Re: Trim opinions Lavinia?

Bobbie Day

Re: Pergolide, veil and APF

Nancy & Vinnie & Summer

Hi Sherry, yes and I just increased the dose from 3ml 2x per day (last rwo months)  to 4-5 ml 2x per day when I noticed the issue.
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018



Bobbie Day

Has anyone tried placing a online order today?? I cannot get past the shipping option, I've tried every browser I have, of course its closed now.

Bobbie and Desi
NRC March 2020
Utah, Nov 2018

Re: Question on bloodwork to be pulled tomorrow

Eleanor Kellon, VMD

The vet tech is misinformed.  The latest research has shown average fasting glucose should be no higher than a little over 5 uIU/mL. Your result is in a grey zone for a certain diagnosis but that's a great reason to repeat it nonfasting this time.
Eleanor in PA 
EC Owner 2001

Target's trim

KATHIE DORVAL <bokayarabians@...>

Vet and farrier are coming Oct 9 to trim Target again. We did a big trim Sept 1 and put clogs on her. The next day we had to take he one off the right front as it made her worse. She  has been barefoot on that one, and has had 2 abcesses break through the bottom of her foot at the toe. Until they covered over She was in a pad and bandage. Vet came out  Sept 23 and hoof tested her and she didn't react at all, yet she limps when walking on it. I have trouble lifting the RF yet she will lift the LF and stand on her RF. Yesterday she started walking backwards with straight front legs, which she just drags. She is up most of the time and down sometimes. Eating and drinking well( even gained about 35 lbs) drinking and peeing and pooping normally. Her blood work showed her ACTH at 3.77 glucose at 5.9 and insulin at 214. She is on 6mg of pergolide, has had a course of omeprazole, and bute and also is now on antibiotics, as her white count was a bit elevated. I have been monitoring her heart rate each morning and it ranges from 44 bpm to as high as 68 bpm. Does anyone have any suggestions as what to do to help save Target? Thanks.
Kathie with Libby and Sweet P
Cobble Hill, BC, Canada
Aug 2018
Case Histories
Target Photos
Sweet P Photos
Addy Photos
Cherokee Photos

Re: Trouble with eating and giving pergolide


I m sorry what is APF stand for ?
thank you  

Renee SD 2020

Re: Iron - worth testing? - Bump


Thoughts?  Vet comes out next week.
Wondering if iron panel is truly worth doing.

Tracy and Salsa (1999 model year Paso Fino)
Middle TN USA, September 2019
Case History

Re: Most Effective Timing on Administering Prascend Dose

Trisha DePietro

Hi Jessica. Welcome to the group! As LJ indicated- it is best to administer Prascend the same time of day and the full dose. It is the consistent timing  of the administration that is key. Below you will find our welcome letter that will give you access to LOADS of information about PPID/ IR. There are active links embedded into the informational sections that will lead you to even more information. Let us know as you do your reading, if other questions pop up! We are here to help! 


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. 


Trisha DePietro
Aug 2018
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder

Re: Questions about Babe on pergolide- Now What is ACTH, actually?

Anna Dolly

Thanks, everyone, for your replies!
Ferne, it may have been a sales pitch, but still explained the mechanism of pergolide pretty well for me.

I received the APF yesterday and we started Babe on the pergolide again. I had intended to start with 1/8 dose and work my way up to the 1/2 dose they want him on. 
I've been pretty ill and wasn't thinking clearly, so we started him at 1/4 dose. Still milder than the 1/2, but wasn't my intention. I dissolved the whole tablet in a known amount of water in a syringe and gave him 1/4 of it. 

We were at 60 degrees with solid all-day-long rain yesterday (we're in the mountains, so somewhat elevated). He came down shivering, so I put his raincoat on him and he was happy to have it. My chunky little Appaloosa got his on, too, even though he didn't really need it for warmth, but because he's not appreciative of standing in chilly rain. He was happy as a clam. Plus, if I do something for Babe, and Boomer misses out, there's a jealousy factor at play. lol

Farrier comes this evening to rasp his toes. He's a LOT more comfortable than he was, I don't think he's in any pain at all at this point, but he's not running laps yet, either.
I'm sincerely grateful to my friend who pointed me at this group and to all here who participate and offer their knowledge and time!
Anna Dolly
Keyser, WV
Sept. 2020
Babe's Case History
Babe's Photo Album

Re: Most Effective Timing on Administering Prascend Dose

LJ Friedman

Where are you getting your mixed information from? I know the group says once a day and it should be the same time every day, doesn’t matter what time of the day you choose as long as it’s relatively consistent
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos


Re: Questions about Babe on pergolide- Now What is ACTH, actually?

LJ Friedman

The prascend video was quite informative.  dopamine for everyone, lol  
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse and majestic ‘s Case History 
Jesse's Photos


Re: Question on bloodwork to be pulled tomorrow

Sherry Morse

Hi Nancy,

Hopefully no fasting this time around.  Were he mine I'd like to see those insulin and glucose numbers with him non-fasting as it will help you assess if his IR is under control or if his diet needs more tweaking.  As always, you can insist that since you're the one paying for the bloodwork the least they could do is humor you and run the numbers again if they try to insist that there's no point in doing it over.

Question on bloodwork to be pulled tomorrow


Hi - My vet is coming tomorrow to recheck Twisters ACTH level. The first and last draw was 6/18/2020. (which was done fasting per vets request)
Should she check anything other than ACTH?  I just talked to vet tech - she said that because he did not have high insulin/glucose before and because it was done fasting it doesn't need to be done again...( I know now that it should have been done non fasting)
Nancy B

Re: Questions about Babe on pergolide- Now What is ACTH, actually?

Maxine McArthur

Thanks Dawn. I’m not, I should add, advocating the use of Prascend over other forms of pergolide—but we shouldn’t forget that in many countries it is the only form available to owners, despite the cost and possible difficulty of administration. 

Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response


Re: Questions about Babe on pergolide- Now What is ACTH, actually?


Ferne, The video is in the middle of that page. its a visual illustration of the structures in the pituatary and the hypothalamus, what they do, what goes wrong in PPID and then how pergolide substitutes for the dopamine that is missing to block off the dopamine receptors. It's an elementary but quite good depiction of what exactly happens in an PPID affected horse. It's worthwhile to have as a teaching tool.
Just today, I had someone on another list I belong ask about her horse having high insulin and what to do about it, ( horse was immediately given Thyro L by vet) and someone else told her to give the horse pergolide.  Of course I directed her here so she can learn more than I or anyone else could possibly tell her in posts. 
There is zero wrong with Prascend's ability to control ACTH. What the problem with it is that it is in tablet form, the most difficult form of meds to give a horse, and it's expensive, which makes using it in sufficient amounts difficult if not impossible for the average horse owner. New members here should not be confused that Prascend is somehow not safe or effective for their horse.
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: .

Most Effective Timing on Administering Prascend Dose



I am getting mixed information on administering Prascend once or twice daily.  Which is more effective at controlling ACTH?

Also, is there a time of day when it is most effective to be given?  I know that some human medication should be given at certain times of day to have the biggest impact on hormones.

Thank you in advance!

Jessica USA 2020

Re: Trouble with eating and giving pergolide


Thank you Sherry! Such a help for a newbie!!
Marsha and Dame - Buzzy TN 2019

Re: Relevante Trim


Good idea Sherry! It would be great to be able to do that in the arena without the Soft Rides because they do obscure things just a bit. But I can get some this weekend to chart progress throughout this process.  Of course the end goal is to return to riding and begin moving toward conditioning/exercise. I took some body view photos side, front and hind ...primarily targeting the appearance of his belly. I attribute it to  loss of topline/conditioning due to all the down time he has had. But the "barn butler" keeps calling him pregnant.
Beavercreek, Ohio
March 2018
Relevante Case History
Relevante Photo Album


Re: Questions about Babe on pergolide- Now What is ACTH, actually?

ferne fedeli

Looks mostly like a sales pitch to me.  But then I started using Pergolide for my horses before Prascend was around and have never touched the stuff!!!  Ha.

Ferne Fedeli  Magic & Jack   2007

No. California
Case History



Re: Relevante Trim

Sherry Morse

Hi Lynn,

This is super news.  At some point you need to get somebody to video Relevante again so you can compare where he is now to other videos from the past - sometimes it's hard to see incremental improvement 'in the moment' but since you have the older videos it'd be a nice comparison to where he was to where he is now.

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