Re: Estradiol


Hello Dr. Kellon,

I have given Rio 2 days of 5 mg estradiol and am wondering when I should start seeing effects.  Today I came home to a very excitable mare who was chasing my other mare around and then backing into my gelding and kicking him if he didn’t move.  She was also vocal when doing this.  Is this to be expected so soon after administration and will this level off?  Any thoughts?

Thanks in advance.

August 5, 2017, Brandon, Manitoba, Canada

Riosa Case History

 Photos,,,20,2,0,0  .


Case History




Re: I.r. horse questioning joint injections

Jonni Jump

I need help I would really like to start getting her back into shape to ride.
Jonni Jump
June, 2018
Augusta Ga.
Mirage i.r. friesian/ssh mare 

Re: Thin soles and no boots question

Lavinia Fiscaletti

Hi Bobbie,

If she isn't tender without the boots you can start leave them off for periods. Just watch her reactions and adjust accordingly. Increase the amount of time with them off as her feet acclimate to being bare.
Leave her legs wrapped when it's cold, maybe with socks on them in the stall at night, if the boots are dangerously sloppy.

Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Thin soles and no boots question

Bobbie Day

Hi All,
Just hoping maybe Dr.K , Lavinia or anyone else that can maybe help me out here. We trimmed Desi the other day, I didn’t take more pictures but hoping to after another try this weekend. She has been in boots almost constantly (2018) since we started this journey. She has several pairs but all too big now. She’s been in socks and leg wraps as well. Our nights are around freezing now. after her last trim the boots  were so sloppy I decided to see how she’d do barefoot.
shes doing really well, now after all that my question 😊
I know it’s hard to tell from her hoof pictures if her sole depth has improved. I know we need new xrays but it’s just not in the budget right now. Would she tell me (ouchy, soreness) if her soles were still so thin that it’s painful?
her coral is pretty packed right now but she does have some soft mats and bedding. I think just to be cautious I’ll get something on her tomorrow but just curious if it’s ok to leave them off if she’s not showing signs of tenderness?
thanks everyone!

Bobbie and Desi
Utah, Nov 2018

Re: When to test for ACTH -what else should I test?


Thank you for this wealth of information. I'll get started on his case history and educating myself. I'll also get my vet out to take some blood for his ACTH. 

I do have hoof pictures from the last couple of years - since he transitioned to barefoot.
Susan P in BC 2020

Re: Hay testing

Cindy Q

Hi Rick

Here is the link to our handy 2 page brochure that sets out some basics of the DDT+E protocol:

Not sure if that will help you for owners to have as a reference.

Cindy and Glow - Sep 2017, Singapore
ECIR Primary Response

Re: When to test for ACTH -what else should I test?

Nancy C

Hi Susan

Welcome.  Good for you for wanting to get to the bottom of this.  Diagnosis is the first critical step.

Your boy is of an age where he may have suffered a seasonal rise in the fall or he may be have progressed to actual Cushing's/PPID. Your other clincial signs of laminitis, skin issues, and lost muscle point to actual PPID  He may also be EMS, suffering from high insulin, either at baseline, or driven by the PPID. Good news that he is sound.

When you are looking for diagnosis, spring is actually the best time to test. Right now and in coming weeks, his ACTH should be at it's lowest, so if he comes back with high ACTH now, this should tell you how to proceed.

If he were here, I would also be thinking about testing insulin and glucose.  Just be aware that cold weather can drive insulin higher. I would not however put off testing the ACTH, based on what you have stated here.  Until you know his insulin status, I would not let him have grass.

Testing for iron overload on a tissue level needs to be done at KSU in the US. Standard blood work reports do not tell you this.  There some info on iron overload in the files here. The most important thing to do to address the iron in your diet is to test the water and his hay.  Addressing any excess or deficiency in that area is a great start.

Here's iron overload info link Iron, Iron Testing, Iron Overload

Below is our official welcome that is full of info for you now and in coming weeks, describing the ECIR protocol of DDT+E. It has info about testing and how to get started on your diet. There is a ton of info and we get it will be overwhelming at first. Tuck this message away somewhere to refer to in the future. bIt has many links to questions you will have going forward.

You can also see more about Getting the Right Diagnosis in the ECIR film of the same name here (scroll down a tad):

Here ya go....

The ECIR Group 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 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 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 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 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. 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. 

Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

Re: IR Calculator

Eleanor Kellon, VMD

I:G is insulin divided by glucose.  G:I is glucose divided by insulin.

RISQI and baseline insulin are normal; MIRG and G:I just a hair under normal. Overall, I'd say normal!
Eleanor in PA 
EC Owner 2001

When to test for ACTH -what else should I test?



I'm new to this group. I suspect one of my horses is in the early stages of Cushings. Last spring I noticed that he didn't shed out as fast has he normally would. In late spring he got laminitic and  he stayed that way for a couple of months. He was better by August by controlling his access to grass. He's barefoot and has been trimmed accordingly. He also rubbed out most of the hairs at the top of his tail last spring despite regular de-worming. He's lost muscle in his neck and back even with regular appropriate gymnastic work and riding 4-5 times a week. He's been in regular work all winter and is sound now. He's 18 years old. The information on ACTH testing and seasonal influences says that the ACTH levels normally go down in the spring and rise in the fall. So my question is should I test him now or wait until July or August? I'm worried that we might go through the same cycle again this spring.

I know that there is a high iron content in my water (I'm on well water). What else should I test for at the same?


Susan P in BC 2020

IR Calculator

Kelly Kathleen Daughtry

I received new endocrine results for Micah from Michigan State from a February 13th blood draw. 
I'm simply curious - the  Michigan Lab Report states that the I:G Ratio is .11
When I used the ECIR Calculator, the G:I Ratio is 9.4
What is the difference? 
Her MIRG is 5.2 but there was no interpretation 
Kelly & Micah, Clayton NC

April 2016

Case History: 

Photos:  .




Re: Chronic laminitis Shetland pony

Sherry Morse

Hi Anna,

There is a good visual explanation on this page: of the difference between rotation and sinking and another one here: but the best visual explanation I've found is here: - you do need to watch the videos for a few minutes to see the change and the difference between the two.

In rotation the coffin bone stays in the same position as in a healthy horse but the tip rotates down from where it should be.  In sinking the entire bone column moves so there is a gap between where the coffin bone should be and where it ends up.  

Re: Chronic laminitis Shetland pony


Thank you.
The farrier has seen her today and said he will do a lot of trimming based on the radiographs, but he was unable to do it today as the feet were very hard and they need to be soaked. He will come back tomorrow.

I am wondering what do you refer to when you mention sinking? Both the vet and the farrier said there is no sinking, but rotation. Farrier said according to him it wasn't very significant and with this grade of rotation, even if it turns out to be chronic rotation (so the hoof wall will not correct itself and will not be able to grow tighter due to scar tissue between the bone and the wall), this pony should be back to normal in about 6 months time.

I will post new photos tomorrow after he has done his trimming.

Anna, Sweden, 2020

Re: Hospitalized horse - what to feed her?

Sherry Morse

Re: Hospitalized horse - what to feed her?

Lorna Cane

Hi Laurie,

Take big, deep breaths. Be sure to exhale!

None of us was born knowing all of this information (ok,except maybe Dr. K.), so dump the guilt and use that energy to  help your girl. You're already on your way with that because you are here!

Ok?  So no looking back.
And deep breaths.
We can't think when we're in a panic. Ask me how I know that.  (Never mind!)


Lorna  in Eastern  Ontario


Re: Hospitalized horse - what to feed her?

Nancy C

Hi Laurie

Welcome.  You are doing great.  You are in the right place. Keep breathing.

If you are feeding the emergency diet, you are well on your way. If you need to, you can review it here.

I am sending you CH instructions privately to hopefully get you started. If you don't see it shortly, look for a message from ECIR in your spam box.   Let us know if you still have problems getting where you need to go.

You will get a full welcome package shortly. 

Hang in there.

Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2019-2020
Join us at the 2020 NO Laminitis! Conference, October 22 - 25, Harrisburg, PA

Re: Where to find case history file?

Sherry Morse

Hi Laurie,

Deep breaths.  You'll be getting a full welcome letter shortly and should have gotten the 'how to do a case history' email already or it's on it's way.  The link for the subgroup is and you'll have to click on the 'join this group' link on that page before you can start your Case History.  This is the body of the email you should be getting if you haven't already - again, take a deep breath and read it through and let us know if you need help:

Where to find case history file?


I am sorry I am brand new here and in a panicked state. Where do I find the case history files please?  Also, don't understand how to get to the sub group.
Laurie R. in Knoxville, TN 2020

Hospitalized horse - what to feed her?


My horse is hospitalized and had a tenotomy yesterday with corrective taped/glued on shoeing with radiographs at the recommendation of the vet due to a significant change in blood flow supply from Friday to Monday on venograms. I am panicking that we are not addressing her underlying metabolic situation. I have gone to get have that has been tested to take to them and will try to introduce beet pulp today. I have shared the emergency diet. Is there a case history where someone can help me? I am so overwhelmed at the amount of information. I have blood work to share but don't know if it's the right information. I am just sick that this is happening and overwhelmed with guilt that I wasn't better educated before. Thank you for any help.
Laurie R. in Knoxville, TN 2020

Re: founder - Mandi photos

Sherry Morse

Hi again,

Just realized that you put your album in the wrong spot, sorry!  It needs to be set up here: and then use THAT link to update your signature.  Once you let us know that it's set up in the right spot we can delete it from the main group but I don't want to do that yet as there may be more comments on the photos.

Having said all that, I'm now going to actually look at them and your CH.

Re: founder

Sherry Morse

Hi Mandi,

It would be great if you could add the links to your CH and photo album to your signature.  To do that:

1) Go to this link to amend your auto-signature:

2) Look at the bottom of that page for the window where you've already typed your name, location and year.

3)  Add your Case History and photo links UNDER your year of joining:
4) IMPORTANT: Scroll to the bottom and hit SAVE!