Jess' vet visit

[Jessey]

Jess's diagnosis with Cushings was 7 years ago now, every time we did a basic ACTH test she came back borderline or negative, but with drugs improved but then the last couple of winters she had what were previously considered ailments tied to her cushings, even though she was medicated. A few months ago I did a review of Jess' case history with Dr Ellenor Kellon on ECIR, and after a chat with my vet we decided to retest her with the more sensitive TRH stimulation test. I opted not to do it in the autumn as it is less accurate then, so have been waiting.

Jess has been very 'fresh' the last couple of months, possibly just winter full of herself but she's pulling like a damn ox and has started yanking the reins out of my hands and over the weekend I realized that's what she did last year, and it all stopped when she got her teeth done in April. So although Jabs etc. weren't due until March I pulled the whole lot forward and had the vet out yesterday, luckily I had already taken Jess off Prascend on 13th December to give it time to clear her system before testing.

Teeth appeared good at first glance according to vet, but once she started working on them she said the bottom, inside edges were actually pretty sharp but we had caught it before ulceration which is good. But she also found some food wadded on one tooth, a little between (not diastema when she got that out of the way) but mostly food impacted on the grinding surface which she couldn't get out. We are going to recheck in a couple of months when the boys are due and if needs be she will go into the horsepital for heavier sedation and sharper things to be stuck in her mouth to get it out as it could be infundibulum caries (cavity in the grinding surface) hiding under there and she might need a filling for that have you heard such a thing or it could just be one of those passing things.

So my poor pony was a pin cushion yesterday, 1 ACTH, 2 for regular blood panel, 1 TRH, another ACTH, and a flu jab to top it off, poor lass. I am anxiously waiting for the results, I should have them today.

On the positive side, Jess' bad breathing from the summer that the emergency vet said was RAO, my vet listened and said it must have been an allergy as she hears absolutely nothing now to indicate there was ever a problem And the lump on her knee from spring that was possibly arthritis, is indeed gone and she concurs it was likely Dan kicking her.

 

[domane]

Well that all sounds fab! Do let us know her blood results....although she sounds in fine fettle!!

 

[Trewsers]

I'm interested in the filling. Storm gets "filling" but only in the gaps. To give the gum a chance to rest. I read about fillings a few years ago but didn't know they had started being done. So why a hospital visit? Would normal sedation not cover it? Just being noseyI see heavier sedation but how do they do this? Would it be full on lying down?

 

[Jessey]

I'm interested in the filling. Storm gets "filling" but only in the gaps. To give the gum a chance to rest. I read about fillings a few years ago but didn't know they had started being done. So why a hospital visit? Would normal sedation not cover it? Just being noseyI see heavier sedation but how do they do this? Would it be full on lying down?

Nope not a general, just a very heavy standing sedation and putting in a head sling so there is very little chance of them moving whilst using very sharp things in their mouth I guess they also need machines to do a filling which they don't have in the field, TBH it's so close and part of my normal practice, so its almost just as easy to take her in than to mess about with another field visit and them lugging out machines, plus I can see the tooth specialist there who doesn't do field visits, and it's going to cost about the same either way. This is a more permanent thing than what I have heard you describe Storm as having, it's a one off that should stay in until it wears away with the tooth.

 

[Trewsers]

Nope not a general, just a very heavy standing sedation and putting in a head sling so there is very little chance of them moving whilst using very sharp things in their mouth I guess they also need machines to do a filling which they don't have in the field, TBH it's so close and part of my normal practice, so its almost just as easy to take her in than to mess about with another field visit and them lugging out machines, plus I can see the tooth specialist there who doesn't do field visits, and it's going to cost about the same either way. This is a more permanent thing than what I have heard you describe Storm as having, it's a one off that should stay in until it wears away with the tooth.

Ah right. Yes it does sound permanent. The filler we have is lucky to stop in place for a few days. It's really just to give the gum healing period. It depends on the gum gap shape too. We have on which stays in for weeks on end due to it being tapered a certain way
And another that comes out the day after. But what you describes sounds almost like a human filling?

 

[Trewsers]

I googled (always curious on their teeth, well, human ones too). There was several vet papers. So what you describe I read that they had done some studies on the why - I only skim read it tbh. It mentioned concentrates / feed but I got the impression the study was quite small? Low prevelance in the South West. Wonder if it's acid in soil / grass that has some bearing???

 

[Jessey]

I googled (always curious on their teeth, well, human ones too). There was several vet papers. So what you describe I read that they had done some studies on the why - I only skim read it tbh. It mentioned concentrates / feed but I got the impression the study was quite small? Low prevelance in the South West. Wonder if it's acid in soil / grass that has some bearing???

I was reading those last night, there was also one in Sweden where the bacteria present was not present in horses without it, and wasn't present at all before 2000, they aren't sure what changed. Jess doesn't really get much in the way of concentrates, she's been on a balancer for the last couple of years but most of her life she just got a bit of alfa chaff and a powdered supp. Most of the studies seemed to suggest that most cases are from blood supply being compromised during development of the teeth causing an area deep in the tooth to be less solid.

 

[Jessey]

Results are in, I've been trying to digest it for a couple of hours, I'm happy but confused.

Shes tested at 10 before the TRH when below 27.2 is normal, then 34.7 after the acth when below 100 is normal. This is a clearly negative result.

This means Jess does not have cushings and her symptoms put down to it are from something else her borderline positive tests could have been altered by stress or handling of the samples and her positive reaction to the drugs coincidental or it did something not yet understood.

 

[Bodshi]

Wow that is pretty mind blowing. So where does that leave you? How can you find out what caused her borderline ACTH results? I seem to remember that she was suffering repeated abscesses which resolved once you put her on Prascend? No wonder you’re confused! It is a happy result though

 

[Jessey]

Wow that is pretty mind blowing. So where does that leave you? How can you find out what caused her borderline ACTH results? I seem to remember that she was suffering repeated abscesses which resolved once you put her on Prascend? No wonder you’re confused! It is a happy result though

Yep, mind totally blown.
She gets footy on much grass and hay with rye in it, sweats like a pig at the drop of a hat and drinks/pee's like no tomorrow, also gets weird 'mud fever' normally at odd times of year which can start in odd places, like on her knee/hock/face that then takes months to clear and she's lacking topline. Then her sudden onset respiratory issue this summer.
The abscesses and big bouts of lameness may or may not have been to do with it too, I think it's easy when they have PPID to blame things on that, but going back on Prascend didn't completely time in with resolution of those (I noticed that when I put together the timeline for ECIR), it was a year later (which tied in with when I stopped using the farrier), though in that year there seemed to be less and the MF she'd had for months resolved in 5 days of starting prascend.
There's no way to tell what caused the borderline results, stress will raise ACTH in a normal horse, as will pain, and if the samples aren't managed properly that can skew it, all borderlines were with my old practice and they sent the samples out to be tested, so more chance of something going wrong I guess. Insulin was tested previously (the EMS marker) and the last few times has been exceptionally low.
The plan of attack for now is to continue with current management because it's working for the most part, and see how she goes unmedicated. The vet did talk about how they know so little about the gut and how it processes things and allergies, but basically they don't have any obvious suggestion as to why she is like it, but if it can't be managed satisfactorily then we can think about looking for more off-the-wall explanations. Its also possible that she is one of the odd PPID cases which only test positive during the seasonal rise, which they also don't understand.