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Cushings or PPID in Horses

Cushings or PPID in Horses

Oct 21, 2024 | Cushings, PPID

Whinny’s Wisdoms

Springhill Equine Veterinary Clinic

Hey, everybody! Whinny checking in this week to discuss one of the most common diseases the Doctor’s here see in horses. I often hear them refer to it as Cushing’s. However, being a proper mouse I’m going to call it by its actual name: PPID. 

What is PPID?

PPID, or pituitary pars intermedia dysfunction, is a disease that occurs when the pituitary gland, a small pea-sized structure at the base of the brain, produces too much of a hormone called ACTH. ACTH stimulates the adrenal glands to produce cortisol, which is a hormone that helps the body respond to stress. At least that’s how Cushing’s works in dogs and humans, two other species commonly affected by a similar syndrome. 

Horses have to be different and that’s why they get a special name for their version. You see, dogs and humans are affected in the anterior pituitary. Horses are affected in the intermediate, or pars intermedia, area of the pituitary. This area releases way more than just ACTH. It can release up to 5,000 different hormones. These hormones are largely responsible for maintaining the status quo of the body. They tell cells things like: it’s daytime, or nighttime, winter is coming, we should probably eat more, time to grow a lot of hoof, and on and on. All the things that make a body function day-to-day. The changes involved in PPID take time to occur. This means most, but not all, affected horses are over 15 years of age. 

Symptoms

PPID can cause a variety of symptoms in horses, and the severity of the symptoms can vary depending on the stage of the disease. Some common symptoms include:

    • Curly coat: The horse’s coat may become dull, dry, and curly. This is the most common symptom people think of with PPID horses, but I’m here to let you know it’s often one of the last ones horses develop! If this is the first sign you see, you’re probably late to the game.
    • Weight loss/weight gain: A change in weight that doesn’t make sense, up or down, often goes with PPID
  • Decreased performance: One of the first, very subtle signs, horses may show is decreased performance. That might show up as less power, speed, or endurance. 
  • Infections: Horses with PPID have a suppressed immune system. This makes them more susceptible to chronic infections of the skin and teeth. It also makes them more susceptible to internal parasites. 
  • Increased thirst and urination: Horses with PPID may drink more water and urinate more frequently.
  • Laminitis: PPID can increase the risk of laminitis. This is the scariest symptom of PPID. Its onset is often insidious. Yearly foot radiographs can help spot this symptom early!

Springhill Equine Veterinary Clinic

Diagnostics

If you suspect that your horse may have PPID, it’s important to consult with one of our veterinarians. They can perform a physical examination and may recommend blood tests to measure the level of ACTH in the horse’s bloodstream. In some cases, a test called a TRH stimulation test may also be performed. This test involves administering a hormone called TRH, which should cause the pituitary gland to release ACTH. If the horse’s ACTH levels increase significantly after the TRH stimulation test, it may be a sign of PPID.

Treatments

There is no cure for PPID, but the condition can be managed with appropriate treatment. The goal of treatment is to help regulate the pituitary gland. This can be achieved through a combination of medications, dietary changes, and regular veterinary care.

  • Medications: There are several medications available to treat PPID, including pergolide and cyproheptadine. These medications can help to reduce the production of ACTH. Pergolid is a very picky medication that has to be manufactured and stored under very specific conditions! Be sure you are using a form that meets those requirements. In North America, only Prascend meets these conditions. 
  • Dietary changes: Horses with PPID may benefit from a diet that is low in carbohydrates and high in fiber. Many, but not all, horses with PPID also experience insulin resistance. If your horse has both, then a low starch diet will be necessary. 
  • Regular veterinary care: It’s important to monitor horses with PPID closely and to provide regular veterinary care. Regular check-ups looking for laminitis, those pesky infections, and fecal egg counts are very important, along with routine vaccinations. 

Conclusion

PPID is a complex condition that can affect horses of all breeds. While there is no cure, it can be managed with appropriate treatment. If you suspect that your horse may have PPID, it’s important to consult with our veterinarians for diagnosis and treatment. By working with our veterinarians, you can help your horse live a long and healthy life.

Well, that’s all for now, folks! I hope you learned something new about PPID. I’ll be back soon with more adventures from the veterinary clinic. Until then, stay curious and keep exploring!

Until next week,
~Whinny

P.S. If you want to know more about PPID, or just about anything else related to horse health, you should listen to the podcast my humans produce! It’s called Straight from the Horse Doctor’s Mouth and you can listen to it right here on my website! Just click this link to go to the Podcast Page, scroll down through the episode list, and click play on whatever catches your eye. As a matter of fact, I’ll put a sampler right below here so you can check it out. Go ahead and click play on something, it won’t bite!

Whinny’s Wisdoms is the official blog of Whinny the Clinic Mouse at Springhill Equine Veterinary Clinic in Newberry, Florida. If you liked this blog, please subscribe below, and share it with your friends on social media! For more information, please call us at (352) 472-1620, visit our website at SpringhillEquine.com, or follow us on Facebook!

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More Adventures of the Horse Doctor's Husband
Is It PPID?

Is It PPID?

Nov 5, 2018 | Cushings, PPID

Tuesdays with Tony

Is It PPID?

There is an interesting phenomenon that seems to strike around this same time each year amongst the horses I see: they get hairy. Despite the consistency and repeat-ability of this syndrome, owners seem to worry every time this happens. What do they worry about, you ask? PPID. Affectionately known as Cushing’s disease, Pituitary Pars Intermedia Dysfunction, or PPID, is a disease primarily seen in senior horses. One of the many signs of this disease, and undoubtedly the most familiar sign to horse owners, is a long, shaggy hair coat. So, is your horse’s winter coat normal, or does he actually have PPID?

Let’s Review

   Why should you care if your horse has PPID anyway? Well, what if I told you your horse has a brain tumor? That’s a little scarier. PPID in horses is in fact caused by a tumor pressing on the pituitary gland in the brain. As the tumor grows, it causes the pituitary gland to overproduce certain hormones. These hormones can cause a myriad of problems when their levels are elevated. Problems such as laminitis, inability to fight off infections, weight loss, lethargy, and abnormal hair coat are commonly seen.
    The most concerning, even life-threatening, consequence of PPID is laminitis. There is no treatment for laminitis, and the damage caused by laminitis is irreversible. This is why preventing laminitis by treating the underlying PPID is so important.
    If you have a senior horse with PPID, you may not even realize there is anything wrong. On numerous occasions I have overheard an owner tell one of our docs that their horse acts 10 years younger since beginning treatment for PPID. Since lethargy, chronic infection, and weight loss are common clinical signs of this disease, it is not surprising that horses feel a whole lot better once their symptoms are properly managed.
    To tell you the truth, the classic long, curly hair coat is actually an advanced sign of PPID. Early signs include a change in attitude, decreased athletic performance, loss of top line, and slightly delayed shedding. Vets are trying to get better about recognizing these subtle, early signs, so that testing and treatment can be initiated sooner, and the more severe signs and effects of PPID can be prevented.

Let’s Test

   So let’s pretend it’s fall and your horse went ‘poof’ and blew out a long, winter hair coat seemingly overnight. Does he have PPID? Before making the diagnosis, our docs are probably going to ask you a few questions.
    First, is this normal for your horse? If he has been blowing out a shaggy winter coat on September 1st every year since he was 3 years old, it may be normal for him. Is his hair coat relatively even over his entire body? The abnormal hair growth associated with PPID is often patchy at first, found initially on the back of the lower limbs. Is the hair straight, or is it long and curly? A horse with a thick, long, curly hair coat covering his entire body has about a 90% chance of having PPID. Does he shed out completely in the spring? Some horses just grow thick winter coats; as long as they shed out completely at an appropriate time each year, they may be completely normal. Have you noticed any other signs? While many of the signs of PPID are somewhat non-specific, it is very common for horses to exhibit more than one. Does your horse have recurrent hoof abscesses, and you’ve also noticed he’s been losing weight recently? Has your horse been a bit slugging under saddle recently, and he also took forever to get over that eye infection he had earlier this year?
   If any of these scenarios sound like your horse, or if your vet suspects that your horse may have PPID, I really recommend that you have him tested. Did you know that there is a simple, one-time blood test that is highly accurate for diagnosing PPID? A baseline ACTH test is all that is needed; no stimulation testing, fasting, or dexamethasone suppression testing required! Did you also know that based on recent research you can test your horse for PPID any time of year? That’s right, there are now scientifically established reference ranges based on season that account for the normal rise in ACTH seen in horses in the fall.
    We now know that many of the signs we used to associate with “normal aging” in horses are actually signs of PPID. And better yet, this means they can be treated! So, ask your vet about testing for PPID at your next wellness visit.

Let’s Treat

   We are fortunate that there is an extremely effective, safe, and easy treatment available for horses with PPID. Prascend (the brand name for pergolide) is a tiny pink tablet you can readily hide in your horse’s grain every morning. Since the medication mimics a hormone naturally found in the horse’s body, side effects are very rare and mild. The best part about treating with Prascend is the results! I have been surprised again and again with the positive difference I’ve seen in horses that come through the clinic before and after starting treatment. And by starting treatment early, you can prevent the development of those advanced signs of PPID including laminitis, tendon and suspensory ligament breakdown, and recurrent infections.
     A rare but recognized side effect we sometimes see with Prascend is horses not wanting to eat their feed with the tablet in it. Lucky for you though, I have come up with some creative tips and tricks to address this issue: First, try splitting the dose into 1/2 tablet morning and night, rather than a whole tablet at once. If that doesn’t work, we can even try going to 1/2 tablet once a day, but we would want to re-test your horse after a few months to make sure his hormone levels were controlled at this dosage. If your horse simply refuses to eat his grain with even a partial tablet in it, try feeding his tablet in a soft treat like a stud muffin. You can also try enticing your horse to eat it with molasses or applesauce on top of his grain. Yummy!
   So now that you know why it’s important to know whether your horse has PPID, how and when we can test them, and how easy it is to treat them, what do you think? Is your fuzzy horse just gearing up for the coldest winter of the century, or might there be something more going on? Call me at the clinic to schedule your horse’s ACTH test, and let’s see if it’s PPID!
     Affectionately,
            Tony
P.S. Are you craving more horse knowledge? Check out the podcast that my docs make, Straight from the Horse Doctor’s Mouth. You can learn a lot in a half hour listening to them talk about various horse things. It’s pretty amazing, even to this cat, and I’m not easily impressed.
Springhill Equine Veterinary Clinic

Tuesdays with Tony is the official blog of Tony the Clinic Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. If you liked this blog, please subscribe below, and share it with your friends on social media! For more information, please call us at (352) 472-1620, visit our website at SpringhillEquine.com, or follow us on Facebook!

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Hot, Hairy Horses

Hot, Hairy Horses

Sep 25, 2017 | Cushings, Heat, PPID, Seniors

Tuesdays with Tony

Why is my horse growing his winter coat already??

Horses are weird. I say that a lot, because it’s true. I was checking out a horse that was hanging out at the Clinic with Teannie and I over the weekend, and noticed he was growing his winter coat. I’m thinking, “It’s not even close to winter, what are you thinking????” Okay, I may not have thought that, I may have said it out loud. And where do I go with my questions? To my Docs…Dr. Vurgason was the first one I saw so I asked her, “What is that horse thinking getting a winter coat when it’s 90 degrees out?” And here’s her answer:

Horses like cold weather

To be more accurate, they evolved in areas where it got really cold. We get a skewed view of seasons here in Florida, but in other parts of the world, it isn’t 90 degrees for 8 months out of the year. Dr. Vurgason informed me that this morning it was 30 degrees in Stowe, Vermont. I informed her I don’t want to live wherever that is, but I did concede that a horse might need a winter coat by now if he lived there. Dr. Vurgason told me there are some breed differences, as well. For instance, Thoroughbreds, in general, don’t grow as much hair as, say, a Percheron.

Sometimes hair isn’t just hair

But, (and with the humans there’s always a but) sometimes horses aren’t just preparing for winter. Dr. Vurgason told me one of the early signs of Cushing’s (also called PPID because humans also like initials) was growing a winter coat earlier or heavier than normal. She told me this is because the pituitary gland, which is the main problem-child in Cushing’s disease, is in charge of knowing if it’s Winter or Summer, and it gets confused. So if your horse is growing way more coat, or growing it earlier than last year, you better contact my minions and get them checked! The test is a simple blood draw, no need to study or purchase Cliff notes or anything like that.

You’re going to need to cut that hair

Due to the aforementioned lack of actual Winter in Florida, you may need to cut that newly grown winter coat off. Horse hair is an amazing insulator, so when it’s 85 degrees on Christmas Day and you want to go ride, you may find your furry horse is a less than willing partner. Never fear, this doesn’t mean you have to go spend $1000 in horse blankets. You can do what I refer to as the “crazy horse people haircuts.” I have heard other people call them bib or trace clips. I still think they look funny. However, they do let your horse sweat and release heat in all the important places, while giving them protection from our “cold” weather. And if you get inspired to add some zest and style to your clip job, take a picture and put it on our Facebook page!

Now go out and inspect that hair coat. Got questions? Let my minions know! Until next week

Tony

Tuesdays with Tony is the official blog of Tony the Clinic Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. If you liked this blog, please subscribe below, and share it with your friends on social media! For more information, please call us at (352) 472-1620, visit our website at SpringhillEquine.com, or follow us on Facebook!

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Tuesdays with Tony – Cushing’s Disease

Tuesdays with Tony – Cushing’s Disease

Apr 11, 2017 | Cushings, Haircoat, PPID, Seniors, Uncategorized

Cushing’s Disease

Is your older horse taking longer to shed out than usual this spring? Is it getting harder to keep weight on the old man? Has your retiree had more than one hoof abscess in the last year? If so, you may be dealing with PPID, better known as Cushing’s Disease. Read on to learn more about PPID from this wise old cat!

What is PPID?

PPID stands for Pituitary Pars Intermedia Dysfunction, which is the technical term for Cushing’s disease in horses. In the most basic sense, PPID is a brain tumor. The brain actually has a very intricate system of glands that produce hormones which stimulate additional glands to produce other hormones that control functions elsewhere in the body. When one of these glands (the Pituitary) in the horse’s brain goes AWOL, you have Cushing’s disease.

The tumor growing on the pituitary gland is called an adenoma. This tumor applies pressure to the gland as it grows, causing over-production of its hormones (namely, adrenocorticotropic hormone, or ACTH). The clinical signs of Cushing’s disease in horses are all a result of too much ACTH in circulation. Time for a nap break…all of these letters are giving this cat a headache!

What are the signs of PPID?

Cushing’s disease can lead to a bunch of problems. For one, overproduction of ACTH can confound the whole winter-coat-growing system, so your horse winds up with long, curly hair in the hottest summer months. Failure to shed out completely or in a timely manner is the most well-known sign of Cushing’s disease. However, now that we know early treatment seems to slow the progression of the disease, our efforts are aimed at diagnosing the disease earlier, using more subtle signs.

In the early stages of the disease, PPID can cause lethargy, muscle wasting, regional fat deposits, recurrent infections, increased water consumption, and increased urination. The most worrisome side effect of Cushing’s disease is chronic laminitis. There is no known cure for laminitis, and it can even be life-threatening in horses with PPID. And that’s bad, because horses have 8 fewer lives than us cats.

Pony with Equine Cushings Disease

How do I know if my horse has PPID? 

Since the early signs of the disease can be subtle, our docs recommend annual testing for Cushing’s disease on any horse over 10 years of age. First the docs will draw blood, then it goes on a trip to Cornell University where they test the ACTH levels. Then, the doctors will compare your horse’s ACTH levels to the normal range for a horse during that time of year.

Considering your horse’s test results and clinical signs, your vet may recommend daily medication to treat PPID. Luckily, the folks at Boehringer Ingelheim have come up with a great medicine called Prascend that is easy to give, and works really well too! Just one tablet a day mixed in with grain is a sufficient dose for most horses. I’ve heard it tastes better than the cheese-flavored medicine the humans squirt in my mouth every day.

Conveniently, I have an event coming up here next week at Springhill Equine on Wednesday April 19th at 6:30pm, where you can learn all you ever wanted to know about PPID and other senior horse problems! Some of my favorite people from Boehringer Ingelheim will be there to answer any questions you may have, and best of all there will be food! Oh, and a chance to win a free ACTH test for your horse. You may think that is even better than food, but that’s where we will have to agree to disagree………

See you there!

-Tony

Tuesdays with Tony – Blessed Be The Old Farts

Tuesdays with Tony – Blessed Be The Old Farts

Mar 28, 2017 | Cushings, Drugs, Heat, Lameness, Laminitis, Leg issues, Medication, PPID, Retired, Vaccines, Weight loss/gain, Wellness Program

Blessed be the old farts.  Around here there is a kind of reverence for the older horse.  I will admit to jealousy.  It’s not pretty, I know, but it’s real.  I mean, I’m a cat.  I deserve all the reverence around here.  In an effort to explore the causes for this misguided worship I talked with my minions, I mean humans, about the phenomenon.

Turns out all my humans went with something along the lines of enjoying their horses, learning from them, and feeling appreciative of all the horses gave to them during their athletic careers.  The humans said they wanted to make sure their horses had wonderful retirements since they had earned it.  I was a little confused by the “earned it” thing, since I don’t need to earn anything, but I digress.

What messes up a horse’s retirement?

Do they golf? Do they play Canasta and Bridge?  Apparently no.  They wander around a field and eat. This is a typical day for me if you substitute ‘Clinic’ for ‘field’, so not sure if I’m retired already or how that works.  Anyway, dental issues, lameness, and not feeling so hot are the biggies that interfere with retirees’ ability to wander around and eat.

The Teeth

Let’s start with dental issues.  Horses are this really weird thing called an hypsodont.  It means they have a whole lot of tooth when they are young, which they wear down to nothing over their lifetime.  The super cool thing is you humans are doing such a good job taking care of your horses that they now outlive their teeth.  Sure. that sounds scary, but with good nutrition it’s not a problem.  What it does mean is that you may notice your horse not wanting to eat.  You humans do a pretty darn good job knowing your horses.  When Tiny backs off on feed, don’t worry that we are going to think you’re crazy.  We won’t! We do the exact same thing! What we are going to do is schedule an appointment for one of our Docs to come take a look in Tiny’s mouth.  They might find some teeth that need to be adjusted a little bit or potentially extracted.

The Legs

Moving on to lameness.  This one I identify with.  I have jumped down from high places one too many times and I’m starting to develop a bit of arthritis in my right front paw.  Life catches up with us all.  All those daring feats of athleticism we displayed in our younger years show up as aches and pain in our later years.  Laminitis (same as founder) may rear its ugly head as well.  Once again the signs can be subtle, and you, the awesome human, may notice Flicka is in a different corner of the pasture than normal.  Once again, we won’t think you’re crazy when you tell us this.  We do the exact same thing! In this case our Docs are going to evaluate feet, legs, and the musculoskeletal system in general to identify a cause for the lameness.  If it’s arthritis, they will often recommend NSAIDs (horse aspirin) like bute or Equioxx, and movement, even in small amounts.  If it’s laminitis, a test for Cushings is almost always called for.  This is a test even a dog could pass!  It’s just a blood draw.  They also get on the phone with the farrier to make sure your horse’s entire team has the information they need.

When all of it goes wrong

Next there’s the “not feeling so hot”.  Again, when you call to say Mister isn’t right, but you can’t put your finger on it, we will be nodding our heads. We know that feeling!  This one is a little tougher.  Our Docs will put on their detective hats and start the investigation with you.  They won’t start with you because you are the prime suspect, they will start with you because you are the best source of information.  You know your horse.  You know if Mister ate and drank normally, and has he been sleeping normally? Rolling over? Is he in the same place in the herd hierarchy?  Next they will take your information, combine it with a good physical exam, and determine a course of action.  Usually, this involves some blood tests (remember they’re so easy a dog can pass them), along with an ultrasound of the chest and abdomen.  Only thing difficult about an ultrasound is the cold alcohol they put on your skin.  Based on these easy, peasy tests, our Docs will help you map out the best treatment options.  Lots of times these tests turn up Cushings disease.  Cushings is an endocrine disease which messes with every system there is to mess with.  Good news though: one small pink pill daily is the treatment. And if you schedule an appointment by the end of the week, our monthly special is $10 off this blood test!

Horses are like fine wine, they only grow better with age.  Totally patronizing the humans there, they told me to write that.  Anyway, let your horse live long and prosper with a little TLC.  The humans yak on a lot about Super Seniors, so this is the first in a four part Tuesdays with Tony expose.  Tune in next week for part 2

-Tony

Tuesdays with Tony – Holy Hairy Horses!

Tuesdays with Tony – Holy Hairy Horses!

Sep 27, 2016 | Cushings, PPID

While Dr. Lacher was off gallivanting at the Grand Canyon last week, I was helping Dr. Vurgason groom her horse for the Racehorse Reclaim benefit horse show. As we were brushing his coat to a glorious shine, what to my wondering eyes should appear but a clump of long hair! I couldn’t believe my eyes: Smokey was already beginning to grow his winter coat. “Is this normal?” I inquired to Dr. V. She replied that yes in fact, a horse’s winter coat begins to grow in response to hormonal changes within the brain. These hormones are triggered by changes in length of daylight.
   You may have noticed your evening rides being cut short recently because it is getting dark by 8:00 already. Well, horses have noticed this too. The brain actually has a very intricate system of glands that produce hormones that stimulate other glands that produce other hormones that stimulate organs elsewhere in the body.
    That long hair coat comes way too early for Florida.  It makes for some hot horses.  In particular, if your horse has heaves (asthma in horses), or is a non-sweater, this time of year is no fun.  Unlike me, your horse likely can’t come in to the air conditioning to get out of the heat.  This means it’s time to fire up the clippers and get rid of that hair.  Sometimes that hair can be an indication of a problem.
  Cuchings horse is hairy!  Long hair at the wrong time of year can mean one of the glands in charge has gone AWOL. In horses, the pituitary gland is the most likely culprit. Nobody knows why, but many older horses will grow a tumor on their pituitary gland called an adenoma. This tumor applies pressure to the gland as it grows, and causes it to over-produce its hormones (namely, adrenocorticotropic hormone, or ACTH). This condition is known as Pituitary Pars Intermedia Dysfunction, or more affectionately, Cushing’s disease.
   Cushing’s disease can lead to a whole slew of problems. For one, overproduction of ACTH can confound the whole winter-coat-growing system, so your horse winds up with long, curly hair in the hottest summer months. Failure to shed out completely or patches of long hair (not in the Fall) are often early signs of Cushing’s disease. Through mechanisms which are not completely understood, Cushing’s disease can cause lethargy, muscle loss, potbellied appearance, fat deposits, laminitis, and recurrent infections. Hmm, maybe I have Cushing’s disease…?
   Luckily, our Docs have ways to determine if your horse’s long hair is from Cushing’s or if they are just getting ready for winter.  First they draw some blood, then it goes on a trip to Cornell University where they test the ACTH levels.  When I was a kitten, ACTH levels couldn’t be pulled in the Fall since the levels go up in the Fall and the humans didn’t know what was normal and what wasn’t.  They have fixed that problem with some research.  Now Fall is a great time to test since horses who are just beginning to show signs will have really high levels in the Fall.  Also….Springhill Equine has a contest going on now where you can get your horse tested for FREE!!!!  Free you say? Yep, FREE.  Just click on this link to the “Does my horse have PPID?” form, fill it out and Voila! You are entered.  That’s easier than getting Beth to share her tuna fish sandwich with you.