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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.
I actually like taking my horses to the vet. Not for emergencies of course, but for regular maintenance, the bill is almost worth the price of admission. I always learn something new, but that's because Speedy usually shows up with some new thing or another. Izzy, too for that matter. Saturday's visit was no exception.  Bakersfield Large Animal Hospital - photo from a previous visit. Both boys loaded up without issue. As a side note, this was the very first time that I hauled my trailer on the freeway with my new truck, Newt. It was also the first time I've hauled both horses with Newt. I have to say that I was pretty happy. All of that aside, Dr. Tolley and his assistant were standing at the ready as I pulled in. As I unloaded both horses, I started with a run down of what I needed. Speedy: dental work, check the fit and suitability of his double bridle, vaccinations, fecal exam, check his weight, blood work to check his ACTH levels (the Cushing's Disease thing), examine the abscess, and examine the weird hole in his hind foot. Izzy: dental, vaccinations, fecal exam, check his weight, and examine the slow-to-heal wound on his lip. Since Speedy DOES NOT LIKE for Izzy to be out of sight, we always start with Speedy because he can stand in a more relaxed frame of mind while the drugs wear off. For the bit check and abscess exam, we worked on Speedy at the trailer with Izzy tied well within Speedy's sight. In an effort to make this marathon of a post shorter, I am grouping the visit's results by body part rather than in the order they were done. Here goes ...  I tried to get a photo of Dr. Tolley examining the bits, but Speedy was less than cooperative. Speedy's Mouth: I slipped Speedy's halter off and replaced it with the double bridle. First, it did my ego a bit of good to hear Dr. Tolley express obvious appreciation for the bits I had chosen. He thought they were really beautiful and well made. Better than that, he thought the fit was good and saw no issues. If I was happy with how Speedy was going, Dr. Tolley felt the bits were fine.  Getting everything in place. During Speedy's dental exam, Dr. Tolley gave the bits a second endorsement. He saw nothing in Speedy's mouth to suggest that the bits were harming him in any way. As he worked, Dr. Tolley also shared a "floating" technique that he felt could be related to the evaluation of bit discomfort.  As he worked the sharp edges from one side of Speedy's mouth, he asked if I had noticed that Speedy lifted his head. I had to admit that I had not. Dr. Tolley pointed out that while he works on one side of the mouth, he has to push the tongue to the other side. This often causes the horse some added discomfort because the tongue is being pushed onto the teeth that are still sharp.  Tools of the trade. To combat this issue, he works for a short while on one side of the mouth, smoothing out some of the rough points. He then switches sides so that he can send the tongue back over to the side that has had some work done. In this way, the horse isn't suffering the discomfort of having his tongue pressed into the sharp points of the teeth that haven't yet been smoothed off. So how does this relate to bit fit and discomfort? Dr. Tolley explained that when a horse is resistant to the bit, it might well be due to tongue discomfort. I don't think that's a novel idea to this crowd, but it bears remembering. It's probably even more relevant for horses going in the double bridle as there is even less room in the mouth for the tongue to "escape" any sharp edges. My boys see Dr. Tolley at least twice a year, so I don't worry about dental issues too much. Their teeth always need touching up in the spring, but if they need it in the fall, Dr. Tolley will point it out. Speedy's Hooves: I pulled off Speedy's Betadine-soaked wrap so that Dr. Tolley could have a look at my handiwork with the hoof knife. He gave the abscess hole a look and seemed pleased with the job I had done. He asked a few follow up questions and told me to keep wrapping it for a total of seven days. Thursday should be the day the wrap can come off. When I explained that I had received some criticism for draining the abscess myself, he gave me a quizzical look and asked why. After hearing my explanation, he reassured me that I am doing the work with his knowledge and guidance. That's all I needed to hear.  Photo from an abscess last year. The second hoof thing I needed Dr. Tolley to examine was the weird hole that recently appeared in Speedy's left hind hoof. Right away he took out his Dremel. I hate that thing because it never bodes well for the preferred diagnosis of "nothing to worry about." The Dremel is actually synonymous for "start worrying as fast as you can." Then he dragged out his knee pads. When Dr. Tolley puts on his knee pads, I know we're in for a long assessment.  Pre-Dremel Weird story ... As Dr. Tolley was strapping on his knee pads, he chatted about having had to wash them recently because they were blood-soaked. From what? I asked incredulously. I was almost sorry I asked. Interestingly, he had to do an emergency C-Section on a ewe who ultimately delivered three lambs. They all survived. My next question was, Three?! How many teats does a ewe have, anyway? To which Dr. Tolley replied, "Two, and yes, that can be problematic." I told you; I always learn something new.  I kept yelling at him to STOP MAKING THE HOLE DEEPER. He didn't listen. So here is where the whole I always learn something new because Speedy is always diagnosed with something new thing happens. The hole was a possible indicator of white line disease. When I pressed Dr. Tolley, he referred to it as wanting to be white line disease. Well is it or not? Well, without drilling even further, it looked to him like it was the beginning of white line disease. To be sure, he asked that my farrier look at the bottom of Speedy's freshly trimmed hooves the next time he was out. That happened yesterday. I'll share that conversation in Friday's post. But in the meantime ... Dr. Tolley gave me a thorough explanation of what White Line Disease is. Here's an abbreviated description thanks to a quick Google search: "White Line Disease is a fungal infection of the white line (or lamina) on the bottom of the horse's hoof. ... This separation is then invaded by bacteria and fungi, leading to infection that progresses up towards the coronary band which produces a white or gray powdery material."  Post-Dremel Dr. Tolley likes to treat White Line Disease by first providing oxygen to the anaerobic infection. That's why he drilled the hole. The second thing he likes to do is apply a daily swipe of Tea Tree Oil which is from the Melaleuca Tree. Tea Tree oil has anti-fungal properties and is also useful because oil is better at penetrating the hoof than are water soluble products. I now have two bottles of Tea Tree Oil in my ever expanding medical kit. Dr. Tolley also pointed out that the Tea Tree Oil will be an excellent topical to use on Speedy's abscess hole once it has epithelialized. Once both feet had been examined, I asked the obvious question: is White Line Disease related to Speedy's Cushing's Disease? The answer is that it's not caused by Cushing's, but there is a correlation. After some discussion, we decided to put Speedy back on Platinum Performance's Hoof Support. It seemed to work quite well when Speedy was growing out new hoof when he damaged his coronary band a few years ago.  He wanted everyone to know, HE IS NOT A FAN! Blood Work: Which brings us to Speedy's Cushing's Disease. When we tested him last year for the first time, his ACTH levels were at 56, just barely outside of normal. A level of 50 is considered the outside of the normal range. Dr. Tolley drew blood and sent it to the lab yesterday. We should hear back in another day or two. In the meantime. Speedy will continue with the Prascend as usual.
Everything Else: I know it's hard to believe, but there's more! As always, Speedy's fecal count came back negative; he's worm free. Even so, he'll get a dewormer once he's feeling better. The vaccinations always make him feel puny. And his weight? I was very pleased to see him clock in at a solid 1,020. That's the most he's ever weighed at the end of winter. For a horse who is hard to keep round during the winter, this was great news. Overall, Speedy is in good health. He obviously has a few issues, the Cushing's Disease being the main culprit. But for a dude quickly approaching 16, everything else is in fine shape. Dr. Tolley's litmus test for the hoof supplement is this: if there are no more abscesses, it's working. If he has two more abscesses in a year (after waiting a few months for the supplement to do its thing), it's not working. I guess I'd rather pay for something and not know if it's working than pay for something and know it's not working. Izzy's vet visit tomorrow ... So what exactly is Cushing's Disease? Until a few weeks ago, I only knew that it was a disease that mostly affects older horses with symptoms that include long shaggy coats, pot bellies, and problems with hooves. Sort of like this guy.  A Cushing's horse I found on the internet. Very simply - or not, Cushing's Disease, also called Pituitary Pars Intermedia Dysfunction (PPID), is a disfunction of the pituitary gland. Over time, the pituitary gland becomes over-enlarged and produces too many hormones. Not good. Ask any woman approaching 50 (cough, cough) what it feels like to have your hormones go out of whack.  In particular, horses with PPID produce too much of the hormone called the adrenocorticotropic hormone (ACTH). High levels of ACTH cause an over-production of cortisol. And since hormones have effects on many different organ systems, increased cortisol creates a variety of symptoms like:
 So who gets Cushing's Disease? According to the AAEP, "the average age of horses diagnosed with PPID is 20 years, with over 85 percent of the horses being greater than 15 years of age. Although most common in aged horses, PPID has been diagnosed in horses as young as seven years of age."  I think you can see where all of this is heading. Speedy will be 15 in April. Speedy has never before had an abscess, yet in the past few weeks he's had not one, but two. My vet decided we needed to check for Cushing's Disease. There are several ways to test for Cushing's: 1) the dexamethasone suppression test and 2) the measurement of resting plasma ACTH concentration. However, one thing to note is that the time of year the tests are done can affect the results. In the fall, horses naturally increase the production of a variety of hormones as the body prepares for winter. Fortunately for Speedy, January is a great time to check ACTH concentrations.  A normal ACTH concentration is somewhere between 10 and 50. Speedy's ACTH level came back at 56, just outside of the normal range. Some horses can have numbers above 1,000. A lot of things can affect that score - time of day, when the horse last ate, and so on. Even though Speedy's ACTH level was very close to normal, Dr. Tolley felt that it would be prudent to put him on medication. Here's where most owners cringe and ask, "What's that going to cost?" I almost find it funny that Speedy needs a daily medication as I had just this month decided to take my boys off ALL supplements. Joke's on me I guess. The only FDA approved medication for Cushing's Disease is pergolide, brand name Prascend.  I bought Speedy's first box of 160 tablets from a friend who no longer needed it. When that box runs out, I'll need to reorder from somewhere like Allivet as Prascend is available by prescription only. It's per day cost is right around $1.75. Prascend is actually cheaper than the Platinum Performance was, so I can't complain too much.  There is a glitch of course. Pergolide is on US Equestrian's prohibited substance list. Don't even get me started on how incredibly stupid my vet found that rule. One of the worst things you can do for a Cushing's horse is to stop and restart pergolide every other week during show season.
There is good news though. As of December 1, 2018, US Equestrian will now allow pergolide if the horse has been granted a Therapeutic Use Exemption (TUE). An explanation of the rule change can be read here. I've already applied for a TUE, and my vet has submitted all necessary paperwork. When I phoned US Equestrian, the woman I spoke to had no idea how long it takes to be granted a TUE. She said that a panel must review my request. Way to go, US Equestrian. No timeline or answers make me feel great. So that's it. Speedy now has Cushing's Disease which means daily medication, annual bloodwork, and of course getting that pesky TUE. Dr. Tolley wasn't too concerned and neither am I. There's just no cure for getting old. |
About the Writer and RiderI am a lifelong rider.
I began endurance riding in 1996 where I ultimately completed five, one-day 100 mile races, the 200-mile Death Valley Encounter, and numerous other 50, 65, and 75 mile races. I began showing dressage in 2010. Welcome to my dressage journey. 
Photo by Lori Ovanessian
About Speedy GSpeedy went from endurance horse to dressage horse. After helping me earn a USDF Bronze medal in the summer of 2020, he is now semi-retired. Speedy is a 2004, 15'1 hand, purebred Arabian gelding. His Arabian Horse Registry name is G Ima Starr FA.
July 2020 (PC AJSK Photography)
About IzzyIzzy was started as a four-year old and then spent the next 18 months in pasture growing up. I bought him as a six-year old, and together, we are showing at the lower levels. He is a 2008, 16'3 hand warmblood gelding. His Rheinland Pfalz-saar International (RPSI) name is Imperioso.
March 2021 (PC Tess Michelle Photography)
FOR THE SMALLER EQUINE ATHLETE
I love her stuff!
Watercolor Artist and Friend
Bakersfield Dressage approved!
National Rider Awards
USDF Bronze Medal - 2020
USDF Second Level Rider Performance Award - 2018
USDF First Level Rider Performance Award - 2015
USDF Training Level Rider Performance Award - 2013
State Rider Awards
CDS Ruby Rider Award - 2018
State Horse Awards
Speedy G - 3rd Level Horse Performance Award - 2020
Speedy G - 2nd Level Horse Performance Award - 2018
Working Towards:
CDS Sapphire Rider Award Third Level: 63.514% Third Level: 62.105% Fourth Level: Fourth Level: 2022 Show Season
Show Rating (***) CDS/USDF/USEF (*) CDS (s) Schooling (c) Clinic (r) Ride-a-Test Clinic (Q) Must Qualify 2022 Shows Schedule
(*) Tehachapi 5/22/22 2022 Completed … Pending ... 2022 Qualifying Scores
Regional Adult Amateur Competition (RAAC) Qualifying 2 Scores/1 Judges/60%: Score 1: Score 2: Archives
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