Re: Lab tests for checking dosage


Test results for Camelot on 3/11/15 after starting Prascend 1 mg daily on 1/23/15:

ACTH = 33   (9 -35)

Does this mean I should stay on this dose for now and repeat ACTH in August?  

Camelot needs to regain weight, but hasn't had the best appetite lately (he has never been a picky eater before).  He has completely decided he will not touch his feed if it contains Beet Pulp.  He also doesn't like mushy, soaked hay pellets.  But he is eating hay pellets if they are unwashed.  Not sure what the answer is.


Merle and Camelot, NE Texas, Dec 2014

Re: Phytolean?

Charlotte B


I've now uploaded a photo of the strange thing happend to Sandras hooves in januari (same thing happend to Soreya as well, in februari). It's been "sunken in" above the coronary band, and what I can see, "bulging out" above that. Hope you kan understand my marks, the photos are not taken on newly trimmed hooves, though I trim quite often, every 2 weeks or so. At the time, these hooves had looked like this for almost two months. She can definetly walk ok (but not perfekt on hard/uneven/rocky ground, usually better but has also been worse), turn and be ridden. I use boots with extra paddings when not only on soft ground. I think she's had this before, but wasn't as attentive at the time.

Please let me know if someone has seen this before or can make a qualified guess what it looks like :)

Photos: ECHistory8


Re: Acth time to re-test?

lj friedman

Vet said your comments were of high calliber.. mentioned things like a more constant radius. dont hollow out the quarters and ask farrier what her reasons were for doing that. Also mentioned a term  sick something, that he told me only an old timer would recognize?  ( I think that was the term.. ) or suck? 

Questions re my Katie

Judy Slayton

Hi Everyone,
I am unsure what to do next with my girl. Could someone review my history and tell me what I am missing? It is current thru mid-Feb. Since then I have:

further increased the prascend, as of 3/13 we are at 3.50mg
started jherb 4 days ago, not helping yet but at least no nosebleeds
Vet coming Monday for cornell bloodwork and the 'talk'
trimmers come Thursday, we were not able to trim in Feb due to pain and reluctance on part of trimmers-they may quit this week, they think it is time to quit on Katie

She is horrid in morning, shaking legs and body, hunched back, improves a bit during the day, cannot go at all without boots, reluctance to move, crabby, pulses but not bounding, hooves warm, not hot. Other symptoms of puffy eyes and head, mild fat pads on side of tail, crud on legs is 98% gone. Laying down some mostly at night. Unusual with her previous attacks she would lay down regularly. Each time, we have increased the prascend we get a 'boost' for a few days enough to make you think we have turned the corner then she crashes. Seems like lami flares up and she has very bad pain. We increase, get better, wash, rinse repeat it seems. 

She was at 19 on acth in February, Could the PPID flare up this much so quick? WEve increased almost a full mg since Feb. testing. How can it not have come down some? I reviewed her entire medical files and Oddly when she was 3 years old, she began stocking up in rears and would do this weird hiccup thing. Thats what it sounds like. Vet did not have an explanation then. As she matured, it went away. It is back and now I can press on her butt fatpads and make her hiccup. If I manage it a few times without getting kicked (it seems to hurt) she will begin drooling which is my sign that insulin is climbing. Ive never gotten full control of the insulin. It is like she cannot process her 'fluids' and they build up causing problems. Does this make any sense? The pain level she has now does not support her normal symptoms, she should not be in this much pain.

Will it skew the results to badly if we increase the prasend again to 3.75? Or should I try to get thru until after blood draw on Monday?

Should I beg the vet for metformin in the hopes of forcing the insulin down and maybe get things going? My vet has so far refused to let me try it. He has never used it.

Thanks for the help.
Judy & Katie
Mojave Desert, June 2010

Re: Teshan booked for trim

Eleanor Kellon, VMD

--In EquineCushings@..., <threecatfarm@...> wrote :

I’m hoping Dr Kellon will comment on how Teshan’s 2006 retained placenta uterine infection might fit into the mix.
= = = = = = = = =

In short, it won't have any ongoing influence beyond any laminar damage occurring at that time weakening the hoof going forward but those changes could be repaired and grow out.

Retained placenta causes laminitis because of the proliferation of bacteria in the uterus and bacterial toxins being absorbed into the blood.  Induced insulin resistance is a part of this picture but it will resolve once the infection is eliminated.

Eleanor in PA
EC Co-owner

Re: High Ca Hay REV: Low Ca Hay

Eleanor Kellon, VMD

Unless your horse can tolerate some alfalfa, which is a great natural source of calcium, I would stick with the calcium carbonate.  If you wet the meal so there is no dust factor it should be well tolerated.

Eleanor in PA
EC Co-owner
Feb 2001

Re: Teshan booked for trim

Nancy C

Hi Kim

Teshan is a freak (to quote you) because she doesn’t feel well. Different horses react differently to feeling ill and/or when in pain.  Her hormones were and maybe still are out of whack, based on your last ACTH test.

I’m hoping Dr Kellon will comment on how Teshan’s 2006 retained placenta uterine infection might fit into the mix.

The ecirhorse article goes on to say:

Cortisol production is elevated in PPID horses largely due to ACTH and can induce a degree of insulin resistance. Excessive secretion of cortisol will also cause immune deficiency causing increased susceptibility to infections interference with normal protein metabolism which results in muscle wasting and pendulous abdomen (due to thinning of skin and weakening of abdominal musculature and connective tissue); and can cause resistance to insulin in a horse not otherwise prone to insulin resistance. also states

PPID = pituitary pars intermedia dysfunction = Cushing's Disease. It is caused by loss of neurons in the brain, originating in the hypothalamus, that send nerve endings down to the pituitary where they release dopamine. Dopamine inhibits/controls the release of the hormones that are elevated in PPID.

Teshan was diagnosed via elevated ACTH in your summer season. The neurons are not coming back. The only protocol to replace lost neurons is pergolide given in a dose to control ACTH.

Horses with uncontrolled ACTH already have too much stimulation to produce cortisol additionally cortisol does not shut down in horses with PPID.

At the last blood draw your ACTH was not controlled.  If she is not reliably getting the correct daily dose of pergolide, it is unlikely to be controlled as you go into the fall. For you that is next week. 

Your 02.26 CH says: 2ml pergolide in feed, from here on I give 1.5 pergolide every other day.

Cannot recall if this has been changed.   Most of members use a carrier other than food to ensure the drug is reliably taken. If you are doing that, hooray. 

Like Kelly, and your mare Teshan, my horse Beau was a basket case, a freak, until his issues were correctly addressed. He led a life of being mishandled by previous owners and professional trainers who did not understand he was in pain and he did not feel well. He was just a bad/nutty/strange/hard-to-manage horse.

In the vast majority of ECIR cases, dealing with and correcting issues of diagnosis, nutritional imbalances, correcting trim issues and the pain from laminitis, brings about a new, willing horse.

Subclinical laminitis is not well recognized as a behavioral issue versus horses who are in acute phase laminitis.

So, if you are short on time and have budget constraints (as most of us do), the most important areas for Teshan would be to:

(1) Make sure the pergolide reliably gets into her in a timely fashion.  Also make sure you take good care of storing the drug. 
(2) Make sure ACTH is controlled. Find out her IR status. I know you are testing end of the month.
(3) Make sure you have a tightly balanced trim.
(4) Get her off grass

As you can

(5) Move from the emergency diet to a tested and balanced diet.

The fact that you can trim yourself will help immeasurably in frequency of trims and keeping the  trim tight and balanced. And save you money.

Learning to take good hoof  photos using the links previously provided, even just for yourself and/or farrier is a gobsmackingly easy way of understanding balance and hoof form.

Kelly - thanks for your input.

Nancy C in NH
ECIR Moderator 2003

FACT: Iron overload has been identified as a significant factor in IR horses
that are not receiving a mineral-balanced diet. (Nielsen, BD, Vick, MM, Dennis, PM, 2012. A potential link between insulin resistance and iron overload disorder in browsing rhinoceroses investigated through the use of an equine model. J Zoo Wildl Med. 2012 Sep;43(3 Suppl):S61-5.)
See  E. M. Kellon, VMD, Iron Overload and Insulin Resistance, 2013 NO Laminitis! Proceedings, Equine Cushing's and Insulin Resistance Group Inc.


---In EquineCushings@..., <kleonaptra@...> wrote :

Is this why Teshan is such a freak? Is she engineering a flight response because it MAKES HER FEEL BETTER? I always knew she was smart and actively managed her own health, but these implications are mind blowing. (From Teshans notes)

I am beginning to believe that her retained placenta and resulting uterine infection are severely to blame or at least a largely contributing factor.

Western Sydney NSW Australia
Teshan 3/2/2015 (photo link) (CH link)

Re: High Ca Hay REV: Low Ca Hay

Sharon Manning

I got my new S/S hay tested and that will be what I have until mid May to June this year.

I have swung from Very high Ca to very low Ca hay. Interesting point to share considering the hay came from the same farm and field.....goes to show you that it has to be tested. I have Cal Carb on the shelf at 38% to supplement and it will be taking quite a lot to balance. Can others tell me what they use please that might require less volume? I did upload the new hay report in the CH and the link is below.

I have not had Blazes ACTH retested yet and hopefully will have it done the first of next week. We went from ice slide to mud slide off this hill.  I got the vet bill from the blood test before the other day and almost went into  $$ shock. But live and learn I guess.... hard to believe any vet would not be aware that extreme cold weather would effect insulin and Thyroid tests. I have also noticed many vets around here prefer Michigan state as to Cornell, so I guess I didn't have my guard up and let that slip by me. You have to ask and insist that Cornell be used and sometimes get and eye roll or grunt. Wonder why? Well, not important....

Blaze is about the same with the swollen lumpy sheath, maybe a little smaller on one side. His long curly winter coat is shedding at least so far. His feet seem fine.

I have gotten all the fencing required to put up a paddock for Blaze, so that's done, now to drive those posts into this East TN rock....... not a easy task.

Re: Teshan booked for trim

Lavinia Fiscaletti

Hi K,

You are also welcome to discuss any foot issues for Zayfir on the ECHoof site as that is not restricted to ECIR horses alone:

That Teshan was last trimmed at the end of January and was just done makes it about 6 weeks since her last trim. Even with it being your summer/fall season, there was quite a bit of excess growth evident for a barefoot horse who is not confined to a stall for most of her days. It would be great to see photos from before and current ones. They would help fill in several blanks in this conversation.

Although xrays would certainly give you the exact position of the bony column in relation to the hoof capsule, there are outward signs that give clues as well. There don't appear to be any major changes in the hoof wall angle growing in directly beneath the coronary band that would indicate serious rotation. What little angle change there may be could easily be attributed to strictly mechanical factors. Slight distal descent (aka sinking) is common over time but doesn't show up glaringly in the external hoof capsule. Sole depth is an unknown as there apeears to be too much un-exfoliated dead sole material present. Trimming to live sole plane would help in determining if this is a factor or not. With the feet being overgrown, the reference points that one uses to gauge these things have been buried so it makes it harder to determine. The repeated wrinkles present in the walls do attest to ongoing insults of some kind dating back at least a year so that is cause for concern.

As horses age, the cumulative effects of all things that haven't been or aren't "quite right" begin to add up. Diet deficiencies/excesses, conformational anomalies, disease processes, trim issues each contribute a piece to the overall effect, with the hooves many times being the "canary in the coal mine".

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team

Help with managing pain

Melanie Christensen


I made a folder,  Melanie and Clyde,  and uploaded the 2 hay sampling results.   I am hoping I can get advice on how to balance out vitamins and minerals for him.

He is still sore and laying down and I removed his boots to feel for heat,  bounding pulse,  but none for either. It takes him a while to come from the haynet to the barn when I come out and the vet recommends previcox. However,  this isn't recommended.   How can I make him more comfortable?

I am doing his CH but it is taking a lot of time.   I also have xrays to upload from my phone and trying to figure that out.

Thank you for any help,  and if I have not done something properly on my folder,  please let me know.

Melanie and Clyde from Minnesota


Re: Erratic behavior

Lorna Cane

Hi Rene',

>Recently he has had episodes where he becomes very scared and goes absolutely out of this world crazy.  He runs, panics, sweats, and even tries to jump out of his paddock.  This behavior is usually triggered by a minor event but not an event that justifies such a huge reaction.

How is his vision?

Lorna in Ontario,Canada
ECIR Moderator 2002

*See What Works in Equine Nutrition*

Can't delete file and replace

tara sullivan

Hi, Just trying to update Elf's ch.  Yahoo  won't let me delete the file and upload the revised.  So please help.
BTW-Elf is doing great.  I have to get some major weight off of him.  With the management changes made already he has lost maybe 10 it's a good start.  He is feeling very good and playing with my gelding again.  I am quite relieved!
Thanks Tara
NEW York 2015

Re: Erratic behavior

Kerry Isherwood

I have two IR horses. One is 21 and early PPID, well-controlled. When her insulin spikes she is extremely depressed & lethargic. However, my 8yo gelding, who's also repeatedly documented severe IR when on pasture, manifests completely opposite symptoms when hyperinsulinemic: he becomes frantic w normal stimuli, constantly agitated, and frankly dangerous to handle. When he's extremely upset he begins to self-mutilate (biting his chest & sides until there's large welts). Its impossible for my vet, farrier, dentist, etc to work on him when his insulin is high. And forget riding--its just dangerous (hence my ER trip/concussion last Feb). However, when his insulin stabilizes (strict diet/off pasture) he is a lovely animal: ground ties for farrier, lets me draw blood/give vaccines by myself w/o even a halter on, is wonderful to ride, etc

It has taken me over four years to figure out wth was "wrong" with my gelding, why the Jekyll & Hyde routine, like an old dude ranch pony one day and a dangerous freakshow the next. Ive had exhaustive diagnostics done over the years trying to find an orthopedic reason, chiro, acupuncture, calming name it, Ive done it. It was only by a fluke chance after I joined this group for my mare and learned that lab "normals" for insulin are now considered too liberal that I realized my gelding was in fact IR (i run monthly bloodwork on my IR mare and decided to run my gelding's also, mostly on a hunch). His insulin during one of his worst crazed episodes this past fall--while on pasture--was 'only' 43uU/ml (or 'pretty good' as my regular local vet interpreted it to me). I thank the stars that i had joined this group by that time and knew otherwise. DDTE has finally 'cured' what ailment I'd been chasing for over four years.

It is not an exaggeration to say that this young horse would likely have been euthanized if I hadnt had the knowledge to recognize that a 43 insulin is not 'normal'. He is truly a dangerous animal to handle when in crisis. I bought him out of the killpen at New Holland as a 3yo. After all these years, I think I now know why he was there.

My point is hyperinsulinemia can present with very different clinical symptoms (ie, my mare vs my gelding). This group and its DDTE philosophy have literally saved both of my horses' lives. I am eternally grateful for this bastion of knowledge and the support of its members.

Kerry in NY
Pinky Sept 2014
Tofurky Nov 2014

Re: Erratic behavior


This is very like what my Teshan did last Winter. Im very interested to her more on this.
Western Sydney NSW Australia
Teshan 3/2/2015 (photo link) (CH link)

Re: Teshan booked for trim


Hello Lorna,
 I have done so, thank you for reminding me. I have been planning to open a new conversation on Zayfir over there, no dramas mate.

Hello Nancy,
 My bad for language again - not specifically regulating ACTH but contributing to symptomatic factors

While cortisol receives some "bad press" with PPID horses, it is responsible for a number of normal, healthy physiological responses. A cyclical change in cortisol levels occurs in normal unstressed horses throughout the day. Cortisol rises with fasting and sleeping, helping to maintain normal blood glucose. Cortisol secretion also jumps during exercise and as part of the flight response, liberating glucose for energy. Levels drop again when the exercise stops. Cortisol is an important regulator in the immune system. It directs key trace minerals into antioxidant enzyme systems (superoxide dismutase), protecting the tissues from the effects of bacterial endotoxins and inflammatory reactions. Cortisol also stimulates detoxification pathways in the liver. These are all normal and very beneficial effects of cortisol.

Is this why Teshan is such a freak? Is she engineering a flight response because it MAKES HER FEEL BETTER? I always knew she was smart and actively managed her own health, but these implications are mind blowing. (From Teshans notes)

I am working on the mare issues. Its simply not possible for me to get that info sorted quickly. I am beginning to believe that her retained placenta and resulting uterine infection are severely to blame or at least a largely contributing factor. As mentioned, she is booked for her blood tests to check insulin and glucose. From the difference between her original case history and her current one, you can see I am making changes. I knew making them quickly would not work on Teshan. She is putting up with me so far and not rebelling so I must be doing things at an acceptable rate. She really is capable of causing herself serious injury if she doesnt like how her routine is changed. So. I am changing things. As for feet out of balance, I can see that. About 2 weeks ago I knew they were ready but made the booking last week when I had the money and he wasnt able to come until this week. Her feet have changed rapidly in the last few weeks. She was last done at the end of January and they didnt look like this. It is the speed of the change that has quite literally, slapped me in the face. (Along with the things I have been reading here)

I am trying not to think anything at all until I have the blood test results back. All I can do is keep doing what I am doing - making changes and look after her as best I can.

Hello Lavinia,
 *Wry Grin* I do not expect my farrier to train my horses. Im a professional trainer. I merely appreciate that he is calm and patient since I have known literally hundreds of farriers and personally worked with a few dozen. The young, inexperienced but willing to learn is exactly what we are dealing with here. He is easily 10 to 15 years younger than me and quite terrified of offending me. He allayed a lot of my fears today. We spoke about Zayfir (I'll elaborate over on horsekeeping) but specifically on Teshan he had a lot to say - he claims he is experienced with laminitis trimming, said that previously there was inflammation in her feet but since being on pergolide it was much better. I will get up pics of her trim and you can tell me how he did. 

Basically Ive decided I have to start trimming again. I never had any problems when I did it myself and Teshan will need more constant and immediate attention. After I lost my gelding to a broken leg (He had a club foot) I lost my confidence in trimming, I believe I did a lot to contribute to that break, in management as well as trimming. Many people have told me it was a ticking time bomb I couldnt have stopped, but I'll never know. 
Thanks very much for your work on the pics. For most of her life, Teshan has done her own feet - such good hard hooves that the minute you think, those toes are a bit long, I better trim - she goes for a run on some hard ground and comes back looking like she's ready for the show ring. So Im still getting my head around her having foot trouble.
 I know its impossible to KNOW without Xrays, but do you think she's starting to rotate? The way I was trained, I would have to behave as if she was, with feet that look like this. I actually took pics of her feet when I first joined but considered they werent good enough to post, would you like to see those? I swear her hooves were not this bad three weeks ago.
Thank you all so much for taking time to reply and putting up with me...Ive become one of those sour old horse gals whose set in my ways...Despite my best efforts.
Western Sydney NSW Australia
Teshan 3/2/2015 (photo link) (CH link)

Re: Acth time to re-test?

Lavinia Fiscaletti

Hi LJ,

Glad the vet thought he was doing relatively well. Would be interested to see what changes he made to the feet. Also good that you were able to get Jesse's minerals ordered.

Whenever it is convenient to schedule the appointment, from mid-April to mid-May, is fine.

Lavinia, Dante, George Too and Peanut
Jan 05, RI
EC Support Team




Acth time to re-test?

lj friedman

Jesse had. a good vet exam today. Feet were in such good shape for a 24 yr old former hunter jumper  with Cushings and severe IR ( via the calculator) that the vet said xrays and other tests werent indicated. He did a trim on him as he is also a faririer. Today, I placed a horsetech order. 

It was suggested here to retest for ATCH Apri/May and increase pergolide if #;s arent low to mid 20's. Jesse was a bit out of range at 40.7  on 1 mg prascend  (ref  9-35) My question? Can someone zoom in and give a  best date to test?  ie  April 30 , or May 31, etc..?    Then, retest August for the seasonal rise in So. Cal. 

lj friedman san diego nov 2014



Re: VERY high ACTH for Magic???

ferne fedeli

It is possible, I guess.  I always only order 30 days at a time and keep it on the refrigerator door.  I use Thriving Pets and have used them for years.  I know some people prefer another pharmacy in Arizona or somewhere.  I suppose I could change pharmacies...
Ferne Fedeli

On Thu, Mar 12, 2015 at 10:55 AM, sally.stork@... [EquineCushings] <EquineCushings@...> wrote:

Sounds like your pergolide is no good--heated up?,old?,degraded? Maybe switch to another form/source.

Sally, Elkton,MD since 2009.

Re: Erratic behavior

Eleanor Kellon, VMD

You're not the first person to question whether extreme changes in behavior might be related to undiagnosed PPID. There are no formal studies to confirm this.  One explanation could be pressure from hypertrophied pituitary on the optic nerve that interferes with the horse's vision.  There are probably other explanations as well.

The first step with this horse is the first D of DDT. Get blood work.

Eleanor in PA
www.drkellon.comEC Co-owner
Feb 2001

Erratic behavior


I have a gelding in my boarding stable that may have early signs of Cushings.  I am in conversation with the owner about testing him.  In the meatime, I am caring for him as though he is.  Except, that he is not on Pergolide yet. 

This gelding has always been an easy horse for turn out, alone or with other horses.  He has always been calm, smart, and rather no-nonsense.  In fact, I used him to teach babies good social skills after weaning.  He was a terrific teacher.

Recently he has had episodes where he becomes very scared and goes absolutely out of this world crazy.  He runs, panics, sweats, and even tries to jump out of his paddock.  This behavior is usually triggered by a minor event but not an event that justifies such a huge reaction.

Here is my Question:

Have you had similar behavior with any other horses in the early stages of Cushings?

The other symptoms he is showing are: unusual sweating, swollen sheath, poor coat that is slow to shed.  Last year he was the last horse to shed out but finally did shed out by late June.  He is also a very easy keeper.  In the 6 years he has been in my barn I have fed him like an IR horse.  I suspect if fed differently he would test positive IR.

Thank you for your input,

Rene' Riddle



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