Bad News

3/2/2020

Speedy and I just can't catch a break. On Thursday, Dr. Tolley called with the results of Speedy's most recent ACTH results. For those who are new here, Speedy has Cushing's Disease. Retesting the ACTH levels can indicate whether the disease is being controlled by medication or not. I wrote a Cushing's Tutorial here. I am not a vet, so take the information with a grain of salt. In short, Speedy's ACTH levels didn't fall as we had hoped; neither did they remain where they were. Oh, no. Instead, his have risen 239%.

In January of 2019, multiple abscesses in quick succession screamed red flag to my vet, especially since Speedy had never before abscessed and he was also quickly approaching his 15th birthday. Dr. Tolley ordered Speedy's first ACTH test. The results came back at only slightly elevated with a score of 56. While low, it was still too high for mid-winter, so Speedy was started on 1 mg of pergolide daily.

Throughout the rest of the winter and spring, things went well. In early August, he developed another abscess, and in November another one. And of course, we had yet a third one in mid-February. Speedy's still recovering from that one. It would seem that the Prascend was working through the first half of the year but not so much in the second.

November's abscess.

I guess the good news is we now have an explanation for why the abscesses continued. The only thing we can do is increase Speedy's daily dose of pergolide from 1mg to 2. Prascend, the brand name for pergolide, isn't cheap though. I pay $2.13 per pill, and before you tell me I can get it slightly cheaper, I am aware of that.

I choose to order it through my veterinarian's online pharmacy because I don't have to do anything except change the AutoShip date when needed. Well, that and provide my credit card. My vet takes care of everything else. It's convenient, and for the $8.00 a box I might save by ordering through Allivet, I'll stick with my vet's pharmacy.

Let's be honest here; $4.23 per day is a lot of money. That's $29.61 a week or $131.13 a month. Even scarier, it's a whopping $1,543.95 a year. I can't afford more. Maybe it's more honest to say I WON'T afford more. It breaks my heart to say it, but at some point, the price of a treatment is more than I am willing to spend. In June, we'll test his ACTH levels again. This test will tell us if his Cushing's Disease is under control or not.

While it kills me to say this, if his numbers have risen even more, I can't justify spending $200 a month on three pills a day. I am willing to do a lot for my horses, but at some point, I'm just going to have to take a step back and let nature run its course. Will that be easy to do? Oh my gosh, no! It will break my heart.

He still likes to goof around though!

For now, we're taking it one day at a time.

Laura link

3/2/2020 05:35:54 am

Oh no... :-( I hope the increased dose helps him. And what a shame it is so pricy...

AMacG

3/2/2020 05:58:34 am

Huh! Weird... Almost like somebody told you recently that repeated abscessing in a PPID horse means that it isn't controlled, and it isn't normal.

Megan K link

3/2/2020 06:08:27 am

I mean, you'll probably just have to move some money from your show budget to pay for his prascend. You won't be able to show anyway if he isn't treated so that'll free up some cash.

Sorry for the less than positive news! But given the number of abscesses he's suffered I'm not really surprised. There's a blogger (Alli at Ponytude) who is a really excellent example of someone killing it in dressage with a horse that has Cushings. And he will be so much happier and in so much less pain with the correct dosage to manage his condition. So there is hope!!

Jamie

3/2/2020 06:32:07 am

Ugh, I'm sorry.. fingers crossed that the double dose will get it under control!

Dom

3/2/2020 06:35:16 am

My dog is on $6 of pills a day. Her job is literally to sit on the couch. I suspect I am about three tax brackets down from you. But feel free to kill your horse over a "whopping" $1500 a year. How much have you been spending to thump around on his back and earn your precious bronze scores FOR HIM?!? I try so hard not to leave comments like this but you really are an asshole.

Mia

3/2/2020 10:36:54 am

"Thump"?? Really? You went there? "Precious bronze scores"? Seriously?!

How about grow up. And if you really can't suppress the flaming asshole, then DON'T READ HER BLOG!

JFC, if this were my blog, you'd be blocked and marked as spam before the page stopped loading. The only thing you've accomplished is proving you're an ass.

Kathy link

3/2/2020 01:46:00 pm

Well said!!

3/2/2020 11:32:10 am

If you don’t like Karen or her blog, quit reading it. As for the asshole comment, it takes one to know one, Bucko.

Carol Holm link

3/2/2020 06:39:36 am

You don't have to publish my comment . I'm surprised at how unsupportive some of these comments are. What ever decision you make and how you come to each decision regarding Speedys care I know you will go thru a thoughtful decision process. Horses are a expensive luxury . It is our duty and our privilege to provide a caring kind home , and a loving end to their lives . You are laying yourself open to the world with your journey and deserve the respect and title of Horse person . Best Regards ,

Jan link

3/2/2020 07:14:39 am

I spend quite a bit more than $4.50 a day in supplements to make sure my big guy is feeling his best- gut, joint, muscle, vitamin. It's paying off because his feet and general appearance have improved greatly in the last 6 months. Horses are expensive, especially when you're trying to get into the mid levels of dressage. I've restarted my dressage journey twice now from 3rd level, so I get that it's frustrating. I think basing this decision on cost is ridiculous, because in reality you'll be adding $777.45 per year, which is the cost of a weekend or two of rated shows. You won't be showing without a 3rd pill if it comes to it, so pull from your show budget and go to fewer shows. Where the decision should come from is, "how much quality of life does a horse needing 3 prascend pills a day have?" In theory, those 3 pills should take care of it and he'll be happy and sound and you can keep enjoying him. We all know that's not quite true of the disease, so I think that kind of thing is where you need to base your decision. It shouldn't be based on money when you still have disposable income to go to shows.

3/2/2020 07:49:05 am

lots of mean comments, i hate that the internet allows people to say things they wouldn't say to your face. There's nothing wrong with your thoughts and intent. You obviously love your horse, and he's showing a downward trend. I remember the most important piece of advice i ever got - it's always better to euthanize too early than too late. I've had to do it, it was peaceful for them, and i have no regrets.

Mel

3/2/2020 09:15:22 am

Karen- I’m a vet. I watch and help my owner’s make difficult decisions all the time. Despite the vocal trolls you’ve gathered with this post, this is something only you, with advice from you vet, can decide. 90% of clients have financial issues with vet care because overall pet health care is not subsidized by insurance. There is a lot of judging going on here from people that are no better and no worse. Everyone has to make choices in life and the upshot is he is your horse. The haters are going to hate. Don’t let them influence you. All I tell my owners is do the best you can within your limits.
This disease sucks. I fought the fight with one of my boys.

emma link

3/2/2020 09:20:02 am

i'm sorry to hear that Speedy's medication may end up exceeding your available budget. here's hoping that he stabilizes and doesn't require any more dosage increases!

last year i faced a financial reckoning too and had to really reevaluate my total spending habits - including line by line horse spending. seems like you've actually already done that work with your "horses are expensive" series. i went back and reread some of them - like in december 2019 where you itemized $189 on browbands, or july 2019 where you itemized $1K+ on lessons and shows alone. i might be misreading or misunderstanding (and didn't read any of the other summaries so idk the full story), but it seems like almost the full cost of Speedy's maintenance treatment could be covered by sacrificing one show per year and some shopping.

3/2/2020 09:43:45 am

This, 100%. There is a big difference between not being able to afford treatment, even if the alternative is euthanasia, and not wanting to make sacrifices. I'm all for euthanizing because budget restricts quality of life. But the change in tone from "I owe this horse so much, look at my new truck, I love my pony and would do anything for him" to, and I quote, "I can't afford more. Maybe it's more honest to say I WON'T afford more. It breaks my heart to say it, but at some point, the price of a treatment is more than I am willing to spend", left me with whiplash and got my hackles up. I had to euthanize my heart horse at 16 because we were actually out of treatment options. If $1500 a year would have saved him, I would have done it, even though it's more than I have in my bank account at any given moment. This post actually turned my stomach. And you bet your ass I'd say this to someone's face if I saw it happening in person. It's hard to stay polite when someone puts commenters on blast for polite and correct suggestions time and time again. If I'm gonna get accused of being rude anyway, might as well stop tip toeing around it.

3/2/2020 09:54:40 am

Reading these comments all I can say is wow. Listen to your vet and your heart and the horse as those are who matter in the situation. Everyone else can go screw.

Above all else, always be kind. There are many who still need this lesson.

Calm, Forward, Straight link

3/2/2020 11:19:17 am

At my farm, the animal health care budget regularly exceeds the human version. By a lot. And let's not even talk about dental care, which the critters have but I don't.

Since I have taken responsibility for these animal's lives - especially Val who has many costly health issues - the order of priority is they get what they need and I find a way to pay for it. They don't owe me anything. I owe them. I have an insurance policy for Val that will pay for a (cushy) retirement home if something happens to me, or his health needs require.

Many people have to make heart rending decisions about giving up or euthanizing their animals because there is literally no money to solve the problem. Much different from <i>there is money but I don't want to spend it.</i>

Not sure if you considered how what you wrote sounded when read by someone else, and having followed your blog for a long time - I know you love your animals. Others have made good budgetary suggestions that sound like a solution to the Prascend issue - just hope that once medicated properly, his quality of life will allow for the comfy retirement he has more than earned.

3/2/2020 01:31:32 pm

I agree 100% that it's how the post comes across (I have the funds but won't spend them), because at some point, yes, it's appropriate to stop putting money into vet bills, and yes, that point is probably 3 prascend pills because isn't that above the max recommended dose anyway? I know she loves her animals, and my heart will ache for her when she has to make that decision, because it's a horrible decision. I've had to make the same terrible decision for a 2 year old that no amount of money could fix. I feel for her, but she phrased it badly here.

SarahW

3/2/2020 11:44:51 am

Hey Lady.

You are definitely in a difficult spot and I commend you for thinking through it thoroughly and thoughtfully. Managing an animal's welfare is not for the faint of heart - neither is publishing those thoughts for all to hear. Your money plans are YOUR money plans. Your animal welfare plans are YOUR animal welfare plans (so long as they are not harmful to the animal but never have I gotten the impression you are less than absolutely diligent to their health and welfare!) and you are not one to take a casual and thoughtless approach to Speedy and Izzy's welfare. What I hear is a lot of concern, strategic thinking, agony over care, and thoughtful thinking toward the future.

This is clearly hitting on a deeply a personal AND TRAGIC topic - we've all faced horrible and heartbreaking situations that cannot be blanketed across everyone else's experiences. My takeaway is that we all need to plan for the future and our animals' health/welfare is personal and at the top of the priority list. As it should be.

We won't have to live with the decisions you will need to make, only you will. And vice versa.

I don't think these commentors are truly mad at you; this is triggering the heartbreak we've faced in the past in similar situations where we were hopeless for a better outcome. Don't let their unique and deeply personal experiences color your own unique and deeply personal experience.

Nat D link

3/2/2020 02:03:54 pm

Im so sorry. Sorry that your horse has cushings, sorry that the medication isn’t working, sorry that you have been so criticized for sharing your doubt with us. Horses get expensive, and there is always so much uncertainty about diagnosis and prognosis. Ive certainly dealt with multiple lameness issues in the past and always wondering if I should do more, or just stop.

While I didn't react to the daily price increase the same as you, I understand the doubt. Everyone has a different threshold. Dont take it personally.

I have appreciated your posts on Horses are Expensive, and perhaps it might help you to add a simple financial “Return on Investment” calculation. Of course it means you have to subtract your heart and love when you do this. But you might also consider what the cost and investment in time would be to restart a new “speedy” or to purchase a third level horse ready to go right now. Of course that assumes that you want a second horse and are not just content with the single horse ownership of Izzy.

I think you might find that you have already invested much in Speedy as of today and while not falling trapped by the sunk cost fallacy, it might be a worthwhile investment to increase your operating expenses to extend the enjoyment of your time together.

All this with the caveat that our horses are much more than simple investments and that we all understand how much heart and love you pour into this wonderful talented not-so-speedy dressage star.

Moe

3/2/2020 03:43:08 pm

I can’t believe all of you making negative comments. I don’t know Karen personally, but I’ve read her blog for years. I’m relatively certain that when she talks about the financial aspect of keeping Speedy healthy she has already crunched the numbers and already cut out the extras like shows and various tack items. She has already said she will go up to the next dose and evaluate from there after his next blood check.

None of us express ourselves well when our emotions are involved and I believe any thing people are reading into her words is just that. Something YOU read into her words. She’s expressing her heart to us, be kind or say nothing. “If you can’t say somethin’ nice, don’t say nothin’ at all.”

Karen, I know you will do the absolute best you can for Speedy. Really for both boys. I’m sorry you have to deal with the people saying hateful things. I’m sending you and the boys all the love and healing energy in the world.

Cheryl

3/2/2020 10:01:39 pm

Yes, what Moe said! Exactly what I was thinking but Moe said it better. I am also shocked by the antagonistic comments. I understand all too well about making difficult decisions about animal health and having to deal with finances as a limiting factor. It sucks.

Karen, you have shown repeatedly that you care deeply about your horses' wellbeing and I know you will continue to do so. Speedy is in good hands.

Joel

3/2/2020 10:28:45 pm

Humanely euthanizing a horse should always be an option. I do not envy your position.

Janet

3/3/2020 05:57:09 am

I have only recently started to read your blog and appreciate your honesty in talking about a difficult issue. I don't understand why people who disagree feel that they must disagreeable in the process. I have a 25 year old on Prascend and it does add up. The vet has put him on Previcox recently. I don't know how long I should keep this up and, unfortunately I have already given up doing shows on my younger horse. Since I don't have a farm, monthly board adds up too. I wish more people would talk honestly about the hard financial decisions. They are real. I also hope this doesn't deter you from writing your blog. The world would be a lesser place without your articles.

Tracy Beavers

3/3/2020 08:53:42 am

I recently had a good friend of mine decide to let her horse go before a major issue occurred. He had several minor daily health issues, as well as a major health problem that would eventually cause his death (somewhat similar to what you're going through with Speedy). Her horse had been retired for a number of years, but slowly declining in health.

It was a very difficult decision for her to let him go, but that's what felt right to her. It was really sad to see some of the people around her question that choice.

Ultimately, YOU know Speedy best. YOU know, in your heart, what feels right and while it will never, ever be easy (no matter what route you choose), don't let ANYONE make you feel like your choice is wrong. Horses owe us absolutely nothing, and you are Speedy's best advocate. Do what you feel is right for you and Speedy -- you're an excellent horsewoman filled with love and compassion for your animals, never forget that or let anyone make you feel otherwise.

Megan link

3/3/2020 09:07:09 am

I saw comments are closed on your latest post. While I feel terrible that Speedy's disease is progressing and you may have to make some hard choices, I think what caused such a visceral reaction in the commenters here was that it seemed to be a financial decision you were struggling with, rather than a quality of life decision. By posting your whole budget for the world to see for so long and then posting about how you can't spend the $200 to keep Speedy on his medication if it takes that many pills, people can look through it and find things that they see as luxuries and wonder why you wouldn't cut back on those things to save your horse. You show and lesson a fair amount, which is great! But since everyone knows how much you put into your show and lesson budget, I think they wonder why you couldn't take the money from that pot to pay for the medicine if it is just a financial thing. If this post had said that you've already run the numbers, taking out all luxuries and still can't afford the medicine (though again, being so honest has its downsides because I'm sure lots of people would be able to rework your budget to accommodate the $200 a month) OR if you came across as more concerned about making sure that all Speedy's days are good and are worried what his quality of life would be like on all those pills, I think the post would have come across better. The tough part about having all your financial information online and then saying that you don't have the money to pay for something is that people will be able to nitpick. This is why I choose to be vague about most of my expenses and horse care items. It's just not something I want people to be able to use against me, the internet is a tough place, maybe it's a good idea to be a little more vague.

Alanna link

3/3/2020 01:35:27 pm

I'm going to second what Megan said regarding the tone of the post being that you couldn't afford the medicine, rather than being concerned about Speedy's quality of life.

Cushings is a sucky disease and I'm so sorry you guys are going through this. I hope the dose change works and that you enjoy many more shows, lessons and adventures on Speedy. You are my inspiration for reaching third with my own arabian gelding. Hugs to you.

Amanda

3/3/2020 01:50:17 pm

Yeah. Came to write this exact thing. I have a horse with Cushing's, and I get it: Prascend is expensive. Cushing's is complicated and difficult to manage. It's a progressive disease so all of us who love horses with it will face hard choices at some point.

But nowhere in this original post do I see any sense of what is actually best for the horse. It's one thing to say "this may keep spiraling and at some point it's unmanageable, no matter how much money we throw at it" and another entirely to say "I've drawn a line ahead of time based on cost" when the cost is actually...not that high? Definitely not in the context of horse-related expenses. That's what is ringing painfully discordant for so many of us.

Nora

3/4/2020 09:42:12 am

I came over to write the same as the others above after reading your most recent post.

Long-time reader here, following along since the Sydney days. Never commented before, or if I have, it was so long ago I don't remember.

I also work in the veterinary field, and this post honestly caused a reaction in me similar to Dom's above. I worked during the recession, and had to present $3k estimates for simple life-saving treatments that would have often bought clients years, sometimes a whole lifetime, with their pets. I'm talking a foreign body removal on a stable puppy. Or amputating a fractured limb that the owner couldn’t afford to repair...and owners still had to elect euthanasia on their young healthy animals because they couldn’t afford treatment. They couldn’t even afford to go into debt for it. It was *heartbreaking.*

Same goes for clients who have the finances, but choose to not spend a fortune on treatment that will simply prolong suffering. In your newest post, you indicate that this is the reason why you would euthanize Speedy over his Cushings. Which is fair. But that is not what you said in this post: in this post, you state that you simply don’t want to foot the bill for a higher dose of Prascend: “Maybe it's more honest to say I WON'T afford more. It breaks my heart to say it, but at some point, the price of a treatment is more than I am willing to spend.”

You wouldn’t have received such polarized reactions to this post if you hadn’t repeatedly posted about your budget for your horses. As others indicated above, the money for Speedy’s medication can be obtained by simply reducing your show budget.

A word about Cushings. We understand that you have limited resources when it comes to equine professionals in your part of California. You are also very loyal to the professionals you use and you are proud of that. But the farrier who has repeatedly commented on your posts recently is absolutely correct: repeated abscesses on a Cushings horse are a red flag that his Cushings is not being well-regulated. Cushings also has the effect of compromising a horse’s immune response: making a Cushings horse’s hoof bleed the way you did is indeed a great way of introducing bacteria into his hoof capsule that he wouldn’t be quite as equipped as a “normal” horse in fighting off. And yes, he is thankfully fine now, but my word of caution is this: if your vet and farrier are okay with this making-an-abscessed-hoof-bleed approach *on a Cushings horse*, they might not be as knowledgeable as you think they are about this disease process. Which is, unfortunately, still a very common problem in the professional equine community.

Speedy has not really had a laminitic episode yet. He hasn’t foundered. He just needs to be better regulated and there are measures you can take *in addition* to increasing his Prascend dose that might even help to lower his required dose. You have numerous horse bloggers with experience in this area at your fingertips for more information who have already offered help. Andrea Galbraith is a former equestrian blogger who successfully manages and maintains a Cushings Andalusian stallion whom she is competing at the PSG level and with whom she just received her silver medal. If you haven’t reached out to her yet, I would recommend her as a valuable source of up-to-date info on managing metabolic horses, both with Cushings and IR. She is on Facebook.

We understand the emotions involved in what is happening with Speedy. It is devastating to lose your competition horse (though having to increase his medication dose for the first time does not mean you are even close to losing him.) We also understand that you don’t write blogs for a living: this post was probably written during a whirlwind of emotion. But the fact that you clearly state here that you “won’t spend the money” on Speedy while complaining about the high cost of his medication (and not mentioning quality of life at all here) at a time when emotions are running high (aka you’re being gut-wrenchingly honest) is what has so many of us feeling “triggered” by this post: your first thought wasn’t his quality of life, it was the cost of his medication and not wanting to pay more. That’s how this post reads.

Kirrily

3/9/2020 03:09:54 am

Have you joined the free ECIR support group? They can help you learn to manage his PPID more effectively, and likely save money. Lots of people are using compounded pergolide at a fraction of the cost with success. There are options!

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