I recently found the ECIR group, I would like some help to my mare in moving forward to get her healthy again.

Sendy, mare, 18 years, welsh part bred, 380 kg
She has hoof and body pain after several epizodes of endocrinopathic laminitis. 
In June 2021 she had the first epizode of laminits, The treatment was succesful and without changes on the hooves. Her diet consisted only of a limited dose of hay with minerals and vitamins (without grass, grain...low sugars). But in the following period she had other episodes of laminitis (with a worse course) without a change of management. Cushing syndrome (PPID) was diagnosed (146pg/ml ACTH), insulin resistance has not been confirmed. The treatment of Prascend (pergolide) began in October 2021 (31pg/ml of ACTH in January 2022). 
But she is still not stabilized. She has good and bad times. Hoof pain returns at irregular intervals (refusing to walk, frequent lying down, etc.). For pain she receives Equipalazone (phenylbutazone). Hoves have transformed (sinking and rotation of hoof bone on x-ray). Special hoof trim every 4 weeks performed by veterinarian, no effect even the barefoot boots.
We don´t know why hoof pain keeps coming back without a change in management. We´ll test insulin resintence and do new x-ray again. We are considering the possibility of gluing plastic ortopedic horseshoes after x-ray. Other options are examination of the reproductive organs (hormonal disbalance) or endoscopy digestive system (ulcers).
actual diet: soaked hay in the slowfeed net (maximum 7 kg per day), mainly for mixing drugs - small handfull Pavo speedi beet, mineral-vitamins supplement, spirulina, ginseng
actual management: small padock with shelter, without grass, high sawdust bedding
It is very frustrating situation for her and for us. I wonder how I can help her from the pain of hooves and all body. 
Thank you for your ideas and advices, especially for your time.

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