# Cushings and Pergolide...



## ImogenBurrows (6 October 2010)

Hi all,

This is a pretty popular topic and I've been reading with great interest the threads about Cushings diagnosis, treatment and most worringly (for me anyway) the dose rates of pergolide given.

I have diagnosed and treatment a lot of ponies and horses with Cushings over the years, most of which have been controlled pretty successfully I'm happy to say.  However, the doses of Pergolide I've used vary between 250mcg up to and MAXIMUM of 1mg daily.  I've not ever found the need to go higher.

I have read a number of people who have horses on prescribed doses 4, 5 and 6 mg of Pergolide! 

I was so shocked by this that I actually rang had a chat with an internal medicine specialist about the dose range...he was pretty shocked too. 

Those of you who have Cushings horses and ponies, especially those on the wackingly high doses....please can you give me some feedback? 

I really would love to know about how the diagnosis is being made, how the Cushings disease is being monitored, are these cases actively laminitic, and is the treatment useful in your opinion or are you finding the doses going up and up despite still having high ACTH levels.... and are the side effects to your treatments??

Come one folks, please help and  and  vet out!!!


Thanks a lot 
Imogen


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## Sadiemay (7 October 2010)

Hi Imogen,

I agree! I have been pretty shocked when I read about some horses being on what I would deem as very large daily doses.  Having said that it really does seem to vary widely case per case as to what should be prescribed.

My 23 year old girl is only on 1/2mg per day after testing positive for Cushings at the beginning of this year (no laminitis)  Initially the vet started her on 1mg daily but this proved too much for her (she is 14.1 NF x TB) and sent her into a almost trance like state, she forgot where her stable was and her field also, very strange to witness!  and she went completely off her food which is VERY unlike her.  

So the vet swiftly decreased the dosage to 1/2mg and this seems to suit her perfectly and she has no noticable side effects.....she is like a 5 year old again  and this was confirmed with a blood test to check her levels and her level was now in normal range. She will be tested every year or earlier if I or the vet feels its necessary and the meds adjusted accordingly.

Interestingly in my new yard there are a few oldies on Pergolide and its seems the dosage varies, one 12.2 is on 2mg a day  and a 16.3 is on 1mg per day....I guess they determine the best dosage by blood tests after the horse has been on the drug for a certain period of time  (this was the case with my sweet girl anyway) 

Sadiemay


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## 0ldmare (7 October 2010)

My mare (who went down with Laminitis, which was the first we knew about her Cushings problem) is on 1mg per day. She was completely zombie for a few days and off her food for about a week, but subsequently seems to have recovered on both fronts. I'm keen for her to be tested again soon to see if the level is right.

I've read that a high (too high) dose of Pergolide can actually make laminitis worse!


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## nativepony (7 October 2010)

Hi Imogen, I've got the 14.3 NF mare (aged 19) who is currently on 2mg a day.  She was diagnosed back in May after a loss of topline and reoccurent bouts of a "colicky type" thing.  The vet thought it very unlikely she had cushings but it came back positive after a blood test.  Her ACTH levels were initially 171 and she was started on 1mg, after a month she was re-tested (at Liphook) and her levels had gone down to 97 so the vet increased her dosage to 2mg.  The ACTH levels are now at 39 and my vet is happy to keep the doseage at 2mg.  She will be retested in January and is "touch wood" doing well I think and is ridden regularly.


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## Old Bat (7 October 2010)

Hi Imogen, I was surprised as well as I have a welsh sec A diagnosed around a year ago. she has never displayed laminitis but I became suspicious when I monitored her drinking, she seemed depressed, had fat pads above her eyes and stores fat very easily in her crest and pads on her back. Her ACTH levels were 523 and she was started on .25mg for a few months which perked her up no end. she then became a touch lethargic and grumpy again so we upped the dose by half a tablet therefore to .375. She has been great ever since but I do manage her strictly as a laminitic and she is in full work, coping with a week of PC camp in the summer and mounted games training up to and including Championships. I constantly feel she is too fat though and cannot seem to get the excess weight off. I'm intending to have her blood checked again if her state changes but am happy with the dosage at present....


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## Old Bat (7 October 2010)

PS, forgot to add , she is only 13 and I've just rechecked the vet report and the level really was 523...surely this is excessively high? Any advice would be appreciated


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## 0ldmare (7 October 2010)

PS From me too - my mare had an ACTH of 583. Am now rather scared as she seems to be v high compared with the others except forderough. She's 15.1hh and 19 years old


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## Sadiemay (7 October 2010)

I cannot remember the exact figure but its something like anything under 120 is considered normal and anything above is considered abnormal and an indication of Cushings.

Sadies orginal ACTH level was I think just over 140 and now with the pergolide is down to mid 50's.  I am sorry but I cannot remember the exact figures but the above is a rough indication of what my vet told me.

I hope this helps somewhat.  I am due to speak with my vet next week so I will clarify with him what the exact figures were.  But basically you want the level to be as low as possible and within "normal" range once established on the pergolide.

Sadiemay.

Edited to add: I am not sure how relevent the orginal levels are, I wouldnt worry too much my vet said that in my case we had diagnosed Sadies onset of Cushings early hence the relatively low level but in most cases horses ACTH levels are alot higher (several hundred even up to nearly 1000 in some cases) upon diagnosis.  And that the main thing is that the levels are brought down through use of pergolide/other meds.


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## ImogenBurrows (7 October 2010)

Thanks for all the posts to date - really interesting.  I asked my boss today at work and the highest dose he's used in 2mg in a big horse.  I'm just really unfamiliar with the higher ends. I'm hoing some more people who have horses on the really big doses may post....
come on folks don't be afraid!!!


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## amandap (8 October 2010)

I've no experience of cushings but this thread is really interesting. I really hope more reply, especially those with horses on high doses.


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## Karla B (11 October 2010)

I have a 13.2 welsh section B gelding who is 22 years old and has just been diagnosed as having cushings.

He does not have any of the classic symtoms such as a thick coat etc and looks in excellent condition and no where near his 22 years.

He has had 3 very mild boughts of laminitus this year having never suffered before which led me to getting him tested.

My vet perscribed 1mg of pergolide per day, he said this was a low dosage and a pony of this size could have up to 2mg.

After 5 days of being on pergolide he had a "funny turn" one morning as i arrived at the stables and turned the lights on he seemed to be wobbly on his legs and not quite himself but recovered quickly.

The next morning i arrived to a much worse case - as i approached his stable he woke up and appeared to have a fit.  He threw himself against a wall and then to the floor with his eyes rolling and did not have any control (nearly giving me a mild heart attack!).  My first thought was that he had colic but after a couple of minutes apart from being slightly shaken he was absolutely fine and looking for breakfast! 

I phoned my vet immediately who said he would look into it but did not beleive there could be any connection between the "fits" and the pergolide.  I stopped giving the pergolide on friday - against my vets advise to carry on with it.

The next day he had another mild seisure in the morning, but not anywhere as bad.

I have not given any pergolide since and the last two mornings he has been absolutely fine.  I have the vet coming again tommorrow to discuss any alternatives?

Has anyone ever heard of this being a side effect of pergolide before? 

I am worrying myself sick!!


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## ImogenBurrows (11 October 2010)

Wow - sorry you had to witness that kind of episode - scary stuff!!!

No I haven't ever witness that kind of side effect....1mg in a substantial pony is a high, but recognised dose...

It initially was used a treatment for Parkinson's disease in humans - and I can't find any reference to seizure activity there either.

Bear in mind that as the new equine licensed drug is on sale we all have to use that rather than the generics....


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## warbank (20 October 2010)

my shetland has been on pergolide for 6 weeks, he also had a fit about 2 weeks ago, which my vet said is due to the tumour in the pituitary gland pressing against his brain, some horses have one fit and never again, others fit more often, one horse on my yard went blind after a fit, she had had cushings for years and was very old. so far my pony is fine, but still on pergolide, and he has started eating again and looking much happier.


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## minime (20 October 2010)

Hi Imogen, If you get time could you read up on my stallion who is having problems. I am afraid it is a bit long and I have received all sort of advice some good some very bad. I was reading about cushings and wondered if it could be his problem.
Thanks
http://www.horseandhound.co.uk/forums/showthread.php?t=402543&page=5


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## marie_d_3 (21 October 2010)

Hi I have a 14.2 Arab mare who has been diagnosed with Cushings due to physical symptoms (long coat that doesn't shed properly, excess drinking and a bout of laminitis despite being slightly underweight.  She is on 1mg Pergolide and the improvement has been dramatic with no side effects at all (touch wood).

Please could someone explain further about testing for ACTH levels.  Is this where they are injected with steriods?  I would like to test her and see if the Pergolide could be reduced.

Many thanks


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## Sadiemay (21 October 2010)

For those of you worried about giving your horses Pergolide I would be thinking 2 things:

1) The dosage is too high and consider liasing with your vet to decrease.  The reason I say this is that my 14.1 mare was prescribed 1mg initially and she became very lethargic and almost in a trance/zombiefied like state and wobbly on her feet.  The vet put this down to a too high dosage and she is now on 1/2mg dosage and it suits her MUCH better.

The effects of too high a dosage were very visible and in my mind extreme que me having heart failure! With regards to testing I plan on having my mare tested every 6 months to check her ACTH levels are still within normal range and asjust the pergolide accordingly if needs be or pursue other treatment if deemed necessary.  The ACTH levels can be done with a simple blood test that is sent chilled to Liphook for example, your vet can advise on this.  But I have to say I am suprised at the high doses prescribed to some horses 

2) If you dont want to give Pergolide full stop then there are some apparently effective supplements available that help with the symptoms and management of the pituitary gland, one the most well known being NAF Cushinaze, there have been some very positive reveiws of this supplement so its worth a look I reckon.

Or Chaste Berry is supposed to be effective also. Also I heard there is a new drug specifially for Equines for the treatment for Cushings called Prascend.  As I understand its basically Pergolide but specifically for horses.  It might be more easily tolerated in some horses than Pergolide which is essentially a human drug, I dont know though as I have not investigated it further as my old girl is doing fine on her 1/2 mg of Pergolide but it might be worth a look?

Sadiemay


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## ImogenBurrows (21 October 2010)

As far as I'm aware Prascend is just the same old pergolide chemically unchanged  http://www.prascend.co.uk/prascend/
The reason it's getting prescribed is due to the cascade so we have to now use this as it's the licensed drug, rather than the generics.


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## ImogenBurrows (21 October 2010)

minime said:



			Hi Imogen, If you get time could you read up on my stallion who is having problems. I am afraid it is a bit long and I have received all sort of advice some good some very bad. I was reading about cushings and wondered if it could be his problem.
Thanks
http://www.horseandhound.co.uk/forums/showthread.php?t=402543&page=5

Click to expand...

I remember the thread in veterinary, but I've been away for the last few days so haven't had chance to post! 
I agree with those about the body condition issue in the first piccie  and often the crest does flop over due to obesity - but in your second set of photos he has obviously lost weight and the crest doesn't look _that_ big.  What did you vets say about the crest when they felt it? And didn't you post these bloods on a separate thread that I commented on?
Have you tried stripping some of the weight out of the mane as suggested??

It would confuse me too....don't think Cushings is on the differential list TBH but you can always test and check.  Due to the weight issue I'd say that metabolic syndrome is more possible. 

HTH 
Imogen


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## impy01 (22 October 2010)

Hi, my 14.2 16yr arab gelding was diagnosed with cushings 5 weeks ago. He had become very lethargic when been schooled (only symptom). I had tried giving him a holiday, changed feed, changed his routine - nothing. So took him to vets for blood tests to see what was going on and it came back as cushings. His reading was 92. Anything 49 and under is normal - as per my vet. The vet prescribed Prascend 1mg a day - couldn't give me pergolide. I asked if I could start on 0.5mg a day and work up if need be. She agreed. I had read  about chaseberry and found Vitex 4 Equids which was supposed to be good natural medication for cushings so started on that too 40ml a day.

Just had second lot of bloods done this week and his reading had gone up to 107 I am taking him off Vitex for time being and putting him on 1mg of Prascend  - back for more bloods in 4 weeks. 

The good thing is that he is taking his tablet - my friends part bred is 19 and on pergolide ( she can continue to get this from same vets as me as she was diagnosed before the law changed?) but he refuses to take treats as he is worried the horrible tasting tablet is in it  Has the taste changed now it's a horse drug?


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## Deedee1990 (22 October 2010)

Have been reading this post with lots of interest but up until now havent posted as been lurking! I am finding this post very infomative and interesting. As I am studying for a degree in equine science and think of doing my final project on Cushings and the current treatments and the effectivness. 
I feel it is very encouraging that people are disscussing this as clearly over the years treatments have changed and veiws and opinions are also changing. And i find it even more encouraging that it was a vet that started this. Well done


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## sueeltringham (22 October 2010)

My Shetland mare went rapidly downhill this time last year.  She had a classic Cushings coat, lost most of her top line, had a Cushings belly and was colicking repeatedly with signs of laminitis.  We gave her Pergolide as we had nothing to lose and no time to get her tested -she was on deaths door.  I did also try Agnus Castis for a while, but she completely refused any food with it in and I hated syringing it into her everytime.  We noticed no change anyway.
After starting Pergolide, she improved slightly after a week, more so after 10 days and within a month was putting on weight and eating like she'd never eaten, showing a new lease of life and a new coat.  The change was remarkable.  She had a 5oo mcg dose per day.  She was fab into spring and summer and we had a brilliant summer attending PC rallies and camp.  
Sadly a few months ago she went into decline again.  I increased her Pergolide in agreement with my vet to 750 mcg with a good improvement in her Cushing symptoms (amount of lethargy, drinking, slight lamnititis, etc.) her diet was very tightly controlled with access to soaked hay, a feed balancer and fast fibre and very restricted turnout on a mud patch.  Sadly she declined again (although I upped her pergolide to 1mg temporarily) with strong digital pulses and laminitis after only an hours turnout with virtually no grass.  We made the decision to have her pts before she declined further.  

There's a lot of experience on a US forum for equine metabolic syndrome and Cushings (http://pets.groups.yahoo.com/group/EquineCushings/).  Over there, Pergolide seems to be started gradually to avoid the 'veil' side effects.  They suggest starting with a 500mcg dose and increasing it in 250mcg amounts over a period of a few weeks.  If side affects/not eating happen then the dose is decreased for a few days.

I don't have experience of higher than a 1mg dose, but I considered that was quite high for a mini Shetland who only weighed about 150Kg.  We think she'd had Cushings for a very long time.
Don't forget that Pergolide is only part of the treatment.  Management on a very strict diet is extremely important.  Hope my experiences help.

Sue


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## EstherYoung (23 October 2010)

It's so hard knowing what to do.

My mare was diagnosed about 10 years ago, but with hindsight she'd had it for years before that. She's now at least 30 (exact age unknown, possible much older) and although she's retired now, she's still going strong, so there is hope.

I started her out on Hormonise (soluable monks pepper) as she wouldn't eat the neat berry. That resulted in a rapid turnaround - to the extent that when I went home to my mum's for xmas, I was thinking I'd have to make 'the decision', but when I came back she was galloping and bucking and kicking. I've never gone down the pergolide route - we thought we'd try the 'small guns' first and then still have the 'big guns' in reserve should we need them. As it was she didn't need them.

However, the biggest thing that turned her condition around was getting her a small pony mate. She took the young rescue pony under her wing, taught him the ways of world domination, and they're still a right old team (even if he does get a clip round the ear every now and then from his ol' gran). I haven't actually given her any supplementation for ages, and touch wood no more laminitis. Our vet thinks she's a legend, as every other horse that was diagnosed when she was is now dead. He also thinks there's something in the fact that improving her psychological stimulation (her happpiness, for want of a better word) improved her condition so much, and its certainly led him to take a more hollistic approach to some of the other cases he deals with. The medication is helpful, certainly, but there is a bigger picture at work here.

The old bat is still cushingoid - she has a coat on her like a yak - but she is a sharp as a die and her metabolism is relatively stable.


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## ImogenBurrows (23 October 2010)

Thanks to everyone who has posted replies to give their experiences - this is really what I was looking for.  

I am glad to hear so many positive experiences with treatment, I personally believe it is a very beneficial treatment as as I said in the OP, my experience of managing cases using pergolide is good.  

I don't necessarily think that if your horse has Cushings (or signs suggestive thereof) you need to rush into treatment.  As the above post says, some horses do very well with environmental management, usually the ones vets see and diganose get treated as there may be an associated problem - or we probably wouldn't be there in the first place!

I'd like to post a photo similar to that of one of my client's ponies...this one had Cushing's - I think although no tests were done and the owner did not have the horse on treatment.  He coped very well!!






Secondly, I would like to comment on my OP.

It has been brought to my attention by members of my profession that my OP was poorly worded, so much as to say it has been a hotly debated and controversial topic of conversation in other veterinary forums.  

I fear that my OP has done two things that I certainly did not intend and as such would like to put the record straight.  

It has been pointed out that the OP could be interpreted in such a way to suggest that I do not approve of vets that had chosen to prescribe the higher levels of pergolide for certain cases. 

This is NOT the case.  Each veterinary surgeon managing each individual case will have the benefit of examination, lab results, a full history etc and will make a clinical decision for treatment based on _all_ this information.  I know of references supporting higher levels of Pergolide doses in specific cases.  I do NOT consider use of these doses to be negative - I would feel sure that they are indicated as they have been prescribed.  

As such, colleagues may have felt this thread undermined their decisions to use higher doses, and for this I sincerely apologise.  The intention was purely to find out owner's experiences so that I, as a vet, will be able to discuss risks etc with my own clients should I need to use these higher doses in the future. As I have no experience with use of these dose levels, I personally felt your opinions matter.  

It was also pointed out that veterinary surgeons have a code of professional conduct to stick too and that by undermining other veterinary surgeons decisions or knowledge, could compromise this. 

I will be posting another thread to clarify my own feelings regarding my contributions on this site to avoid future controversy I hope!

Happy posting.
Imogen


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## loopylucifer (23 October 2010)

Deedee1990 said:



			Have been reading this post with lots of interest but up until now havent posted as been lurking! I am finding this post very infomative and interesting. As I am studying for a degree in equine science and think of doing my final project on Cushings and the current treatments and the effectivness. 
I feel it is very encouraging that people are disscussing this as clearly over the years treatments have changed and veiws and opinions are also changing. And i find it even more encouraging that it was a vet that started this. Well done
		
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I very much agree with DeeDee1990 on this. And have too found this post very informative and intresting. It is always useful as an owner to hear other people veiws and opions on things. 
What a shame it is vets themselves that seem not to be embracing discusion. from an owners perspective I do not feel any vets have been undermined. More vets should be willing to come on here to give thier views too if they feel that strongly about it.
Well done Imogen for this thought provoking and very intersting thead.


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## impy01 (27 October 2010)

I agree I think Imogen has done a great job. My friend who also just diagnosed 6 mths ago and I where saying only this week about how little information is given to owners when your horse is diagnosed and it's a shame vets don't hand out information leaflets on things like cushings- giving you all the facts.

Imogen just wondering if you know how much testing has gone on with Prascend, my lad is becoming depressed and ratty. He has been on Prascend 6 weeks now. My friends horse is on Pergolide and really happy and back to himself. As I posted earlier his aeth range has gone up and we are now on 1 full tablet a day. It's awful to see him so sad. Do you think it's possible he would react better to Pergolide?


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## Laura1812 (27 October 2010)

Have people had much luck with agnus castus for cushings?

I have a friend with an old horse that has been diagnosed but not treated. The horse gets very hot and its feet and coat grow like wild fire - it has just been started on agnus castus - too early to see if its made a dfifference yet.


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## Wishful (27 October 2010)

Prascend is Pergolide - same chemistry, the only difference is that the makers of Prascend have gone off and jumped through the hoops to get it approved as a medicine for horses, so it jumps up the cascade.  The stuff is probably made on the same production line, costs the same to make, but the drug companies are getting more money through it being the only licensed product.

There's quite a few drugs that are the same formulation (and are made by the same factory) which have different meat withdrawal periods/ status as regards being given to Equines without the relevant bits of the passport being signed off.  Might be Domesedan/equivalent...


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## impy01 (27 October 2010)

I know Prascend contains Pergolide but there must be a difference lots of horses in fact most of the ones on Pergolide start to refuse tit bits scared it's going to contain the tablet - it's amazing some of the length's people have to go to to get the tablets down. Where as I haven't heard one person have problems getting Prascend down. Something is different somewhere. I know the Pergolide smells and taste's of nothing to humans (my friend took one so see how bad it tasted as she is really having to come up with inventive ways to get the tablet down)


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## ImogenBurrows (27 October 2010)

impy01 said:



			I know Prascend contains Pergolide but there must be a difference lots of horses in fact most of the ones on Pergolide start to refuse tit bits scared it's going to contain the tablet - it's amazing some of the length's people have to go to to get the tablets down. Where as I haven't heard one person have problems getting Prascend down. Something is different somewhere. I know the Pergolide smells and taste's of nothing to humans (my friend took one so see how bad it tasted as she is really having to come up with inventive ways to get the tablet down)
		
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I've not had reports from my clients that they have had issues giving pergolide or prascend tbh.  There will be a different formulation of pill as one is for humans and one more for horses....but no active ingredient difference to my knowledge.

On a different note...the prascend won't cause a difference in depression/mood vs the pergolide that I can think of....

If the ACTH levels are still high despite the 1mg dose then may be other treatments are worth considering?  Not every case responds perfectly to the pergolide...and other treatments are available, but are used less commonly due to usually lower response rates...discuss that with your vet maybe?  This may be a case that does need higher doses? 

Regards,
Imogen


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## amandap (28 October 2010)

EstherYoung said:



			It's so hard knowing what to do.



However, the biggest thing that turned her condition around was getting her a small pony mate. She took the young rescue pony under her wing, taught him the ways of world domination, and they're still a right old team (even if he does get a clip round the ear every now and then from his ol' gran). I haven't actually given her any supplementation for ages, and touch wood no more laminitis. Our vet thinks she's a legend, as every other horse that was diagnosed when she was is now dead. He also thinks there's something in the fact that improving her psychological stimulation (her happpiness, for want of a better word) improved her condition so much, and its certainly led him to take a more hollistic approach to some of the other cases he deals with. The medication is helpful, certainly, but there is a bigger picture at work here.
		
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This is my feeling very strongly. A horses mental health and feeling of security is so important imo. 

Imogen, I greatly respect you posting on here and I'm sad to read how your OP has been read by some other vets. However, code of conduct or whatever, no one is beyond question and instigating a hot debate that causes people to think more is a good thing imo.
Thankyou for taking the time and effort to post, I much appreciate it as I'm sure many others do.


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## Luci07 (28 October 2010)

ImogenBurrows said:



			Thanks to everyone who has posted replies to give their experiences - this is really what I was looking for.  

I am glad to hear so many positive experiences with treatment, I personally believe it is a very beneficial treatment as as I said in the OP, my experience of managing cases using pergolide is good.  

I don't necessarily think that if your horse has Cushings (or signs suggestive thereof) you need to rush into treatment.  As the above post says, some horses do very well with environmental management, usually the ones vets see and diganose get treated as there may be an associated problem - or we probably wouldn't be there in the first place!

I'd like to post a photo similar to that of one of my client's ponies...this one had Cushing's - I think although no tests were done and the owner did not have the horse on treatment.  He coped very well!!






Secondly, I would like to comment on my OP.

It has been brought to my attention by members of my profession that my OP was poorly worded, so much as to say it has been a hotly debated and controversial topic of conversation in other veterinary forums.  

I fear that my OP has done two things that I certainly did not intend and as such would like to put the record straight.  

It has been pointed out that the OP could be interpreted in such a way to suggest that I do not approve of vets that had chosen to prescribe the higher levels of pergolide for certain cases. 

This is NOT the case.  Each veterinary surgeon managing each individual case will have the benefit of examination, lab results, a full history etc and will make a clinical decision for treatment based on _all_ this information.  I know of references supporting higher levels of Pergolide doses in specific cases.  I do NOT consider use of these doses to be negative - I would feel sure that they are indicated as they have been prescribed.  

As such, colleagues may have felt this thread undermined their decisions to use higher doses, and for this I sincerely apologise.  The intention was purely to find out owner's experiences so that I, as a vet, will be able to discuss risks etc with my own clients should I need to use these higher doses in the future. As I have no experience with use of these dose levels, I personally felt your opinions matter.  

It was also pointed out that veterinary surgeons have a code of professional conduct to stick too and that by undermining other veterinary surgeons decisions or knowledge, could compromise this. 

I will be posting another thread to clarify my own feelings regarding my contributions on this site to avoid future controversy I hope!

Happy posting.
Imogen
		
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Shame your post was taken the wrong way. I didn't read it like that at all (albeit I am not a vet) and found it extremely interesting to have a vets view/perspective and questions on this subject. Yes we talk to our own vets but threads like this are brilliant for prompting other thoughts and questions that we might not perhaps think of on our own.

My mare who is a TB x 16.3 is on 2mg at the moment because that is the level she was on when she came home. Now my own vet is questioning this but not from a perspective of critisisim of the previous vet but rather she wants to understand the diagonisis that led to my mare having this level prescribed - and we are going through this at the moment. I am new to cushings so all this information is very helpful - my own mare is very overweight as was out of work and is a very good doer but has certainly firmed up since starting fittening work again. 

Please keep posting Imogen, anything that helps broaden our experience can only be for the good!


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## ImogenBurrows (29 October 2010)

Luci07 said:



			Shame your post was taken the wrong way. I didn't read it like that at all (albeit I am not a vet) and found it extremely interesting to have a vets view/perspective and questions on this subject. Yes we talk to our own vets but threads like this are brilliant for prompting other thoughts and questions that we might not perhaps think of on our own.

My mare who is a TB x 16.3 is on 2mg at the moment because that is the level she was on when she came home. Now my own vet is questioning this but not from a perspective of critisisim of the previous vet but rather she wants to understand the diagonisis that led to my mare having this level prescribed - and we are going through this at the moment. I am new to cushings so all this information is very helpful - my own mare is very overweight as was out of work and is a very good doer but has certainly firmed up since starting fittening work again. 

Please keep posting Imogen, anything that helps broaden our experience can only be for the good!
		
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Thank you and best of luck - keep us updated of your mare!
Imogen


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## alsiola (2 November 2010)

The dose range for pergolide is 1-5mg/500kg horse/day.  The two most prominent researchers into endocrine laminitis are probably Cathy McGowan at Liverpool, and Andy Durham at Liphook, and both will happily use up to 5mg a day if needed.  1/2mg a day is only really appropriate in small ponies with mild disease.
As far as diagnosis and monitoring, then ideally we should be using a dex suppression test, ACTH assay and insulin assay, although the dex suppression is commonly missed out.  Clinical signs are obviously key as well.
I've never seen a horse with pergolide side effects, so IME the consequences of underdose are far more severe than the consequences of overdose.


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## ImogenBurrows (2 November 2010)

alsiola said:



			The dose range for pergolide is 1-5mg/500kg horse/day.  The two most prominent researchers into endocrine laminitis are probably Cathy McGowan at Liverpool, and Andy Durham at Liphook, and both will happily use up to 5mg a day if needed.  1/2mg a day is only really appropriate in small ponies with mild disease.
As far as diagnosis and monitoring, then ideally we should be using a dex suppression test, ACTH assay and insulin assay, although the dex suppression is commonly missed out.  Clinical signs are obviously key as well.
I've never seen a horse with pergolide side effects, so IME the consequences of underdose are far more severe than the consequences of overdose.
		
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I've not seen a horse with side-effects either, but then as I stated in the OP, I personally have not needed to use doses higher than 1mg.

I hope you realise that I am NOT criticising other vets how have used/do use higher doses - it is just something I do not have experience with, and several people had been reporting possible side-effects so I felt it interesting to try and see how most people felt about the effects of higher dose treatments, _from an owner's perspective._

I am however, interested as to why you feel diagnosis and monitoring should be made with _both_ the low dose dex suppression test and acth as well as insulin levels....we send off ACTH and insulin (if req'd) to Liphook and I'm not sure many of my clients would want both dex and acth every time....I was under the impression that with the latest seasonal reference ranges established, that the ACTH alone is a pretty accurate diagnostic and monitoring tool.  I would be interested in your thoughts.

There is no doubt there are wide ranges of the levels of pergolide required in the horse/pony to stabilise Cushings.  The dose required is the correct one IMO. 

Again, apologies if you feel offended by my OP or posts, this was started out of genuine interest, rather than to criticise. 

Kind regards,
Imogen


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## Crackerz (2 November 2010)

My 14hh 19yold was diagnosed last monday with a level of 1200, which apparently is ludicrously high!!! after i saw a slight change in his weight and coat. I've had him over 13years so know him pretty damn well.

He started Pergolide Saturday, on half a tablet for 7 days, which will be followed by 1 tablet for 7 days, then 2 for 2 weeks then another blood test to hopefully be able to reduce the doesage - we will see.

Any help advice on an already VERY hard to manage pony appreciated!


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## Crackerz (18 November 2010)

Just bringing this back up....

He's due for his blood test, but i'm having terrible trouble getting the Pergolide into him now, he was fine to begin with. He's not a food orientate pony so would rather go without than have something that wasn't 'right' in his books!!
Managing, just, to get it in with a apple & extra strong mint puree! He won't put up with a daily syringe either..

Any help/advice appreciated!!


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## Sadiemay (18 November 2010)

Cut an apple into segments and push the tablet well into the middle of a segment.  

This is how the Pergolide is administered to my girl and so far she is happily takng the apple slice 

Sadiemay


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## LizzyLou (18 November 2010)

My 15.2 Welsh cob was diagnosed with Cushings about a year ago, Nov 2009.  My vet put him straight on to Pergolide 1mg daily.  My vet gave me prescriptions and I took them to a local Lloyds Pharmacy.  100 tablets were around £40 this way although I had to pay £8 for each prescription as well.

Over the winter he seemed to put on some condition and his fat pads went down.  Although he did develop quite a nasty bout of COPD over the winter and had to have Ventopulmin.  I was told that Cushings plays havoc with their immune system and they will get all sorts of infection.

When February came, he got hind leg laminitis (in both legs).  He lost alot more condition and then got laminitis in both his front feet as well.  He had not had laminitis before this for four years, and then for six years before that.

He was in so much pain and had lost so much condition that only a dose of four bute a day would make a difference to him.  Obviously this could not continue and he was put to sleep on 14th June this year.  He was 23 when he died.  I miss him very much.  A horse of his type should have gone on alot longer and his loss is tragic.


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## Crackerz (24 November 2010)

Sadiemay said:



			Cut an apple into segments and push the tablet well into the middle of a segment.  

This is how the Pergolide is administered to my girl and so far she is happily takng the apple slice 

Sadiemay
		
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He won't even entertaining sniffing it, never mind eating it!! He can tell straight away that it is in the apple/carrot/chocobiscuit etc 

We tried crushing it & syringing it with an apple juie, but it made him violently object and throw himself against the stable wall.


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## Zuzzie (24 November 2010)

I had a welsh cob (now sadly passed away) who was on Pergolide for years.  I just opened his lips and tucked the tablet down inside his cheek and let it dissolve.
My other horse will not tolerate it in any way except when the tablet is broken in half and then hidden in half a scoop of cool mix - he loves it.


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## debbier4 (15 February 2011)

I too have a great interest in this thread.

My 7 year old (homebred) mare has been ill for 3 months. Initial symptoms were an enlarged ovary and granulosa cell tumour was suspected (inhibin level at 0.7).

Whilst waiting to confirm this diagnosis and decide whether to operate to remove her ovary she developed laminitis - she has teh classic symptoms of fat deposits on her shoulders, crest and rump.

She also has a cracked heel which I cannot get top heal up - depressed immune system?

Current view is that she has a pituitary adenoma  and has just started on one tablet a day of percolide - hence the relevance to this thread. (She couldn't start on the percolide until the laminitis had subsided - she is also on bute and sedalin)

I am also feeding her milk thistle to support her liver.

I love this little mare to bits and will be devastated to lose her. There is very little info on pituitary problems in young horses and my vet says it is not Cushings per se (she has no curly coat - indeed her coat is coming our in handfuls.)

I share this in case it helps anyone who has related issues or if anyone has encountered something similar. 

Debbie


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## bensababy (15 February 2011)

Crackerz said:



			Just bringing this back up....

He's due for his blood test, but i'm having terrible trouble getting the Pergolide into him now, he was fine to begin with. He's not a food orientate pony so would rather go without than have something that wasn't 'right' in his books!!
Managing, just, to get it in with a apple & extra strong mint puree! He won't put up with a daily syringe either..

Any help/advice appreciated!!
		
Click to expand...

I too like you had this issue, mine was on 2 x 1mg a day started off ok and eating it out of a apple slice, then i started to notice a difference in him, he actually looked depressed and lacking of any kind of energy or enthusiasm (which if you knew him is not what he is like at all), he then stopped eating any food at all other than hay, refused to take anything from my hand or anyone elses. I resorted to trying every possible feed/mints/fruit and no luck.. even marmite he seemed to still know it was there, then i tried syringing.. which he spat out and threw a proper tantrum (to me it wasnt worth him getting stressed) i then tried blow piping down throat.. same result.

Feeling defeated i done hours of internet research on case studies and what other people have tried (mainly in the USA) and thought this was basically his last chance - so i gave up trying the pergolide and put him on Cushylife liquid supplement, Echinacea (3 weeks on, 1 week off) and Milk Thistle and he improved dramatically within a month - bright shiny coat and eyes, got his cheekiness back and was full of beans, he has been on this combo for a year now and touch wood.. doing well. I am due to get his levels checked soon so i will be interested to see if there is a difference.


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## cobwithattitude (15 February 2011)

Hi - thread of interest to me too - horse aged 8, initial diagnosis laminitis, then blood test at Liphook showed Cushings - all shocked.On 1mg Pergolide a day, next blood test next Tues to check levels against oringinal test.  Also being checked for EMS.  Like you Debbie, no  curly coat, but agian fat pads on rump,  above eyes and on rump.  Fully in work and fit and no other signs but was very mareish and now is not.  4th week box rest; read avidly of any info that can help.


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## alsiola (15 February 2011)

debbier4 said:



			I too have a great interest in this thread.

My 7 year old (homebred) mare has been ill for 3 months. Initial symptoms were an enlarged ovary and granulosa cell tumour was suspected (inhibin level at 0.7).

Whilst waiting to confirm this diagnosis and decide whether to operate to remove her ovary she developed laminitis - she has teh classic symptoms of fat deposits on her shoulders, crest and rump.

She also has a cracked heel which I cannot get top heal up - depressed immune system?

Current view is that she has a pituitary adenoma  and has just started on one tablet a day of percolide - hence the relevance to this thread. (She couldn't start on the percolide until the laminitis had subsided - she is also on bute and sedalin)

I am also feeding her milk thistle to support her liver.

I love this little mare to bits and will be devastated to lose her. There is very little info on pituitary problems in young horses and my vet says it is not Cushings per se (she has no curly coat - indeed her coat is coming our in handfuls.)

I share this in case it helps anyone who has related issues or if anyone has encountered something similar. 

Debbie
		
Click to expand...

I have been seeing a similar case recently - a mare with a confirmed GCT (diagnosed 3 years ago, not removed for various reasons) who has recently developed laminitis.  She has normal ACTH levels (i.e. no Cushings) but significant insulin resistance.  Although it is entirely possible this is down to Equine Metabolic Syndrome, she is fed sensibly and was exercised regularly up until the lami.  I did some research into insulin resistance and sex hormone disturbances, which is fairly well studied in humans (think pregnancy diabetes etc.).  It seems that in humans ANY sex hormone imbalance can lead to insulin resistance, and as we know in horses IR can lead to lami.  There is a possibility that the laminitis is due to insulin resistance, caused primarily by abnormal sex hormone concentrations from the GCT.  We tested Oestrogen, Testosterone and Progesterone - the first two were low/normal, the progesterone was raised.
As it turns out from the human literature, IR secondary to sex hormone imbalance is most often treated with Metformin, which helps not only with the IR, but has also been know to somewhat normalise the underlying hormonal problem.  Metformin is also the current recommended treatment for EMS.  We are currently treating with metformin, and will resample both insulin and sex hormones after around 6 weeks therapy.  I will be interested to see the results.
The bottom line of my waffly post is that sex hormone imbalances may a cause of laminitis, and treatment with metformin may be beneficial.


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## debbier4 (16 February 2011)

Thanks Alsiola - very interesting  and cobwithattitude - all young horses.
In my case  - mare had ovaries scanned yesterday and vet has ruled out GCT as both ovaries are similar size.

Doesn't want ot use metformin yet as feels it could cause hypolypaemia (sp?) ie liver problems if the signifcant fat deposits break down too quickly.

It would be good to keep in touch for moral support if nothing else.

I am currently investigating if glue on support shoes would help.


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## ameeyal (17 February 2011)

Sorry to hijack your post but my horse has been diagnosed with cushings last week, i had his reports back which mean nothing to me, next to ACTH it reads 43.0 pg/ml {<29} that sounds low to me having read what other people have wrote, what is a normal reading, where it says insulin it says 14.0mlU/L {<20} is that normal, {the vet said he only has cushings.


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## cobwithattitude (17 February 2011)

Hi Debbier4 - would be good to keep in touch re what is happening and what is going to happen in the future or what is going to be able to happen in the future - vet came on Tuesday and is retesting mare next week - mare hates needled, so sedalin first and then fingers crossed and hard hats on! Vet pleased with mare progress but still needs to be on box rest. ho hum!!!  very kind people offering me horses to ride but i really only want to be able to get back on mine!


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## alsiola (17 February 2011)

ameeyal said:



			Sorry to hijack your post but my horse has been diagnosed with cushings last week, i had his reports back which mean nothing to me, next to ACTH it reads 43.0 pg/ml {<29} that sounds low to me having read what other people have wrote, what is a normal reading, where it says insulin it says 14.0mlU/L {<20} is that normal, {the vet said he only has cushings.
		
Click to expand...

The normal values are the ones in brackets, so Insulin is normal, and ACTH is mildly raised.  Not a dramatic ACTH level, but probably significant and probably worth treating.  And as it always says on my lab results - a normal fasting insulin does not mean that there is no insulin resistance.


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## iestynlad (18 February 2011)

Just checking I am logged in - I gave a long reply last time and it appeared I wasnt


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## iestynlad (18 February 2011)

Hi Imogen. I have a Cushings pony diagnosed in June last year after mild lami. I think he can be termed actively laminitic as he went down with it at Christmas despite all precautions and still unsound on one foot. Very active riding pony and I am desperate to get him back on the road. 

He started on a lower dose but he is now on 1mg of Perg per day since about 4 months. Having a great deal of trouble getting it into him. Tomorrow I am resorting to a worming bit with a dosing syringe but I still expect a fight. Have tried many tempting things but he seems to smell it. Sometimes after the feed has stood for a day he will eat it but I am not certain if the drug is still active after this length of time being immersed in soggy feed. Any idea? Any tips for getting the drug into him? 

He is tested by Liphook with seasonal adjustment.  Last test ACTH was 65.2pg/ml. Script mentioned that inappetance may be due to laminar pain (prob was) but could also be due to Perg. Advised potential increase in Perg as Cushings not under control. 

Missed doses at Christmas probably due to laminar pain/inappetance and became madly diabetic - weeing and drinking stacks. I have managed to get the Perg into him most days since and this has abated.      

Behaviour: the spark has gone! sometimes very lethargic but could also be partly due to change in lifestyle - no grazing and no outings of course due to unsoundness. Also agressive with me over hay mainly - I have owned him for 18 years and been his sole carer. 

I am trying to get hold of the laminitis clinic to see about A. a lightbox to counteract winter onset of lami b. use of Vitex 4 Equids. Has anyone had any success with these please?


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## debbier4 (18 February 2011)

Update on Dixie....

Have had to switch from Equipalazone to Danilon as she wouldn't eat the former.

Sedalin increased to 2.5 three times a day as digital pulse is still raging.

Pergolide being administered by dissolving tablet in water and pouring on feed - no problem so far - she has been on this for 4 days.

She still has fat deposits above eyes, behind saddle and crest.

Hind feet better, front feet still bad.

Has now been on box rest for 11 days (feels like 11 weeks) .... how hard is it watching  a horse you love in pain. But vet still optimistic about prognosis.


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## iestynlad (18 February 2011)

METFORMIN

Previous poster on this: I have had success with Metformin. I have another lami pony due to EMS. A shetland going down with it towards the shortest day of the year period (so winter onset - pineal gland issue). He has been on Metformin for over 4 years and only this year went down with lami over the very cold weather period. He is good now, sound but he is not a riding pony. Thanks to Metformin he has (at least up to now) 4 years of extra life.


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## iestynlad (26 February 2011)

Update on Iestyn: bloods taken Monday, result yesterday show a decrease of  14 from 65 January to 51 now (should be 30 seasonally adjusted). Pergolide increased to 1.5mg. Next bloodtest 6 weeks time.
Any more recommendations on how to get it down 'em! I tired garlic puree - 1/2 tablet in the middle of a dollop - worked once yesterday, today Zilch result! Now resorting to worming bit and dosing syringe rearing or not! 
P.S. www.themetabolichorse - really good website on this sort of stuff. Very helpful diet sheet sent immediately out to me. Many thanks Jackie Taylor and to poster on here who recommended.


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## vikkic (1 March 2011)

My pony has had cushings for about 7 yrs. He has been on pergolide 1mg. Last Feb he came down with laminitis, he recovered well. The same has happened this year only this time he seems worse. These are the first time he has had lami since being on pergolide.

I am going to have a chat to my vet about getting his acht levels checked to see if everything is in order. If the levels are high will increasing the pergolide help with his lami? He has had it for about 2 weeks now and is still really lame. He is not fat. 

Any help would be appreciated. 

Thanks 

Vikki


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## glenruby (1 March 2011)

Vikkic - if his ACTH levels are high then increasing the pergolide levels should help the lami as the current dose would not sufficiently be controlling the Cushings. Might be  worth geting tested for EMS at the same time.


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## vikkic (1 March 2011)

Thanks for the advice Glenruby. I hadn't thought of EMS.


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## cobwithattitude (3 March 2011)

My horse blood retested by Liphook and now normal levels. Blood test showed no insulin restistance. Vet talking about reducing Pergolide down form 1mg.  Been in box 8 weeks and still really footy - never realised before how awful laminitis is and how long it may take to recover; one step forward, 2 back at mo.


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## debbier4 (3 March 2011)

Oh how I agree. Dixie now in 4th week of box rest and frankly I have seen little change.

She is currently on bute, percolide and about to start Metformin.

I hadn't realised that Metformin are sugar coated human tablets - how are you all feeding them?

I am dissolving the percolide in water and pouring on her feed which is working OK - wondering if I can do the same for the 8 tablets a day of metformin.


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## sallym (9 March 2011)

I don't want to hijack this thread with my first post, but there are vets here and people with a lot more experience of dealing with Cushings than I have. My 25 year old, Welsh cob mare was diagnosed at the end of last year. Her only symptom currently is a slightly wavy coat this winter (which seems to be starting to shed) and an iffy blood test. My vet is totally against prescribing Pergolide as she feels the side effects are too nasty. Should I be arguing? I intend to put her on Vitus Agnus Castus anyway, as I really feel I can't do nothing.

I would very much appreciate your thoughts.

Best wishes

Sally


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## alsiola (10 March 2011)

sallym said:



			I don't want to hijack this thread with my first post, but there are vets here and people with a lot more experience of dealing with Cushings than I have. My 25 year old, Welsh cob mare was diagnosed at the end of last year. Her only symptom currently is a slightly wavy coat this winter (which seems to be starting to shed) and an iffy blood test. My vet is totally against prescribing Pergolide as she feels the side effects are too nasty. Should I be arguing? I intend to put her on Vitus Agnus Castus anyway, as I really feel I can't do nothing.

I would very much appreciate your thoughts.

Best wishes

Sally
		
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What side effects? Having used a lot of pergolide on many horses I have seen a very few become slightly depressed for maybe a week or so after starting but that is all.  In humans, heart conditions and a predisposition to gambling addiction (!) have been reported, but these aren't reported in horses.
I personally wouldn't waste money on Vitus Agnus, it has effectively been proved to do nothing of any benefit for Cushings.


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## sallym (10 March 2011)

Thanks Alsiola. Time for another discussion with my vet I think.


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## henryhorn (10 March 2011)

Our 12 hh 23 year old pony is on 225 dose per day and looks fine. 
He arrived back home from his loan home quite pottery despite their pro-active regime of in at night and out in a small paddock restricting grazing.
He is now on virtually ad lib hay, in a steepish field so he has to walk and is sounder than at any time in the last 5 years. 
I don't monitor him other than keeping an eye on him, and he doesn't appear to have any noticeable side effects.


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## pizzi (18 March 2011)

I had my 17 yr old Welsh pony tested for Cushings a few months ago, as she has had recurring laminitis for over 18 months, drinks a lot, very wet bed , fat pads over eyes (or as farrier likes to call them, "frog eyes"), thick coat, (although she does lose it in the summer)sweating etc.  Her ACTH levels came back in the normal range. 
 She is on laminitic diet, has to go on Danilon on a regular basis, has a laminitic trim. She has hardly been out and she is not overweight, - she is not a good doer. She is happy in herself and very alert.  I wonder if anyone else has had similar problems?


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## Kellys Heroes (18 March 2011)

What a brilliant thread, very informative for people such as myself who have a horse who has recently been diagnosed with Cushings.
My part loan mare is 17 years young (!), still a complete pratt at times, and is 14.2hh and a Sect D X. She was a rescue horse so not managed terribly well as a youngster and has been lami prone for years (I've had her 5 years and known her for 8) However about 15 months ago, she came down with very severe lami and was crippled. 

She DID suffer 2 seizures of unknown origin (Karla B, the same as your Shettie) and suffered another last week. The vets have decided not to investigate any further as she can be a stressy girl and she brings herself round from them very quickly - no fitting as we know of, just very glazed uncoordinated and confused lay down for a while which is unusual.

We tried all the usual, walking it off, box rest, she has magnetic boots on daily - she is managed as a very strict laminitic anyway, muzzled, exercised daily, Healthy Hooves feed, soaked hay etc. She's shod with heart bars and has been for quite a while and has benefited from this - she does seem better on them.

2 weeks ago, we had a setback and she went back onto box rest - this week she's out and about pootling round quite happily. 
Is it quite normal to have ups and downs until the meds start to settle, as it were? 
She is very happy in herself, nibbling away at everything in sight (and trashing her double nets because they won't feed her quick enough!) and still being grumpy with other horses 
K x

ETA - is it silly to think it could be partly psychological??? She is very odd in that way anyway, the amount of times we have rang the vet 'cause she's crippled and she bloody trots up fine! she seems to cringe going out of her stable and all of a sudden its like 'ooh, this doesnt hurt' and she's off!


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## ameeyal (19 March 2011)

My horse has recently been diagnosed with cushings, and from what im learning is 2 steps forward 1 step backwards,my horse is still in his stable since christmas, i let him out in the yard which is a stoney yard so he walks slowly on it, the other day i let him out and he trotted out and was off up the yard to the gate, no soreness at all, so i got him in, the next day he was his normal slow self on the stones, im getting scared off ever letting him out just in case he has a set back, today he was rodeoing around his stable becuase he wanted to go out, What can you do thats for the best for them


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## Kellys Heroes (19 March 2011)

ameeyal said:



			My horse has recently been diagnosed with cushings, and from what im learning is 2 steps forward 1 step backwards,my horse is still in his stable since christmas, i let him out in the yard which is a stoney yard so he walks slowly on it, the other day i let him out and he trotted out and was off up the yard to the gate, no soreness at all, so i got him in, the next day he was his normal slow self on the stones, im getting scared off ever letting him out just in case he has a set back, today he was rodeoing around his stable becuase he wanted to go out, What can you do thats for the best for them 

Click to expand...

Mine is EXACTLY the same - turned herself out one week and was careering round the field like a lunatic! the next week, crippled again.
We just leave her door open now - if she wants to wander, she will, we just keep an eye on her.
She has been lame on/off for about 15 months now and just got diagnosed at Christmas - very up and down since, which I believe for quite a few horses is normal before any significant improvement.
K x


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