cushings · senior horse

Fall 2017 Cushings Update

I haven’t done one of these in a while (in fact, almost exactly two years) because it’s been going overall pretty darn well, but I wanted to sit down and make these notes if only for my own reference later on.

Tristan was diagnosed with Cushings or PPID in the fall of 2014. He was started on 1g of Pergolide a day, and has continued on that since.

We have not tested his ACTH levels since 2015, in part because the vet does a regular visual assessment of him every few months. I ask her each time, and each time she says that absent any resurgent symptoms, it doesn’t make sense to spend money on new testing. So, I’ve held off.

He’s holding on the same levels of food he was in 2015: 1/4 quart of Blue Seal’s Carb Guard, and a daily vitamin/mineral ration balancer supplement. I took him off the SmartPak supplements and put him on Blue Seal’s Min-a-Vite, because the barn offered it as part of grain, and he handled the transition just fine and is doing just as well.

blurry-headed but in good condition

With the colder weather, he got a teensy bit ribby, but the barn adjusted his hay upward and he’s looking terrific. So now he gets free choice hay in turnout, and 5 flakes a day in his stall, spread over three meals. He’s still eating out of his Nibble Net to slow him down.

He’s grown a thicker winter coat this year, but I’m not sure I’d attribute that to Cushings; I think it’s going to be a bad winter. He hasn’t had any trouble shedding his coat out yet, so this spring will be the real test.

He is running a bit colder overall. I invested in some new blankets this year, a turnout sheet and a stable blanket with medium fill, to give him more options as we get colder and darker. I am holding in reserve the possibility of buying another new blanket as needed; potentially a heavyweight. We’ll see.

pretty good muscling, too!

Energy levels are pretty darn good, and his fitness is holding better than it has in some time. He’s in higher-level work than he’s ever been (which, I grant you, is not much) and he’s adapting and bearing up nicely. He’s overall cheerful and happy, too, which is the best part of everything.

So, three years of Cushings, and a healthy, happy horse.

physical fitness (horse) · senior horse

Balance

I’ve said many times that managing Tristan’s brain is harder than managing his body. His body is not exactly easy to manage either, but his brain? Well, he had a decade of looking out for himself, four years of wild roaming and then six of nothing but unreliable or neglectful humans. Only this year have we been a team for as long as he was solo.

He’ll never be a ride-every-day horse. That mostly works out for me: I don’t have a ride-every-day life. There’s a lot of gray in between that high-maintenance horse and a pasture puff, though, and I’ve struggled with finding the right balance in the moment. It keeps changing, and a lot of the changes now are directly tied to his 22 years of hard living.

pretty darn good right now

Right now, though? Knock wood, I’ve found a sweet spot. I’m balancing the hard 60 minute fitness rides with the 20 minute dressage intensives with the 30 minute longeing sessions with the 45 minute hacks – and the days off in between. He is really and truly a horse that’s happier and goes better when he’s had time to process and rest.

February was a great month for building on success in all areas, but at the end of last week I longed him and he was just not happy. So we backed off. He got two days in a row off for the first time since early January, and then he got a road hack on Sunday and his brain was already a bit better. I was on a roll with house work on Monday, so he got that off, too.

Tonight, we’ll ease back in with a light longeing session, and then tomorrow back in the saddle for some trot sets & fitness work. I’m working hard to make days off and light days conscious decisions that I make based on the horse in front of me, and it’s paying off in a big way.

dressage · senior horse

Little Snags

Oh, okay, not little snags. I haven’t been riding my horse terribly well lately. He hasn’t been cooperating either, so there’s that.

Right now, here’s one of our problems: cantering improves the trot. But he is not quite strong enough to hold himself well in the canter.

So I am left with, after a 15 minute walk warmup, shoving him through the trot, insisting on forward and through while begging for any semblance of softness. He is stiff and sore in his hind end, I know this; I am attempting to remedy this in other ways. But he is not so stiff and sore that he cannot do the things I am asking of him.

(This, I think, is the endless daily compromise of an older horse. He is sore and he is tired. But the ways to fix that involve more basic dressage. There is a lot of working through to get to the other side. He’s going to come out of his stall stiff no matter what; but he is a horse, and horses live in the moment, and he doesn’t believe me that after warming up his body will feel better, and that the daily work of simple dressage is keeping him healthier and more limber overall.)

Cantering: that helps. A lot. It gets him excited, it breaks up the tension in his back, and it is smoother and easier for him right of the bat.

Best of all is cantering forward on a loose rein, with me out of the saddle.

We cannot do that outside, not yet; though he is way better than he was earlier this summer, when he was bolting hell-bent for leather at the slightest provocation, he is still not what I would call reliable enough for a forward canter in half seat on a long rein. Bolting straight is one thing – bolting sideways is another.

When we are inside, it works, and it helps, but it’s summer in Vermont, and we don’t want to be inside.

So we canter in a more constrained manner, with a firm hand on the reins, and only occasionally do I feel secure enough to stand in my stirrups. Which lessens the effectiveness of a good long canter. Which in turn makes the trot work that much harder.

I tried to get away with just working up through the trot last night, and it was awful. I spent 40 minutes bullying him into softness, which is really not fun.Or good. Eventually he got there, and he got all the praise, and when he gave me a nice soft 20m circle in the trot we called it quits in the upper ring, and I made the mistake of picking at him a bit more in the lower ring.

But afterwards he was nosy and affectionate and sweet, so there’s that, at least.

adventures with the vet · senior horse

Next Steps (Literally): Investigating OsPhos & Other Biophosphonate Drugs

Bad news first: Tristan is still lame.

From there, it’s actually mostly good news.

He was first off last Monday/Tuesday. He got one gram of bute am + pm through Friday afternoon, and then on Monday I put him on the longe line.

He was definitely not comfortable but a) he worked out of most of it and b) it was much better.

I asked the barn manager to watch him with me, and her observations matched my own: he was acting almost like he had a stone bruise. That RF was short and sort of stabby, like he didn’t want it to rest on the ground for long.

He was much, much more willing to move forward than he was at this point last week, offering up a canter to the right several times when he flat-out refused last week.

So what’s next?

First step: one month of Previcox, an anti-inflammatory that will be much better on his stomach than bute would. That will help ease overall osteoarthritis symptoms and anything more specific going on in that RF. I’ll keep checking in to see how he goes.

My hunch, based what he presented yesterday, taking into account his history and the way he looked? I think he’s showing some soreness in his foot from the ongoing RF problems, because that foot is (apparently) always going to be more sensitive and weaker to any kind of problem. It’s always going to be thrushy, always going to trend toward abscesses, and always going to show sole bruises immediately. I think it’s some kind of sole bruise.

However, I also think he’s got some ongoing arthritis issues in both his hocks and that coffin/fetlock. He is on monthly Pentosan injections, and that has helped with his overall fluidity in terms of the cartilage, ligaments, and tendons, but I think we also need to add something to help with inflammation.

Again, if he were younger and in full work, we’d start joint injections. He’s not and he’s not. I said this to the barn manager last night, and she raised a new possibility.

OsPhos is a new drug specifically marketed for the treatment of navicular. It basically helps joints and bones that are remodeling due to arthritis or abnormality. It has a really promising research outlook, and works in similar ways to Tildren, a drug that’s been on the market for a bit longer.

For my purposes, the benefits are thusly: it is a system-wide joint support that is not quite as powerful as an intra-articular joint injection would be but at the same time tackles more joints at one time. It is delivered IM, and costs between $200-$300 a dose. (As opposed to $1,000 a dose for Tildren, and $500/joint for injections). Perhaps most importantly, our local best lameness vet is very familiar with it and has used it on several of the schoolhorses in the barn to excellent effect.

That said: it has drawbacks. Some of them are not so great. Because it’s such a new drug, there are some serious concerns about longterm consequences.

The most legitimate concern seems to me to be the question of how, exactly, biophosphonate drugs like OsPhos (and Tildren) remodel bone. They work by basically killing the things that remodel bone, preventing bad changes from happening – but also good changes from happening. Bone remodels throughout its entire life. Stopping that from happening prevents bony changes, but it also prevents the kind of bone density growth that’s important in strengthening. Do they create truly good, new, strong bone, or do they just make x-rays look better?

These are drugs that have been available for humans for some time now, and on the 10 year outlook there are reports of necrotic bone (particularly in the skull and jaw) and dramatically lower bone density. There are also reports of spontaneous fracture.There’s lots on the COTH forums; here’s one good thread.

On the one hand: that is scary as shit.

On the other hand: Tristan is in light dressage work and he is 20. He is not jumping or otherwise putting sport horse stress on his bones. Would helping him be more comfortable and keeping him in light work to keep him healthy be worth the tradeoff?

On the other other hand, at least some of his lameness issues in that RF are due to bone remodeling, so the biophosphonates would help in that way. But they’re also due to a lack of bone in that area, ie the carved-out portion of his coffin bone from the infection. So they might help one problem and worsen another.

I also don’t see any good outlook on how many times a horse has to be dosed before the problems crop up – or before they are sound. “It depends” is always the answer.

There’s also the possibility, mentioned by a few people, of doing a regional perfusion of the problematic limb with Tildren. That would localize the treatment to the problematic RF, but it would also do nothing for his hocks and any other overall osteoarthritis he’s dealing with.

Anyway.

Lots to think about.

Has anyone out there used Tildren or similar drugs?

senior horse

When is enough, enough and what is too far?

I am somewhere in between deeply morose and utterly pissed off at life right now. Yesterday started with a $373 vet bill for the dog, who has begun peeing everywhere and who got a full barrage of tests to make sure she didn’t have a UTI, or a problem with her kidney function, or who even knows. Then problems with my bank, work fuckery, the computer I just got $180 worth of repairs done on refusing to work at ALL because the repair guy wiped the drivers…

It ended with me getting to the barn with plans for 35 minutes of dressage schooling…and Tristan was lame.

Not lame-lame. But…not right. Stepping off his RF a little too fast, not using himself right. Then he wouldn’t canter right – Sunday I thought that might be because of my use of the bareback pad. He was deeply reluctant to do it on the longe after I jumped off and put him through his paces. He didn’t want to land on that RF.

So I gave him bute in his PM grain, he’ll get more today in his AM grain, and we’ll see what he looks like tonight. It could be a momentary thing. It could be a more worrying long-term thing. All I know is I’ve been chasing problems in this foot for 3.5 years now and I am so fucking tired. I just wanted to ride my horse.

I am in a place I have been before, and have been increasingly the last few months. What is the right next step? I can keep chasing things with his foot, and obviously I will do everything I can to keep him happy and comfortable – and he is by no means uncomfortable, he is just not sound enough for work at the moment.

If he were 14, I wouldn’t hesitate – we’d inject that coffin joint, and probably his hocks, too. But he’s not 14 anymore. He’s 20, and he’s not in full work, and which path is the best? Basic maintenance and just enough work to keep him stretched out and comfortable, or joint injections and a stepped-up maintenance plan to keep him in work?

I still love riding my horse. I still need that release. I’m not ready to let go of that, but I’m also deeply reluctant to commit to thousands of dollars in maintenance. I don’t know what the answer is, but I do know that we’re getting closer and closer to decision time.

at least he’s cute, right?

senior horse · winter

Fall 2015 Cushings Update

So, continuing on in our Cushings journey.

Previously: Tristan’s fall 2014 ACTH levels were back within normal range, and he had a good spring and summer.

My horse is sad because jump standards are not part of his diet.
Tris has not had a ton of work in these past weeks; every time I think my work schedule is about to even out, it ramps up again. The house has been taking the lion’s share of my mental and physical energy. I’m getting him worked maybe 3x a week in light work. So his physical condition from exercise is not terrific.
Overall, though, he’s in great shape as we head into the winter. Last week, on November 4, he got an updated flu/rhino vaccine, an overall physical, and his vet pulled blood to run another ACTH level so we could make sure we were on track.
She was pleased with his overall condition and demeanor, and reported that he tolerated her kissing his nose several times. Good pony. ❤
Last night, we got his ACTH levels back: 33.7 pg/mL, which falls within the normal range of 9-35. It’s a smidge on the high normal side, but the vet was not concerned, and it’s definitely still within a safe range.
So: good boy, Tris!
For reference and future blog posts: he is down to 1/4 quart of Blue Seal’s Carb Guard AM + PM, still on what grass is left, and 3-4 flakes of hay. He also gets a ration balancing vitamin & mineral supplement and a hoof supplement. He is maintaining a healthy weight just fine on that. He’s started his blanket rotation for the season – depending on overnight temps, he’s in either a stable sheet, turnout sheet, or slightly thicker honeycomb sheet. He seems more comfortable with the temperature swings this year, knock wood.
senior horse

On Loving an Older Horse

Tristan turned 20 years old this spring.

He spent the first 4 years of his life wild, and the next year in a government holding pen. The four years after that were in his first adopter’s home, from which he was seized twice for abuse and neglect after several other horses on the property died. The second time was permanent.

He then spent a year and a half at a rescue, and then he became mine. I’ve had him for almost ten years now, almost as long as he had on his own.

I give you that background to say that he has had a relatively tumultuous and varied life, and also that only half of it was spent with positive human interaction.

It feels like in the last year or two, his physical problems are starting to cascade. Nothing bad, but for the first five years I owned him I think I had two emergency vet calls.

In the last few years, it seems like I’m always dealing with something. He’s a little off because he tweaked an ankle. A week and a half ago, he scalped his foot. He’s getting more and more prone to White Line Disease. Last night, I opened his stall door to find this.

not helpful.
None of these are really new problems, or dire problems.
(Insert standard eye warning: I have been dealing with swollen/goopy eyes on Tristan for nearly the entire 10 years I have owned him, and have well over a dozen consultations with vets under my belt in relation to his specific challenges. If your horse is not prone to eye problems, and he looks like this, CALL THE VET. NOW. Do not play waiting games with eyes.)

So I picked out and treated his feet. I checked the scab on his heel. I flushed his eye with saline and treated it with his opthalmic antibiotics. Every day, it’s something.

Some of this is his Cushings, making his overall immune system more susceptible to all these little things.

A lot of it is age.

I was wondering, last night, as I drove home: is this the emotional burden of older horses that no one talks about? I know that there are young horses who do stupid things to themselves on the regular, but it always feels different to me. Is this the slow unraveling, the wearing down of your heart, the thousand tiny pricks so that you grow used to the idea of physical challenges involving your horse?

I should clarify: none of his problems are bad, and they are all a long way from his heart. He is overall a really healthy horse. But last night, finding that eye, it just felt like the slow drips of water wearing down our more carefree days.

I still can’t imagine a life without Tristan, but I am beginning to feel, maybe a little bit, how the preparation of many smaller problems wears you down, helps you deal in tiny small ways with sadness, so that when the ultimate moment comes, it might hurt a little less.