Cushings and appetite
My 16 y/o SWB gelding was started on Pergolide May 2019 with ACTH 45.4 pg/mL. He was started on 1 mg daily, had a beautiful hair coat and got very dopey from the drug. After 2 weeks we dropped it to 0.5 mg daily. He perked up. He started getting a bit hairy the last couple weeks in July 2019 after being on pergolide for about 6 weeks. Prior to this his coat had been the most beautiful one on the farm. His hair coat has continued to be dull. His ACTH in November 2019 was 54.6 pg/mL.
We bumped him back up to 1 mg daily. His hair coat looked a little better over winter. March 2020 ACTH 8.31 pg/mL. Continued on 1 mg daily because his haircoat seemed a bit heavier and dull. He is blanketed over winter, out daytime, in overnight. He has always been a good eater.
Now he is not wanting his grain as much, still eats hay which he loves but even leaves some of that. Appetite ok with treats, and carrots but they have to be very fresh and cold. He has been off of work since Sept 2019 as he had a very serious abscess, first one ever, up in middle of right front hoof. Very hard to diagnose and thank God U of MN has CT scanner and great veterinarians. Surgery was done and very specialized farrier care continues and his hoof is almost completely healed. I've questioned at times is he true Cushing's? The reason he was tested is he would stare off at times and just be frozen like he left us. My instructor and her husband, both trainers, raised him from their mare and stallion so complete history is known. They had another Cushing's horse, no relationship, that had episodes of staring off and was diagnosed Cushing's. That is why we tested my guy. He never got the poor coat until he was on pergolide. Long story. Thank you for any input. I just want to do what's best for him. He's still very safe in condition and feeling fine but sometimes seems depressed. I worry about his fussy eating. He has lost some weight but that is also partially from muscles not being in condition from no riding. Is pergolide helping or hurting him? Is dosage wrong for him? He's really a challenge to make sure he takes his pill. It can be in a carrot or a muffin and sometimes he finds a way to spit it out and you find it on edge of feed box in his stall. We try and be consistent hand feeding it like a treat and sometimes he is wise to that as well. I'm just confused and want to do what's best for him. Would appreciate any info. Thank you so much, Kristen--
Kristen L. in Minnesota 2020
Welcome to the group. It's great that you have been proactive in testing and medicating your gelding, and glad he is maintaining good condition and recovered from his hoof abscess. Many of us have fussy eaters, and we certainly understand the challenges. (In fact, there is a "fussy eater's checklist" in the Files, as well as a heap of other useful information.) You will have received instructions on how to create a case history for your horse, which will help us answer your questions better, as the more details we can understand, the better.
In the meantime, I'm including below the welcome message that we send to all new members. It contains a lot of information that will help you manage your gelding, so take your time to read through it and let us know if you have any questions.
As your gelding did test over the normal range in May, it is likely he is PPID. The fluctuation in his ACTH levels November and March follows the usual seasonal fluctuations (more on the seasonal rise below). If he started immediately on 1mg of pergolide and became lethargic, it is likely he experienced what we call the "veil", which can be avoided by titrating the dose up slowly (more on this below). If he doesn't like eating the pergolide with a treat, you can dissolve it in a small amount of water and syringe it in, or enclose it in a gelatine capsule to conceal the taste/smell. In order to decide whether it is the right dose for him, you need to consider both symptoms and blood test results. If his last blood test was in March, it might be an idea to test again now before the seasonal rise starts in earnest. More on testing in the links below.
I hope the information below (don't forget to click on the links for more on each topic) will resolve some of your confusion, and look forward to reading the case history.
Welcome to the group!
The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.
Have you started your Case History? If you haven't done so yet, please join our case history sub-group.We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.
Orienting information, such as how the different ECIR sections relate to each other, message etiquette, what goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have.
Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.
DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.
PPID is diagnosed using the Endogenous ACTH test, while IR is diagnosed by testing non-fasting insulin and glucose.
The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".
In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk
*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.
*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now.
Treatment: IR is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed.
No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:
We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an IR horse, but also supports the delicate immune system of a PPID horse.
*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it). The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers.
There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it.
What you don't feed on the IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only.
No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for IR/PPID individuals.
We do not recommend feeding alfalfa hay to IR/PPID equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.
TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.
Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet.
You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.
EXERCISE: The best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercisecan begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.
There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.
If you have any technical difficulties, please let us know so we can help you.
Maxine and Indy (PPID) and Dangles (PPID)
Canberra, Australia 2010