Cushings tests

[lauren123]

Hello!!! Just wondering if someone can help!
There was a Communication error today at the vets. So when vet came down to see the boy they took blood. I was like ' Im Ready with the timer!'
She then said did i mean the SRH test (the one sox normally has) i said yes. Office people has got it wrong!

But it led to interesting chat in that. My friend was saying basically what bloods. Bloods are bloods. YO stated it was a different test. Friend was like doesnt he have the cushings test? I said yes but there is another one. So they said why bother with the other test then? I said obvs this other one it more accurate. Which led to the question. If the normal test stated sox was bordeline then does he even have cushings as surely that test would be enough? And if it isnt why use it if its not a reiable indicator?

I was stuck. Any ideas?

The boy sleepy after his teeth

 

[carthorse]

Because some horses are clearly symptomatic despite testing borderline and some vets won't prescribe without a positive test.

PPID is still relatively new as a diagnosed and treatable condition and there is a lot we need to learn about it, including why some horses throw false results with the acth test. But may tests for animals and people can show false results, it doesn't mean they have no value just that they can't be completely relied upon.

 

[Lollykay]

This ^^^^

I have a horse whose ACTH numbers were just one number over the high/normal in April, 2021. They were well within normal range in the Spring of 2019. The vet said no Prascend but wants to retest this horse this spring, when he retests my other horse who is on Prascend.

Smoochies to your fella - dental work is no fun, I don’t care who it is. That is a “you are not my friend ATM” look, if ever there was, lollol

PS. Does he stay in the stall? I had a horse (RIP Duke). who was a master at opening that style of latch. When he was in a boarding situation, the BO had to put three of those latches on his door, with the bottom latch being clear at the bottom. Good thing Duke was only 14.3H and couldn’t reach the bottom, lollol

 

[lauren123]

This ^^^^

I have a horse whose ACTH numbers were just one number over the high/normal in April, 2021. They were well within normal range in the Spring of 2019. The vet said no Prascend but wants to retest this horse this spring, when he retests my other horse who is on Prascend.

Smoochies to your fella - dental work is no fun, I don’t care who it is. That is a “you are not my friend ATM” look, if ever there was, lollol

PS. Does he stay in the stall? I had a horse (RIP Duke). who was a master at opening that style of latch. When he was in a boarding situation, the BO had to put three of those latches on his door, with the bottom latch being clear at the bottom. Good thing Duke was only 14.3H and couldn’t reach the bottom, lollol

Yeah i dont think he was happy. Certainly wasnt happy having no food and been tied up so he couldnt eat then choke!
We have the kick bolt at the bottom lol

 

[carthorse]

I've known a few who figured out that if they tapped the bottom of the door at the right frequency the kick bolt would flip open. One of them - not mine! - would then go round the yard and let others out! He was a Houdini though, it seemed anywhere he went he set about finding a way out and supposedly animal proof bolts weren't beyond him either, I used to wonder if his mouth had a hidden opposable thumb!! It wasn't safe but in the end the only way to keep him in a stable was to padlock it since he hated a grill that stopped him looking out and would stress badly.

 

[Mary Poppins]

I had the same question. Ben was tested for Cushings and the first test came back as borderline. The vet came back to the blood test which is supposed to be more accurate, and I wondered why they didn’t just do that from the start? It is more expensive which may be one factor. In the end it turned out that test was borderline as well so I was non the wiser! As it turns out he had a serious tooth problem which explained his odd symptoms, but I always wondered if he had the start of Cushings as well.

 

[Jessey]

The standard ACTH test is just less accurate, the TRH stim test is more accurate but also more expensive as it is actually 2 blood pulls plus a dose of hormone injected. It's like the difference in using a ruler with CM's marked on it, to one with MM's marked on it, the first is fine if its clearly way over/under, but you need the more accurate one if it's close to the mark.

 

[PePo]

P's results came back equivocal on both tests but have seen a huge improvement on a low dose of treatment.

The TRH stim test is more expensive & more fiddly - so I can see why they usually use the cheaper ACTH in the first instance when it might bring an obvious positive.

I presume P is metabolically more sensitive and just a small increase in ACTH was enough to trigger symptoms, which was then a domino effect on him.

I wouldn't rule out trial treatment for PPID if there are symptoms (even lesser known symptoms as P didn't display all of the obvious symptoms) even without a positive result, personally.

 

[carthorse]

I wouldn't rule it out either @PePo , but some vets are very difficult about this and it's a prescription only drug.

 

[PePo]

I wouldn't rule it out either @PePo , but some vets are very difficult about this and it's a prescription only drug.

Yes, that's true. I've not yet met an anti trial vet, but I'm sure they are out there! I think mine was glad I suggested a trial before them by the look of relief on their face

You can get herbal treatment too, which is very good IME.

 

[carthorse]

But doesn't the herbal stuff just, at best, control some of the symptoms? My understanding is that Prascend, if got early enough, can actually slow the rate at which the tumour grows. I'd also be wary of using anything herbal if I was wanting to test in case it confused the results.

I have had experience of vets not wanting to prescribe without tests. In Little Un's case I kicked up such a stink that she gave in - I felt we were rapidly running out of time and symptoms had come on extremely quickly, told her this and said we can test too but I wanted drugs now, In Jim's case I referred the vet to one of the senior partners who knew him and knew there was a very good reason we didn't do routine acth tests before renewing his prescription - it tended to play havoc with their staffing and even if, by some miracle, they managed to get a sample it wouldn't be from a calm horse at rest!

 

[Jessey]

Chaste berry is only effective in 33% of cases in studies, where prascend is near as dammit 100%. If it’s used and is controlling acth then it’s being effective so can be used with normal monitoring. There’s some question over both being used together because one is an agonist and the other an antagonist which means they work in different ways and could counteract each other.