I've downloaded the case history form, will complete on my computer tomorrow. In the meantime between uploading what case history I have and my vet coming out....

26 mare started to seem off in the fall. Just seemed generally off, moving a little less and little less enthusiastically. Still moving lots but not what I'd expect from her. Reminded myself she's getting older. Didn't appear footsore just seemed blegh. She looked great in July / August but the weight started to drop slowly over the fall. I had to have abdominal surgery in late September and was recovering for several weeks so horses went without mash (soaked and rinsed beet pulp with soaked timothy alfalfa cubes and with mad barn amino trace +  and salt added). Thought that maybe she just hadn't been getting enough calories from the mixed grass hay round bales in slow feeder nets out 24/7 (not tested but plan on my next batch being tested I only have two more round bales left and will be buying in the next couple weeks - she won't eat soaked hay, but I could up her beer pulp as her main feed). By late November I became more concerned, had mash back on track, and opted to blanket this year with a heavy weight (temperature gets to -25 Celsius over night during colder periods, giving daytime breaks in mild weather around 0 Celsius). Seemed to be holding weight okay in December - thinner than I'd like but not dropping. But January she has taken a nose dive, massive weight loss, muscle wastage, pot bellied appearance, back is dropping, still moving but no spark in her. Decided it was time for the vet, my vet has since stopped servicing our area so had to submit my new client information with the brand new clinic which has opened up, and never heard back, finally got a hold of the clinic (1.5 hours awa) and have an appointment scheduled for February 7th. I asked for dental work, worm count, and PPID test. Was told I can't get her tested for PPID until the vet has assessed her. Is this common? I don't want to wait any longer than necessary to begin treatment if it's PPID - could I add Chaste Berry until I get the vet out / get my results or is that a no no? For weight support, are omega 3 balanced oils something to consider (mad barn has their w3 oil, I could do Carmelina oil, or I could feed ground flax)? 

I feel terrible, she wasn't quite right but she wasn't this bad either. It just seems like it's happened so fast but I know my recovery period from surgery is probably when her symptoms all started compounding. Her symptoms scream PPID to me. 
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Emilee Moore - British Columbia, Canada - 2020

Hi Emilee,
Is this the same mare you were concerned about earlier with possible laminitis that resolved with an abscess emerging?

If she has PPID, it’s quite likely she will not be able to maintain weight, no matter what you feed her.  You can try chaste tree berry to see if it helps.  It won’t lower her ACTH, if it’s elevated, but it might relieve a few of her symptoms.  Whether it would help with her weight, I really can’t answer.  I would probably withdraw the CTB a few days before testing ACTH just to be cautious.

You could take a blood sample yourself or get a local tech to do it and deliver it to the vet for submission; however, you would need to review the Cornell blood handling protocol as ACTH is quite labile.  When you or your vet draws the blood, be sure it is done first - before any other procedures.  And do not consider trucking her to the vet as that might likely skew the results.

Not sure what sort of assessment the vet plans to make that would be better than what you’ve shared but the vet should be able to do that visually, maybe even from photos, immediately before drawing blood.  If the vet gets her agitated through stressful handling, that could skew the results as well.  I’ve never heard of a vet needing make an assessment other than visual before confirming with a blood draw although I have heard of vets who refused to do a test because it didn’t fit their reasoning or observations.  The test is not invasive; it’s your money and your horse so I’m not sure what the thinking behind that is.  Pergolide will not harm a non PPID horse and sometimes we suggest doing a pergolide trial if the symptoms line up but the ACTH level is still normal.

The coincidental timing of your surgery and the fall rise is not something you could have anticipated to be an issue and there should be plenty of time to get things in order before the next rise starts near the end of June.  But time does fly, things come up and it takes time to figure out the appropriate pergolide dose for her.  
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Hi Emilee, 

From your description that sounds a lot like an obvious case of PPID.  Maybe if you can speak to the vet themselves,  instead of clinic staff who probably have a canned line they give everyone about assessment first, your vet will agree it's likely PPID.  Even if you have to pay for a 15 min phone consult to make your case.  During the call:

1. Ask your vet if they can be prepared to pull blood for the UGuelph PPID panel as soon as they arrive (so that ACTH is not affected by exercise or stress from any of the other procedures), then do the assessment and make a final call on whether or not to send it in?  The sample will need to be centrifuged within 4 hrs of pulling, but a small animal clinic could do that if she is on the road all day.  Your vet will need to bring the correct blood tubes and have an account set up with UGuelph.

2.  Ask your vet to bring a 30-day supply of Prascend to start her on right away, if they agree that it's likely needed after assessing her.  As Martha said, it WILL NOT harm your horse to take it unnecessarily.  She will likely develop some inappetance and lethargy, but those symptoms go away when they adjust to the drug, and they can be minimized by starting with 1/4 pill a day and working up by an additional 1/4 pill every 3-4 days.  You can physically split the pill into quarters, or you can split it in half where it's scored and dissolve one half in water then only give half of that (to get 1/4); store the remaining 1/4 in to the fridge until the next days's dose.

Inappetance can be worrying when you have an underweight horse, but if PPID is the cause of her weight loss, she will only put on weight after her ACTH is controlled.  Lots of fresh ground flaxseed, extra rinsed-soaked-rinsed beet pulp, as much hay as she wants are all good sources of calories.  If you can get Ontario Dehy Timothy Balance cubes (aka Triple Crown Naturals Timothy Balance cubes), they can be soaked or steamed into an easy to eat mash and are a good source of calories.

--
Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
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