Endocrine Disease: PPID (Cushing's) and EMS
If your have any suspicion that your horse, pony or donkey may be affected by Cushing's Disease and you would like to test them, vouchers can be obtained to cover the cost of the testing. Owners must generate the code and then give it to us either at the time of booking your visit or at the visit so we can apply this to your account. Vouchers can be obtained here. Please be aware visit and sampling fees apply.
Endocrine disease is a little known term; however, thanks to campaigns in the media to raise awareness, pretty much every horse owner is aware of two extremely common endocrine diseases: PPID, as known as Cushing's syndrome, and equine metabolic syndrome (EMS).
The reason these two diseases have become so prominent in the equine world is due to their link to laminitis. We now know that approximately 80% of laminitis is endocrinopathic in origin, i.e. is caused by either PPID, EMS or both. Trying to treat laminitis in a horse, pony or donkey with one or both of these conditions at its root, in isolation is akin to running up a downhill escalator! Laminitis is the one of the most devastating diseases that equines suffer from and management of these cases is not only hugely financially costly to owners, but also carries an enormous emotional cost too. Identifying and treating underlying causes of laminitis is imperative to successful management and improving outcomes.
Although both PPID and EMS are common place terms within the equine world, these are two very complicated diseases and it helps to understand a little more about both conditions, how they affect the horse and why treatment is important.
PPID (Pituitary Pars Intermedia Dysfunction)A huge amount of support is available for owners regarding PPID which clearly describes the disease, how to spot it and what you can do to help support your horse or pony once they have been diagnosed. The Care About Cushing's website is a great resource for owners and enables you to record and keep track of your horse's progress.
Other useful resources include these two checklists to help you identify whether your animal is at risk of endocrinopathic laminitis or PPID itself. If, after completing either of these checklists, you believe that testing your horse for PPID is worthwhile we are still able to offer vouchers to cover the laboratory fees of your animal's initial blood test. Vouchers are best generated by owners from the Talk About Laminitis website - another great resource.
EMS (Equine Metabolic Syndrome)EMS is the second endocrine disease contributing to laminitis in the equine population. This syndrome is subject to much ongoing research so the depth of our understanding of it, specifically regarding its diagnosis and management, is changing day by day. Although it feels like there is a huge focus on PPID, the Talk About Laminitis website provides some information regarding this syndrome and the role it plays in laminitis, and more information on the very complicated topic of insulin resistance can be found at The Laminitis Site.
Very simply, EMS is characterised by a triad of factors:
- Obesity: generalised or regional (abnormal fat deposits)
- Insulin resistance
Obesity may be generalised, which is easy to spot; or regional, with the persistent of stubborn fat in focal areas. This may include bulging of the supraorbital fat pads as shown in the image on the right; or commonly located in other areas such as the crest; shoulder; behind the withers; on the back, behind the saddle or around the tail head.
Testing for EMS involves a number of different blood tests depending on the clinical presentation of the pony and what we are trying to determine from the test itself. For example, different tests are required to ascertain whether the animal has metabolic obesity consistent with EMS or try to assess the risk of developing laminitis with grazing access. To discuss EMS, testing and management in more detail, please ring one our vets who will help you.
There are a whole host of conditions that affect the equine eye ranging from mild to severe, ultimately resulting in loss of sight or even of the eye itself. Luckily most of these conditions affect one eye only, but in the cases where both eyes are affected the end result of problems not treated promptly and appropriately can be catastrophic.
Signs to watch out for signifying eye pain that require examination by a vet include:
- tearing/watery discharge from one or both eyes;
- prominent third eyelid position;
- change in pupil size or shape;
- ocular discharge: white or yellow;
- blood from the eye;
- changes in colour of the eye surface: cloudiness/blue tinge;
- swelling of the eyelid(s); and
- wounds affecting the eyelids.
Eyes require careful treatment and some of our equine friends are not the most obliging, particularly when they are in considerable pain. In certain cases, we may offer alternative treatment methods including placement of a subpalpebral lavage system or subconjunctival injections. Often, even in the most straightforward of cases, treatments may need to be applied every couple of hours, proving impossible for owners. We welcome such cases at the clinic for the initial intensive treatment and find this works very well at resolving problems in the most efficient way possible.
Our vets are experienced in managing ocular problems and we are able to offer more advanced techniques such as intraocular pressure measurements, ultrasonographic imaging of the ocular structures and even surgical treatments where required. We also work closely with the team of specialist ophthalmologists at Optivet should we feel your horse or pony require specialist intervention; and arrange in house referrals to ensure your animal gets the care they need, where you want it.
If you wish to seek advice or chat to a vet about any concerns you may have, please give us a call. Alternatively, complete the form opposite for non urgent appointments and we will get back to you. For any urgent concerns, please ring the clinic directly on 01342 300008 and we will arrange a vet to see your horse, pony or donkey as a matter of urgency.
Lumps, bumps, itching, hair loss....many of these signs can appear in the same disease process and make diagnosing the underlying cause tricky. Common techniques employed in the work up of skin problem include blood tests, hair plucks, skin scrapes, biopsies and allergy testing.
Treatment is often topical and owner led, but may require a much more prolonged treatment time that other body system. Systemic treatment may be advised if topical medication has not been fully successful or there are concerns that the problem affects another internal body system. In the case of skin tumours, e.g. melanomas or sarcoids; chemotherapy is commonly used and surgery may be advised. It is uncommon for horses to require referral for surgical treatment: laser surgery is often performed under standing surgical anaesthesia, by specialist soft tissue surgeon Safia Barakzai. We also have the facilities to undertake general anaesthesia for lesions in less accessible sites, should this be required.
For more advise or information give us a call.