Too Thin and Weepy Eyes


Stacey Smith-Bohn
 

Since foundering in February we have come a long way with the support of this group.  Last week we had the vet and farrier out for trim,  X-rays and blood work.  Both the vet and farrier were very positive about how Terry looks and moves.  He is turned out on a dry lot  a good part of the day and continues to wear his Clouds when outside of his stall because the ground is hard and his soles are still on the thin side but improving. He moves beautifully and is comfortable and sound, but not ready to be put to work just yet. 

The vet's concern is that Terry is still on the thin  side with ribs visible and hips still a bit pronounced, and winter just around the corner.  I have gradually increased his hay (soaked 1st cut Timothy) up to 22 lbs. a day with no change in appearance but a happier horse the extra hay.  I recently read on here that increasing protein could help him put some weight on and before this founder/laminitis he was of Purina Enrich Plus which about 3 years ago was increased to 6 cups a day to improve his topline, so the protein did help in that instance.  If I wanted to try to increase his protein what would be a safe choice and manor to do so?  I hope to have the results of his latest ACTH and Insulin/Glucose very soon.

Also, this time of year Terry gets weepy eyed (which also started about 3 years ago) and my prior vet told me to give him 10 Zyrtec (Cetirizine) twice a day.  Is this drug safe to use for PPID/IR horse?

Thanks in advance for you help.
--
Stacey Smith-Bohn, New Jersey, 2021
https://ecir.groups.io/g/CaseHistory/files/Stacey%20and%20Terry
https://ecir.groups.io/g/CaseHistory/album?id=261301


Sherry Morse
 

Hi Stacey,

The lack of topline and the weepy eyes are both indications that Terry's ACTH is not well controlled.  At 18 he could be early PPID and a TRH stim test could help you get a better idea of his status. Should you decide to do this it needs to be soon as there's no adjusted range for a TRH test performed during the seasonal rise.




Sue Ring
 

Hey Stacey,

Have you had Terry checked for uveitis??  Weepy eyes can also be a sign of a flare up of the uveitis inflammation and the condition is made worse in some horses due to the auto-immune connection, sometimes.  I have a horse who is PPID and also has uveitis.  Conditions such as uveitis are not caused by the PPID but having Cushing's can make the uveitis flare ups more difficult to control.  You are fighting a two-pronged problem....one not causing the other but inter-related at times because of a possibly compromised immune system.  Ask your vet about the possibility.......

--
Sue R in NC 2021

CASE HISTORY:  https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty

PHOTO FILES: 


 


Stacey Smith-Bohn
 

Sherry, I thought the ACTH test would tell us if we need to increase his Prascend?  What will the Stim test show?
--
Stacey Smith-Bohn, New Jersey, 2021
https://ecir.groups.io/g/CaseHistory/files/Stacey%20and%20Terry
https://ecir.groups.io/g/CaseHistory/album?id=261301


Stacey Smith-Bohn
 

Sue thanks, I will ask my vet about it.
--
Stacey Smith-Bohn, New Jersey, 2021
https://ecir.groups.io/g/CaseHistory/files/Stacey%20and%20Terry
https://ecir.groups.io/g/CaseHistory/album?id=261301


Stacey Smith-Bohn
 

Sherry, questions about the weepy eyes, if it is related to early PPID would it happen just from July to early fall as this has been the past few years?  If it starts in mid to late July each year is it connected to the fall seasonal rise, and if so am I too late to test?  As you may remember, since you have been kind to help us in the past, we have tested ACTH in the spring the past 3 years and he didn't test positive but has been showing signs in the fall and winter that has raised concerns.  Then this last winter he had horrible founder  and vet put him on 1 Prascend a day.  We did ACTH, Insulin, Leptin, Glucose, T4 on July 13th hoping that it would tell us where we stand and whether we need to increase his meds. I thought I had read that the Stim test was not helpful if they are already on medication for PPID.   I want what is best for the horse but I want to better understand what this additional test can show us.  Will it just show us if it is not under control or will it give us some indication how much more  Prascend he needs? Should we go ahead and increase his medication to see if he gains weight???   
--
Stacey Smith-Bohn, New Jersey, 2021
https://ecir.groups.io/g/CaseHistory/files/Stacey%20and%20Terry
https://ecir.groups.io/g/CaseHistory/album?id=261301


Kirsten Rasmussen
 

It's never to late to test baseline ACTH.  But if he needs an increase in pergolide, now is the time to start increasing the dose.  The TRH Stim test really should be done outside the seasonal rise though so if you don't do that soon (ie in the next week) you might have difficulty interpreting the results.  Generally we recommend taking them off pergolide for at least 3 weeks prior to the stim test, which I don't think you should do now.

Another option is to test baseline ACTH in the middle of the seasonal rise (late Sep, early Oct).  That will show you how high it goes in Terry.  Of course, by then any medication increase will have less of an effect, but you will have a better idea of how well his pergolide is controlling the PPID.

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Stacey Smith-Bohn
 

Thank you Kirsten. I don't think my vet will make it out here again to do more blood work within a week and certainly I don't want to take him off the Prascend at this point.  I did receive the July 13th Cornell results last night and will need some help from my husband to get them posted.  In the mean time the ACTH Baseline is now 26.2 which is up from 18.2 on March 17, 2021.  Although it is still within the reference range I see that it is a significant increase.  He was started on Prascend in early February 2021.  I am still waiting on some guidance from my vet, how would you you recommend that I start to increase his medication and what should I use as a gage to see when we have a good dosage?
--
Stacey Smith-Bohn, New Jersey, 2021
https://ecir.groups.io/g/CaseHistory/files/Stacey%20and%20Terry
https://ecir.groups.io/g/CaseHistory/album?id=261301


 

Stacey, I’m not a vet but I think I would try to increase the dose a bit.  Now is time of year you spoke of getting weepy eyes.  You could decrease it again after the rise but I usually don’t.  The added pergolide will be more effective if you do it soon, as others have mentioned.  One mg seems to be controlling him well otherwise so maybe try 1.5 mg.  The proper gauge is an appropriate ACTH but following symptoms is not a bad way to judge.  In your case, it seems to be topline and eyes.  You may recognize other symptoms as they disappear.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Kirsten Rasmussen
 

Stacey, I agree with Martha here.  My horse, too, just tested within normal range at 28.1 on Jun 28, but physically looks like he really needs a higher dose.  I'm moving him up from 0.5mg to 2mg right now, then will see if physical signs improve.

--
Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


Eleanor Kellon, VMD
 
Edited

A reminder that reference ranges for ACTH aren't "normals" any more than the ones for insulin are.  It's a statistically generated range. If you talk about ceilings or cutoff values instead, it's more like 28 to 30 outside of the seasonal rise months https://www.thelaminitissite.org/news/ppid-weekly-acth-cutoffs-now-being-used . When you add in the possibility of lab error or poor sample handling, a value in high 20s with symptoms warrants an adjustment.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Stacey Smith-Bohn
 

Thank you for your comments, I appreciate your experience with this issue.  I would like the support of my vet to increase him up from one pill to 1.5 but so far she seems reluctant since he has never tested high, but this change since March is significant.  He is a beautiful Morgan with a shiny coat.  His weepy eyes didn’t start this year until after the vet visit on the 13th so she hasn’t seen that yet. Can anyone tell me what the annual weepy eyes is and how it relates to PPID?  Looking for a way to bring my vet on board, thanks.
--
Stacey Smith-Bohn, New Jersey, 2021
https://ecir.groups.io/g/CaseHistory/files/Stacey%20and%20Terry
https://ecir.groups.io/g/CaseHistory/album?id=261301


Eleanor Kellon, VMD
 

The eye irritation/tearing can be related to the exaggerated inflammatory responses and new allergies that PPID horses can develop.

The abnormal coat of "classical" PPID is actually a sign of very advanced disease. We have become a lot better at diagnosing them before that point, which in turn has greatly expanded life expectancy.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Stacey Smith-Bohn
 

Thank you Dr. Kellon.  Is there a list of early signs of PPID that I can share with my vet?  About 3 years ago when Terry was 16 I started to see changes, foot abscesses, weepy eyes in July, loss of top line and neck sweats at night and no one was able to help see  what all these changes meant.  When this all started we had already been treating his insulin resistance for 10-11 years.  Three years ago we started also testing his ACTH each spring which always came in around 18-19 and my vet was never concerned.  Then this past winter, all went bad, and I want to do what I can to avoid this founder/laminitis again.    I'll share your comments with the new vet I am working with and hope to get her on board.  Your advice is greatly appreciated.    --
Stacey Smith-Bohn, New Jersey, 2021
https://ecir.groups.io/g/CaseHistory/files/Stacey%20and%20Terry
https://ecir.groups.io/g/CaseHistory/album?id=261301


Nancy C
 

Hi Stacey

Have a look here for a list of subtle symptoms:  https://www.ecirhorse.org/physiology-ppid.php

You are able to email the link to your vet right from the website. I might beef up the subjext line a bit so she knows it is not a phishing email.

--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room