: thoroughly scrubbing buckets and tubs, rinsing with distilled water, offering clean water from different sources at different temperatures, flavoring the water, etc. After 48 hours or so he was getting dehydrated but all his other vital signs were normal. We opted to put some water in him via stomach tube because of my fears that he would develop colic. We did this for 2-3 days before putting him on IV fluids due to my fears that the frequent tubing would cause problems. I have a lot of fears! LOL

After 48 hours or so on IV fluids he began to show some interest in drinking. Initially I could only get him to drink water flavored with Sonic green apple slushes (his pre-IR favorite!) I gradually reduced the amount of flavoring until after several days he started drinking quite normally again.

Never did find out what his deal was, but I wanted to throw this out there since I might have attributed this strange behavior to a medication or diet change had either one of those been potential causes. As it is we do not even have a good guess what triggered his refusal to drink. Thank goodness hubby is a vet and we had all the stuff on hand to treat him as we did! Otherwise I might still be paying off the bill...


Lisa in TX
Zippy, Rita and Bunny, IR
June 2010


Eleanor Kellon, VMD
 

Just to throw a nonmedical cause out there, I know of several horses that have done this (stop drinking) because they were shocked by stray currents.  It's actually pretty common.

'Stray Voltage'--a Shocking Barnyard Woe

 

Stray Voltage | www.heartlandpower.com

 

Eleanor in Pa
www.drkellon.com
EC Co-owner
Feb 2001




 

Re: escaped electrical currents and not drinking--

An old horseman that rubbed some pretty nice TBs back in the day told me that back when the ubiquitous Powerfloat hit the dentistry scene, he had more than a few horses stop drinking bc of sensitive gums/teeth. I always thought that was interesting.

FWIW,
Kerry in NY
Sept 2014


Tracy H
 

Thank you all for your ideas. We've tried everything. Water out of various containers. Scrubbed buckets, new buckets; mixing bowls from my kitchen, the special pasta pot we make his beet pulp in. Water flavored with gatorade, apple juice, molasses. He will happily lap flavored water in small amounts, like a dog, but not "drink" it. So far we are keeping him hydrated with very soupy meals. But even then he doesn't "drink" the water. He laps enough to push a pile of the mashed hay pellets into a mound and then eats off the top of the pile. When that's underwater, he starts the process all over again. 

We are beginning to suspect a dental problem. He was scoped at the hospital and had a dental exam while there. Nothing remarkable, they said his teeth looked great. I am wondering about the power float too. He had his teeth done this summer.....with power. Also possible is that the problem is below the gum line in the roots. Next up is a dental x-rays. Can damage form a power float be repaired? Someone also mentioned to me a dental syndrome, EORTH, which begins at the roots. PPID is apparently one of the risk factors for the disease.

You can lead a horse to water.......  and then lose your mind trying to get him to drink it. 


Eleanor Kellon, VMD
 


--In EquineCushings@..., <silversnaffle317@...> wrote :

... Can damage form a power float be repaired? Someone also mentioned to me a dental syndrome, EORTH, which begins at the roots. PPID is apparently one of the risk factors for the disease.

========

No, that damage cannot be repaired.  EORTH only involves the incisors.  Just put a paper in the files.

PPID can cause tooth loosening due to weakness of the ligaments but has not been confirmed as a risk factor for EORTH.

EORTH has only been described in the past 10 years or less, corresponding with the spread of aggressive dentistry.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


 

Re:  Powerfloat

Two years ago my young horse needed a sedated oral exam so I trailered him and my old PPID mare over to the clinic and both had Powerfloats (and exams by a very good veterinary dentist whom I like alot).  About three weeks later, I discovered a broken tooth, lower L arcade, on my old mare.  Thank goodness it was a "clean" break and flush with gumline, so recovery was not much more than monitoring.  However, my usual firstline go-to vet mentioned that these older horses often have more brittle teeth that just can't handle the Powerfloating, making them vulnerable to fissures & cracked teeth along weak spots, etc.  Sure enough, in thinking back, my mare had been kicked under the jaw about six years prior which resulted in a very swollen lower L jaw but no obvious fractures (no radiographs done, however).  That incident healed uneventfully.  Lesson learned ;)

One other thought, which no doubt you've tried, is offering water of different temperatures, and leaving it for him while observing from afar, in case he's behaviorally associating humans hovering with drinking (animals learn all kinds of bizarre food/consumption behaviors, I've observed).  Just a thought.

Best of luck,
Kerry in NY
Sept 14


Lisa S
 

It''s a pain to have to do dental radiographs, but they are as helpful in looking into dental problems as hoof x-rays are at looking into foot problems! 

We had them done fairly routinely on my aforementioned gelding that had the refusal-to-drink episode, because he had four fractured molars (likely caused by an over-zealous power float when he was young, before we got him). We always warmed his water when it was cold to help minimize discomfort. Still, that scary episode he had where he would eat but wouldn't drink was the first and only such occurrence. I have no reason to believe that it was related to dental pain--he had other ways of showing us his teeth were hurting (mainly banging his head rhythmically against the stall wall). 

Forgot to mention we used the customary physical parameters to assess his hydration status during the water strike and began supplementing water when it looked like he was getting into trouble. Things like heart and respiratory rate, capillary refill, and skin elasticity are easy to check and not invasive. My gelding always appreciated those non-invasive tests!

Lisa in TX
Zippy, Rita and Bunny - IR
June 2010