Re: New Member - Question - Acetyl L Carnetine

Eleanor Kellon, VMD

Re: Is anyone in the UK using Invokana

Eleanor Kellon, VMD

I don't see the value to fasting insulin. He shouldn't have insulins that high even in you fed him a bucket of sweet feed so the diagnosis is made already. It's reasonable to remove anything that drives him higher but you would need before and after feeding tests to know that.  On the other hand, he has to eat something and if your diet is already rock bottom S/S there's no place to go with diet since you are already soaking hay.

You can't tell if Metformin is helping if you fast him first. The whole point is to control his insulin response to eating.

I saw in his record there were 2 low insulins. Were those fasting? Since he's a pony, he may be in the group where high insulin and glucose are related to high levels of incretin . Also see . These ponies have increased absorption of glucose from the gut and therefore increased insulin. Their response on intravenous testing is normal so they don't really have insulin resistance.

In the end, it doesn't really matter for you and Dewi since he ends up with high insulin and laminitis. The Invokana will work whether he has IR or abnormal incretin and glucose absorption.
Eleanor in PA 
EC Owner 2001

Re: New Member - Question - Acetyl L Carnetine

Eleanor Kellon, VMD

There's nothing harmful in giving them together but high fat will block the metabolic effects of ALCar (I'll get a file up.) Wait until you're down to 1/2 cup to start it.
Eleanor in PA 
EC Owner 2001

Re: New Test Results for Bella & Destiny - Dr. Kellon, asking for input about possibly starting Invokana?

Eleanor Kellon, VMD

Antech is OK.
Eleanor in PA 
EC Owner 2001

Re: Orchard Hay from Oregon


Hi, Cindy.
I can't imagine how hard it must be for you to buy hay sight unseen when you can't touch it and open a sample bale. 

My "As Fed" conversion is the same as yours.

This winter, some late season orchard grass from southern Oregon was clearly impacted by very heavy smoke pollution from wild fires burning from September until they finally burned out. Every plant growing outside over a large area of the West Coast was coated with soot from wildfire smoke, which is a nasty mix of everything that burned. I suggest you ask if this hay was affected. I rinse all hay from one load that was harvested after August 2020.

2020 was also a drought year. That can result in dirty hay.
I don't share the assessment of Timothy being superior to Orchard Grass hay. Good hay is good hay, weed-free, suitable for the level of work of the horses being fed. 
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Re: Vet in North Texas?

Cindy Giovanetti

Orchard Hay from Oregon

Cindy Q

Hi all

I thought I would pick the collective experience/brains here. Our small yard depends on imported monthly hay (mostly shipped from US). We were feeding horses and ponies bermuda hay (only periodic basic hay test provided by the company - NIR and often not covering trace minerals at all and some of which were dated more than a year ago - and I suspected may not be matching the hay deliveries to us as they overlap with the last shipment in warehouse and may be mixing it up). This hay quality seemed to be dropping - looking very dusty and small little bits quite powdery so we are looking to change hay supplier.

Anyway, we now get told there is an issue with the usual bermuda shipment and it will come in late. We have checked around and our new supplier also can't supply us bermuda yet as it's all spoken for so we have to wait for their next shipment in about 3 to 4 weeks. They said they have timothy or orchard hay until then. We managed to secure some remaining bermuda only for Glow (she's currently is having laminitis pain and still gets her hay soaked and the vet is seeing her). I got a basic NIR test for the orchard hay that is in stock currently,,,100,2,0,0

I converted to as fed (it's NIR only so take with pinch or bucket of salt) and that's why we soak:
2.86% starch
6.35% ESC
12.96% crude protein (but I see bermuda NIR tests here up to 13.5% sometimes)

I know nothing about Orchard but I checked ECIR search and seems it's grass hay like bermuda and timothy and it we still look for the same things (ie best to hay test). We are more familiar with timothy and whatever we get here seems to be more conditioning than bermuda generally. Around here, if a sport horse is in hard work and under-condition, owners will pay the livery yards extra money to switch to Timothy and generally it does seem to help condition. I've asked for a hay test for the current timothy as well but that may take awhile. We have a few fat ponies/horses that we were soaking their Bermuda for calorie and sugar reduction. Whether we switch to Orchard or Timothy, they will continue soaking as before.

I saw the hay test stated the hay was from Volwood farm which I googled, seems to be in Oregon. 

I read some posts that give me the impression that Orchard cheaper and sometimes mixed with fescue or even alfalfa and we don't want to risk that. All the supplier could tell us other than sending the basic hay test is that it looks grassy. My general impression searching around is Timothy is more popular or widely fed and whatever we have gotten from either supplier previously seems to be pure at least. Otherwise, we will have to make a call on the Orchard vs Timothy (with or without the basic test) and are leaning to Timothy since that has always looked pure and more familiar. 

My backup is that if we then run out of the remaining bermuda for Glow, we will have to use the 2nd hay and continue soaking. Maybe replace some of the hay with increased soaked and rinsed beet in the bucket.

We need to do the switch of hay over the weekend so probably need to come to a decision by tomorrow morning. Any red flags or things I'm missing please? 

Cindy and Glow - Sep 2017, Singapore
ECIR Primary Response

Re: Vet in North Texas?

Joe Snow

You many want to talk with  Dr. Sammy Pittman - Innovative Equine Podiatry in Collinsville, TX.   He is a Vet and a Farrier.   He will not find your requriements for Bloodwork  / Xrays, etc, bothersome.  A high percentage of his patients are IR/EMS/Cushings/Laminitics as he specializes in equine foot care (he does not provide general equine vet services).  
Joe S. in TX 2020

Re: New Test Results for Bella & Destiny - Dr. Kellon, asking for input about possibly starting Invokana?


Thank you Dr. Kellon,

Does this (Chemistry screen and Triglycerides) need to be sent to Cornell?  Or is Antech okay?

Lynn Cox
Kern County, CA

May, 2007 

Bella Case History
Destiny Case History  .
Photos, Bella, Destiny, Zoe, Pip  

Re: Equishure and Insulinwise

LJ Friedman

why liquid pergolide??
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos


Re: Vet in North Texas?

LJ Friedman

hilarious  dr grove?  my vet  
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos


Re: Phytoquench pellets

Michele Goldberg <ladipus@...>

I could maybe see if she was just more forward ...This was more like a crazed spooky /super distracted wild woman....definitely Un characteristic of her as she’s normally spur& stick quiet...but so strange after just 2 doses of it??I also just gave it to my gelding with heaves and saw no difference in him as far as his behavior ..he also has only had it 2 days so far.

Michele Goldberg
Bernville, Pa
joined 5/19/2016

Re: To much pracend ?acting a bit aggressive ,planting hay this season

Nancy C

Hi Tara

As we discussed, Timothy is the primary grass in my grower's fields.

Can you clarify your second question please? Are you asking about Invokana, Prascend or both?
Either way, testing is always best. You may want to review recent messages on Invokana, eg.,

Updated info has been sent to all vets currently working with Dr Kellon.

Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room

Re: To much pracend ?acting a bit aggressive ,planting hay this season

Tara Smith

So which grass type may be the best ,orchard or Timothy for best choice?also is there any chance 2 much ivonkanna would cause mood change when he is controlled he is on 150 mg and how do you know if they actually will need the increase in pracend long term.Will at test show if we are offering to much or is it about watching symptoms and playing with doses ?
Tara and Gavilon
Mass.  Nov 2017

Re: New Member - Question - Acetyl L Carnetine


That's great! Thank you. 

He is currently receiving two full cups of oil a day.  I was considering tapering him off of the oil 1/2 cup at a time; much in the way I introduced it to him a 1/2 cup at a time, (I'd do that 1/2 cup decrease a week at a time) If I went that route, would it be ok to be giving him the Acetyl L-Carnetine during the month it takes me to deplete the oil -- or should I not give them simultaneously?

Thank you for your patience and support.

- Laura
March 2021, Northwest Connecticut
Case History:


Re: Is anyone in the UK using Invokana

Kirsten Rasmussen

Another factor here is PPID.  Is Dewi on pergolide/Prascend and if so can you add it to your Case History?  You'll want to retest his ACTH 3 weeks after being on the full dose to make sure it is helping.  Uncontrolled PPID could really be compounding the high insulin, so you need to make sure this is under control.

Your vet probably just wants Dewi's insulin results to be comparable, so if he thinks you have fasted him in the past he is going to want you to continue to fast him for bloodwork so the numbers can be compared.  Again, point him to the EEG document saying testing should be done non-fasted, on pasture or hay only and tell him that's how Dewi needs to be tested going forward, so that you can see how his diet is influencing his insulin.  Yes, it would be nice to test after a specific meal to see if the beet pulp is a trigger, but testing is also expensive so that may not be something you want to pursue.

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

Re: Is anyone in the UK using Invokana


Thanks Eleanor and sorry I have been so slow to respond. My vet has spoken with Andy Durham at Liphook and seems more prepared to consider writing me a prescription for Invokana. But Andy said he has never used Invokana. Andy Durham’s advice is to blood test Dewi one hour after different meals to see what is triggering him. But Dewi is only on soaked hay and unmolassed beet pulp to carry his minerals so I don’t know if that is worthwhile? I guess we could take blood an hour after his beetpulp but could that be a trigger? It’s low ESC and starch. 

He has already had a blood test done whilst on hay (unbeknown to my vet as I ignored the advice to starve) although it was done in the morning and Dewi had run out of hay when I arrived, so I wonder if a test done in the afternoon would be better when he has been consistently eating? 

 My vet also wants to blood test him while he is still on Metformin but wants me to fast Dewi first (arghh!). I presume that is an incorrect approach and I should feed him his usual hay ration? 


Jenny Comish
England, UK
Dewi Case History:
Dewi Photos:

Re: Platinum Performance for a IR laminitic horse

Trisha DePietro

Hi Leian. Welcome to the group! I have attached our welcome letter for your review. I have some questions, but first, to answer your diet question.. Your hay sounds really good ( except for the higher iron) and I agree with you, the Platinum performance product is not the best choice at this time.

If he were my horse, I would definitely trial him on the Emergency diet, because even though he may have tested negative for PPID- He can still benefit from the tightest diet right now.  The Emergency diet is not going to hurt him one bit and that will give you time to get the next step together which is your case history information. This document is soooo incredibly helpful to the volunteers that review your information to give you that "solid" advice that you are looking for. Here is your welcome letter...

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/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 Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/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 EMS/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: EMS 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 EMS/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 EMS/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 EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR 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: Phytoquench pellets


Phytoquench pellets contain Devils Claw for its pain relief.  Perhaps she is just feeling better.
Martha in Vermont
ECIR Group Primary Response
July 2012 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


Platinum Performance for a IR laminitic horse


This is my first post....I am at my wits end.  I have a 16 yo Missouri Foxtrotter gelding who has struggled with laminitis for the past 3.5 years, recouping and then regressing back to lameness and pain.  He is in a laminitic state now with inflamtion and pain.  We just did his blood work and it only shows IR.  Having said that I wanted to place him on the ECIR emergency diet until he shows signs of improvement HOWEVER my vet reccommended not going with the beet pulp and additional salt, flax vit e. but to use Platinum Performance Wellness.  His hay is solid at an ESC of 5.8 and startch of .5 (iron is a little high at 652).  My dilemma is after calling the company and getting the ingredient list I feel it will not be beneficial.  The NCS is 10.25 per scoop and the startch is 14.8 % and the feeding dose is 2 well as the product contains molassas and whey (which is highly inflamatory).  Any solid advice would be appreciated! 
Leian Susee in WA 2021

20581 - 20600 of 279985