Hi Kristin, welcome!

As a TB, your horse is less likely to be IR at baseline than others, meaning if his PPID is well controlled, he probably won’t need as many restrictions to his diet.  You don’t mention any blood testing but I assume that has been done prior to your starting him on pergolide.  Please share the bloodwork values with us so we can comment more productively.

My horse, Logo, a WB with many years of PPID, never showed any indication of being IR, even when his PPID was less controlled than I liked.  He had issues with scratches which I treated with everything imaginable, even taking a plug for biopsy, which showed nothing unusual.  Once I started him on pergolide, that problem lessened dramatically, even becoming a guide as to whether or not I needed to increase his pergolide.

I tested my hay and a commercial blend similar to Vermont Blend, which had yet to be developed, was recommended as being close to perfect.  His continuing problems with hoof quality concerned me and eventually I switched to a custom supplement.  That switch made a remarkable difference in the quality of his hooves.  Vermont Blend does have added salt but, if I remember correctly, more salt is still indicated.  Do you know the source of your hay?  I often see truckloads of haying moving through here from Canada, going south. Knowing it’s source would help you to know what additives are needed.  You will find lots of members here have similar hay sourcing/testing issues to yours so do some creative searching of the messages.

I use TC balance cubes as carrier for additives but I do have some IR ponies which need their sugars and starches more controlled.  With Logo, who never showed any indication of being IR or having foot pain, I used a senior feed for years before I learned of the cubes.  The cubes contain a small amount of beet pulp as a binder so it might be good to locate a sample to try.
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Hello Sherry and others, 

I have gradually weaned Bullitt onto the #1 hay on the hay analysis in our case history. This had much lower ESC + starch than the "March" hay we were feeding with soaking, but even with soaking this #1 hay his symptoms for laminitis seem to be getting worse and he has developed hives even though he was on this hay in June and July before he had the laminitis and he had no issues with hives. I can't put him on the #2 hay which has the least amount of ESC+starch because the calcium ratio is way off and we are still desperately trying to figure out the mineral balancing. He has also started eating poop which is very concerning to us. Between the hives and the laminitis we are really struggling. There is nothing in his diet right now but soaked hay and the rest of the emergency diet because we are still trying to work out the mineral balancing. I don't know what to do about the hives because there is really nothing I feel comfortable leaving out from the emergency diet because it is already so minuscule in terms of nutrition and I feel like that is why he is eating poop. It seems like no matter what we do his situation is getting worse. Any input from the group would be welcome. 

Thank you, 
Sarah 

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Sarah O. 
Rudolph, WI
2020

Hello Kristin

Welcome to the group! Thank you for getting your signature up.

I'll be sharing our group's welcome letter below. It is long but there is a lot of detail on diagnosis, diet, trim and exercise (where applicable). There are links embedded to pages/files with more elaboration and options as well. It sounds like you have found some of them already but it is still worth a read in the order in which it appears and is a useful reference you can bookmark to refer back to. I hope you will be able to work on your case history as there's some gaps in the information that could be helpful in providing you with advice (eg. whether he has other symptoms, was he ever footy, diagnosed with laminitis before? Tested for IR? His body condition?)

A few comments:
- non-healing scratches. My previous lease horse (warmblood) also had a lot of ongoing scratches but they eventually cleared up. You may find that being on prascend helps to resolve some skin issues (with appropriate care as applicable).
- Prascend (pergolide): To know whether he has reached the right dose needed for him, his ACTH can be retested 2 to 4 weeks after you reach your intended dose. Read more about it here: https://www.ecirhorse.com/pergolide.php
- hay testing. For people who have constantly changing hay due to supply, regional hay analysis might be the next best thing but only if the hay is coming from the same region and only for mineral balancing. Another method worth trying is to test periodically so that over time you build an average for hay in your area. I would do this even if you end up feeding one of the safe mineral supplements which are like best estimates/best guess types. It's hard to say which of the acceptable balancers will suit you more since they are all not based on precision of your actual hay analysis. Dr Kellon may be able to comment more based on regional information. You may also want to approach the companies for a sample as some of them do give samples for you to check palatability since you already know your horse is very picky. The 3 companies you named are reputable and the iron if listed is naturally occurring and not added.
- You need vitamin E, salt and since your horse doesn't graze much anyway omega 3 (flaxseed meal). Flaxseed meal may also be a useful thing to help his condition (I'm guessing he's not over-conditioned since he is a stressy ottb and picky eater) and skin. You can read that more in the diet section below. You asked if a textured feed as a carrier is ok as it's only 1 cup - that depends on your horse. It's not recommended but some horses are less sensitive than others. You could try reducing the amount if it's just a taste tempter to eg. half a cup or 3/4 cup. Maybe you will be lucky and he likes flaxseed and that could be your taste tempter. Omega Horseshine contains stabilised flaxseed meal and is safe specs and seems quite palatable. If your horse is PPID but not IR and his PPID is controlled with Prascend or pergolide at a suitable dose, you have a little more wiggle room in my experience. A safe carrier you may want to try is stabul 1 which comes in a range of flavours. I know you said he doesn't like hay pellets soaked or dry but some members have also reported that the Ontario Dehy Timothy Balance cubes or TC Naturals Timothy Balance cubes (same product with the latter marketed under Triple Crown so you may be able to get this easily) are very palatable and break apart with only a little water and can be served pretty dry.
- magnesium: this depends on whether your current feeds are short. But if using magnesium oxide, it's quite safe to add. If you have too much, you will see loose stools. I haven't so far had that experience after feeding magox to several different horses/ponies.
- The alfalox forage at minimum 7% fat is also not within the recommendations here. But on TC's website they say over several months they will be phasing this out anyway and replacing it with another product. No information on sugar or starch levels but molasses and wheat middlings are ingredients. Some horses are sensitive to alfalfa in that they get footy/footsore on it. I have to defer to Dr Kellon or the other mod volunteers on recommendation here.
- Also have a look at our picky eaters checklist: https://ecir.groups.io/g/main/filessearch?q=Picky

Here is the full letter:

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 etiquette, what 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.

EXERCISE: The 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.

https://ecir.groups.io/g/CaseHistory/files/Sally%20with%20Tabby%20and%20Maisie 

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

https://ecir.groups.io/g/CaseHistory/files/Sally%20with%20Tabby%20and%20Maisie