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Current Management Recommendations for Equine Pituitary Pars Intermedia Dysfunction (Formerly Equine Cushings)

By Ashley Phelps, DVM

Dr. Ashley Phelps has more than 10 years of field experience as an equine veterinarian. She holds her Doctorate of Veterinarian Medicine from Mississippi State University and in her spare time enjoys doting on her horse, Ava.

Equine Pituitary Pars Intermedia Dysfunction (PPID) is commonly diagnosed in horses older than 15 years of age, although it can be found in horses as young as 7 years of age. Clinical signs are due to an overproduction of hormones from the pituitary gland as it enlarges.

PPID equine tipClinical signs can vary due to the stage of the disease. The most commonly associated sign of PPID in horses is long, curly hair that does not shed properly (hirsuitism). Other signs include excessive drinking, excessive urination, laminitis, lethargy, repeat infections due to immune suppression, excessive sweating, ravenous appetite, loss of muscle mass, bulging eyes due to abnormal distribution to the fat behind the eye, and infertility. PPID horses may also be insulin resistant, which is the failure of tissues to respond to insulin. A blood test, before and after administration of Kayo Light Corn syrup, measuring insulin in the blood can determine if your horse is insulin resistant. Diagnosis of PPID is usually through various blood tests. The most commonly used test for diagnosis and monitoring include combined baseline test for endogenous ACTH and Insulin, the TRH-response test, and the Dexamethasone-suppression test measuring cortisol.

Therapy rarely results in resolution or remission of PPID and is typically lifelong to improve the quality of life of horses diagnosed with PPID. Therapy and other management recommendations include:

1. Pergolide: The FDA-approved Pergolide, Prascend, is the medication of choice in the management of PPID in horses. Often, owners will use other forms of pergolide other than the FDA-approved version. It is important to understand that the FDA-approved product is the product that has been tested for safety and effectiveness. Pergolide is usually recommend for the life of your horse once diagnosed. Your veterinarian will repeat blood work 1-2 months after initiating medication of pergolide to determine the proper dose for your horse. Repeat blood work will be necessary to ensure proper dosing. Typically, clinic signs improve after 2 months of treatment with pergolide.

2. Cyproheptadine: Some studies indicate that is marginally effective in controlling clinical signs, but results when using this drug are mixed.

3. Complete Wellness Plan: Maintaining a complete wellness plan is essential for horses diagnosed with PPID. It is important to have PPID horses on a strong preventive care plan due to due to the immune suppression of PPID. Vaccinations, deworming, routine dental care and routine farrier work are necessary to keeping PPID horses well. Clipping the long hair during summer months will also often be necessary as PPID horse often do not shed properly. In addition, blanketing during the winter may be necessary due to the decrease body condition.

4. Dietary Changes: Often your veterinarian will recommend a change in diet for your horse after diagnosis. The dietary recommendations will depend on numerous factors including body condition, presence of laminitis, and presence of insulin resistance.

5. Laminitis management: Many horses diagnosed with PPID will also have laminits. Your veterinarian may recommend corrective shoes and trimming, pain medication, or dietary changes if laminitis is present.

Management of PPID is lifelong but can be rewarding. Working with your veterinarian and farrier can provide many wonderful years with your horse.

References:
Frank N. Managing Equine Metabolic Syndrome. Compend Contin Educ Prac Vet 2007
Zinnel, Dana; Management of Equine Cushing's Disease and Equine Metabolic Syndrome. AAEP Website

By Trish Broersma, member of PATH Intl. Equine Welfare Committee

Say you attend a conference and hear about inspiring new possibilities for your work back home. You eagerly share ideas with your colleagues, clients, board members, etc. Some raise doubts right away while others are eager to find a way to develop these exciting new directions.

Pretty soon, it gets complicated. Maybe a core group is totally on board and a split develops between those of you for and against these changes. Maybe you realize that your board is all about making money and you are all about improved quality of life for your horses. Maybe you’ve decided to incorporate groundwork lessons into your mounted lessons but the parents question why their child didn’t get a riding lesson today. You get discouraged and are tempted to go back to previous ways of doing things, or you get cranky about those who are not fully on board.

Welcome to the roller coaster of living in the 21st century where the rapid availability of new information catalyzes change which in turn affects your fundamental practices. Paradigm shifts are taking place. Your eyes are opened to exciting opportunities and you realize the very ground of your being is experiencing a paradigm shift. It’s easy to feel unprepared for the complexities of the challenges before you.

Here are a few tips that may be helpful in riding the rough terrain of changing paradigms:

Recognize and honor the herd dynamic

This is what forms the foundation of our equine partners’ lives, and it’s important to recognize its wider wisdom for us: we are part of a larger herd that is made up of you, the horses, the people, everyone in your community – even the ones who may not be enthusiastic about your paradigm shift. It includes unexpected connections, too, according to validating science.

Engage in the Long-Haul

Realize that to accomplish a paradigm shift effectively, you are engaging in an ongoing, long-term educational endeavor for your entire community: horses, students, parents, volunteers, board members, including yourself as you grow into a new way of being. Let go of your expectations for quick results.

Develop Creative Ways to Educate Everyone

Create frequent, ongoing training and practice opportunities for staff and volunteers:

Monthly or weekly meetings with discussions and experiences with the horses that encourage everyone to grow.

Give your board of directors personal experiences of what’s new:

Design and offer half day or full days with the horses for them to personally experience the power of what’s new.

Ongoing education for clients:

Include new approaches in the written materials that parents and new clients receive when they sign up.

Feature stories and photos demonstrating what’s new in regular newsletters, monthly at least.

Harness the power of the internet for reaching widening circles of people:

Share videos and written material that demonstrates what’s new, via email and social media, movie nights, etc. on a regular basis.

Feature fresh material on your website regularly.

Nurture Your Own Vision

Keep yourself on track by posting inspiring quotes where you will see them daily. Find an item that visually holds the vision for change: a pendant to wear, a photo in your office, a precious stone in your pocket, etc.

Find a motto that brings you back to focus, like “Don't ask what the world needs. Ask what makes you come alive and go do it, because what the world needs is people who have come alive.”

Read the book Braving the Wilderness: The Quest for True Belonging, by Brene Brown, a handbook for those who pioneer the new.

Stay in touch with other colleagues who hold the same vision

Committees, conferences, webinars, phone calls, etc. to renew the herd connection.

Learn the Valuable Life Lessons of Living with Chaos

  • It is not messy happenstance.
  • “It is an underlying interconnectedness that exists in apparently random events. Chaos science focuses on hidden patterns, nuance, the ‘sensitivity’ of things, and the ‘rules’ for how the unpredictable leads to the new.”
  • Nature uses chaos to create something new and you can, too.

Read Seven Life Lessons of Chaos, John Briggs and F David Peat

If you are like me, there is nothing more exhilarating than successfully trekking with friends through the rough terrain of a new trail with my horse who enjoys it as much as I do. You can claim the power of this metaphor for the adventure of your day to day life.

 

 

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