Ask Horse Journal: Handling Joint Pain in a Cushing's Horse

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My 26-year-old horse has Cushing?s. He's on pergolide. He also battled both EPM and Lyme a few years ago and, although we got him through both, I'm sure?they took their toll on him. He's extremely arthritic, but He's never battled laminitis and he is not insulin resistant, per the last blood test.

I had him on Cosequin ASU and BL Pellets, which contain yucca and devil?s claw. He did OK on them.?Then I heard that a Cushing?s horse shouldn't be on devil?s claw or yucca because it's bad for them. I wasn?t sure about the glucosamine in Cosequin either.

The vets had me alternating?him between firocoxib (Previcox,?Equiox) and bute, but they really don't help much. The arthritis is definitely painful, and my own vets aren?t sure about the devil?s claw, yucca and glucosamine. All I want are ways to keep him comfortable for the remainder of his life. He's very special.

?Veterinary Editor Grant Miller DVM responds: Indeed, a 26-year-old is special because relatively few horses make it through life that long.?Admittedly, upon reading?your letter, I did have an overall feeling of concern, given the multiple issues that your horse?is experiencing and the statement that anti-inflammatory medications aren?t helping much.?But,?horses never?cease to amaze us in their ability to rally and persevere, so please?ponder these suggestions as you move forward in your journey with him:

1.? Revisit the?bute and firocoxib issue with your veterinarian.? In many cases, the?amount that owners decide to give and the?frequency at which they give it?don't adequately address the horse's needs.? Communicate with your veterinarian, to let them know that you have run into some trouble with these.? Although both drugs can potentiate gastric ulcers (especially in a Cushingoid horse), they may be necessary at this point to help curb the pain of arthritis.? Making sure that you are giving them at the dose and interval that they are designed for is important.

2.? Consider?switching off of oral joint supplements and move to injectibles.??Legend and Adequan used in combination on a once to twice monthly basis?can REALLY?make a profound?difference in a painful horse.? The fact is that?glucosamine does have a base molecule of?glucose, which is a?sugar.? This isn?t ideal for Cushingoid horses, so stopping it and starting injectibles would be a good idea anyway.? Also, Cushingoid horses are predisposed to gastric ulcers, which can be painful.? Feeding devil?s claw can further aggravate ulcers, so I would stay away from that for now.

3.? Try to keep him out and moving.? Avoid?turnouts with steep?slopes and slippery surfaces.??Many horse owners have reported that their horse has done well when put in a pasture?with a very slight 2 to 3 degree slope.

4.? Consider cortisone injections in the most painful joints.? Although Cushingoid horses can experience serious side effects from cortisone injections, those that receive pergolide seem to manage well, provided that a safe dose of cortisone is used.? Cortisone can make a tremendous positive?difference in a painful joint.

5. Feel free to feed yucca and MSM.? Both are relatively inexpensive and don't cause?negative side effects.? Yucca should be fed at?10 grams (10,000 mg) per day and MSM should be fed at 30 grams (30,000?mg per day).

6.??? Keep his weight under control!? For every pound that a?horse is overweight, the more pain they will experience from overloaded?joints.??The same as people who shed a?few pounds:?A horse's comfort, energy level, and mobility can go up dramatically.

7.??? Acupuncture can?help with just about everything you listed?in your description, and we'll discuss that in depth in our upcoming May 2012 issue.? Horse owners everywhere commonly report that their horses have less arthritic pain, better control of their diseases, and more energy when they receive acupuncture on a regular basis.

Please make sure that?if you choose to use an acupuncturist,?he or she is a veterinarian.?Also, know that acupucture does not work quick and big.?Rather, it takes a while to work, so?you must commit to several treatments before you decide whether or not it is helping?your horse.