safe muscle relaxers

Chris Hanson

Are there any muscle relaxers safe for Cushings and IR horses?
Chris H in CA 2021

Equioxx and ulcer

Chris Hanson

Does anyone know of research around Equioxx and ulcers?
Chris H in CA 2021

Re: starting adewuan

LJ Friedman

thank you for both replies. I have rearranged schedules where majestic will be injected every four days exactly. And I will repeat this cycle in approximately three months time.  thanks 
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos


Re: Third request. Re: [ECIR] My vet would like to talk to Dr. K about Eeyore's pergolide

Lorna Cane

Hi Ronelle,

Is this American Skullcap ?

Lorna in Eastern Ontario

Re: Chia question

Eleanor Kellon, VMD

Just for the record, it's impossible to be allergic to an oil because there's no protein in it - unless it is unfiltered.
Eleanor in PA 
EC Owner 2001
The first step to wisdom is "I don't know."

Re: Chia question

Bonnie Eddy

Hi Jean,
My mare was allergic to flax, so I had to find the alternative which was ground chia. 
She was fed the triple crown flax for years, but became allergic. Vet thought she didn't tolerate even the oil which was what she got after discontinuing the tc.
Bonnie with Allie and Racham(over the rainbow) from Southern California, Nov/2016

Re: New Member Active Laminitis PPID

Kirsten Rasmussen

Hi Brittany,

I had a couple thoughts for you.

Here's the info you need to correctly take hoof photos, name them, and upload them into a Photo Album in the Case History sub-group:
Lavinia, our resident hoof expert, will do a free set of trim markups for you if post a request once your photos are uploaded and correctly named.

The Bute will slow down abscess mobilization which will only prolong the pain.  Best to encourage abscesses to exit the hoof as quickly as possible with warm Epson soaks, or dry poulticing if the soles are really thin, and by giving jiaogulan (a vasodilator herb) to increase circulation to the hoof and clear out collections.  Generally we don't advise jiaogulan until the trim is in order because it does actually speed up hoof growth and shortens the trim cycle by at least 1 week, but if your trimmer is able to come more often (every 2 weeks to start, which is ideal if you are rehabbing hooves) and you have markups to guide you, you can try adding jiaogulan.  Both my horses are on a low dose of jiaogulan and I find an optimal trim cycle is 3 weeks, but I can push it to 4 if needed.

I use boots extensively and my horse has them on his fronts 24/7.  I always put a sock over his hoof inside the boot, and smooth his hair down under the sock if it gets bunched up when pulling the sock on.  Men's large athletic socks work well, but in winter I use a wool blend to help warm up his hooves.  The socks protect him from rubbing, and the thicker the sock the better that works.  I also use a liberal amount of foot powder in the boot, and the socks prevent the powder from gunking up his soles.  Socks get changed daily because they do get damp (2x a day if they get soaked), and I have a second set of dry boots I can switch him to as needed.

After he's been on pergolide for 3 weeks it's time to retest to see if the dose is enough.  You can wait until January as was suggested, but we are far enough out of the seasonal rise now that testing before Xmas would be fine, too.  Yes, acute laminitis can inflate ACTH and insulin, but usually diet adjustments will reduce the severity of the laminitis within 1-3 days to a point where bloodwork is useful again.

Now that you're here, it will get easier.  There will always be setbacks (abscesses months later being one possibility) but we've all been there and we know what works, so you're on the right track now. 

Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Snickers' Case History
Snickers' Photo Album

Re: Chia question

Jean Hurrle

Bonnie, had you been ok with the Triple Crown Golden flax, which says it is stabilized? I'm thinking of using it to help keep weight on my IR mare..
Jean Hurrle
Illinois; 2022

Re: New Member Active Laminitis PPID

Sherry Morse

Hi Brittany,

If his current laminitis is due to elevated insulin (and everything points in that direction) isox isn't going to help (and it's not much help in any event) so no point in giving it IMO.  Ace isn't recommended for pain due to elevated insulin either.  What IS recommended is getting the diet changed ASAP as that can help bring insulin down within days as well putting the horse in boots/pads to offer some relief that way.  If the boots don't fit you can tape stryofoam to the bottom of the feet for now until you get the trim in order.

Most important - no forced movement and if he wants to lay down LET him.  Weight gain will come when diet is correct, PPID is controlled and he's not in pain.  If he'll eat the timothy balance cubes that plus salt, flax and vitamin E is all he needs for now to have a balanced and SAFE diet.  

Re: Third request. Re: [ECIR] My vet would like to talk to Dr. K about Eeyore's pergolide


I know this is anecdotal, but this might help your guy's nervousness.  My horse has been a nervous/scared for a long time due to having poor vision.  As he continued to lose vision (almost completely blind), his nervousness got worse (my nervousness/anxiety too).  I've tried commercial calming meds for horses but nothing helped him.  Several months ago I was introduced to a herbalist who suggested the herb "Skull Cap".  (It looks and smells like grass).  She said to start slow, so I started Yo at one tsp.  I put it in his mash (3 oz of hay pellets, twice a day). I moved up every 4-5 day and got to one Tablespoons twice a day.  It seems to be help quite a bit.  He had stopped pacing before meals, pretty strong spooking and chewing wood.  Then he started some of this behavior again, particularly the spooking and chewing wood.  I increased the Skull Cap and now have settled at two Tablespoons twice a day.  He is in general calmer plus less spooking, but mostly flinching or looking in the direction of the noise.  Once the snow goes away, I'll start going off my property again with him.   I put a little bit in my tea for me.  I buy it through Mountain Rose Herbs (based in Oregon).  They use organic herbs, have sales regularly and for me are as local as possible.   I haven't been using it long enough to calculate the monthly cost  (normally $57.00, plus shipping, per pound). 

Ronelle and Yoyo
2015 Bend, Or, US

Re: Charting progress can be graphic...

Sharon Bice

Thank you so much for sharing this, Joy! Very organized and that can make this feel all the more simpler. Happy Holidays to you and Emmy! 
Sharon Bice
December 2020    Sandia Park, New Mexico

Taillight's Case History:

Taillight's Photo Album:

Re: New Member Active Laminitis PPID


Oh, I totally forgot to address the medications!  Sorry about that.  I had isoxsuprine prescribed for one of my ponies once.  It did not appear to make a difference.  It seems that it’s not well absorbed by the horse.  It’s supposed to increase blood flow but there are better options for that.  With increased blood flow, comes increased hoof growth.  If your hooves are headed the wrong direction (not literally, of course) stimulating growth will encourage them to head that way faster.  So let’s get the trim assessed before making that recommendation.  Ace is a sedative and, not being a vet or having experience with using it, I’m not sure why it was recommended, unless he is frantic about being confined.  I’m sure someone else will fill us both in.  So, you made a wise decision there.  Your brain is still functioning well under stress!

My understanding is that QH feet have a tendency to grow “long and low”.  It may be that they are trimmed that way because it’s what’s expected.  I don’t know but Lavinia here is our hoof expert and I’m sure she will give you correct guidance.

Martha in Vermont
ECIR Group Primary Response
July 2012 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo

Re: New Member Active Laminitis PPID


Hi Martha,

Thank you so much for your response! Your words have already made me feel a little bit better tonight.

I will be sure to get all of the case history and pictures figured out asap. As well as going over the welcome letter in more detail.

His front feet have basically always had a tendency to go into the long toe/underrun shape, but this year is first time we've had issues as far as being sore and lame like this, yes.

His insulin and glucose was not tested at the time that his ACTH was unfortunately. But I will make sure it is next time. The vets recommended holding off on doing any further blood tests during the current laminitis pain as they said they could be falsely inflated. So I guess January it is.

I decided to hold off on those two additional medications for tonight at least. Hopefully I can get some more guidance on that.

Thank you again!
Brittany J in Ohio 2022

Re: New Member Active Laminitis PPID


Hi Brittany,

It sounds like you’re about as stressed as most of us were when we found our way here.  I think it helps to write things down so it’s good you did that.  Don’t forget to add all this to your case history details so we have all the details at hand.

Your first post triggers this welcome from the ECIR group.  I’ll address some the issues and then, before overwhelming you, I’ll add the formal group welcome letter.  There is lots of reading material there, including details for some of my suggestions and comments.  Don’t worry if I don’t  get to every detail that concerns you because others will comment where they feel appropriate.

From your description, it sounds like his hoof problems only began this past year?  When you tested the ACTH, did you test insulin as well?  It’s the high insulin resulting from uncontrolled PPID that causes hoof pain and laminitis.  You need to do everything you can to decrease his insulin, which includes diagnosis, diet (and drugs), trim and exercise if appropriate.  We use the acronym DDT/E to describe this. 

He should be managed as an insulin resistant horse.  It’s quite likely, because of his breed, that his insulin will drop out of the danger zone once his PPID is controlled but you don’t know that yet.  He should be fed the emergency diet we describe until his hay has been tested for safe feeding.  The timothy balance cubes would probably be ideal for him.  They are generally of a low enough ESC+starch; they are mineral balanced; they are easily chewed and easy to digest.  I have five horses, mostly about the age of yours and those cubes make up most to all of their diets.  We’ve found that it generally takes about 3/4 as much weight for cubes as you might need for hay.

Recent studies indicate that pergolide begun during the fall rise is unlikely to be very effective.  Once the rise abates (late Dec), it should begin to take effect.  With such a high ACTH, it’s unlikely to be controlled with 1mg of pergolide but I thought that once before and was very surprised by the results.  At any rate, the goal is to get the ACTH into the high teens to low 20’s before the rise begins again in late June.  You need to wait three weeks between adjusting a dose and retesting.  At the same time you follow his ACTH, you will want to test insulin and glucose.  I would suggest starting that process in mid January which will give the pergolide he’s getting a chance to reach its optimal effectiveness.

Post your hoof photos (there are directions in our Wiki) and radiographs in an album on our case history sub group and we can share our thoughts.  Underrun heels and long toes are our specialty here.

I can’t advise you on the boots as my experience there is limited but I’ve seen that very topic addressed so try searching the messages.


Now for all the details I promised.  Keep this information handy as it will continue to be useful.

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck. 

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.


DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.


There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

Martha in Vermont
ECIR Group Primary Response
July 2012 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo

Re: Use of Ertugliflozin

Maxine McArthur

Thank you, Dr Kellon. I thought their observations about triglycerides were interesting and am looking forward to reading yours and Dr Gustafson’s paper. A few vets here are starting to prescribe canafligloxin instead of metformin but without much instruction to owners on monitoring or diet considerations, which is a bit of a worry. 
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response


New Member Active Laminitis PPID


Hello, seriously overwhelmed new member here. Sorry, I don't have my case history file figured out yet. I'm not even sure where to start, everything seems so complicated. Sorry it's so long.
- 32 year old quarter horse gelding, have had him for 21 years. Active laminitis right now, had x-rays done today and waiting on official results from vet. They also prescribed 2 new meds I am unsure of whether I should give - Isoxsuprine HCL powder and Acepromazine oral liquid, which I saw is on the avoid list here with pergolide. I'm supposed to give it tonight and not sure what to do!
Diet keeps changing because he's a super picky eater, but currently just getting orchard/Timothy/tiny bit of clover mix hay and then 1 lb soaked Timothy pellets and 1/2 lb rinsed, soaked, rinsed beet pulp shreds, and 1/2 cup ground flaxseed twice a day. I can't get him to finish more than that so far in a day. Hay is by far his favorite thing to eat. I've been trying to add the rest of the emergency diet recommendations like salt or soaking, but he won't eat it and he needs to gain weight. I was giving him 1 lb of Triple Crown Senior Gold twice a day, but he stopped eating it and I think it was contributing to the loose stool. Also was giving him 1/2 lb of Tribute Essential K GC Plus twice a day until this past week because it's one of the only things he would consistently eat and take his pill with, but after reading through more info on here it made me nervous. Just got a bag of Triple Crown Naturals Timothy Balance Cubes today to try.
More Info:
- Diagnosed with Cushing's officially this September 2022, though in hindsight I feel guilty for being undereducated/misinformed on the subject and he probably started showing symptoms over the last couple years (started shedding out weirdly, swollen sheath but has always been a little bigger in that area than other horses). When I asked my original vet about it the first time I noticed his hair, he said there may be something hormonal going on but dismissed it and didn't want to run any tests. I guess it didn't alarm me too much because he's always grown a super heavy winter coat, it just used to shed out fine. Wish I would have found this group sooner.
Tested ACTH at 1250 in September, the highest their count went to. On 1mg Pergolide since October.
Timeline that I will try to keep as brief as possible:
Started noticing weight loss in July and on and off sore front feet since then, but not as bad as it has been the last two weeks. He's been laying down a lot. Blew an abscess in front right about 2 months ago and one in front left last week. Thought that was all that was going on right now, but wasn't getting better after a few days and had vet out who said it was an abscess and that it's healing, but also a bout of laminitis. Prescribed Bute 2x a day for 5 days and 1x a day for another few days after.
Also switched farriers in August and have been making progress on his long toes/underrun heels. I don't understand why he was more sound when his feet looked so much worse. He also had an abscessed tooth that ended up being pulled in September that has been a long and complicated process and has caused issues with chewing for the first time in his life.
And got Soft Ride boots for him that got here yesterday, but they seem to be rubbing his heel bulbs badly and made them soft and gummy after less than 18 hours. Actually got two sizes because he's measuring in between sizes and not sure if either is fitting right. I'm at a loss of what to do every way I turn. Any help would be so, so appreciated.
Brittany J in Ohio 2022

Re: Rico's ACTH normal now, insulin high

Jenny Heishman

Hi Dr. Kellon,

I sent you an email with my vet's email for the Steglatro precautions/management info.
This will set us up to use it should the immediate need arise.

For now, I've decided to carry on with Rico's current management and exercise - increasing his exercise whenever I can (I really do my best with this!) and closely watching him for hoof tenderness.  He is a body score of 5.  I watch this closely, trying not to allow it to go up.  And he has a cresty neck and pretty big fat pad above the base of his tail.  The crest and fat pad are difficult to "monitor" in that I haven't perceived any changes in them in a couple years.

Thanks for all of your support and advice!
Jenny Heishman and Rico  
Bainbridge Island, WA   June 2018

Re: previcox and the ir horse


Hi Daisy,
Previcox is the canine version of Firocoxib.  The equine version is Equioxx.  Firocoxib is an NSAID which claims to be “gut friendly” but we don’t recommend giving any NSAID long term, which is likely the case when used to alleviate stiffness.  I’m sure Previcox and Equioxx will both come up in a search of the messages, if not the files.
Martha in Vermont
ECIR Group Primary Response
July 2012 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo

previcox and the ir horse

Daisy Shepherd

many people in my area use previcox for equine stiffness.  is this something that is used for  the ir horse?  i did not find anything in files. thank you daisy, tiko, whisper
Daisy, Tiko and Whisper
CO, April 2019
Case History: 
Photo Album:,,,20,2,0,0

Re: Third request. Re: [ECIR] My vet would like to talk to Dr. K about Eeyore's pergolide

Cindy Giovanetti

Well, he’s 27 years old. He’s a little sensitive. He gets anxious (or sore?) and goes off his feed. He shivers both with anxiety and cold (not constantly). He is anxious about the vet, and he’s anxious about my syringing his pergolide. And he’s lumpy in the donkey way.

He has lost weight, but it’s because he’s been on the program (with Oden). I don’t see that as a bad thing. He actually still needs to lose more weight. Possibly quite a bit more weight.

I know the correct dose of Pergolide will not help him with his anxiety, but it might help him with his weight, his lumpiness, his sensitivity to cold, and his soreness, if indeed, he is sore. And since my syringing him causes him so much anxiety, it sure ought to be the right does.

Thanks again for helping.


Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19

1 - 20 of 282405