# Treating cushings in a performance horse.  Help please!



## eventer13 (15 May 2014)

Hi all!

After struggling with weight loss and having kissing spine surgery earlier this year my 12 yr old intermediate eventer has finally been diagnosed with cushings (the initial test came up negative).  Reading through all of the literature there were signs there, but it is so easy to say that in hindsight.

My poor boy is TB (ex-racer), super talented and loves his job.  The idea that this is the end of his career is absolutely gut-renching, but it seems that all the pharmaceutical treatment options are illegal under FEI rules (which of course BE, BD and BS have followed suit on).  He's been prescribed prascend, picking it up tomorrow...

Has anyone managed to keep a horse with mild/early stage cushings happily competing in the mid-levels?  I've seen some great success stories on here from feeding herbal supplements with chasteberry etc. such as NAF Cushinaze and Cushy Life, which I assume are legal under FEI rules.  Has anyone any experience with using these on TB or sports horses? 

Any advice/experiences much appreciated!


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## Micky (16 May 2014)

I'm afraid the only thing that really treats PPID is prascend, you may find the cushinaze etc may help for a week or so but to get your horse feeling and back to a happy soul, prascend is the only solution...


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## charliejet (16 May 2014)

Micky said:



			I'm afraid the only thing that really treats PPID is prascend, you may find the cushinaze etc may help for a week or so but to get your horse feeling and back to a happy soul, prascend is the only solution...
		
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This ^.  Have a look at http://www.thelaminitissite.org/ for the best up to date information.

Plenty people will tell you that Chaste berry etc works but it actually only treats a few of the symptoms which can make the horse appear 'better' for a while but Prascend is the only proven thing to actually treat and slow down the progress of PPID.

Sorry to hear that your horse has PPID, I am hearing of it in a lot of younger horses now.  I have 2 with it one diagnosed at 7 and the other 16 but she was new to me and was already quite advanced in the disease when I got her.


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## flaxen tail (16 May 2014)

Equine Science have a formula for cushings and you can still compete with it. I havnt used it but have used some of their products to great effect, may be worth talking to them as they are very helpful.


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## Micky (16 May 2014)

It may help for a short period but prascend is the only way, sorry you will have to retire from FEI comps but you could still compete locally where they dont test? Its not the end of his working life, my lad is still going strong a year on and has a much livelier attitude to boot ( and is a better weight/healthier)


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## eventer13 (17 May 2014)

Thank you for the responses!  Unfortunately BE, BD, and BS all follow FEI but I have just checked and pergolide (prascend) is under "controlled medication" so that it can be used, just not during competition (anyone any idea of what the withdrawal period is?).  

I've got his test results here and am interested to see how they compare with other people's if possible.  As I said, the first test (which i think was just a ACTH concentration test in his blood) was negative, but the stimulation test was positive.  Here are the results:

Before, ACTH = 26.2 pg/ml (normal = <29)
10 min post TRH = 333 pg/ml (normal = <110)
30 min post TRH = 57.7 pg/ml (normal = <65)

This is "a convincing result... Indicative of PPID", but is better than I was expecting!

He is underweight if anything and has never had laminitis.  He is on 1 mg Pergolide (prescend) a day and will be tested again in a few weeks to see if we need to adjust the level.

I guess we'll see.  I just hope he perks up as he is rather mopey at the moment :-(


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## eventer13 (17 May 2014)

This is the test he had done:

http://liphookequinehospital.co.uk/wp-content/uploads/Lab-Book-PPID.pdf


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## EstherYoung (17 May 2014)

The drugs are ruled out for BEF affiliated competition. If you're young enough, they're still permitted under pony club rules (when the pony club sign up to BEFAR fully there will be hell on as most of the older schoolmaster ponies are cushingoid). Other than that, you're left with unaffiliated competition and non competitive pleasure rides.

Hope you can get your boy stabilised.


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## Micky (18 May 2014)

Check out the laminitis site as it has v useful info regarding PPID (cushings), and leads you to a forum, where you can find out feed, management and ask questions, Andrea is very knowledgeable and helpful and importantly, accurate!


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## paddy555 (19 May 2014)

eventer13 said:



			Thank you for the responses!  Unfortunately BE, BD, and BS all follow FEI but I have just checked and pergolide (prascend) is under "controlled medication" so that it can be used, just not during competition (anyone any idea of what the withdrawal period is?).  

I've got his test results here and am interested to see how they compare with other people's if possible.  As I said, the first test (which i think was just a ACTH concentration test in his blood) was negative, but the stimulation test was positive.  Here are the results:

Before, ACTH = 26.2 pg/ml (normal = <29)
10 min post TRH = 333 pg/ml (normal = <110)
30 min post TRH = 57.7 pg/ml (normal = <65)

This is "a convincing result... Indicative of PPID", but is better than I was expecting!

He is underweight if anything and has never had laminitis.  He is on 1 mg Pergolide (prescend) a day and will be tested again in a few weeks to see if we need to adjust the level.

I guess we'll see.  I just hope he perks up as he is rather mopey at the moment :-(
		
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I didn't find the test results very convincing. They were little more than numbers for mine. His first test was 18 and second was 11. They assured me he was negative on those numbers. He did however have every symptom in the book and the prascend certainly didn't think he was negative. 

Vitex (chasteberry) didn't work for mine. I cannot see the science behind the Equine America product mentioned. The first named ingredient is soyflour. I don't think that one can underestimate the importance of dealing with cushings correctly and with the correct drug.

I was lucky, my lad was treated with prascend and now I have my old horse back with a vengeance. There was another horse I knew at the same time who was not treated with prascend, the owner wouldn't listen. It had later to be PTS.  

The following 2 quotes are taken from the laminitis site (quoted above) I would urge you to read that site. (pergolide = prascend)

How is PPID treated?
Pergolide, a dopamine agonist, is the drug most vets prescribe to control PPID.  Pergolide acts to replace the dopamine missing in horses with PPID, inhibiting the over-production and release of the POMC-derived hormones, &#945;-MSH, &#946;-endorphin, CLIP and ACTH

Can Vitex Agnus Castus/Chastetree Berry be used to treat PPID?
See Vitex Agnus Castus.  Although Vitex Agnus Castus appears to have dopaminergic effects on prolactin, and horses in trials have shown a lifting of depression, there is no published research indicating that Vitex Agnus Castus reduces ACTH or insulin levels..


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## magicmoose (19 May 2014)

eventer13 said:



			Thank you for the responses!  Unfortunately BE, BD, and BS all follow FEI but I have just checked and pergolide (prascend) is under "controlled medication" so that it can be used, just not during competition (anyone any idea of what the withdrawal period is?).
		
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I would find a tame FEI vet and pick their brains. There is a list on the FEI website, or you could look at the FEI schedule of your most local event. 

https://data.fei.org/OffListRpts/OfficialsByOffFct_VET.pdf


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## cyberhorse (20 May 2014)

We looked into this after attending a client evening with our vets about Cushings. From the research I did any organisation that is signed up to FEI rules will not allow you to compete. Also I don't think that having your horse on and off it will be good for his health, as a metabolic disorder needs consistent therapy for best results. The only thing I did find when I looked into it was that some Unaffiliated also have it on the ban list yet I very much doubt they would test. The other interesting one was trailblazers who I contacted a couple of times but they seemed very reluctant to respond or comment, so possibly they are sidestepping this one and turning a blind eye. 

I personally find the ruling on this drug ludicrous! I certainly would not feel someone had an unfair advantage over me if they had a Cushings horse treated with this drug, compared to my horses who thankfully don't suffer from this disorder. It is also not unkind/unfair to compete a horse with this condition who is medicated. We as owners need to have the confidence to test at a much earlier age, and I feel people are putting off testing due to the fear of a diagnosis being career ending and just sticking their heads in the sand for as long as possible.


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## eventer13 (20 May 2014)

Thank you Paddy.  I posted his results on the ECIR forum and someone suggested it might be a false positive.  He is on prascend now so we will just have to wait and see if it works.  All his symptoms fit so... :-(

Thank you for the advice magicmoose and cyberhorse.  If (hopefully when) we get him back to his fit and happy self I'll see if I can bend a few ears regarding competing.  I would be reluctant to take him off any medication to do so though depending on how it will impact him and whether there is a legal alternative to tide him over.  It does seem absolutely ridiculous that they can't compete IF that is not going to do them any harm.  From his test results we have hopefully caught it early at least.


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## paddy555 (20 May 2014)

eventer13 said:



			Thank you Paddy.  I posted his results on the ECIR forum and someone suggested it might be a false positive.  He is on prascend now so we will just have to wait and see if it works.  All his symptoms fit so... :-(

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I didn't retest. I had too many symptoms and I judged the performance of prascend on whether it improed his symptoms. It did. Good luck with yours 

Cyberhorse I agree all the  comments in your last post. 

The quote below is taken from another group where we discuss PPID and was in relation to the ban It was written by Andrea of the laminitis site. Maybe it would be an idea to contact BI. If enough people do they may have more chance perhaps? I don't think taking them off prascend would be a good idea. I give mine at the same time each day ie early am and ride in the morning. He seems to need a daily dose to keep him OK and he definitely needs the exercise.  


"We've spoken to Boehringer Ingelheim about this, and they are working hard to improve the situation with the FEI, but it is apparently "delicate".  What would be useful is to know just how many horses the controlled substance classification of Prascend affects.  So if you have a horse that you would compete if pergolide/Prascend was allowed, it might be worth contacting BI, perhaps through the Talk About Laminitis facebook page - their negotiations may carry more weight with the FEI if they can show that a significant number of horses/owners are affected by the ban."


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## Micky (20 May 2014)

Cushings, now known as PPID, is not a metabolic disorder, EMS is...( Equine Metabolic Syndrome)..hence check out the laminitis site for correct diagnosis and link to facebook page/forum.
 I would advise keeping your horse on Prascend, as you will soon see the difference if you take him off the meds. 
A friend has noticed over the years, when she competes her pony at local pony club shows, that some weeks he has more energy than others, and he has been positive for PPID for over 5yrs.
Check your horses diet for sugar/starch levels too..its all about management in the end, not the end of riding.


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## Micky (20 May 2014)

Oh and you dont get false neg results very often in PPID tests, that ocurs more so with EMS/IR testing.


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## eventer13 (20 May 2014)

Thank you both.  Hopefully the prascend does work, otherwise it's back to square one!  The diet front is rather tricky at the moment as he isn't an enthusiastic grazer and we're having trouble keeping weight on him.  He has been on a combination of PAVO slobbermash, Winergy Equilibrium conditioning and linseed meal since October last year (symptoms pre-date this by a number of months).  Obviously this isn't ideal on the sugar/starch front but he has a tendancy to rapidly loose weight so I'm a little reluctant to change too much at once (having started him on prascend).


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## paddy555 (20 May 2014)

eventer13 said:



			Thank you both.  Hopefully the prascend does work, otherwise it's back to square one!  The diet front is rather tricky at the moment as he isn't an enthusiastic grazer and we're having trouble keeping weight on him.  He has been on a combination of PAVO slobbermash, Winergy Equilibrium conditioning and linseed meal since October last year (symptoms pre-date this by a number of months).  Obviously this isn't ideal on the sugar/starch front but he has a tendancy to rapidly loose weight so I'm a little reluctant to change too much at once (having started him on prascend).
		
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I had teriffic weight problems. He could eat for England was was still thin. Obviously you cannot change things short term but I found soaked copra, soaked alfalfal pellets and linseed plus all the soaked hay he could eat and I finally started to get the weight back on. 
I suspect mine started to become PPID at around 6 and was 14 when diagnosed. It finally explained so much. 
It has taken about 18 m on prascend to get back to the stage where he needs to go on a diet to control his weight but he was very far down the line with it. 

He reacted to the prascend after about 2 weeks on a full dose (I introduced it gradually) by going completely crazy. He went from lethargic and couldn't be bothered to move to the duracell bunny with long life batteries.


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## cyberhorse (21 May 2014)

Diet wise we have one horse with EPSM, he is also generally a poor doer and a very fussy eater. The only thing he would eat which was not packed with sugar & starch was fast fibre which we then added a max dose of micronised linseed to (point blank refused alf alfa in any form). He got by on this for a while until we tried ERS pellets (does not notice the alf alfa given all the flavorings in it), this has allowed him to come up to a normal weight with plenty of energy without aggravating the EPSM - can't recommend it enough.

I really hope you get somewhere with supporting BI with lobbying the FEI. As more horses are now being diagnosed through increased awareness of the condition, especially those at a young age, pressure for a rule change will surely build.


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## horselover68 (22 May 2014)

Take a look at this site http://www.freestepsuperfix.co.uk/cushings.php as they do a supp that should enable you to compete and might be worth a try? I'm trying it at the mo as my boy is the opp to yours in that he has likely EMS as well as Cushings so I'm trying it to hopefully rid the fatpads and his cresty neck (I've tried all manner of things and his diet/management is already carefully monitored). As someone else said seems ridiculous that Prascend is listed as a banned substance as I can't see how it would affect performance but hey ho what can you do!


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## eventer13 (24 May 2014)

Hi all, thank you again for all the advice -I will definitely look into those feeds when he starts bouncing back and I feel more comfortable changing his diet.  I cannot tell you how ecstatic I would be to have a duracell bunny to ride after everything that has happened in the last year!  
Thinking back, there were some signs when I bought him 5 years ago, but there always seemed to be another explanation.  I have to say that I have been largely ignorant of all the symptoms surrounding cushings until now -it was always a disease that only elderly Pony Club lead-rein ponies had, not my super-duper TB in his prime!  I think this is a common held misconception which at least partially extends to the FEI and other regulating bodies.  Given my boy was successfully competing at 2* maybe I can add some fuel to the fire.  I will get in touch with BI as soon as we've confirmed that it is definitely cushings (i.e. he responds positively to treatment with prascend). 
Thank you again everyone, it's great to have this kind of support!


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## ballyduff (25 May 2014)

Hi sorry to hear that  my old horse got it and was prescribed one pergolide tablet a day however since being kept in work and well fed we have been able to cut it down and eventually out completely as he was perfectly fine without! Don't know if this is normal or if we did a terrible thing but he is very happy and has no symptoms without it, so why fix what isn't broke? Sorry if this is appalling advice and no help whatsoever but I just thought I'd let you know it's not all bad! He was also a competition horse!


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## splashgirl45 (25 May 2014)

ballyduff said:



			Hi sorry to hear that  my old horse got it and was prescribed one pergolide tablet a day however since being kept in work and well fed we have been able to cut it down and eventually out completely as he was perfectly fine without! Don't know if this is normal or if we did a terrible thing but he is very happy and has no symptoms without it, so why fix what isn't broke? Sorry if this is appalling advice and no help whatsoever but I just thought I'd let you know it's not all bad! He was also a competition horse!
		
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I would be careful if you aren't having regular blood tests as you may find the first problem you get is laminitis, he may seem ok but the medication doesn't cure,   it only slows the progression of the disease...


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## Micky (25 May 2014)

Ballyduff, it sounds more like your horse had EMS, not PPID, prascend is for life, you cant take them off it and the horse get back to normal...that happens with metformin, the drug for EMS... 
Generally, the vet will want to retest after 6 wks of being on the prascend to check ACTH levels to see if pills are working, and then check every 6 months ish, you may have to upp the dose or if you are lucky, reduce by half a tablet, however thing s change as the years go on, and you may find you have to upp the dose..
Yes you will have to be aware of grass sugars with your horse as splashgirl has said, laminitis can be an issue, so be vigilant.  The laminitis site can give you lots of information if you desire,


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## ballyduff (25 May 2014)

Micky said:



			Ballyduff, it sounds more like your horse had EMS, not PPID, prascend is for life, you cant take them off it and the horse get back to normal...that happens with metformin, the drug for EMS... 
Generally, the vet will want to retest after 6 wks of being on the prascend to check ACTH levels to see if pills are working, and then check every 6 months ish, you may have to upp the dose or if you are lucky, reduce by half a tablet, however thing s change as the years go on, and you may find you have to upp the dose..
Yes you will have to be aware of grass sugars with your horse as splashgirl has said, laminitis can be an issue, so be vigilant.  The laminitis site can give you lots of information if you desire,
		
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thanks both of you, i no longer have him and he was already a laminitic but was diagnosed by the vet with cushings... i dont want to get into an argument or anythiing ahh i'm new here! i don't know i just thought i would let her know my own experience


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## Micky (26 May 2014)

No I'm not here for arguing either, just wanted to make sure correct info is given concerning PPID/EMS/IR horses


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## Northern Hare (15 August 2014)

Hi eventer13, was just searching through the forum for feeding a cushings horse and came across your post.  I was just wondering how your horse is doing on the Prascend - and have you managed to get some weight back on him?  I hope he is doing well. I have a TBxWB with Cushings who even now in August is looking a little too lean for my liking, so I'd be very interested to hear how you are getting on - especially with the feeding.  My horse (1 tablet Prascend/day) gets the full recommended amount of Topspec Balancer, Alfa A Molasses Free and conditioning cubes - and is out on good grazing at nights.


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## Micky (15 August 2014)

horselover68..I found magnesium oxide really helped to get rid of my horses fat pads and he isnt on it now ( not been since fat pads disappeared), a scoop ( small) added to feed for a month or so seemed to do the trick. Hope this helps


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## eventer13 (15 August 2014)

Unfortunately I am at my whit's end.  He has actually lost since putting him on the prascend and I have taken him off it as he has become ataxic and had only slightly responded to the drug, even when we pushed up to 2 tablets.  It is possible that the diagnosis is either wrong or, more likely, there are compounding issues.  We X-rayed his neck and there is a suspect vertebrae which could be pressing on the spinal cord.  He does seem to have improved slightly since coming off the prascend though and it's difficult to assess him properly as he is very skinny and weak.  He has barely been grazing for the last 18 months and although we were giving him 4 meals of top quality feed a day he has been steadily loosing since being turned out for the summer; tried bringing him in but he only picks at the haylage -most ends up on the floor.  Anyway, we are now feeding him 8 smaller meals a day which are Pavo slobbermash (~4kg/day) and winergy equilibrium conditioning (~4 kg/day)  top dressed with linseed meal (450 g/day) and now topspec super conditioning flakes (currently ~2.5 kg/day).  Hoping to give him enough condition and energy before reassessing for ataxia.  

I would recommend adding linseed meal.  We use the Charnwell Mill stuff but you can get it pre-balanced with Vit E and selenium (for safe metabolism of the fats) from other manufacturers -I think the make that Countrywide carry is pre-balanced.  I read elsewhere on this forum that people feed up to 500g for weight gain and I think it's safe for laminitics (I will just point out that for mine we weren't bothered about sugar -the main aim has just been to get weight back on).  Just be wary of selenium levels if you also feed good quality complete feeds, this is why my boy is topped up with Topspec as I couldn't feed him any more of the others.  Also make sure he's getting plenty of biotics for digestion, though I would have thought the Topspec would have that.  Hope that helps!


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## Northern Hare (15 August 2014)

Hi eventer13, thanks very much for taking the time to reply, but I am really sorry to hear of your on-going problems with your horse with him still losing weight. My horse really went off his feed when he started on Prascend and we really had a struggle keeping his condition on him as he went off all feeds. In the end we tried Topspec and that made a real difference and he started eating small feeds again and hasn't looked back - except that he is a little on the lean side at the moment - possibly due to the change in weather. I will try the micronised linseed again thanks for the suggestion. The other thing that the Topspec feed equine nutritionist recommended was soya oil but we have only just started with that so I don't know if that is having any effect yet.

The other thing, is that in hindsight, if I was starting him on Prascend again, I think I would have introduced it very slowly rather than starting straight onto the one tablet - ie a quarter, half and then three qtr of a tablet in phases. Apparently this can help them to avoid what is sometimes called the "Prascend Veil" i.e. the phase of depression and loss of appetite.  

Have you had your boy retested for Cushings - I believe that the autumn is a good time for testing, so maybe retest, but I am sure you have that in hand in amongst all his other treatments.

I hope you get to the bottom of your horses problems and you are able to get him back on track - I can really sympathise with you I know it is such a worry.  My horse is much older than your horse (23 but thinks he is 5!) and his competitive days are behind him, but once everything settled down with the Prascend, I have seen a huge improvement and he is generally in fine spirits and on good form. He was diagnosed a year ago - the previous year his results were normal, so we know he hasn't had it for years without being diagnosed. 

Thanks again and good luck!


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## Fides (15 August 2014)

Please do bear in mind that Cushings is caused by a brain tumour. I personally would retire the horse


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## Micky (16 August 2014)

Actually no its not...its the pituarity gland malfunction, a tumour can develop but is not the cause, hence why it has been renamed PPID, please look up on the laminitis site dor accurate info.


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## FizzyPony (19 August 2014)

Cushings by all means is not the end of a horse's ridden career. Although frustratingly the emd of an affiliated career (hopefully something which will change on the near future). People are extremely surprised when told my Welsh/TB pony suffers from Cushings. My main advice would be to keep them as fit as possible, have regular blood tests to monitor levels and change dosage of Prascend as appropriate, be cautious when it comes to Laminitis- my pony had it this spring when very lean so it is not just a fat horse issue! My pony has also has also been slightly anaemic so usually at the start of the summer we notice him becoming lethargic and have to put him on an iron supplement. Got my fingers crossed for you, it does get easier.


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## eventer13 (19 August 2014)

Thank you FizzyPony, that's good to know!  My boy is putting weight on and has a lot more energy so we're finally getting somewhere.  Everything rests on the ataxia issue now -reassessing later this week.


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## Jsye (20 August 2014)

Fides said:



			Please do bear in mind that Cushings is caused by a brain tumour. I personally would retire the horse
		
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Why would you retire can i ask?
Just because i have a 10 year old diagnosed with PPID and now on 1 prascend a day and i must say he is now the best he has ever been. What a shame it would be to retire him especially now he is feeling so much better.

Also I must add PPID is not caused by a brain tumour. In some cases it can be due to a growth on the pituitary gland but if you do some reading up on it you will find more accurate information.


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## Fides (20 August 2014)

Jsye said:



			Why would you retire can i ask?
Just because i have a 10 year old diagnosed with PPID and now on 1 prascend a day and i must say he is now the best he has ever been. What a shame it would be to retire him especially now he is feeling so much better.

Also I must add PPID is not caused by a brain tumour. In some cases it can be due to a growth on the pituitary gland but if you do some reading up on it you will find more accurate information.
		
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A growth is a tumour, it may be 'benign' in that it isn't going to spread but it is still a tumour that will grow and eventually cause other symptoms, sometimes neurological ones.

I would retire as it is against the rules to compete on prascend and is also ethically questionable IMO.


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## Nudibranch (21 August 2014)

I had a 30 yo PPID mare who on reflection probably developed it at about 7. Anyway she lived a very long time, and never developed any other symptoms other than those of PPID. There is no basis for stating that neurological issues may develop and no reason to retire the horse on the basis of PPID. From competing yes, due to the ridiculous ruling on Prascend, but providing the OP was able to control the PPID then there's no reason he couldn't continue in work. "Tumour" is a catch-all word which covers many growths; there is no need to assume it's the end of the road.

OP I hope your boy has improved, your last post sounded worrying.


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## Northern Hare (21 August 2014)

eventer13 said:



			Thank you FizzyPony, that's good to know!  My boy is putting weight on and has a lot more energy so we're finally getting somewhere.  Everything rests on the ataxia issue now -reassessing later this week.
		
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Hi eventer13, that sounds more promising that your horse if putting on weight and that he has a lot more energy - fingers crossed for his continued recovery!



Fides said:



			A growth is a tumour, it may be 'benign' in that it isn't going to spread but it is still a tumour that will grow and eventually cause other symptoms, sometimes neurological ones.

I would retire as it is against the rules to compete on prascend and is also ethically questionable IMO.
		
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Hi Fides, I'm keen to understand more about what neurological symptoms can result from Cushings?  My horse has been diagnosed for a little over a year - he is 23 and on one Prascend a day.  After a bit of a down period when he started Prascend, he's now doing really well.  Can you elaborate please on the potential neurological symptoms - I'm keen to know as much about Cushings as possible.  

Also, there's no chance of my horse competing any longer, but what are your reasons for thinking that competing on Prascend is "ethically questionable" - I know that many feel that Prascend is not performance enhancing - but is there evidence to show that it is in fact performance enhancing - or when you say that it is ethically questionable, do you mean from another perspective?


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## Nudibranch (21 August 2014)

NH, I think - although I may be wrong - that Fides is thinking of "brain tumour" and making the leap to neurological symptoms as a result. There is information on the laminitis site about associations but the links are not clear and if there are any it is in advanced cases. Many horses never develop any and are more than capable of living a healthy, working life with medication for many years.


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