Cushings Horse

Update

2010-08-25T17:35:00.000-07:00

Good intentions.. I had such good intentions. But the care of a Cushings horse his first year was busy and I failed to capture it all on blog. :(

That said, I am working on writing up an "annual report" to tell what I learned. What works, what didn't, what surprised me, what was a waste of time, and so on. Since Zippy was diagnosed last July, it seems timely.

I'll have Zippy's Annual Report published out within a week here- check back soon. I have loved the mails I've gotten and the chance to connect with other horse owners who have experience (or need advice on) Equine Cushings.

Medicine Increase- expensive!

2009-09-03T23:18:00.000-07:00

Zippy's coat does look better, but the excessive urination and drinking continues. For that reason, the vet has decided to increase him from 1.0 mg per month to 1.5.

Zippy loves his medicine comes from SmartPak it is flavored so nicely, I've had no issue getting him to eat it since starting with them, though he lost his enthusiasm for grain now that his sweeter feed has been replaced by timothy pellets.

Unfortunately the first couple of months with SmartPak mean you pay for a prescription and about a week or 10 days later you have to pay for the next month so they can begin preparing it and get it shipped.

This system is very efficient for ongoing meds because it ensures you don't ever run out- but when you're in that first few months on a medicine like Pergolide you are likely to be adjusting doses and there just isn't time to allow your horse to adjust to the new dose and (if it needs to increase) change the next dose. So I'd recommend using a local compounding pharmacy for Pergolide until your dose is determined.

Since this month we already have a refill coming this week we had to call in the other portion of the dose, so I got to pay for two prescriptions. :(

Our 1.0 mg SmartPaks for this month cost about $48.95, and $3.99 shipping. Add that to the second prescription which was $38.50 - that is over $92 for this month alone. Ouch!

I asked the pharmacy how much I'll spend if he stays at this dose (1.5 mg), and here are the results:

$56.50 from Woodinville Pharmacy for 30 days, and $158.50 if I buy 3 months at a time. So I can get down to about $53 per month and pick up locally. This is for capsules, that I break open and sprinkle on his feed.
The 1.5 mg dose from SmartPak will be $68.95 (plus shipping it's about $72 per month) for the individual pots of flavored powder.

Well, I am just going to have to figure out how to make flavored powder because that's almost $20 a month savings to go local and buy 3 months at once!

I am going to do some research on what SmartPak uses to make flavored powder, perhaps I can make something similar at home. If you have ideas for making the powder more appetizing let me know- remember, I can't use molasses, sugar, alfalfa - those aren't good for a Cushing's horse (as we've discussed).

So I started him on his increased dose this evening, I can hardly wait for him to do less drinking and peeing, the poor fellow has a soaking wet stall every morning. The other day I stripped it at 8 pm, he'd been in for 3 hours and there was nowhere dry for him to lay.

he WILL learn to like shows, he WILL learn to like shows

2009-08-25T21:01:00.000-07:00

Saturday, Zippy and I headed out to the SAFE Benefit Show, an annual event that I have never attended.

Pause for some background info:

Zippy was sold due to his old age (12 then, now 13) and increasingly naughty behavior in the ring- he had been a youth show horse for years and decided he was done with behaving, he had a bad incident in a show (he was startled badly by a child running along behind a wall with a stick, running the stick along the metal siding) and when his young rider got nervous, Zippy sensed it. I believe he saw it as a way out of the tough life as a show horse- he found a weak spot and capitalized on it. A young rider would almost always be reactive to a major spook, and soon enough he was replaced.

We did a show back in March and Zippy was a PILL. It was not fun. He was impatient and annoyed, bitter and temperamental. We won our equitation class and placed in several others but this was definitely not the Zippy I know and love. During our last class, he stopped on our way to line up and peed and peed for a very long time. This was before I knew he had Cushings and I wondered if he had been holding it this whole time or if he was just determined to say NO to a continuing show career.

When I got Zippy, he didn't spook until a few rides in and that first fake spook was outrageous- he literally went from a beautiful collected superslow jog into a full bolt. My trainer told me to ignore it, not to fight. That's what I did and soon enough it stopped, but you always have to watch for the slight ear twitch that indicates he's getting bored and looking for something to do.

Anyhow, I really just enjoy showing locally, so I really want him to like it as well and I feel if I make it pleasant he will learn to like it again. So I had a plan- make shows fun. A stall, lots of treats and love and plenty of breaks for his still frequent potty needs. For me, I enjoy the (mostly) friendly people and fun atmosphere. And ribbons. I don't want to work all day and get 'points', how boring! What would I hang on the wall? I like ribbons :)

So Saturday I was prepared- I planned to do just 2 riding classes and a class or two in hand. I also paid for a stall (rather than tie to trailer, which is usually what I do to save cash). I was hoping he would actually enjoy the experience.

We started in Showmanship and tanked that class when I got the pattern wrong, but Zippy could not have been better so the ribbon didn't matter. Next we did trail in hand, and he did beautifully. It was a good sized class and we won. Our two riding classes were Western Pleasure Walk-Jog Open and Western Pleasure Open. We won both of those classes as well.

So 4 classes total, and we won 3 of them. We even won 3 prizes in SAFE's most excellent raffle. In addition I met some new friends and had many many laughs. It was a great day.

As for Zippy, every time we went to the stall between classes or walks he would urinate- he still drinks and urinates a LOT more than any other horse. I bet he went 6-8 times that day. But he got lots of snacks and tons of love and he really was a wonderful horse- he gave me his all in the ring. I couldn't be a luckier horse mom, and Saturday was a glimpse of a really bright future together.

So bright Zippy had to close his eyes and have a nap while I packed for home...

Chasteberry

2009-08-10T22:16:00.001-07:00

I returned from vacation last night- a week in California camping with the family was such a good stress reliever. I've been so consumed with Cushings, it was time for a break.

While out and about I found a place to buy bulk chasteberry. I got 10 ounces for about $1.60 an ounce- it is quite fragrant and seems fresh. The chasteberry is dry little round balls that you bring home and grind up in a coffee grinder- it takes longer than grinding flax or other seeds, those little balls are tough. The store I bought this herb from is Mt Shasta Herb and Health and they do process mail orders- the lady was very sweet there.

I will be starting Zippy on 2 tbs per day- this seems to be the standard dose. It does not smell really pleasant (some people use it as a pepper of sorts on foods) but I am hoping he doesn't notice if I mix it with his flax.

I do not plan to use this instead of the pergolide, as I am seeing substantial improvement already (just 3 weeks in) but do hope that the chasteberry helps as well.

I also ordered Zippy's next month of pergolide, he goes up to 1 mg per day and I will be using SmartPak's apple flavored powder. The cost is $48.95 which is about $10 more than I paid at Woodinville Pharmacy for the capsules, but the does is twice as high. I also want to see if he is going to be more eager to eat it with the flavoring.

Since he was diagnosed with Cushings I've removed all sweet feed and tasty treats so Zippy just gets timothy pellets and his flax supplement and medicine- he is not enjoying his grain right now and I fear that he will lose interest in it and stop taking the medicine so I want to see if the apple flavor powder makes it more palpable.

It's good to be back, Zippy has lost even more fur- it was hard to be away from him for 8 days but I was relived when the weather cooled down, as I know it keeps him more comfortable.

Update before Vacation

2009-07-31T12:00:00.000-07:00

I am going on vacation, gratefully I have a wonderful friend and barn owner so Zippy is safe and sound.

I have put his timothy pellets into Tupperware containers with his flax supplement and then I opened the capsules and sprinkled them in. It's not as perfect a way to give medicine as it is to make him it the capsule but he does tend to spit the entire capsules out so I chose this method.

He's still getting electrolytes every night in his stall water and is drinking them well, they really help with his comfort and reduce his sweating.

I placed an order for his next month of medication from SmartPak- they were having a 3 days shipping free and they offer an apple flavored powder form that sounded more palpable for Zippy.

I talked to the vet, and he is going to jump Zippy from .5 mg to 1.0 mg a day, sometimes he only increases .25 each month to work his way up but since the main risk is that they can get a stomach ache and go off food (and this has not been an issue for Zippy) we're going to make the jump now. If he reacts badly we'll go back to .75, but we feel he will do fine.

We're now about 2 weeks into his medication and I feel he's shown a small amount of improvement (energy and a bit of shedding) but not a lot, though we expected it to take a month or two. He's definitely enjoying all the love and attention, I've been at the barn daily instead of my usual 3-4 times per week so he's loving all the mommy time.

I'll be out of town and not blogging from Sat 8/1 through Sun 8/8 but you can bet I'll be back online as soon as I return to share our progress.

Sweat, Rinse and Repeat

2009-07-28T13:11:00.000-07:00

The heat our area (Western Washington) is in the 80's and 90's this week- many horses are sweating but for a horse with Cushings (who is hot from the inside out, for metabolic reasons) it's extra miserable. You can see his sweat in this photo of him (left) in his stall from when I arrived at 4:30 yesterday. I've been going to the barn every evening to rinse Zippy down to cool him off.

I don't use shampoo daily, because I don't want to irritate his skin (which has some areas of dermatitis from the Cushings) so I just tie him up and rinse him down.

Yesterday evening I rinsed him off then we went to the arena for his favorite game "I just got a bath and now I'm gonna roll" in which I take him up there after rinsing and he rolls and rolls. He barely got in the door before he was on his knees rolling, he rolled 5 times in the half hour we were in there. It was great to see him enjoy himself.

Here he is rolling...

I really loved this last photo- he is so beautiful to me and I love seeing him feel a teensy bit better every day, it makes it all worth it.

Better Pics (current)

2009-07-28T13:06:00.000-07:00

I borrowed a friend's camera and got some better photos to show Zippy's symptoms:

sweating (primarily neck and chest)

Medication Time- Keeping Costs Down

2009-07-17T12:16:00.000-07:00

So in order to buy Zippy's prescription, I needed a compounding pharmacy. Compounding is when a pharmacist mixes the dose of medication for the specific patient, and puts it into pill, liquid or other form. This makes sense when a 1200 pound horse is going to take a medication usually used by 150 pound people- the need for a different dose is apparent.

The price for Pergolide varies tremendously, and while it has come down substantially for equine doses, the difference between spending $60 a month and $38 a month matters to me. Heck, that difference pays for his electrolytes.

But time was of the essence, I wanted Zippy on his new medication and was not willing to order by mail (often cheaper). The cost for one month of pergolide through Woodinville Medical Center Compounding Pharmacy was $38.50 for the 1/2 mg dose. (This pharmacy does do mail order as well, so I am supplying their contact information).

Woodinville Medical Center
17000 140th Ave NE Unit E101, Woodinville, WA 98072
(425) 485-2900

Woodinville Med Center's price was highly competitive with other places I called, and best of all they were very kind and even hurried and put together his dose that day for me since he was just diagnosed. I promised I'd call ahead for future refills but I was really impressed that they cared about my horse enough to do a rush order.

Best of all when I drove out to get it, the pharmacist had to do a consult, since it was a new medication- and when he read the bottle that it was a horse medication he looked right at me and whinnied (as if translating the directions into in horse language). I'd never met a pharmacist with a sense of humor.

I opted for capsule form to keep the price down- it's always best to get the horse to take the entire capsule if you can, as it ensures he gets the full dose (per the pharmacist) but you can also break them open and mix in with food.

Zippy has so far eaten his doses whole along with grain (though he is not loving his new pellets- more on his feed changes next time). I have also had success hiding the capsules in a peice of apple, but that won't be practical long term since I board and dear Paco (who works at the barn) hardly has time to slice apples for me daily. I may need to find some other creative solution.

Ways to keep medicine costs down:

find a compounding pharmacy in your area, pick up instead of having it shipped
call around- pharmacy charges vary
use capsule form if possible, it's cheaper than flavored powder or flavored liquids
if your horse is on a consistent dose, order several months at a time and the cost goes down
negotiate- is there a compounding pharmacy near you that you use for other prescriptions? If so maybe they will be willing to work with you to keep the costs down
SmartPak also offers pretty competitive pricing, so if you already do your vitamins through them you may be able to combine orders and save. Their flavored powder version of pergolide for my dose was just 45 cents more expensive (not including 3.95 barn buddy shipping) so if you've got a fussy eater, it may be worth it.

As soon as I get Zippy to an ongoing dose (right now we are escalating monthly until symptoms resolve) I will write more on best prices. For now (my first few months) I'll probably go through Woodinville Pharmacy to save every dollar I can.

The Diagnosis

2009-07-16T08:26:00.000-07:00

Even his time in a pasture with a loafing shed (getting maximum daylight hours) was not causing Zippy to shed or adjust to the seasons, Patricia (dear friend and barn owner where I board) watched Zippy carefully, measuring his drinking and watching for frequency of urination since that is a symptom of Cushings and she was beginning to get concerned that he may have it.

His symptoms had been increasing over the past few weeks (starting in June). We both noticed he was lethargic but it's so hard to tell- is he lethargic because he sweats so much and is hot? Is he hot because of his longer coat (which never did get super long, but compared to a slick summer coat was 'long').

We had the vet out for some other horses at the farm on Monday 7/13 so we decided we'd have him take a look at Zippy as well just to let us know what he thought.

He felt it was Cushings, without a doubt. I admit, I was shocked. I felt guilty for not discovering it sooner (the symptoms had only been there a month) but Dr DeWard and Julie (his fiancee and assistant) were amazing.

He reviewed Zippy set of symptoms with me:

growth of fur- thick and wavy see second photo which shows wavy fur on neck

sweating, particularly on neck and chest (and head)- see top photo- it almost appears that I had rinsed him off, but that is his sweat pattern

lethargy (less energy than usual, sort of a disinterest in things that would normally interest him)

dermatitis between front legs and on chest, as well as on shins. one photo is a close up of his chest, he had some scaly spots that were losing hair. another pic shows pink spots on the fronts of his legs/shins, he was losing hair and skin on those.

frequent drinking and urination

Dr Deward said that those items individually, or a combination of a few was one thing, but all of them together was Cushings. We decided to go ahead with a blood test to confirm. He gave Zippy a shot of steroids with the intent of doing a blood draw the following day. From http://www.infovets.com/ the test is performed as follows:

"dexamethasone suppression test (DST) .... First, a blood sample is taken to establish a baseline on cortisol levels. Then, dexamethasone is administered and another blood test taken in 19-24 hours. Cortisol levels are normally elevated in horses with Cushing's disease. "

A normal horse's levels would be under 1.0, and Zippy's were at 2.3. My heart sank when I heard the diagnosis, it wasn't the potential expense that scared me it was the idea of my horse suffering and the fact that Cushing's is a pituitary tumor and while medication can control symptoms and relieve discomfort, tumors are unpredictable- would there be a day when he'd just start spiraling out of control with illness and have to be put down? It was time to really begin to weed through the information on Cushing's and get to know what we were fighting.

Electroyltes

2009-07-15T14:55:00.000-07:00

We started Zippy on Electrolytes before we even had the diagnosis back and it seemed to reduce how much he sweated and it definitely made him feel a bit better.

After much research, I chose SmartPak SmartLytes (their own brand) because they have no sugar and offer calcium, magnesium, and potassium and are the lowest cost electrolytes with these important vitamins/minerals (to be honest, they are lower cost than many other electrolytes that don't offer those additional supplements). Product description states:

"SmartLytes was carefully formulated to mimic the mineral losses in equine sweat. This cherry flavored powder is SUGAR FREE and contains Trimethylglycine (the B vitamin Betaine), to help cells maintain normal fluid levels. What a smart electrolyte!"

I was concerned that cherry flavor would be unappealing to Zippy, especially with no sugar added (thinking of those cherry vitamin c tablets I've tried that are so sour) but he loves his SmartLytes- the first bucket I gave him was after he'd already been drinking and he sniffed around and drank a lot of it, he loves the flavor.

I bought these in a bucket, the 58 day supply for $15.70 and couldn't be happier. My plan is to keep him on them at least through September (in October it begins to cool enough he should not need them, especially since his medication should kick in by then so he can be off them for winter. No need to over supplement, it's expensive and time consuming).

Home and Happy, but soon Downhill

2009-07-12T21:19:00.000-07:00

Zippy came home late March and immediately settled in. He had been in a stall 24/7 at training so getting out every day was a thrill- he rolled and played and really enjoyed himself. You can see him at right with his usual comical facial expression- he's covered in mud from rolling. This muddy pic is from late March.

He grew a bit more fur since he was now in colder temperatures (he'd been indoors and double blanketed) but still looked great and had his usual energy.

April and May passed without a hitch, though I was a bit surprised that the bit of extra hair hadn't blown out (shedded). I wasn't worried about it- I kind of expected him to get a bit rough at first.

By June I was worried, and I also was noticing that the hair on his neck was a bit wavy, and he was sweating quite a bit. But Cushings? No way, he's only 13 (turned 13 in May) and the Cushings horses I saw online looked like this (left) but Zippy wasn't all that hairy or old looking. No, it couldn't be Cushings.

As I asked friends, most said it would likely just be an 'ugly year' for him and I agreed. Surely this was a big adjustment from being indoors all the time. I didn't mind, he has a great personality and I had just purchased a new trailer and didn't have the funds to do any shows anyhow. I was just enjoying having such a sweet horse. He was doing great whenever we worked in the arena and was everything I'd hoped he'd be.

I began to notice some of the fur on his back looked 'fried' (dry) and again assumed this was an adjustment. After all, many people use fly sheets and such to protect their horse's coats from bleaching out- perhaps his fur wasn't used to sun exposure.

I continued to give him flax seed for his coat and groomed him regularly. His face was furry and when I went to clip his muzzle I couldn't believe the line it left. (see photo at left- you may have to click on it to see the larger version but there is a clear line from his nostril to his jaw where I clipped- unusual for June on any horse in Washington).

But overall Zippy remained strong and energetic still and looked good overall (below is another photo from June):

Figuring maybe his body was out of whack, I put him in a paddock that would allow him to get more daylight (as it had a stall outside that he would have free access to). He was starting to sweat every sunny day by mid-late June and it concerned me. The sweat was always on his neck and sometimes all over his head.

The sweating seemed to increase with the additional sunlight exposure, so I had him go back into his regular stall at night. I felt bad that he seemed more miserable when exposed to more sunlight (rather than shedding and adjusting as I had expected).

Background

2009-07-11T10:00:00.000-07:00

Some of you who read this blog know of me from my side business, http://www.cowgirly.net/ but for those of you who don't know me, allow me to introduce myself.

I am a pretty regular gal- I work hard and play hard, I love my husband and kids and my critters. I'll turn 40 this year (eek!) and I live in Western Washington. I have 2 cats, a dog, and a horse named Zippy who I board (I don't think my neighbors would approve of him being in my yard). I love to camp and garden and read and hang out with my family, and of course I love to ride.

I've ridden since I was in about kindergarten (though I was on horses earlier, that's when I took control of the reins) and loved every minute of it. My parents were divorced but incredibly supportive of my love for horses and worked very well together to allow me to ride, which I appreciate more than they'll ever know.

I work full time and volunteer on the Board of Directors for Serenity Equine Rescue. I volunteer at church and when I am not doing all that I enjoy doing horse designs on my computer for my little cafepress store. It brings in a little money that helps contribute to my horse expenses and it's something I can do after the family is tucked into bed at night.

Cowgirly is a nickname, I've been a cowgirl since my first Shetland pony and I love feminine things, so the combination of the words "cowgirl" and "girly" just felt right. I named my business after this and it's often my username.

My horse is Zippy, also known as APHA Zipity Do Rock. I bought him last September (08) and he was a very accomplished show horse, which is what I wanted- one that's been there and done that. I wanted to spend my horse time with an enjoyable horse who knows his cues so if I feel like heading out to a show I can, but I can also trust him on the trail. Zippy fit the bill and seemed to choose me immediately, he wasn't known for being friendly but after my test ride with him he rested his head on my shoulder and the trainer said she knew he'd chosen me. I felt lucky to get him- he'd gotten arena sour and had decided he was done showing. At 12 years old his days on the big circuit were over anyhow, so he was for sale.

I'll do a post sometime with some of his accomplishments and more about his bloodlines, he's worked hard his whole life. When I found him I knew he was the perfect horse for me- happy and healthy and ready for life as an adored, spoiled horse (who only occasionally would be asked to win a ribbon or two). It was perfect for him, after years at barns where he was stalled 24/7 and had little time to play and just be a horse.

He remained at the training barn until March and I stayed to learn his buttons and how to get him to do what I wanted. We bonded so well, I did lessons about 3 times a week before work and by the time we did our first schooling show in March we were ready to go home.

The schooling show went well but his mood turned partway through and he was very agitated- I'd never seen him like that. I assumed it was the arena sour situation and decided that the next show I took him to we'd do one class, have carrots and go home. In one class he even bucked when a horse approached from behind with a rider wearing jingle bobs. I was shocked that he reacted like that, it wasn't fear it was more like he was irritated.

In our last class as we were about to head to line, he slammed on the brakes and urinated. He didn't even wait until he got in line, it was like he couldn't hold it one second longer. I immediately reviewed the day in my head- he hadn't had a break where he'd been tied up and relaxed so maybe the mood was caused by having to urinate so badly. It seemed a bit dramatic, but he was much more relaxed and happy as soon as he was done. This show was morning only, so know that I did not work him from dawn until dusk, it was just a few hours- a pretty normal show day. I look back now (knowing about the frequent drinking and urinating in Cushinoid horses) and wonder if it was a sign. Or maybe he just had to pee...

Anyhow, we won some ribbons that day (yay!) and he came home to the farm where I board in Maple Valley.

I am fortunate to board at the home of a friend who takes amazing care of the horses, she runs a rescue as well and every horse on the farm gets individual attention daily. This is important for them mentally and physically, because she is able to identify potential illness early. Little did I know how important this would be to Zippy.

So that's how Zippy came into my life and came home to my barn.