Can anyone advise? PSSM, ppid, ems .......

[Toz]

Cushings!
What’s the difference, do they all show up in bloods? Would they have shown up in the basic cushings test (the free one you print a voucher off for)
I’ve spoken to vets several times now about some symptoms jake has shown, not just recently but over the course of a year or two. Starting out very mildly and tbh is not too bad at the moment but I just came across a very old question after googling that someone asked in Horse and hound forum that sounded quite like Jake at his worst and PSSM was suggested. I’ve searched that and it doesn’t really sound like it fits. Vets have never suggested anything like but I had him tested for cushings and it was clear (early summer)
I’ll try and list what I think are symptoms or at least changes.
1. He’s hairy, this summer he didn’t really get a nice summer coat. He’s also a bit greasy in his coat. Now fully clipped out which helps. He’s not a particularly sweaty or hot horse
2. He itches madly at times. This involves him biting at himself, slight head shaking, skin twitching, imagine riding a horse with swarms of horse flies, this is how it feels at its worst. I did get bucked off at one point.
This is not effected by clipping, any sprays, washing powders, etc bathing in malasab helps for a day.
He doesn’t have lice and rarely rubs himself sore in any place it’s just general all over.
(Currently pretty good not sure what’s changed) he’s never been a horse bothered by flies really.
3. I think slightly abnormal fat deposits, he’s a narrow horse really (for a coblet) but has developed fat under the saddle area this summer.
4. He went through a phase of slight discomfort in front but that’s settled, never shown any sign of laminitis and has fantastic feet

I think that’s about it. Does this scream anything to anyone?
The last vet suggested an ear bonnet and nose net I must admit I didn’t try either!

 

[Toz]

Sorry as an afterthought he’s 19 pushing 20 and in otherwise good health. Worked I suppose fairly lightly about 4 times a week. (Check lig about 18 m ago which took a long time to come good)
Stabled 7-5 (day) wet hay, minimal feed

 

[Bodshi]

Apart from the hairiness they don't sound typical symptoms of Cushings (PPID). I don't know too much about EMS, but it isn't the same as Cushings (although some horses have both) and it won't show up on a Cushings blood test. I think EMS could cause the production of fat pads (horses tend to lose weight, specifically muscle, with Cushings). PSSM is something completely different. It affects the muscles and causes stiffness and potentially tying up symptoms. There are two types, one will show up in a blood test (not the Cushings test though) and one needs a muscle biopsy to diagnose. You need @Jessey to come along and explain it, she's much better than me.

The itching sounds worrying as it's so bad. We had a horse on the yard that got progressively more itchy and the vets could do nothing for it. They decided it was an allergy but they never found out what to. Hope someone can offer you some practical advice on that one, but it sounds unlikely to be related to Cushings, especially given that his test was clear. However Cushings is a funny disease as it affects the immune system so can throw up a whole hose of issues. Early summer isn't a good time to have a Cushings test, the levels tend to peak in Autumn. Might be worth having another one to set your mind at rest?

 

[Jessey]

PPID/Cushings, PSSM and EMS are quite different conditions and tested differently. The free blood test for PPID will only check for PPID, the basic test checks resting ACTH (a hormone), or the more reliable test is TRH stimulation test which check ACTH before and after giving TRH hormone. EMS can be checked by blood test but the look at insulin, or insulin before and after giving glucose or a glucose substitute (karo) and some vets recommend checking leptin (US) or adiponectin (UK) but some do not. Both PPID and EMS are metabolic problems. PSSM is a genetic disorder that effects the way they store and use glucose in the muscles. PSSM has many variants, types 1 - 6 last time I looked into it and no 1 type shows the same symptoms in all horses which is what make it tough to track, it is also known as EPSM in some breeds. You can send a hair sample for testing but it can only ID certain types, there is still at least 1 type that can only be diagnosed by muscle biopsy. Normally PSSM shows up when a horse is backed, the increased work causes all kinds of problems including tying up badly as work increases.

If anything the coat might say cushings, but perhaps very mild, often the standard ACTH test (the free one) won't show up borderline cases and especially not outside of the seasonal rise August-December, so a retest could well be warranted. Odd fat deposits can show up with PPID, but they normally start with the ones above the eyes. My old boy phoenix had cushings, lived with it for some years and he only ever had the crazy coat and eye fat, not all get all symptoms. I chose not to medicate him and clipped him year round to keep him comfortable

 

[Toz]

Thanks both. He’s as I say actually not too bad at the moment, but it’s been long term now. So isn’t something seasonal.
I will retest for cushings though. Especially as the first thing a friend said recently while looking at him was has he got cushings? !
I’ve tried complete tack and bit changes and he definitely prefers the old combo which I’ve gone back too.
He has physio tomorrow booked to see if that throws up anything, although I have had him checked a few times since this all started.
He did have a brain problem a few years back and the vet also suggested it could be neuro related but didn’t expand on that as I was supposed to be trying the nose net etc.
It’s just a bit odd!

 

[carthorse]

To me that sounds like he's ticking several PPID boxes despite the test being clear. I think retesting is a good idea, this is a better time of year to test with the standard blood test, and it may be worth asking your vet about the TRH test instead.

 

[Jessey]

The seasonal rise doesn't refer to something you always see outwardly, it is a seasonal change in ACTH levels, naturally ACTH rises between august and December in all horses, but those on their way to PPID have a more dramatic rise than normal horses, that's why the test is more accurate during the rise for horses that are otherwise borderline or even normal the rest of the year Overly high ACTH at any time can be symptomatic, but it won't necessarily appear as a 'seasonal thing'

 

[Toz]

Sorry when I said it’s not seasonal I just meant it’s not something I can say is summer midges bothering him or he’s over rugged and too warm or coat change- all thing things I’ve been blaming the past year!
I will ask about a TRH test aswell.
I actually have a vet out tomorrow so will see if she has time to fit this in.

 

[Huggy]

These definitely sound like Ramsey with cushings - he always had a bit of sweetitch, but it got terrible when the cushings took hold. All over, but worst on his face and shoulders. All I could do was clip him in the summer, and fly rug from April to October. It's a sh****y disease. I didn't even have to test him - one look and you could see what it was.

 

[Toz]

To me that sounds like he's ticking several PPID boxes despite the test being clear. I think retesting is a good idea, this is a better time of year to test with the standard blood test, and it may be worth asking your vet about the TRH test instead.

These definitely sound like Ramsey with cushings - he always had a bit of sweetitch, but it got terrible when the cushings took hold. All over, but worst on his face and shoulders. All I could do was clip him in the summer, and fly rug from April to October. It's a sh****y disease. I didn't even have to test him - one look and you could see what it was.

Face and shoulders are the worst actually when he is “itchy” he bites at his shoulders under saddle. I thought he’d developed sweetitch for a while.
Obviously having posted this I know very little about all these metabolic type illnesses but I was convinced the results would come back positive. It was a genuine shock when they said not.

 

[Toz]

Face and shoulders are the worst actually when he is “itchy” he bites at his shoulders under saddle. I thought he’d developed sweetitch for a while.
Obviously having posted this I know very little about all these metabolic type illnesses but I was convinced the results would come back positive. It was a genuine shock when they said not.

Sorry carthorse didn’t mean to quote you in that aswell!
Oh good god! I’ll quit now