Wednesday, March 17, 2010
A Cushings Comparison
Saturday, January 2, 2010
Aha! Its NOT Just Our Imagination!
"It was pointed out that PPID is difficult to detect in its earliest stages, while advanced disease is relatively easy to recognize. The two most commonly used tests for PPID--resting adrenocorticotropin hormone( ACTH) concentrations and the overnight dexamethasone suppression test--can be used to confirm the diagnosis. However, these tests are less likely to yield positive results when PPID is first developing, so clinical judgment must be relied upon in these cases."
"New diagnostic tests are being developed for PPID and might allow earlier detection of the disorder. These include the combined dexamethasone suppression/thyrotropin-releasing hormone (TRH) stimulation test, TRH response test (with ACTH concentrations measured 10 and 30 minutes post-injection), and oral domperidone challenge test."
Thursday, December 10, 2009
Herbal Insulin Resistance Treatment Options Reviewed
“Appropriate treatment for IR is controversial,” said Noble,” But the effective management of IR may prevent the crippling disease, laminitis.”
Some of these compounds are marketed for other uses, such as anti-inflammatories, anthelmintics, muscle builders, and coat conditioners. Scientific evidence demonstrating any beneficial effect of these herbs on insulin resistance in horses is lacking.
Noble and her coauthors emphasized, "The aim (of this review) is not to advise clinicians or horse owners about what to use, but to inform equine scientists contemplating research in this field."
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Labels: Cushings, Insulin Resistance, IR, laminitis, PPID
Thursday, November 26, 2009
Cushings/IR Talk, Jan12, 2010, Leesburg VA
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Labels: Cushings, education.books, IR, PPID
Wednesday, November 11, 2009
Cushings horses: Use topicals with care!
"We were really surprised to see such massive systemic changes in such a short time," Abraham said. "And this was in healthy horses.
The study, "Effects of dermal dexamethasone application on ACTH and both basal and ACTH-stimulated cortisol concentration in normal horses," was published in the August 2009 Journal of Veterinary Pharmacology and Therapeutics.
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Tuesday, November 10, 2009
Drum Roll, Please!
Monday, November 9, 2009
TREES' Cushings Club
Friday, November 6, 2009
Welcome, Sherman!
Friday, September 25, 2009
How Beneficial Is Soaking Hay?
Many people believe that soaking hay removes water-soluble carbohydrates, making the hay safe to feed to laminitis-prone horses. This may not be the case.
In this may 2009 study,:
“The results showed a highly variable leaching of WSC and substantially less leaching than reported previously for chopped hay soaked for 30 minutes” explained Clare Barfoot. “Very few samples reached below 10% WSC, despite prolonged soaking. The concern is that this strongly suggests that soaking may not be sufficient to render some hays safe to feed to horses and ponies prone to laminitis.”
In addition, there is concern that soaking for a long time may remove so many other nutrients that deficiencies in protein, vitamins and minerals may result.
For more information, please read the Equine Science Update article, Laminitis: value of soaking hay?
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Thursday, September 24, 2009
Laminitis is Not a Disease
The first thing to realize is that laminitis is not a disease unto itself. Laminitis - meaning “inflammation of the laminae” - is a symptom of something else going on in the horse’s body.
In other words, to control the laminitis, you must determine and treat the cause. Administering all the anti-inflammatory and vasodilating drugs on the planet will not help if the root cause is not addressed at the same time.
In TREES' case, the laminitic horses we care for all suffer metabolic disorders, some related to Cushings Disease, some not. In every case, though, all tend to have high insulin levels unless their diets are very carefully managed. In every case of active laminitis, the insulin levels were well above what is considered normal, sometimes as much as ten times the norm seen in unaffected horses.
To manage those horses' insulin levels, we think of their management in the same way we think of caring for diabetic humans. Foods low in sugars and other simple carbohydrates, small frequent meals, maximum turnout (exercise - also beneficial in keeping arthritic joints moving, and guts functioning properly), and plenty of water. In the food category, no sweet feeds, no apples, carrots, or other starchy treats, no sugar cubes, no peppermints or other candies, no cookies, no applesauce, no corn syrup, no maple syrup, no ....well the list is endless. What IS allowed is a feed low in non-structural carbohydrates, soaked alfalfa cubes, and hay (remember, though, that all hays are not created equally and greatly vary in sugar content.) That's it!
Do our horses feel neglected or unloved because they get no "treats." Of course not! Grooming, scratches and personal attention fill the definition of "treat" as well as any peppermint could. (An added plus of the "no edible treats" rule is that we don't have horses rooting around in our pockets while trying to work with them, or pushing and shoving each other when visitors arrive.)
And, of course, the ultimate benefit of eliminating every source of sugar we reasonably can eliminate is an appreciable reduction in laminitic episodes in even those horses previously deemed "chronic."
We do take a deep breath any time one of our "metabolic" horses takes one bad step but most often that bad step is not because of laminitis. Should laminitis, however, rear its ugly head again, we'll re-evaluate, find the cause, and work to resolve the underlying issue as we also nip the inflammation in the bud.
Meanwhile, since personal attention is our herd's "treat," please consider a visit. All you need to bring is your fingers! For an appointment: info@equineelders.org
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Labels: Cushings, fat horses, feeding older horses, laminitis, PPID
Tuesday, September 1, 2009
Josh's New Coat
Josh arrived in April 2009, looking a little like a Lesser Virginia Yak. When I first saw a picture of him, I forwarded it to our vet with the note "I'm thinking Cushings." Her reply was something like "Yikes! I think your right."

When we ask our vet to evaluate or monitor a horse who has, or who is suspected of having, Cushings (more technically called Pituitary Pars Intermedia Dysfunction or PPID,) she takes a blood sample to measure the level of Adrenocorticotropic Hormone or "ACTH." Since ACTH levels naturally vary with time of year (its one hormone that increases as hours of daylight grow shorter, signally the body to prepare for winter,) we usually wait until late spring or very early summer to test.
In early June, we had a ACTH test festival, testing nine horses - 5 previously diagnosed were tested to see if their pergolide dosages were adequate, and 4 suspects. Two of the four suspicious looking horses were just grazing the upper end of the normal ACTH range. They will continue to be monitored and will be tested again next year. The other two of those four, however, Sonny and Josh, were added to the Cushings roster. As a matter of fact, Josh's numbers were not only high, they were "off the charts." We were not surprised. He did shed his yak coat in the spring, but it was immediately replaced by another winter coat. In May!
Josh was started on pergolide and within a couple of weeks, began to shed. He doesn't yet have a "normal" summer coat, but what a difference!


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Friday, August 7, 2009
Nathan - The Saga Continues
A diagnosis of EPM is often difficult to confirm. It can be ruled out when a test of either blood serum or cerebrospinal fluid shows a negative result. A positive result using CSF is "highly suggestive" of the disease, while a positive result in a serum sample only proves that a horse has been exposed to the protozoa (Sarcocystis neurona) that cause the disease. In Nate's case, we tested serum. Based on the result and clinical symptoms, it was determined that there is a 90% chance he has the disease. Reason enough to start treatment ASAP.
We've opted to use a product called Marquis, hoping for quicker results than some other treatments offer. Marquis should kill any protozoa present, but it will not repair existing damage to Nate's nervous system. Unfortunately, at this point, there is no way to know how extensive that damage may be.
EPM, like Cushings, affects each horse in a different way, depending in part on where the lesions are and how long the disease went untreated. We also don't know how Cushings may complicate treatment or how EPM may complicate Cushings.
In other words, for every answer we get regarding Nate's case, we get five or ten new questions.
The good news is, for now Nate is doing very well. He's eating well, gaining weight, and his spirit is bright. Last night, in a little burst of energy after hand-grazing, he tried a little lope after being turned back into his small paddock. OK, so it wouldn't have been considered "pretty" to most horse folk, but to us it was a gorgeous sight to see. Nate felt "kick-up-your-heels" good. Even if it turns out he only has a short time left in this life, we know he had that.
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Sunday, July 5, 2009
How's Nathan?
We’ll start with a few details about Nathan’s condition on arrival. A one-word description of the overall picture might be “overwhelming.”
As the trailer door swung open, the most obvious problem was his weight. Even with an abnormally thick summer coat, hip bones, ribs, shoulder blades and vertebrae were clearly defined. The heavy coat itself seemed a big bold arrow pointing clearly to Cushings. Nathan’s feet were all abnormally shaped, obviously not trimmed in some time. The biggest concern, however, was his balance. The gray gelding’s back end did not seem to be doing quite what he asked it too. He “listed” to the right, dragging his left hind leg any time he turned in either direction. There was no life in his tail, which hangs limply while the other horses’ tails swish gracefully back and forth as they graze.

Any one of those conditions, other than neglected feet perhaps, put Nathan’s future in question. Together, they seemed impossible to manage.
Once he was comfortable in his new accommodations, we stepped back to evaluate one step at a time. First…..feet. That issue seemed like it should be easiest to resolve and might bring the most immediate comfort. The problem, however, is that impaired balance meant it was difficult for Nathan to stand on three legs. When Nate finally did pick up the foot that appeared to be in the worst condition, we found it was heavily infested with maggots. The heel was virtually nonexistent accompanied by deformed bars and overgrown hoof wall headed in every direction. The smell was nauseating. Yet, Nathan looked fully weight bearing on that foot. Had he been like this so long that if felt “normal?”


The Animal Control Officer who brought Nate to Traveller’s Rest considered this a need for urgent veterinary care. We agreed and made the call. While here, the vet also documented Nate’s condition at time of arrival.
During the veterinary exam, the two biggest concerns were Nathan’s feet and his balance. Working together, the two issues made each difficult to evaluate separately. With poor balance, Nate couldn’t pick up a foot easily. Abnormal feet aggravated the balance problem. This combination of problems also made it hard to determine just how much of his lameness was pain and how much was neurological impairment. In addition, Nate had no muscle mass due to his malnutrition. Starve horses often drag their feet until they become stronger and rebuild muscle.
The maggot infested foot was addressed first. It was cleaned, flushed and poulticed with a Betadine/Epsom Salt paste, held in place with a baby diaper and duct tape. Not pretty, but functional. The hope was that the salt would kill any maggots that might still be hiding in any crevices, or hadn’t yet emerged from the diseased tissue covering the bottom of Nate’s foot. To thoroughly debride the foot, Nate will likely need to go to the vet clinic, but that’s a decision for later. At the moment he is likely not strong enough to tolerate anesthesia.
Where do we start in formulating a possible rehabilitation plan? Can we rehabilitate this beautiful old soul? Being realistic, as we continue to evaluate, it may be determined that the kindest thing we can offer our big new horse is a peaceful transition to his next life. That remains to be seen, but we’re trying to keep an open mind.
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Thursday, June 25, 2009
New Guy A-coming
This is one of those "Stay Tuned......." posts. We're making preparations for a new arrival, to be welcomed this weekend. All we know to this point is that he is 36 years old, a draft horse cross, has melanoma and Cushings, and needs to put on some weight. Challenges ahead..........?
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Labels: Cushings, feeding older horses
Wednesday, May 6, 2009
Freddie, the Self-Cleaning Arabian
Thank Goodness. Freddie really is self-cleaning most of the time. We're on our way to a record number of consecutive rainy days (or so the local weather gurus "joke.")
Even so, look at our 26 year old Arabian gelding, Fred Astaire:
No kidding! This is Freddie, as is, no special grooming, bathing, or "photoshopping," after several days of rain and mud. What a good guy.
We also have to take the opportunity to point out that Freddie is one of TREES' Cushings patients. Freddie's symptoms have been controlled for three years now, using dietary management and Pergolide. Again....Thank Goodness! Can you imagine dealing with an almost white "Cushings coat" during mud season? We don't even want to think about that prospect.
Wednesday, March 11, 2009
More thoughts on pergolide
Second, be sure you know what concentration your pharmacy sells. We've had some pergolide that was 1mg/ml, meaning the horse gets 1 ml of liquid to get 1mg of the drug. We've also had some that was 0.25mg/ml (4 ml liquid = 1mg of drug) and now use 0.20mg/ml (5 ml of liquid = 1 mg of drug.) One advantage to the more dilute form is a lesser difference in dose if you don't measure to the exact hair.
Finally, *when* you test ACTH levels has an effect on results. ACTH naturally increases as winter approaches and is lower in summer, so season will affect your test results.. Some people compensate by giving a different dose of pergolide in the winter than in the summer. We haven't done that, but it is something to be aware of.
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Tuesday, February 24, 2009
Is Your Horse's Pergolide Stable?
Stability and Efficacy of Compounded Pergolide Examined outlines a few recommendations, based on findings of a study conducted at the College of Veterinary Medicine at North Carolina State University:
>Store compounded pergolide mesylate products in a dark container, protected from
light;
>Refrigerate products to help minimize excessive degeneration;
>Dispose of products within 30 days from date of compounding;
>Evaluate the color of the product prior to each use and discard any pergolide product that has undergone any change in color, and;
>Request that your pergolide is compounded by pharmacists that use only the officially recognized formula (by the United States Pharmacopeial Convention).
Based on comments by a regular TREES visitor, these suggestions do seem to have a big impact on how well pergolide works. Here, we only purchase two weeks worth of pergolide at a time from a pharmacy that does not compound the drug until it is ordered and it is always kept refrigerated. Our visitor has mentioned that other farms using different forms of pergolide or different storage techniques seem to see more obvious symptoms than we see here. That is far from scientific proof, of course, particularly since each Cushings patient may exhibit different symptoms to varying degrees and may respond to treatment differently than other horses. We know we are paying more for our pergolide than some other people, but it may be worth the extra expense if quality treatment helps to prevent serious complications such as laminitis.
When visiting the link to the article, please also pay attention to the sidebar concerning "Human Health," particulary if you are using pergolide powder:
In response to the demonstrated stability concerns of liquid pergolide products, there has been some discussion regarding the use of bulk pergolide powder in equine practice. According to pharmacists, this is not a realistic alternative to the, "pergolide problem" as inhalation or ingestion of pergolide mesylate by humans is unsafe. In particular, inhaled or ingested pergolide can cause damage to the central nervous system and cardiovascular system (heart and lungs).
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Sunday, February 1, 2009
What is with this weather??
Some of our Golden Muck Fork winners (Gene and Carol,) though, got the rest of the farm cleaned up and helped prepare for the next winter storm, forecast to arrive tomorrow night. Stalls and sheds are ready to go, fields and paddocks are clean, a new load of hay was brought in, extra feed will arrive tomorrow and water tanks will be filled to the brim in case of power outages (when you're on a well, no electricity = no pump = no water.)
On another note, a young horse we placed in a wonderful home several years ago had to return to TREES a few days ago. Once we let her settle in, we'll re-evaluate her and see about additional training before making her available for adoption. Crea will be 6 years old this spring. We don't know her breeding. Coming from a "nurse mare farm," she could be almost any combination of breeds. She has been started under saddle according to her last family, but is very green and needs some confidence building.Thank you to Jorg and Tom, the powerhouse behind White Bird Appaloosa Horse Rescue, for trailering Crea to her current foster home. Many thanks, too, for the clippers (small clippers much appreciated for small jobs. We're still in search of something for full body Cushings coat clips - maybe something comparable to a Clipmaster 610.)
We're were also happy to have Mary Beth stop in and drop off some senior feed on Friday. Please come again when the weather is a little more conducive to a tour and introductions to the residents.
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Labels: Crea, Cushings, donate, nurse mare, visit, volunteer, winter
Monday, January 26, 2009
More on Handling Metabolic Challenges
"What's a Horse Course? It's an online video seminar given by experts on a specific horse health topic*. They're all free, thanks to our sponsors. (*Note: Topics are subject to change according to the presenters’ discretion.)"
2. Pituitary Dysfunction Problems in the pituitary gland of older horses. Sponsored by Fort Dodge Animal Health. Available Now. Dianne McFarlane, DVM, PhD, Dipl. ACVIM, ABVP (Oklahoma State University)Presented at the University of Kentucky’s Livestock Disease Diagnostic Center in conjunction with the Department of Veterinary Sciences.
Visit http://www.thehorse.com/Videos.aspx?tab=hc to sign up.
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Labels: Cushings, feeding older horses, Insulin Resistance, IR, obesity
Saturday, January 24, 2009
Feeding the Metabolically Challenged Horse
Feeding the Metabolically Challenged Horse
Amanda Blanton, DVM
Establishing an appropriate feeding plan for a horse with an endocrine disorder (PPID/Cushings disease, Equine Metabolic Syndrome, and/or Insulin Resistance) can be challenging and is tailored to each horse’s specific situation. As a result, it is important to discuss your horse’s endocrine status and nutritional needs with your veterinarian and to closely monitor your horse’s body condition, appetite and presence of any foot soreness (in those horses that are at high risk of developing laminitis.)The goals in feeding a horse with an endocrine disorder are to decrease body fat in obese horses and to avoid feeds that will worsen insulin resistance (IR.)
Weight Loss
Overweight horses (body condition score 7-9) require a strict program of dietary management and exercise. It has been shown that the risk of developing insulin resistance (IR) increases as the length of time a horse is overweight increases, and studies have shown that IR horses are more likely to develop laminitis. As a result, it is imperative to get the excess weight off these horses. Obese horses should be fed a diet of hay plus a vitamin and mineral supplement. Since they will be receiving no other calories, these horses should be fed enough hay to meet their energy requirements: 1.5-2.0 % of their body weight. This is equivalent to 15-20 pounds of hay per day for a 1000 pound horse.** Obese horses that are not actively laminitic should also be exercised daily to further reduce weight.
Avoiding Insulin-Resistance Causing Feeds
The key here is to avoid excess sugars and carbohydrates. Most sugars in a normal horse’s diet come from pasture grasses. As a result, when managing IR ponies or horses, you must restrict or eliminate pasture from the diet. Options for pasture restriction include strict dry lots, use of a grazing muzzle, free grazing for 1-2 hours a day and strip grazing with electric fencing. It has been shown that grasses are highest in sugars during dynamic stages of growth. Therefore, it is important to avoid grazing during the following times of year: spring (when grass is growing quickly and turning green,) early summer (when grass is starting to dry out,) following heavy summer rains (when grass is rapidly growing,) and fall (when grass is entering winter dormancy.) Sugar content in pasture grasses also varies with the time of day. Sugar content is low early in the day and high later in the day. As a result, it is best to graze horses with metabolic issues in early morning versus late afternoon. However, since each case is different, consult with your veterinarian to determine the best option for you and your horse.
Unlike the obese horses, some horses with endocrine disorders (lean horses in regular work and/or ribby horses with regional adiposity) will require supplemental calorie sources. How do you increase caloric intake without increasing the sugars and carbs that can lead to IR? If your horse is one of these and needs to be fed a concentrate, look for those feeds that are low in sugars and carbohydrates. Dividing the feedings into smaller, more frequent meals is a great way to decrease your horse’s natural glycemic response to each meal. It is also good practice to feed hay before concentrates to slow the transit from the stomach to the lower digestive tract where many carbohydrates are broken down into harmful sugars. You will also want to feed a hay that is <12% non-structural carbohydrates. To achieve this, you can send away hay to be tested or you can soak your hay for 60 minutes in cold water (30 minutes in hot water) prior to feeding it to your horse.
Other additives that may be used in tailoring a diet specific for your horse’s needs include rice bran, rice bran oil, or corn oil as high calorie, low carb supplements. Molasses free, soaked beet pulp is another great way to add calories and fiber to the diet while avoiding carbohydrates. Again, ask your veterinarian for recommendations to meet your horse’s specific requirements and tastes. Remember to make all feed changes gradually, at least over 10-14 days. And don’t forget to stay away from high sugar treats (no sugar cubes!)
As you can see, there are many factors to consider when establishing a feeding plan for a horse with a metabolic disorder and it can be challenging to create a plan that is feasible for you and palatable for your horse. However, it is very rewarding to see the results when an appropriate feeding plan is couple with exercise and appropriate medication (if needed.)
References
1. Frank, Nicolas. How to Feed Horses with Endocrine Disorders. AAEP’s 53rd Annual Convention Proceedings. 2007:186-192
2. Gordon, M.E. et al. The effects of dietary manipulation and exercise on weight loss and related indices of health in horses. Longview Animal Nutrition Center, Land O Lakes Purina Feed, Gray Summit, MO.
3. Gordon, M.E. The Effects of Nonstructural Carbohydrate Content and Feeding Rate on Glucose and Insulin Response to Meal Feeding in Equine.
** TREES note: Feeding only hay may not be possible in elder horses with advanced dental problems. Talk to your vet about finding a suitable replacement.
For more on pasture in relation to metabolic disorders visit SaferGrass.org
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Labels: Cushings, fat horses, feeding older horses, Insulin Resistance, IR, obesity












