Re: Desperate - no improvement

Lavinia Fiscaletti

Hi Melissa,

I have a Percheron cross, so know what it's like dealing with their foot issues. Their weight definitely works against them, as gravity just isn't a friend when something goes wrong. That he is comfortable in boots is a good sign. You can make the boots function even better for him by rasping a larger bevel onto the front treads and onto the backs of the heel treads as that will ease his breakover and take pressure off the laminar connections when he moves.Have a look here:,,,20,2,0,0

Add the breakover to the front of the treads from 10 until 2 o'clock, at about a 45* angle. Add one to the backs of the treads from 5 to 7 o'clock.

Agree the radiographs do not look all that bad - very little change from the 2017 ones, except for some slight rotation on the LF. Soles continue to be thin, toes continue to be too long horizontally. Possibly some minor sinking, but nothing significant.The long toes are part of the reason his soles are remaining thin. Significant side bone has been present for some time, which usually doesn't cause lameness. It is an indication of some medio-lateral imbalance over time, however. RF has significant medial flaring. Unfortunately, the LF DP view cut off the entire medial wall but there is visible flaring of the lateral wall. The flaring is a trim issue that also needs to be addressed.

It would be helpful if you would provide a full set of hoof pix. Here's what's needed:

When you have the new radiographs done, it would be extremely helpful if you could see the entire foot, rather than having the views shot thru the blocks the foot is standing on. Have a read here for more info:

Paying for pictures of the blocks isn't the best use of your funds. If Tango is having difficulties standing for the rads to be taken, discuss with your vet using nerve blocks to allow him to be comfortable during the shoot.

You mentioned that the farrier shortened the toes - did he touch soles at all? If that happened, it could account for his being "crippled" right after the trim. The sole shedding may be due to him being in boots all the time, rather than actal sole shedding. Are you powdering his feet liberally each time you change out his boots? Gold Bond medicated foot powder (or any of the generic types) works well to help keep things dry and greebly-free.

You can try doubling up on the Cloud pads inside the boots: once he crushes a pad down, just add a second one under the first. Leave the one that has conformed to all the contours of the bottom of his foot in place as it will provide provide support across the entire bottom of the foot. If needed, you can cut out a hole in the crushed pad in the area just ahead of the tip of the frog to provide some pressure-relief to the area where the sole is the thinnest.

Hang in there and don't forget to breathe.

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

Re: Flooring: Shavings and pellets

ferne fedeli

Thanks for the detailed "recipe" for setting up your pellets.  I don't bother with them much during the summer, but set them all up with bedding in their stalls when the rainy season starts and I will try your method.  Sounds good!

Ferne Fedeli  Magic & Jack   2007

No. California
Case History



Re: Desperate - no improvement

Candice Piraino

HI Melissa,

Great job on having the extra set of pads on hand!!! Thats fabulous! Also, a little tip- you might want to try turning the pads around and having the wedge part that is usually in the back under the toe of the hoof. he may gain more comfort with that. See how he responds to it on the next set of pads. If he seems more comfortable great, if not, then turn them back around. 

So for the next set of X-rays, please ask them to remove the hoof wall marker when they do the DP (Dorsal Palmer) view. Also, have them place a darker at the apex of the frog (the tip). This will be more beneficial for podiatry purposes instead of only diagnostic. The marker at the frog and along the hoof wall can help guide us with rotation as well as sole depth. Usually these guys have thin soles but it doesn't need to be this way. 

Looks Tango has had a lot of side bone, even evident in his rads from 2017. It may or may not be causing him issues as well. Poor guy. 

~ Candice 

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History:

Shark's Photo Album: 


Re: Flooring: Shavings and pellets


Just another take on pellets.   I use the soft pine pellets.   Starting with a stripped stall I lay down 3 bags of pellets flat on their sides.  I cut a big X from corner to corner and lay back the plastic.   Then I pore water over the pellets a bit at a time.   It's kind of like wetting down the ODTBCs.  I give them time to absorb the water and fluff up.  I use enough water to soften most, but not all the pellets.   When they are done absorbing, I pull the plastic bags out from under the piles of pellets and rake them all together using a garden style heavy duty rake.  The resulting fluff will be dry if I haven't used too much water.   It was a learning process.  Side note :  this is also what I use in the horse trailer.   Fluffed pellets prepared some time before the trip.   Very soft and absorbent and the piddle won't run all over the trailer.   
The manure is very easy to sort out of the fluff with very little waste of bedding.   The first day or two, I just rake the wet bedding into the dry and it actually does work.  Then there  comes a time when certain areas will be ready to remove.  If I scoop under a wet spot with a manure fork and turn it over and see the fluff has "pancaked", like small wet slabs of bedding, then I remove those and add clean, partially pre fluffed pellets to the mix.   When I can't keep up that routine for some reason, like in super freezing weather, or when time is very tight,  I top the fluffed pellets with the big shavings the way Dawn and Lorna describe.   Also, Chappie is rarely shut in his stall, so he goes to the bathroom out in the drylot part of the time.  
Laura K Chappie & Beau over the bridge
2011 N IL

Re: 3 questions (hay analysis, ODTB, feeding pill) #nirwetchem

Candice Piraino

Hello Barbara!

I noticed this is your first post! Please make sure you also join the Case History group and upload your Case History when you can. You can also upload the hay analysis and we will be sure to help you with that as well. The instructions are found below. If you still are having issues, please let us know so we can assist you.

Welcome to the group! 

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 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: 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. 


~ Candice 

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History:

Shark's Photo Album: 


Re: Desperate - no improvement

Kirsten Rasmussen

Hi Melissa,  could you add this link to your rads to the signature
and also hit enter after the signature to your Case history to make it live?

It would also be great if you could move the 2017 rads into the above photo album.  They are located here:
Probably easiest to delete this album and add them to the other from your computer.

Looking at the 2020 rads,  honestly they do not look bad IMO.   I don't see any sinking and only slight rotation.   Others more qualified can comment further on them.

I'm not familiar with the protocol for sepsis related laminitis so I'll leave that for Dr Kellon to address.

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

Re: Recent Bloodwork results- where should I go next?

Kelly Gilmartin

Re: Treating for Lyme's ?

Sherry Morse

Hi Amy,

You may find the Cornell article on the Lyme multiplex helpful if you haven't already read it: but in a nutshell for OspF anything over 1250 is positive, even if it's a low positive.  OspC anything over 1000 is positive and both being positive indicate an early infection.  For your guy I'd say he's low positive and what would be the harm in treating him.  As far as the Lyme treatment you need to advocate for him.  If he has symptoms of Lyme even with the relatively low OspF numbers and you want to spend the money to treat him, it's not the vet's decision, it's yours.

What is his current insulin level?  Was the Metformin started at the same time as the bute?  Do you have a CH for this horse? There are too many unknowns to be able to give you any sort of an answer if the laminitis is related to IR and PPID vs. Lyme, but having that information may help us help you better.

Re: 3 questions (hay analysis, ODTB, feeding pill) #nirwetchem

Barbara Henry

I am having brain fog on how to download info on Monroe's case history. I have an analysis of the hay I am getting ready to buy. I have had my pasture tested plus the soil tested. I am lost where I attach them. I have been soaking his hay (12pd)I believe that is not enough for him. Can someone walk me through this? He has not dropped any weight but I did find out how much he needs to weight for being a light draft. Is there someone that can look at the hay report before I buy a year's worth of hay? 
Thank you very much for all the help!
Barb Henry

Second Request for Help for Teeny immature neutrophils high CPK


Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
Joined 2019

Treating for Lyme's ?

amy in VA

OSPF is 1354 (OSPC 948) and my boy has laminitis that is
very painful and did not respond to 5 days of bute.
His legs have been slightly swollen too. My vet says that 1354 is nothing to worry about. He is IR and low level PPID. He started metformin 5 days ago.
I think he should be treated for Lyme's, what do
you all think? Thanks
Amy in Va

Recent Bloodwork results- where should I go next?

Kelly Gilmartin

Dr K et al,
my initial metabolic panel is in from Cornell- still
awaiting TRH stim results- he always had a normal ACTH but was abnormal on stim. The same appears here. 

baseline ACTH 22.3 of/mL range 9-35
insulin 99.75 uiU/mL range 10-40
glucose 100 range (71-122)

what should I do next? Metformin? Invokana? Do horses get hypoglycemic on metformin? Welcome suggestions for getting insulin down as he is still not comfortable moving long term. 

Kelly Gilmartin/Buddy
Western Massachusetts 
member since 2019

Re: Question regarding bloodwork for horse on Metformin

Sherry Morse

Hi Mara,

Hopefully the vet is not charging you for the bloodwork do over!  Looking at the numbers in your CH it looks like Enzo's lost about 40 - 60 pounds, is that correct?  As far as feeding...if you're feeding for 2% of his ideal weight per day you need to be at 17 pounds TOTAL - that includes hay (which I am hoping you're weighing) as well as any hard feeds.  That extra 12 oz from the Omega Horseshine and the Timothy cubes may not seem like a lot but it could be just enough to be sabotaging some of the weight loss efforts.  If you need those to get the supplements in him/have the right amount of minerals than you may want to cut the hay back just a titch more.

I think you're on the right path, especially as he's more comfortable than he was, it's just going to take time to get the weight off.  Will be curious to see what the new blood results are.

Re: Grey Horse Melanoma and AAKG


Dr. Kellon, do you remember Jackie Deckers mare Torri?  She has huge melanomas internally and externally.  Jackie did a youtube video about it.  Torri is still alive and Kicking!  This is the video.
Diann Kuzma
One Hoof at a Time
Medford, OR
Joined 2018

Re: Question regarding bloodwork for horse on Metformin


Vet will pull blood again tomorrow.

He is doing really well. So much more comfortable. We are walking in soft footing without boots. I use boots on hard surfaces. He was never cresty. His weight has not changed significantly. Still working on how much more I can take out.

Re: Desperate - no improvement

Melissa V

Yes it was septic. I uploaded everything, I hope I did it correctly.
Ruffin NC 2020,,,20,1,0,0

Re: Desperate - no improvement

Melissa V

Ruffin NC 2020

Re: LMF Low NSC feeds


Ok, great. I'll give the Stage 1 or Complete a try.

I'm looking to switch from Stabul because I currently get it from Chewy but I will be living in an apartment where delivery of 50 lbs bags will be tough. He's done fine on Stabul but nothing exemplary so I'm not concerned about a switch as long as the new feed looks good. But I'll stay with Stabul if for any reason he doesn't seem to to as well on LMF.

May 2018
Los Angeles, CA
Buster's case history:  .

Re: Lily's ACTH still high

Eleanor Kellon, VMD

Re: Grey Horse Melanoma and AAKG

Helen Connor

Hi Kristin,

I think my first response to you was swallowed by the computer. Just wanted to thank you. It is useful to hear that once Shaku's cancer was under control, you could resume AAKG. Sorry it no longer helped, though. 
Helen Connor and Blessing (IR/PPID)
Scappoose, OR
Member since May 2017
Case History:
Photo Album:

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