New Case History - looking for advice


Patty
 

I've submitted a case history, photos, hay analysis and labs for my horse INKY.  I've followed this group for some time but it has taken awhile to organize my data.  Inky had one laminitis episode in 2017.  He is not in acute distress, however, his most recent set of labs in August revealed his Cushings could be better managed, and the question arose about insulin resistance.  
Before I institute any changes, I'd like to know overall what should be addressed. I must rely heavily on the barn to carry out his feed, turnout, meds, etc., as I am an hour away and work full time.  The philosophy of management at the barn is traditional/old-fashioned in that things like soaking hay or multiple supplements - anything besides basic hay, grain, turnout and exercise - are superfluous.  Therefore, I need to 'pick my battles'.  I want to understand what Inky needs on a priority basis, and what changes are necessary, and what changes are recommended.  
Please review and request clarification where necessary.  Thank you

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Patty and Inky
https://ecir.groups.io/g/CaseHistory/files/PATTY%20AND%20INKY/INKY%20CASE%20HISTORY.pdf .
https://ecir.groups.io/g/CaseHistory/album?p=Name%2C%2C%2C20%2C2%2C0%2C0&jump=1&id=268362 .
horse located in SE Wisconsin
owner located in north suburb of Chicago
joined Aug 2019

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