Re: NEW MEMBER: emergent case

Josephine Trott


I looked up those ultimate wedges you have on your pony.  Lavinia will give instructions on the trim your pony needs after she sees X-rays and hoof photos etc but in the meantime, are they the Nanric Ultimate Wedge Shoes?  There are contraindications to using these:    "One common mistake is not paying attention to the palmar angle prior to applying the ultimates. Instructions clearly state do not apply ultimates when the palmar angle (of coffin bone) is greater than 5 degrees. If the palmar angle is higher than 5 you must lower it prior to application. If you do not there is a chance that rather than loading the heels the weight through the bone column will be in direct alignment with the toe and this can cause abscessing or distal displacement of P3 within the hoof capsule. Likewise the Ultimate is not to be used with sinkers. With sinkers loading force is a greater concern than tendon force."

It sounds like that left front is sinking so I would be thinking very strongly about removing those wedges ASAP.

Good luck. You've found the best resource possible to help your pony
Davis CA 06/09

Re: NEW MEMBER: emergent case

Lavinia Fiscaletti

Hi majademers,

Welcome to the group. So sorry to hear of your troubles with Oreo. You will be receiving an in-depth welcome shortly but I am going to address some of the hoof questions you've asked now so you can get a head start on making your decisions.

We really need you to join the case history sub-group, fill out a case history for your pony and make a photo album. Please do add any xrays you have, as well as pix of the feet, to the album as soon as you can so that we can see exactly what is going on. If you could add the hay analyses to your case history folder that would also be a help.

There is a high likelihood that the PPID is not well controlled and that may the driving force here. Need to immediately stop the TC Senior and Lite, as well as the alfalfa. Soak your bermuda coastal for now until things get a bit more settled - it's in the may help, won't hurt category. That will help to stop the likely cause of the laminitis he is experiencing. You'll know more once you get the blood work back. Where was it sent?

Venograms are tricky and are not without risks themselves.If not done properly, they can be a waste of your funds. At this juncture, it is not something we would generally recommend.

The excessive heel growth is pretty common with laminitis and rotation, as is the apparent slowing of the toe growth. In many cases, it's that the toe growth is being jammed up by the excessive heel height. This is why shoes can be problematic as it makes it extremely difficult to make the frequent (read no more than 2 weeks apart) trim adjustments that can be necessary to keep the hoof capsules in a properly realigned position. We are not generally in favor of tenotomy as it doesn't address the underlying cause and can make the situation worse as in many cases it has led to sinking in addition to any rotation that may be occurring. If the Ultimates have been on for 3 weeks without being reassessed, they have been on too long. To increase perfusion, you need to get the bony column in the correct alignment so the coffin bone stops compressing it. A correct realigning trim will do that. Adding padded boots rather than attached appliances will allow for the hoof mechanics to provide more help getting the circulation working better.

Please have a read on our informational website:

I'll add that we have a wealth of experience dealing with the effects of PPID/IR induced laminitis and that it is quite possible to stop the laminitis, reverse the rotation and get the equine back to soundness without resorting to tenotomies in the majority of cases.

Hang in there.

Lavinia and George Too

Dante, Peanut, Nappi and George over the Bridge

Jan 05, RI

ECIR Support Team

Help please with Feed Analysis #FACTS



I have uploaded to new feed tests for hay that I have sourced close by.  From what I can see the ESC and starch are under 10% and I think the protein is ok.  What concerns me is maybe the moisture. What moisture should we be looking for in hay?  Also the iron seems a bit high from doing some research on the forum and searching messages?  Can someone give me some feedback?  The lab results are from A and L Canada labs and pics are saved in my photos folder.  Here is the link:,,,20,1,20,0

Would it be possible to feed this hay now unsoaked? I have sent away another sample that is straight grass that I also want to see what its analysis looks like as think it may be more suitable.  I am waiting to get this hay analysis back and then once I do am hoping to get rations balanced for these hays.  But for now am looking for some feedback on these and what people's thoughts are.  Thanks so much!!

August 5, 2017, Brandon, Manitoba, Canada



Re: NEW MEMBER: emergent case

Paula Hancock

Hi and welcome!
We are very sorry your pony is not doing well but he is very lucky to have you on his side.  What he really needs to get better are two things.  The first is to remove/control whatever is triggering the high insulin.  The second is to realign the trim so that it best supports his internal hoof structures and allows the hoof to grow out in much better connection.  Both of those are required for him to improve.
The most common triggers for high insulin are diet and uncontrolled (or under-controlled) PPID (Cushing's).   If you take care of that, his feet will calm down very quickly.  He sounds like he is both insulin resistant and PPID, so both of those will likely need to be under better control.  That may also help with the sweating issue.
As to the trim, I will leave that for our hoof guru Lavinia to address, but take heart.  There is a lot you can do to help him.

Can you get his main information into a case history for him?  Especially the latest glucose, insulin and ACTH if you have that. If you don't have a current ACTH for him, that would be important to get done, following the protocols listed below.  The diet information is based on what works, so although some of the information may make your head spin, it is worth implementing immediately. 

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

In order to help you and your horses quickly and effectively, we need you to fully explain your horse's situation by following the instructions you were sent upon joining. Your completed case history form and ECIR Signature will save days of back and forth questions. If you haven't done so yet, please join our case history sub-group. Follow the uploading instructions so your folder is properly set up and then upload your case history. If you have any trouble, just post a message or email the case history group explaining specifically 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. As I explain each part, I'll add comments pertinent to the information that you've provided. As you read along open any of the links (in blue font) for more information/instructions that will save you time.

DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or 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 IR is diagnosed by testing non-fasting insulin, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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: IR 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 unsuitable - 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. 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 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. 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 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 IR/PPID individuals.

We do not recommend feeding alfalfa hay to IR/PPID 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.

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.

We ask all members to sign their first name, general location, date of joining and link to the case history and photo album every time they post. It helps us to find your info faster to answer your questions better. You can set up an automatic signature so you don't have to remember to do it. 

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.  Once you go through the information, please post any questions.  Hang in there!

Paula with Cory (IR) and Onyx (IR/PPID)


Bucks County, PA, USA

ECIR Primary Response

NRCplus 2011  ECIR 2014


Re: Test results- Lacey

Lavinia Fiscaletti

Hi Tracey,

As long as you tell the pharmacy you want the equivalent of 3mg Prascend it will be correct. That way, the conversion is done properly. Otherwise, there can be differences due to terminology misunderstandings.
Lavinia and George Too

Dante, Peanut, Nappi and George over the Bridge

Jan 05, RI

ECIR Support Team

Majik - After the Hurricane Harvey flood plus new hoof pix


Hi y'all,

I have updated Majik's hoof pictures (my farrier came out today).  I'm out of practice and missed some shots.  She was flooded in, I was flooded in - Hurricane Harvey was mean.  You will see her hooves look a bit rough as we are about 2 wks late on the farrier.  Her heels were looking great before this and now are pulling a bit forward again as she was growing too much toe.  We couldn't even get to each other!  She was dry in the barn for the most part.  I was dry (except one room in the house), but boxed into my neighborhood by flooding.  I do not want to repeat this.  She has remained sound and her neck crest is soft.  No fat deposits at the tail head or behind the shoulder at all.  We are all worn out for sure!  Thanks for checking in on us LeeAnn!  Sorry I've been such a stranger. 

Currently Majik's exercise schedule is turn-out in a small dirt pen.  Most turn-outs are still damaged or under water.  Arenas and round pens are also damaged and still have water in them.  Our beloved trails along the creek will have to be remade.  She seems quite content with just being out of the stall.  Thanks so much.  I look forward to any feedback on Majik's feet.  I hope and pray everyone stays safe for Irma as we recover from Harvey.

Grateful.  :)
Shannon and Majik (IR) and Rafiq (PPID/IR, over the rainbow bridge)
Houston 2009


Majik's Photo Album

Rafiq's Photo Album

NEW MEMBER: emergent case


Good afternoon
I have a 12 hand, approximately 18-21 year old,  490 lb pony (body score ~4) that is reaching a crisis point.  I have managed successfully a mechanical founder case due to neglect and another IR case that happened on my watch and I handled immediately through diet management, DMSO (I know old school), and that pony has no rotation and currently working Prix St George dressage level.  

I purchased this pony (Oreo) that is currently in crisis thinking I could handle his chronic case since his diet was terrible and his toes were so long, he needed better trimming technique. Everything was going well up until the end of July 2017.  He was sound from the point I got him November 1, 2016 until about July 10, 2017.  He was in regular work (5-6 days per week with his kids) until we went away on vacation in mid-July. We came home and the vet had diagnosed him with an abscess on July 28, 2017.  However, after a week of treating it like an abscess I realized he was having a laminitic episode. I contacted the vet again and had Oreo re-trimmed and re-shod in August since he was due at the end of July, but we were waiting for the abscess to "pop".  The shoeing did not seem to help his soundness so I called the vet again for more x-rays and called in another farrier who specialized in more severe and active  laminitic cases on August 18, 2017. He did a much less conservative trim and took off a lot more toe and put on "ultimate" wedges on his front feet. It will be three weeks tomorrow that these wedges were put on.  The pony is still sore and today we X-rayed him again to check for growth and any progress.  Here are the stats:
August 18: Right front: ~9-10% rotation, 1 cm sole thickness; Left front: ~11-12% rotation, 0.8 cm sole thickness
September 7: Right font: 9-10% rotation, 1.2 cm sole thickness; Left front: ~14% rotation, 0.6 cm sole thickness
His right front appears to have stabilized and is growing. He has grown significant heel on both front feet. Minimal toe on his left front feet and the left front continues to rotate and the sole does not appear to be growing. This foot has caused much concern amongst my vet and farrier team. they are currently recommending a tenotomy of both front DDF tendons and realignment. They believe if we don't go forward with the tenotomy that he will likely require euthanasia as the left front is not turning around.  We could do a venogram, but the evidence of lack of growth in that foot suggests that profusion is compromised and the left hoof will not recover on the current path. We are trying to address ecomically so if a venogram will not tell me anything new, I will not do it and save the money for the tenotomy (if required) and recovery.

On August 18 we also drew blood. He is hyperinsulinemic, low glucose. We know he has cushings and he has been on Prascend since I have had him. With the high insulin we added Metformin twice a day.
Today, September 7, we drew blood again.
He was hyperinsulinemic when I purchased him November 1. He was on a local mill molasses based feed and I switched his diet to Triple Cown senior and Lite along with bermuda coastal and alfalfa.  He is thin (body scoe of 4) and was in regular work so the alfalfa and senior added some protein to his diet while still being low starch.  I have had my hay tested since I do have three IR and/or Cushings ponies. Between November and July he had no lameness and seemed to be thriving. He would only go slightly "off" on hard ground when we took him out and a quarter tab of previcox always resolved any ouchiness. His previous vet said his thinness was due to a respiratory disease; however, he has never shown signs of respiratory stress.  He did stop sweating this past July with the onset of this lamininitic episode. But he does not cough or strain when breathing . Old lung X-rays do not indicate anything interesting either.  I have x-rays that I can post from his previous owners through the recent xrays I had taken. His initial laminitic episode was in 2015.  I am just hesitating and want to make sure I have all the information I need before going ahead with a tenotomy.  My vet and farrier team are comeptent and have done these with success and horses returning to pleasure riding.  I understand the long road to recover. My husband is a vet so I have resources and I am a horse professional so can handle daily maintenance whatever course I need to take...

Re: Test results- Lacey


I'm seeing discussion on whether 1mg compounded pergolide is the same as 1mg prascend.  Since I needed to increase the dose to 3mg prascend I ordered 3mg compounded pergolide.   Is that correct or do I need to give a higher dose when it's compounded??    

May 2017, Bismarck, ND

Case History: 

Lacey's Photo Album:  


Re: How safe is this product

Lavinia Fiscaletti

Hi Bridget,

It's fine to ask questions.

Why are you wanting to add turmeric? It has the potential to increase insulin production so is not a good idea for a horse whose PPID is likely not controlled and is also likely IR:,,turmeric,20,2,0,13841544

The Golden Paste Co. product: Ingredients: Beet pulp, Lucerne, Turmeric, oatfeed, apple cider vinegar, glucose syrup, diacalcium phosphate, vegetable oil, black pepper.

This would not be a suitable choice for IR horses as it contains oats, glucose syrup, vegetable oil, lucerne (alfalfa).

Lavinia and George Too

Dante, Peanut, Nappi and George over the Bridge

Jan 05, RI

ECIR Support Team

How safe is this product

Bridget Riggs <bridget.riggss@...>

I have just ordered from golden paste site some tumeric pellets just a sample can or am I allowed to ask if you think they are ok as they have lucerne in them ??

July 2017
Blandford Forum Dorset

Re: questions re: IR and Cushings

Karen Warne

Dr. Kellon,

Inflammation is a huge disease stimulator in humans, and I believe more and more that there must be a definite connection with the inflammatory processes and our horses.  Ever since I got Luke as a youngster, he has had inflammatory responses to grass (he had gingivitis which I figured out was due to the grass sitting on his gums, so I brush his teeth everyday... of course, now he has no grass at all), and he reacts to vaccines (I just did titers for WN this year due to past severe reactions), and bug bites have bugged him relentlessly (until I put him on flax several years ago), but the bug bite reactions are almost non-existent this summer since Claire suggested 10-12 Gms Chondroitin Sulfate/day.  That plus he's on his balanced diet with as low sugar as I can make it.  

Karen and Luke 

May 1 2017

Northern California

Re: Early Cushing's??

Lavinia Fiscaletti

Hi LM,

I was referring specifically to the "Neosporin + pain relief" product (or generic equivalent) itself:

A broken back HPA is a pathological condition that is created. As with any pathology, it's possible there is a hereditary component but generally, this is a trim problem. In a QH, especially in the hinds, it can happen in what seems like the blink of an eye as it seems the CB tends to sit at the lower end of the "normal" range for palmer angle and the slightest excess toe length sets up a ground parallel/negative plane scenario. Once that happens, it takes a lot of consistent attention to the trim to get it back to correct.

If you have Clouds, the pads should already be wedged. You could add the wedge in under the current cloud pad as a trial as I agree it sounds like he definitely needs to have soft padding for comfort. Yes, alleviate the pressure under the area where the leading edge of the coffin bone is - which you have already done :)

It looks like he needs every millimeter of height he has in the back half of his feet so don't try to move those heels back at all. The xrays will really be helpful here - just please be sure they are done technically correctly and the dorsal wall and frog location are marked.You don't want to waste precious funds on lousy xrays. Check here for the specifics:

Ramp or bevel the heel: Leaving the current heel buttresses completely alone, bevel the remaining under run heel area slightly, starting at the rear of the current buttress and moving back toward the heel bulbs. Bevel the heels in his boots the same way. Does that make more sense?

How does he land when he moves? If it's toe first, it's sabotaging everything you're trying to do. Heel first is the goal but at least flat for now. One possibility here may be to try rim casts instead of the boots. That way, you don't get the soggy factor messing things up. Plus, it would help with keeping the wall integrity stronger. But first, you need to get the trim set up well.

Let's see what the xrays tell us, then we can devise a better strategy going forward.
Lavinia and George Too

Dante, Peanut, Nappi and George over the Bridge

Jan 05, RI

ECIR Support Team

Re: questions re: IR and Cushings

Karen Warne

Thank you... I had wondered, knowing that hyperthyroid is an issue in humans too.

Karen and Luke 

May 1 2017

Northern California

Re: questions re: IR and Cushings

Karen Warne

Thank you Helen... yes, we are actually close so should meet someday.  I am in Shingle Springs.

Karen and Luke 

May 1 2017

Northern California

Re: questions re: IR and Cushings

Karen Warne

Re: questions re: IR and Cushings

Nancy C

On Thu, Sep 7, 2017 at 04:51 am, Eleanor Kellon, VMD wrote:
I'll be spending an hour looking at this question of inflammation and fat in equine IR.
Just to be clear, and especially for new folks ---

Dr. Kellon is talking about an hour at the 2017 NO Laminitis! Conference, October 27-29,2017 in beautiful Tucson, AZ.

Veterinary and hoof pro continuing ed credits available.

Early bird pricing of $250 expires 09.23.17

All speaker and lecture info, continuing ed info, conference registration and Hilton reservations can be found at

Thank you for the opportunity to get this commercial in one more time!
I am so looking forward to this and to seeing you all.
Nancy C in NH
ECIR Moderator 2003


Save the date! The ECIR Group Inc. NO Laminitis! Conference, October 27-29, Tucson, AZ

Learn the facts about IR, PPID, equine nutrition, exercise and the foot
Check out the FACTS on Facebook
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group

Re: questions re: IR and Cushings


I am near Santa Rosa California.  No problem to ship to Cornell.  You just have to get your vet to contact them and learn the ropes.

Gail Russell
Forestville CA
July 2009

Re: Electrolytes for "the move"

Jane Fletcher

I bought it in Australia from Gravel Proof Hoof, Pauline Moore. Hopefully should be available elsewhere!


Sent from my iPad

Jane, South East Western Australia
Nov 2016
Garnet and Bill

Re: questions re: IR and Cushings

Helen Temps

Karen, my Vet has sent to Cornell for me with no problem.  Have your Vet get the pre-paid overnight shipping labels from Cornell for $15.  There should not be any problem.  I am also in No. Cal.

Helen Temps and Chloe  June 2017
Placerville, CA

Re: Flax seed oil capsules

Eleanor Kellon, VMD

If you were to feed 2 oz of  ground flax that would be 28,400 x 2 = 56.800 mg and at about 30% fat it's 0.3 x 56,800 = 17,040 mg or 34 500 mg capsules.

I think you're referring to flax lignans, not lignin.

There are no lignans in the oil.
Eleanor in PA 

EC Owner 2001

71281 - 71300 of 280104