Re: New Bloodwork & question on feed while exercising

Eleanor Kellon, VMD

 The clearing of the urine means it is less concentrated and he is better hydrated.

With his insulins running 100  to 200 before Invokana even when ACTH was low suggests he is indeed IR at baseline regardless of leptin although probably neither one is 100% reliable.

I'm wondering if going to dry hay from soaked is at least part of the reason for the insulin rise. There is also one paper that     found a seasonal rise in insulin during September but others have not. All things considered I'd probably hold off on increasing Invokana until you can get a test strip reading. You had two very good readings after dropping the dose. Most suspicious of the unsoaked hay, possibly season.

Did their coat color issues resolve?

Eleanor in PA 
EC Owner 2001

Commercial Feed Analysis Library - Thu, 10/08/2020 #cal-notice Calendar <noreply@...>

Commercial Feed Analysis Library

Thursday, 8 October 2020


Commercial Feed Analysis Library

Over the years individual ECIR Group members have sent various commercial feeds to be tested then generously shared the information. The Commercial Feed Analysis Library is a new term for an old file folder where any member can go and view unbiased analyses of commercial feeds. These analyses are a valuable part of the science that the ECIR uses to help our IR and PPID horses and are valuable tools used to prevent laminitis. 

If you have an analysis of a commercial feed please, instead of uploading it to your own folder, please consider sharing it with the entire group by by notifying us here.

View the Commercial Feed Analysis Library 

Thanks for your help and cooperation.

- ECIR Group Owners and Support Team

Re: hay analysis and balancing minerals

Brenda Gasch Mittelstadt

Hi Renee!

I’m learning too. One thing I’d like to ask group is how to keep a thread of a personal, or other members, conversations that are helpful. 

But first, how to see whole thread from digest email?

I have new cushings and ir dx and have a kitchen full of supplements and more. Lol. Love those ponies. They will have better nutrition than I do. 

Good luck Renee. 



September 2020, Dodgeville WI USA

Case History:

Re: feed question post laminitis

Cherie Bandrowski

Thanks Kristin that’s very helpful. I should be getting the glucose in a few weeks (long story...). The ACTH was not fasting.

Cherie Bandrowski in SE Michigan 2020

Re: Squamous Cell Carcinoma

Cindy Giovanetti

God bless, Allison.  I’m so sorry for your predicament.



Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19

Re: Mule diagnosed with PPID. Questions

Trisha DePietro

Hi Sherrie. Welcome to the group! I have attached a welcome letter for you. In it, you will find, key topics of diet, exercise, diagnosis and within those topics, you will find links to even more information. To answer your question about Insulin Resistance...The diagnostic tests for Insulin resistance is a non fasting insulin and non fasting glucose test.  You will find that fully described in your welcome letter under the Diagnosis section. Determining the IR status first will help you answer your questions about how to manage the hay testing and snacks etc. There is a lot of information here. Ultimately, you decide what you want to do for your horse. But first, you need a clear picture of the IR status. 


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: ACTH/glucose high on second blood test

Lorna Cane

Well done, Mary Ann !!  You're not alone. Improvements are being made as we speak.


Lorna  in Eastern  Ontario
Check out FAQ :

Re: ACTH/glucose high on second blood test

Mary Ann

My apologies, I'm not very computer savvy. I did not realize I was supposed to delete the old CH and upload the updated one. I find this website very difficult to navigate, not user friendly for non-techy folks like me.
Mary Ann & Rosie - Nova Scotia, Canada - Joined August 2020

Re: ACTH/glucose high on second blood test

Mary Ann

Sherry Morse, I've updated and saved it three times and it is not saving the updated information. Am I supposed to SAVE AS every time I update my CH document?
Mary Ann & Rosie - Nova Scotia, Canada - Joined August 2020

Mule diagnosed with PPID. Questions

Sherrie Yuschak


I have a 10yr old mare TWH mule diagnosed last week w/ PPID. 
ACTH = 124
Glucose = 70
Insulin not evaluated.
She was not fasted (pasture and hay pellets prior blood draw)
She has been losing topline and has a hay belly. The loss of topline has been since winter but it has gotten worse over the summer. No laminitis. I will be moving her home within the next month, putting her on a grassless track system with hay and starting Prescend.
  • My question is regarding grass and diet. I so often see PPID combined with IR and recommendations all lean toward managing the IR. How strict do I need to manage her diet once she is in a good range with Presecend? No grass? No weeds? No fruit or starchy vegetable treats? OR are these ok to give in limited amounts since she doesn't have IR?
  • Also, must I have my hay tested? I planning on timothy (shipped in) or coastal is local. 

I recognize in a perfect world it's helpful to manage most horses as if they have IR and that traditional horse feeding isn't healthy. However, I don't want to worry myself sick about things that aren't critical as that steals joy.

Wishing I didn't need to be part of this group but so thankful for everyone's support and knowledge!



Sherrie Yuschak in NC 2020

Willow x-rays loaded to album


Vet on Saturday says episode is over, recovery was quick.
Evidence of previous episode about 8 months ago. (While at different barn, wearing shoes, in January, with no grazing, lameness not detected at the time.)
X-rays loaded to our album.
Farrier is coming tomorrow.
August 2020
Metro Vancouver BC Canada

Re: Squamous Cell Carcinoma


Just got off the phone with the surgeon. He also strongly feels amputation is the only option besides euthanasia, since the tip of his penis is basically rotting at this point. So that's where I'm at. He feels his age is not a concern since he's otherwise in good shape, and commented that they often do this sort of surgery on horses in their 20s, since that's when these types of issues arise. I am going to try contacting the University of Guelph Hospital to get their input also tomorrow.
Allison in Ontario 2020

Case History:
Photo Album:

Re: Squamous Cell Carcinoma


Nancy and Carol, thank you!! I'm including these in my list of questions when I call my vet. I'm going to keep trying to get him interested in treating my horse, and am going to see if he will consult with the hospital at Guelph. I am also waiting to hear back from the surgeon I was referred to so I can ask some questions. I'm very concerned with the impact of surgery on a horse his age. 
Allison in Ontario 2020

Case History:
Photo Album:

Re: Squamous Cell Carcinoma


It's been a while since I've commented since my Cushings horse passed on years ago but this caught my attention. My thoughts are with you.  

 When I had a bone infection and was scheduled for amputation because the antibiotics weren't killing the infection, I found some research on silver killing stubborn infections and dosed myself that night. Infection was gone next morning and MRI showed proof and we did not have to amputate. I still have my foot 5 years later. Vets can prescribe silver in a compound with sulfer. Or you can get colloidal silver online or even at some stores like wal-mart. My vet prescribed silver sulfadiazine for one of my horses when she tore up her knee and had a mess of a wound. The other antibiotics had poor results. The silver got the results for us. 
Also IP-6 has shown results against cancer. IP-6 is a form of inositol, a natural sweetener found in grains. 

On Tue, Oct 6, 2020 at 9:52 PM Allison <morningstar_acres@...> wrote:
Yes I will ask for a different antibiotic.
Allison in Ontario 2020

Re: New Bloodwork & question on feed while exercising



His urination & drinking has been very consistent for a year & a half. Ten gallons water per day while getting soaked hay, summer & winter. The last month I have been feeding mostly dry hay in bags & yes, his water intake went way up. Doesn't seem to be urinating any more but it's hard to tell with new stall/bedding arrangement. What I have noticed is that out on our walks his urine is much clearer (not cloudy as it has consistently been). I'll take a sample jar & strip next time we're out so I can sample it there.

He only seemed hot to the point of a little damp sweat a couple of days all summer. (He sweats moderately hard on our walks, but so do I - it's been hot.)

He gets 1 1/2 oz, of NaCl twice per day in his BP & ODT, so a total of 3 oz.

For the last week he has had intermittent cowpies, which is the only time I've seen his manure off at all.

Symptomatically, when he was on  300mg dose, he just seemed to run out of gas on our walks & wanted to stop & kept gently nickering at me to tell me something. He has much better exercise tolerance now. Could have been due to being non-exercising for so long. I could try upping the Invokana again & see what occurs. Looking for better exercise tolerance & more urination.?

I don't think he's metabolic at baseline, either, so it's my management that has to improve. Will go back to soaking hay - sigh...

By the way, the Invokana I ordered arrived here in 5 business days - coming from England!
Thanks for all the ideas.
Virginia F, Lily, Jasuur, Cache, Haat & Spiritt in the sky, in South Central Oregon
ECIR 2010
Jasuur case history and bloodwork folder:

Re: Squamous Cell Carcinoma


Hi Allison - 
I have a Fjord that years ago started bleeding when he urinated.
Longs story short - he has a mass in his urethrae - we tried many
methods to get the bleeding to stop. But finally a vet said to
try Cytoxan. It worked! He was on it for years and it didn't
seem to bother him.  I wonder if something like that would
We got the drug from Canada - way cheaper...
Thinking of you!
Nancy B 

Nancy B

Re: ACTH/glucose high on second blood test

Sherry Morse

Hi Mary Ann,

1 - can you please update your CH with the current bloodwork numbers?
2 - If this was my horse and she was that elevated I'd titrate her up to 2mg daily and then retest after 3 weeks to see if that's brought her down into the lab's range.  At 240 even 2mgs may not be enough to control her PPID and you may need to bump her up again.

As we always say, the right dose of Prascend is the one that control the ACTH in your horse and 1mg was obviously not enough for Rosie.

On Tuesday, October 6, 2020, 6:34:48 PM EDT, Mary Ann <horsehead64@...> wrote:

I finally received the results from my mare's second blood test. Her ACTH and glucose are still very high. Her insulin was low and my vet does not consider her to be IR. She did increase her Prascend from 1 mg to 1.25 mg and monitor her for lethargy or appetite suppression. Her dose was increased starting October 2nd. After 5 days on the slightly increased dose, her appetite remains good and she is still quite energetic. My vet was going to confirm with other colleagues who specialize in PPID as to what her dose should be and whether or not she should remain on the increased dose during the seasonal rise. 

I'm looking for input from the group on questions I should be asking my vet regarding her current level of Prascend. Can I increase her a further .25 mg for another 4 days to get up to 1.50 mg. What is considered a safe dose to administer with ACTH and glucose that high? 

Mary Ann & Rosie - Nova Scotia, Canada - Joined August 2020

Re: feed question post laminitis

Kirsten Rasmussen

Cherie, when I look at everything you've posted I'm thinking this is more of a trim and minerals issue rather than EMS, especially as her ACTH was not elevated.  A few more details though would be helpful: was ACTH done fasted (hopefully not, but even if it was it still looks normal for this time of year), and did you get insulin and glucose done, too?  If not, I don't think it's necessary right now, but if you did please add the results including your ACTH to your Case History.

I personally would get an analysis of the hay you are planning to feed this winter (the 603 package from Equi-analytical is ideal), and then have a mineral supplement balanced to that hay (one of our balancers can do that for you for a 1-time fee).  This should help with tightening up her hoof growth and growing unflared walls over the winter (from the photos you provided, I can see her hoof walls are flared quite high up her hoof capsule , so you can expect this to take 6-9 months minimum).  The trim is also critically important, too, but I'll leave that for someone more experienced to comment further on.

I think her body condition looks quite good for going in to winter, not fat and no ribs obviously visible.

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

Re: Squamous Cell Carcinoma


Message received this morning from vet #2:

"Your next step is surgical intervention or humane euthanasia. The ultimate reality is that regardless of whether we can get the infection under control or not, if you don't go the next step with amputation then we are wasting our time. As we discussed, the idea of treating to reduce the swelling and try to control the infection is only a short term fix at best. The infection is the secondary problem. Without fixing the primary problem the end result will not change. Sonny is in significant discomfort and will stay that way and only get worse until the primary problem is resolved.....even if we can get the infection under control. It is very obvious that you care deeply for sonny but we really need to consider quality of life. Please take emotions off the table,and make a decision that puts Sonny's best interest in mind whether that is surgical intervention or humane euthanasia. He is suffering and it will only get worse. "
Allison in Ontario 2020

Case History:
Photo Album:

Re: Squamous Cell Carcinoma


Thank you so much Nancy. Your words comfort me a little. My mind is racing constantly over this, it's hard not to become obsessive.

Last night was the first night he tried to kick out when I was messing around with him down there. I don't blame him poor boy. After our lunge/cold water hoseout/lunge/wash with soap/cold water hose out...I put him in his stall for a couple of hours to eat and chill. Then tried rinsing him out again with just plain water to make sure I got all the soap. That's when the kicking out started. He'd had enough. Then I applied Special Formula 17900 in there as best I could. I have 2 tubes of it left so I'm going to stick with it until the end of this round of antibiotics and then switch to the frankincense oil mix. This is the ingredients list of the SF:

MEDICINAL INGREDIENTS: Penicillin G Procaine 100 000 I.U., Dihydrostreptomycin (as dihydrostreptomycin sulfate) 100 mg, Novobiocin (as novobiocin sodium) 150 mg, Polymyxin B Sulfate 50 000 I.U., Hydrocortisone Acetate 20 mg, Hydrocortisone Sodium Succinate 12.5 mg., per 10 mL.

Allison in Ontario 2020

Case History:
Photo Album:

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