To treat on not to treat


Dear group,

Let me give you the perspective of a veterinarian faced with a possible
diagnosis of pituitary tumor in a horse.

For years and years, old horses with long, curly hair coats that failed to
shed out were recognized as having pituitary adenomas. It was known that
these animals also were more prone to get laminitis, infections, drink and
urinate too much, become unthrifty, and in very advanced cases, become blind.
What no one knew was that the other symptoms could develop individually or
in groups without the shaggy hair (hirsutism). Since there was no known
treatment, I used to advise my clients what was going on in these horses, and
when the horses became too sick, or skinny, or foundered, we usually put them
down. But, I can remember many horses who went on for years and years, happy
and comfortable as long as their owners body clipped them.

Now we have some laboratory tests to confirm our suspitions and opinions, and
we also have a few medications that we can use to help control the symptoms.
We still do not have a single medicine that prevent the disease itself, or
the progression of the tumor growth, or the secretions from the tumor.
Whether or not to treat has to be a decision made by an owner with the
complete understanding that it is for the rest of the animal's life, it can
be very costly, and it is probalby only buying the animal more time at a
reasonable quality of life. And, the individual may have done just fine for
years without the medication.

Certainly, laminitis, foundering, is the greatest indication for treatment,
because if it is unchecked, the demise of the animal is imminent. I have
certainly seen equids (donkeys and mules included) with the only sign of
pituitary problems being unexplained laminitis.

If you have an individual who is starting to get a shaggy hair coat but has
no other symptoms, it is a tough call. Permax and cyproheptidine are fairly
costly. Permax has been $5 for 1 mg. At $5/day ($10 if your horse needs 2mg
a day), that's $150 for a months supply. If you can put off that cost for a
year or two and the animal is OK, then you can save up for when you really
need it. On the other hand, if you can prevent the individual from ever
foundering that first time, you can prevent a very painful episode or period
of damage to the feet.

I do not criticise the decision made by an individual owner on whether or not
to treat. I try to offer all options, be as realistic as possible, and
discuss when I think it becomes time to possibly accept that the end has
come. If people understand the condition, I have faith that they will try to
do a humane thing, whether it be to treat aggressively, or put the animal
down to end its discomfort when it gets to that stage. I personally feel,
and others may disagree, that it is OK to do the lab work to determine if the
horse has this condition, and then do nothing for a while. Likewise, if an
animal is foundering, and lab work is indicative of this condition, it may be
necessary to begin treating aggressively immediately just to get the animal
over the episode of foundering.

All of us associated with this condition hope for the day when a cheap
effective medication is found to prevent or stop the tumors' growth
completely. Until then, it will be a difficult condition for both owners and
veterinarians to manage.

Lists like this serve a very valuable purpose, because education is of the
utmost with this condition.

Belinda S. Thompson DVM
Pine City Veterinary Clinic
Pine City, NY

Susan Laflamme <f4mlatir@...>

Thank you for your post...... My horse is 40, 3 years ago she had laminitis
and it has been on and off since then. She does not have a long hair coat,
doesn't drink or pee any more than our other horse. She started cypro last
year but it hasn't made that great of a difference. She is on 1 ml of
liquid cypro. I have always understood that treating cushings with drugs
doesn't really make that much difference....the tumor is there and it will
continue to be there.
I can increase her cypro up to 2 ml.
I have to say this horse has always shed right on target she started
shedding soon after june 21 for her winter coat and she started her summer
coat in Dec.
It's a frustrating disease especially when your horse's body is giving out
before their mind wants to.
Thanks again
PS My vet always reminds me that it is a progressive disease