Cushings / Prascend

[NancyDrawed]

I took on a veteran to save him from being PTS a few years ago. Had the vet out recently as he was just not himself and was slow to gain weight this spring.

He was tested for Cushings, despite not having the classic symptoms, although he had shown a high worm egg count which remained high (although halved) after a dose of wormer, which I have now been told can indicate Cushings. After the first wormer he gained some weight and looked tons better, the vet said she was happy with his body score (which she put at 2.5 to 3 out of 5)

Having had his teeth done and a second, different wormer on vet advice, he has perked up no end and is back to his old self.

The vet would like to start him on Prascend immediately as he tested a low positive for Cushings (by whatever marker it is that is measured). I am interested to know if I can avoid starting the Prascend yet? The vet offered me a free test - through the company that makes the drug, not sure if they test the sample though - as a sort of 'you might as well if I'm taking bloods anyway'. I doubt he would have been tested based on his lack of symptoms, but now that I know he is positive for Cushings, I can't really ignore it. His standard blood profile came back as normal for liver, kidney function, wbc count etc

Does anyone have any words of wisdom for me or experience of Cushings they can share, please

I personally would only medicate to manage symptoms because once you start, it's difficult to come off and the meds have side effects. At the moment he sounds fit and happy so why medicate?

The drawback is that he does get symptoms without meds, then it takes a while to get it under control especially if it's lami. But with low levels I'd look at some of the supplements available and keep a very close eye. I'd measure him with a weight tape, not just girth but neck as well to monitor for any changes and do this monthly. Plus take photos each month from the same angle to compare any changes in his body.

Cushings is linked to the seasons changing as well. Autumn is a common time to notice issues, so I would be tempted to leave him over the summer then retest come November. I had a pony with cushings and wish I had held off a bit longer with the meds, she seemed to go downhill on meds, got her back up but it was always a bigger balancing act than before we gave meds.

Thank you for that.

I asked whether I could delay starting until after the summer because I would REALLY like to get away with my children this year if at all possible and a daily medication involves more input from (genuinely) allergic OH than a daily welfare check over the fence. I was told no, it had to be started straight away. I am slightly cynical as to the free testing if I'm honest and as I said, I would not have suspected Cushings.

You can delay treatment, it's your pony afterall! And the testing is a bit of a con. I bet if they tested every leisure horse or pony over 15 there would be a really high % come back borderline. And I wouldn't give meds to something without symptoms. I'd at least want to retest November, if levels are going up then absolutely have another conversation, but not when no symptoms and borderline for a positive.

I think you're right in that loads of horses and ponies over 15 would test low positive - perhaps increased cortisol levels are just a normal part of ageing?

Like you, I'm not keen on giving medicine without symptoms, so will do another worm egg count next week and if that is back to a low number I will leave the prascend for now and keep a close eye on his weight and general condition. He came to me with lumpy rump fat, so I suspect he is a high-ish risk for cushings / ems / laminitis. Looking good at the moment though!

I've had two with Cushings and both were on half a tablet for years with no change.
My cousin has a pony with Cushings and the medication made him so withdrawn and unhappy,that she stopped it and is treating him with chasteberry instead,along with restricted grazing,soaked hay ect. He has perked up no end,and I agree with her that it's better to have a happy,possibly slightly shorter life,than a miserable one that is longer by a few months.

I had this a few years ago. My mare got laminitis and they tested for cushings and it came back low positive. I asked for other figures to get an idea of this as the vet just said positive, need to start medication.

The laminitis was the only symptom although in retrospect this was just my fault - had only had the horse a few months and did not spot the changes. The medication is also costly and wouldn’t help with the laminitis risk as well as the time issue like you say. The vet advised that the other risk was poor healing/infection risk. I decided that I could monitor this carefully and not treat her.

Several months later she had a separate issue and the vet was concerned about giving her steroids to treat it so did another cushings test that came back negative!

As well as the issues above I am suspicious when there is only one treatment available. There doesn’t seem to be any particular testing or evidence how it helps. Now obviously if other symptoms need treating its different but if you can manage their condition it isn’t necessary. Also as with previous poster your job is to keep him happy not keep him alive for ever!

Yes definitely quality over quantity. I chose pts at quite a young age (18) for my little mare. We were increasing the dose of meds 1/4 tablet a year, then it would take 3 months to get her right, 6 months of restricted grazing, then lami again September/October then the whole cycle started again. When she developed some weird respiratory thing in the summer I decided enough was enough and had her pts. Broke my heart but she was spending more time ill than well.

I have 2 who've been on 1/2 tablet for a few years:

Pony is c. 20yo, and I had him tested when he was losing condition and muscle despite being very fit. He was about 2x the Springtime "normal" level. He'd had a history of low-grade lami episodes, and was prone to lice/mites. He went completely nuts for a while: think super reactive and paranoid. It's the opposite reaction to the usual "veil", but there was one study that observed this in a minority of horses. He calmed down again, and seems healthy, other than taking longer than the others this year to lose the last of his belly fur.

Horse: I had her tested at 12yo; her younger brother was already diagnosed by then. She wasn't showing much in the way of symptoms, other than getting fat just by looking sideways at a blade of grass despite being in lots of work, and carrying her fat in specific places. Her bloods (in Autumn) came back at 200 or so; after 6 weeks on Prascend, they were down to 20. She was also diagnosed with EMS, which we keep under control by lots and lots of exercise, as well as careful diet. She's not changed at all, in terms of temperament: she was greedy before, and is still greedy now. At the moment, at 15yo, she's doing great (fingers crossed)!