Dolly update - updated - updated yet again!

Cortrasna

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Well today she had more bloods taken - some are apparently going to an equine lab here in Ireland and some to Liphook - my vet (fortunately!) is a good buddy of an expert in this field at Liphook - and he (my vet) did some of his training there himself back in the day, so hopefully will give us an extra view point and opinion on what is going on with the Doll.

Since last visit a week ago she is now abnormally quiet - like falling to sleep over her feed when she comes in quiet - not good to be honest - it seems we have either one extreme or the other just now.

He is leaning more and more towards the opinion that she may be one of the rare cases that Cushings can present with very aggressive and unusual behaviour as well as the very quiet lethargic symptoms. She has never had laminitis since I have owned her - he thinks probably because I am very strict with her diet to try and alleviate her sweet itch as cushings/lammi diet is actually very similar to an ideal diet for a sweet itch horse. However due to the increased risk I can no longer risk giving her a Kenalog (steroid) jab when her SI becomes unmanageable as it did last year and the year before. He is hopeful that when she is on Prascend that might actually alleviate some of her SI symptoms - I truly hope so - has anyone any experience of this please?

if it doesn't he will cross that bridge when we come to it and will try some alternatives to help her other than steroids - (this poor old mare will literally throw herself writhing on the ground when the Si really gets too much too bare) I hope he can as I would PTS tomorrow if this possible cushings diagnosis interferes with the only relief I can give her when the SI is totally unbearable for her.

Pointless, slightly depressed post - more thinking out loud but please excuse me - I promise to revert to my usual sarcastic, opinionated, very dark and sometimes offensive sense of humour self ASAP. ;)
 

MrC

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Yep I totally get where you are coming from with the falling asleep. Kia had fits that looked like he was having a stroke or a heart attack, staggering and shaking. He would constantly sleep, lips and eyes and ears all twitching uncontrollably. It was worrying to look at.

If they start her on it go up slowly, the vets don’t tell you about the veil effect. Mine poopooed it when I just whacked Kia on 1mg and he stopped eating and went lethargic and dropped weight.

Massive hugs to you, with the Prascend controlling her symptoms you may get away with the steroid injection along with your already very good and careful management x
 
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Bodshi

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Poor old Dolly, I hope you can sort her out. Raf (touch wood) has never shown any laminitic tendencies and my vet says there is no need for me to take any precautions diet wise unless he does (although feed companies disagree).

Raf never had the extreme mood swing symptoms that Dolly does, but there were times when he seemed so ill I was convinced I was going to lose him. It took a few months but he came through ok and is just like a normal horse on the Prascend, although it's always at the back of my mind that the disease will progress and his life expectancy is probably not great.

Keeping everything crossed for you and Dolly x
 
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eml

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Over the years I have met two cases of this, one was a mare who initially seemed angry and then had all the signs of a phantom pregnancy, another side effect rare but known. Another was a gelding who became dangerous to handle and showed stallion like behavior.

I am not a great fan of Pracend as that also modifies behaviour and disguises symptoms.acting sometimes like a sedated horse. Equally sweetitch is so nasty I couldn't contemplate being without a long stop of a steroid injection

I don't envy you your current dilema ...

Sorry to hear about this .
 
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Jessey

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It's good to hear you have a good and pro active vet on the case, it can make the world of difference in an unusual case. We're rooting in the Dolly corner over here :)

I have no personal experience with sweet itch in PPID horses but I have read lots of comments on cushings groups about increased itchiness perhaps being a symptom of PPID and it improving with Prascend, lets hope that is the case with Dolly :)

I would echo the others about avoiding the veil by gradual increase (and the fact that most vets have no idea about this) but given the extreme behavior you are dealing with you probably don't want to fiddle about for months getting her up to full dose so I thought I would mention APF supplement which according to Dr Eleanor Kellon is 100% successful in eliminating the veil when starting on pergolide/Prascend. I have personally never used it, but having just looked it up again to put a link on here, I am tempted to try Jess on a round to hopefully get her over the hump and eating better again and help with her not great skin at the moment :)
https://forageplus.co.uk/product/apf/

I don't agree that Prascend disguises symptoms, as a dopamine agonist it is directly treating the hormone problem caused by the pituitary by activating the dopamine receptors. The veil does often modify behavior but once their body adapts to the huge change in hormone output they more often than not get back to 'their old self' and the symptoms which had built up progressively before diagnosis also disappear or minimise. Jess isn't my first with PPID, I chose not to medicate Phoenix for it and now I know much more about it I think that probably played into the way his cushings progressed, relatively quickly to neurological problems. Prascend isn't a cure, it's only aimed at slowing the progression by limiting the damage being done by unregulated production of hormones which I think does improve their quality of life also. I'm not a drug to fix things person, I would much rather not use drugs, but I do think in some situations drugs are a good option to manage a problem.
 

Lissie

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Sorry I have no experience with anything like this so no advice unfortunately. Sending all the good vibes I can and hope you get to the bottom of it and can help her.
 
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Cortrasna

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Thank you all for taking the time to respond.

@Jessey - I had already stumbled across that on Forageplus and also asked my vet about trying vitex - he said he would normally be more than willing to try her on a few alternatives if she was presenting as most Cushings horse's do and to help with any possible side affects of the dose she may need - but in her case he is extremely concerned about the aggressive outbursts and feels we cant afford to 'try' different options at this stage, we need to get the dangerous behaviour modified ASAP and he is only confident that putting her on Prascend will have a real chance of doing that. He is happy to review that in 6 months if all aggression and sudden erratic behaviour has stopped altogether - then he will be happy to try and reduce her use of prascend alongside something more alternative, but for now she is only to have a very low key diet with just her SI mineral supplement added in. He seems to think that in 99 per cent of cases the 'veil' does lift within a few weeks and contrary to popular belief it is actually a low percentage of them that go through the veil anyway, so it is (hopefully) possible she might not lose her appetite etc. etc.

@eml - that is exactly how my son described her behaviour to the vet yesterday - like an ill mannered stallion with no previous handling. Very scary when she kicks off actually :(

I am now waiting for results - half of me hoping it isn't Cushings - and the other half terrified if it isn't, if that is the case then the alternative possible diagnosis is very bad news for her. :(
 
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carthorse

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It's good to hear you have a good and pro active vet on the case, it can make the world of difference in an unusual case. We're rooting in the Dolly corner over here :)

I have no personal experience with sweet itch in PPID horses but I have read lots of comments on cushings groups about increased itchiness perhaps being a symptom of PPID and it improving with Prascend, lets hope that is the case with Dolly :)

I would echo the others about avoiding the veil by gradual increase (and the fact that most vets have no idea about this) but given the extreme behavior you are dealing with you probably don't want to fiddle about for months getting her up to full dose so I thought I would mention APF supplement which according to Dr Eleanor Kellon is 100% successful in eliminating the veil when starting on pergolide/Prascend. I have personally never used it, but having just looked it up again to put a link on here, I am tempted to try Jess on a round to hopefully get her over the hump and eating better again and help with her not great skin at the moment :)
https://forageplus.co.uk/product/apf/

I don't agree that Prascend disguises symptoms, as a dopamine agonist it is directly treating the hormone problem caused by the pituitary by activating the dopamine receptors. The veil does often modify behavior but once their body adapts to the huge change in hormone output they more often than not get back to 'their old self' and the symptoms which had built up progressively before diagnosis also disappear or minimise. Jess isn't my first with PPID, I chose not to medicate Phoenix for it and now I know much more about it I think that probably played into the way his cushings progressed, relatively quickly to neurological problems. Prascend isn't a cure, it's only aimed at slowing the progression by limiting the damage being done by unregulated production of hormones which I think does improve their quality of life also. I'm not a drug to fix things person, I would much rather not use drugs, but I do think in some situations drugs are a good option to manage a problem.

I found that Jim's sweetitch (although never allergy tested to confirm it truly was this, my vet's approach given his violent aversion to needles was "if it looks like a duck, walks like a duck & quacks like a duck assume it's a duck!" & I completely agreed) improved dramatically on Prascend to the extent that as long as the weather was favourable he could have time out without a sweetitch rug. He also reacted less severely to any fly bites though he always remained unhappy if he could see or hear them around him.

I couldn't agree more with the last paragraph of your post Jessey. My vet was reluctant to prescribe Prascend to Jim for reasons I think I've already mentioned above, but when he started getting bouts of laminitis in the autumn no matter how carefully I managed him she was left with no choice except to prescribe & put on file that she'd discussed her concerns but I'd wanted to go ahead. Initially he probably did hit a veil which at the time I didn't know about, but after that he became his old self for a few years until things got completely beyond the ability of Prascend to control. With hindsight I wish I'd known more earlier because I would have got him on it sooner even though his acth readings - on the odd occasion we managed to get them - were only borderline despite not being taken from a calm horse at rest! But we can't change the past, only learn from it. Maybe if I hadn't had him from a 2yo I would have blamed Prascend for some of his changed behaviour once he was settled on it, but the reality was it helped him return to what was more normal for him - if I'd bought him as a 14yo I'd have been horrified at the change!

I think all anyone can do is try it & see. Try to remember that people only tend to post on the internet when there are problems so you do get a skewed view of possible side effects, also some of those side effects can be the PPID itself rather than Prascend.

I'm still thinking of you & Dolly, and wishing you all the best x
 
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Jessey

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Thank you all for taking the time to respond.

@Jessey - I had already stumbled across that on Forageplus and also asked my vet about trying vitex - he said he would normally be more than willing to try her on a few alternatives if she was presenting as most Cushings horse's do and to help with any possible side affects of the dose she may need - but in her case he is extremely concerned about the aggressive outbursts and feels we cant afford to 'try' different options at this stage, we need to get the dangerous behaviour modified ASAP and he is only confident that putting her on Prascend will have a real chance of doing that. He is happy to review that in 6 months if all aggression and sudden erratic behaviour has stopped altogether - then he will be happy to try and reduce her use of prascend alongside something more alternative, but for now she is only to have a very low key diet with just her SI mineral supplement added in. He seems to think that in 99 per cent of cases the 'veil' does lift within a few weeks and contrary to popular belief it is actually a low percentage of them that go through the veil anyway, so it is (hopefully) possible she might not lose her appetite etc. etc.
Just to throw in another thing that I stumbled across, Prascend is an agonist (receptor stimulator), and vitex/agnus castus/chaste berry is an antagonist (receptor blocker), so they work in opposite ways, and there is a short blurb in the Prascend leaflet to say that using antagonists alongside Prascend should be avoided, but it's not specific to chaste berry and if you call boheringer the customer service can't give any specifics. My vet had no idea if they would counteract one another either. Anecdotally it seems some find using both helps, some find it doesn't. There was a study on chaste berry and its effectiveness in PPID cases and, from memory, it showed it only controlled ACTH in 33% of cases but did control other symptoms in more.

I didn't go through the veil with Jess on either of her starts on Prascend, or any of the times I have given her a short break from it, I have been around several others who have and several others who haven't, its probably accurate that its not a high proportion of cases that suffer the veil, but its good to know about as it can be quite scary when it happens if you aren't aware.
 
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Cortrasna

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I found that Jim's sweetitch (although never allergy tested to confirm it truly was this, my vet's approach given his violent aversion to needles was "if it looks like a duck, walks like a duck & quacks like a duck assume it's a duck!" & I completely agreed) improved dramatically on Prascend to the extent that as long as the weather was favourable he could have time out without a sweetitch rug. He also reacted less severely to any fly bites though he always remained unhappy if he could see or hear them around him.

I cant tell you how thrilled I would be if Dolly has that same happy side effect from the Prascend - at the moment I think my vets highest concern is that it doesn't exacberate her unwanted behaviour - if it doesn't and her all round health and some of the SI problems improve it would be a miracle cure as far as I am concerned. I shall hold on to those positive thoughts until I am proved delusional and desperate! ;)
 

Bodshi

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I don't know whether these pictures are of interest or even relevant, but these are what I look back on ...

Raf in early Nov 15, just after diagnosis and starting on the Prascend

Raf Nov 15 1.jpg

A couple of weeks later - he was on 1/4 tablet a day at this point - and this was when I thought I might lose him. The vet was surprised he had such an extreme reaction to what he said was the starting dose for a Shetland, but he told me to take him off the Prascend for a couple of weeks and then re-start it. It did the trick and he didn't have any more 'veil' symptoms on restarting, nor when we increased his dose.

Raf Nov 15.jpg

And in May 2016 after 6 months on Prascend (and some spring grass!)

Raf May 16.jpg
 

Cortrasna

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Raff certainly looks damn good in Pic 3 - you would never know he is Cushinoid would you? All recent pics of Dolly actually say it all - I was just so blind I couldn't or wouldn't see it. :( The 2nd pic is how Dolly looks a lot of the time before going on Prascend - if not that we have the eyes on stalks explosive cant stand still look, no happy medium at the moment :)
 
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