NEW MEMBER - Recurring eye ulcers/stromal abcesses for mare with Cushings


kbcrking1002@...
 

Hello!  I have a 23 year old mare that was diagnosed with Cushings about a year ago.  Her ACTH numbers late Sept 2021 was originally 347.  She was tested again in mid October and it was 61 and then again mid November and it was 26.  She was tested again in the spring and I believe it was well under 50 but I cannot find the results for that test. 

For the last couple of years she has battled several recurring eye ulcers/abcesses that just would not heal with her right eye.  We tried different antibiotic ointments several times a day and 3 conjunctival flaps (she kept rubbing them off after a week before her eye healed) before it healed.  Then it came back early July.  We were treating it with 2 antiobiotics in the eye before her cornea started melting.  She was hospitalized and the vet placed a catheter above her eye where she could get meds easily every 2 hours.  After 5 days the cornea still ruptured and the decision was made to remove her eye.

She never had problems with the left eye.  So I thought we were good.  Not the case.  About 2 weeks ago she started showing that she had pain in the left eye.  Took her in and she had another stromal abcess in the left eye.  We started treating her with 2 meds in her eye - Itraconazole and Carpoflaxican 3 times a day along with Atropine for pain in the eye and Banamine.  She would improve for a day and then regress.  The vet did a treatment of 1.5 ml dose of Renovo on Aug 20th.  Her eye improved by Monday but then got worse again this week.  The vet has watched her closely and the abcess has not gotten any worse from what he can see when he examines.  But she still is wincing and partially closing the eye much of the time.  It's probably 60% open right now.  

I started researching on Cushings and discovered it can lead to problems with eye ulcers and abcesses and difficulty clearing them up.  So I'm hoping to get some help from anyone in this group that has been through these eye problems and has suggestions for other things that we can try that were successful.  I just don't know if different meds and/or treatments would be beneficial.  But I would love to hear any suggestions!  

I ordered today a Recovery Vizor from Protective Pet Solutions.  Reading the reviews it seems like there are many horses that wear this vizor for eye protection when they are prone to ulcers/abcesses and there were alot of success stories.  I feel like she is going to have to wear some eye protection always going forward to help protect her from further ulcers/abcesses...when we get this one cleared!!  

Praying for my girl to get a healthy left eye again!!
Thanks in advance for any advance/help!

--
Beverly King
Edmond OK
Joined 2022


Maxine McArthur
 

Hi Beverley
I feel for your situation with your mare, as my mare also has eye issues with corneal ulcers. I'm sorry your mare lost one eye and really hope you can get on top of the problem in her other eye. As this is your first post, the purpose of my reply is to send you our welcome message for new members. It sets out the basic philosophy, protocols and recommendations of the group for managing PPID and IR horses. So while it doesn't directly address your question, please read through the message and follow the links to more information, as there may be information there that can help you. 

We do have a number of members who have suffered through eye problems with their horses, and I hope some of them will chime in with their experiences too. Their messages have also helped me greatly over the years. I also recently purchased Recovery Vizors and have found that so far (over a month now) they hold up very well and seem much more comfortable than other mask options I've tried. 

I did have a couple of questions--you said your mare was diagnosed with PPID, but is she medicated with pergolide? If not, please start. If so, you might try bumping up her dose a trifle to see if it helps her immune system. We like to see the ACTH levels in the early 20s (pg/mL) all year round for best control. 
Has she been tested for ERU? Would your vet consider consulting with a specialist opthamologist? 

Finally, you can do a search of the Messages using various terms, which should bring up some of the previous threads discussing eye issues. I'd try "ERU" and "corneal" to start with. 
Hang in there. 


Hello 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/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 etiquettewhat 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 Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/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 EMS/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: EMS 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. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

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 EMS/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 (look under the Hay Balancing file if you want professional help balancing). 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 EMS/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 EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR 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.

EXERCISEThe 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 exercise can 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.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

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
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Ronelle
 

I can speak of my experience with the Recovery Vizor.  I bought the first one when my horse lost his left eye due to uveitis.  He wore it after his surgery to remove the eye.  It protected the eye from being rubbed or in case he bumped into his shelter wall/post or a tree as he healed.  I now have a clear and tinted one.   Because the vizor is a solid, but not hard, plastic (not sure exactly how it is made) it protects better than a "soft" UV fly mask.   I'll be using it again as he was recently diagnosed with uveitis in his right eye.  For now I'm using their solar visor, but I have him wear the dark tinted one when we go out hiking or riding.  But as soon as I see evidence that rubbing is happening when he's home, I will start using the Recovery again, 24/7.   Also, they do scratch easily- especially from sand/dirt.  There is a fly mask to fit over the vizor to keep flies out as there are air holes big enough for flies to get inside.
--
Ronelle and Yoyo
2015 Bend, Or, US


Sherry Morse
 

Hi Beverly,

In addition to the great advice on this group you may want to join this FB group as well:  https://www.facebook.com/groups/111524575685278 which is a support group for owners with blind or partially blind horses.  There are lots of management tips and tricks shared there.




Jensmccabe
 

Hi Beverly!

I’m so sorry to hear about your mare losing an eye. 

My mustang mare Bella has had the same issues mostly in the summer over the last two years (her 15th and 16th years). 


We had a vet stay last year for 8 days after she reinjured her right eye. 


I had great luck with Equivisor (she can rub anything off but left this on knowing I think we are trying to help her.

This year I monitored her ACTH and Insulin much more closely with frequent (every month or two) labs sent to Cornell as we moved from Idaho to Maryland and had a lot of other life changes that can really affect a PPID horse. 


I worked with our vet to keep increasing Bella’s dose of Pergolide until her lab values were within this group’s recommended ranges AND I saw almost no goop eye or face itching…for her now that dose is 4mg/day split into 2 doses morning and evening. 


So don’t despair - if your girl is not already on a steady dose of Pergolide I’d talk with your vet and start; and take the labs, monitor and adjust the dose as needed until you see less ocular symptoms. 


Feel for you! The eye stuff can be so scary, but there is hope! 
--
Jen McCabe
Laytonsville, Maryland 
Joined 2022
+ Odin (2010 BLM Mustang Gelding - IR, dx 2022), Bella (2008 BLM Mustang Mare - PPID/Cushings dx 2000) + Fiki (2015 Arabian, ok so far!)
Odin and Bella Case Histories


Eleanor Kellon, VMD
 

Hi Beverly,

You have gotten good advice from other members who have gone through this. I want to comment on the medical end. Recurrent ulcers can be an early sign of PPID, as you probably now appreciate. In addition to the antifungal and antibiotic treatments, I would consider adding an antiviral like topical ganciclovir. The uveitis is likely due to organisms already in the horse's body and activated when the PPID damages the immune system. Possibilities include Leptospira, Borellia (Lyme) and also Herpes. The Renovo can't possibly work until the underlying cause is eliminated. You could also consider adding DMSO topically. Finally, it is best to keep ACTH no higher than the low 20s when you have issues like this.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


kbcrking1002@...
 

Hello Maxine!  Angel is on 1 mg tablet a day of pergolide.  I will ask the vet to run another blood test on Monday to test her ACTH level and get him to look up what it was in March/April when we ran it.  I know it was under 50 but I don't remember the exact number.  Is there anything else specifically I should be asking my vet to test while running the blood work?

I'm not familiar with ERU.  Is that a blood test as well?  I'm guessing that makes her more susceptible for the ulcers/abcesses not healing?  

I am sure my vet would consult with a specialist opthamologist.  Is there someone in particular you know and recommend?

I appreciate the advise for my girl!
 
--
Beverly King & Angel
Edmond OK
Joined 2022


kbcrking1002@...
 

Hi Ronelle!

Thanks so much for the feedback on the Recovery Vizor!  I have one tinted and one clear ordered that should be here by Tuesday.  Very excited to hopefully have found a solution to her rubbing the eye and/or getting new injuries and ulcers.  

Now just praying I can get this left eye clear of the stomal abcess.

Thanks again!!
--
Beverly King & Angel
Edmond OK
Joined 2022


kbcrking1002@...
 

Hello Dr Kellon!

Thank you so much for the information!!  I will be asking my vet about it tomorrow (possibly this afternoon if I can catch him doing his rounds at the hospital).  You are so correct!  Just had a lightbulb moment when I realized that recurrent ulcers were most likely trying to warn us a year earlier that she had PPID.  She is getting the antifungal and antibiotic treatment 4 times a day currently.  Do you think that is adequate?  

I will ask my vet about adding antiviral like topical ganciclovir.   So would it take care of the possibility of Leptospira, Borellia (Lyme) and also Herpes?  I am also going to ask him to rerun bloodwork for ACTH & IR.  Anything else I should have him check?  

Last, what do you think about steaming hay?  I have looked at getting one of the steamers from Haygain.  Would love your thoughts if that is beneficial?

I so appreciate you taking the time to reply to my original post!  I'm desperate to get this left eye healed up and her healthy and under control.

--
Beverly King & Angel (PPID diagnosed 2021)
Edmond OK
Joined 2022


kbcrking1002@...
 

One other thing that I forgot to put in my original post.  She also was diagnosed as having EPM in the fall 2021.  Since doing the treatments for EPM last fall, she has not exhibited any of the symptoms she had before (she was weak in the back end).
--
Beverly King & Angel (PPID diagnosed 2021)
Edmond OK
Joined 2022


Sherry Morse
 

Steaming does not reduce ESC like soaking does. Lepto and Lyme are both blood tests and if you want to rule them out you should have those tests run as well.
--

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response

PA 2014

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

 


Eleanor Kellon, VMD
 

You are certainly not in a high risk state for Lyme but you can see high risk areas here https://oklahoma.gov/health/health-education/acute-disease-service/disease-information/tickborne-and-mosquitoborne-diseases/lyme-disease.html . Best available testing currently is the Lyme Multiplex at Cornell, although that could be negative and still have a Lyme issue, especially if localized to the eye.  Worth testing though. I would add the topical antiviral and if any suspicion of Lyme you could change antibiotics to ophthalmic minocycline.

Steaming does nothing to lower sugar. It kills mold spores but horses with respiratory allergies to mold spores will still react to the dead spores. It's a fairly good way to soften hay for horses with trouble chewing.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."