Mikey Richardson in MA 2021 

www.drkellon.com 
EC Owner 2001

Hi Kirsten,

Thank you for your detailed response! I mentioned it in my CH but should have been more clear - I took her toes back some after the rads, HCP did more before the glue-on shoes, and I was able to take her toes back further the other day to get the breakover back (close) to where it should be according to the angle of new growth. I don't have updated photos in my album yet because I don't have good on-axis photos right now, but I can get better ones tomorrow and I'll also be taking proper photos the same day as rads.

Her pain level today, with no Bute, is approximately what it was last Sunday with 2g Bute on board. So, it's objectively improved, but perhaps not as much as it should be? I don't really know what timeline to expect with the diet change. I'm pretty concerned about her overall comfort right now as she also is not happy about her new living situation so she is just overall miserable ☹️. I don't want to be keeping her off meds if it's the lesser of two evils to improve her quality of life vs. other downsides of meds.

I'll be calling my vet tomorrow for an update so I'll ask her about options including devil's claw, but maybe also moving up the date of rads and bloodwork. I did poultice her foot with epsom salt Sunday night as I wondered if she was abscessing. Nothing so far. This does seem like a long time for an abscess to come out but I suppose the Bute could have suppressed it. The vet did not think it was an abscess when she came out 10/2 because Pele didn't have focal tenderness to hoof testers, rather diffuse pain around the distal margin of P3. Vet said bruising/pedal osteitis flare up was a possible d/dx vs. laminitis.

I should also clarify that the planned bloodwork is for sure insulin and glucose, I will make sure to get ACTH as well. Hopefully rads and BW will provide some information.

Thanks,
--
Ellen and Pele
Boulder, CO
Member 2021

Ellen and Pele Case History
Ellen and Pele Photo Album

Hello Jane,

Welcome to the group!  Martha has addressed your question about dosing pergolide.  With my horse I increased by 1/4 tablet at a time, every 3-4 days.  I noticed some mild inappetance but
nothing alarming.  I had lots of time to increase my horse's dose.  You might want to do it faster, with 0.5 mg for 3-4 days, then 1 mg.  Once you do have him at the full dose for at least 3 weeks, we do recommend re-testing to make sure ACTH has come down enough.  Ben's initial result was unusually high but that doesn't necessarily mean that 1mg Prascend won't be enough.  However, you will want to make sure it is enough for him.

His insulin result was not in the range for laminitis danger (>80 uIU/ml), and we are coming out of the seasonal rise now so it should drop with the season change and addition of medication.  When you retest ACTH in the future, make sure to include insulin and glucose so you can monitor it.  High insulin is the cause of laminitis so if you are really worried about laminitis, stopping all pasture and soaking hay for the rest of the seasonal rise (until late November) would help lower insulin and strongly reduce any risk of Ben developing laminitis.

Please do put together a Case History for Ben.  Since PPID is a progressive, lifelong disease it will help you immensely to have a full history that you can refer back to year after year when you are deciding what dose of pergolide he should be on.  It also helps us advise you better. 

What follows is our standard welcome letter.  There is lots of good information that you will find very relevant to Ben, so take your time to read through it and click on the hyperlinks.  Let us know if you have any questions!

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 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 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 (look under the Hay Balancing file if you want professional help balancing). 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.

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.

Hello Ellen,

Welcome to the group!  Thank you for doing a Case History and making a photo album!  You have lots of good questions.  I'll start by saying its very unusual to see a Thoroughbred with metabolic-related laminitis, unless its related to PPID.  Your mare is a little too young still to have PPID, although don't let that stop you from the diagnostic testing for it at your next vet appointment.  Please read through the "Diagnosis" section below for details on what tests and conditions we recommend.

If the laminitis is acute and only in one hoof, then its more likely to be related to weight-bearing after an injury to the opposite leg (which is easy to rule out), or to be an abscess.  In looking at her radiographs what I see is mild capsular rotation, which is a trim issue and can usually be fixed as the hoof grows out by backing the toe and rolling it more aggressively.  Both her radiographs and hoof photos show toes that are much too long, especially on the fronts.  You're right that there's some remodeling at the tip of P3, but that could be related to excessively long toes as over time that will cause P3 to 'stretch' forward with the toe.  The long toes and capsular rotation can also cause blood in the whiteline at the toe because the long toes cause excessive tearing forces on the laminae at the toe.  Pele does not have any significant event lines in her hooves.  There is definitely some rippling but very minor.  It could also be trim related, or it could be nutritional.

I see in your Case History that you tapered the Bute before stopping it.  I would suggest trying Devil's Claw for pain relief.  Jiaogulan will increase circulation and that can cause pain if there are abscesses that start to mobilize as a result.  If this is truly metabolic laminitis you should see a reduction in pain within 48-72 hours of starting the Emergency diet.  Has she improved at all since you removed the alfalfa?  Can you start soaking her hay to see if that has an effect on pain?

Jiaogulan will not affect bloodwork.  I also would not worry too much about pain influencing insulin and ACTH.  It could have a small effect on the insulin but its more important to get some diagnostic bloodwork done, especially if this is related to PPID because she will need medication in addition to dietary changes.  The youngest I've heard of a horse being diagnosed with PPID was 5...very rare, but not impossible.

Handwalking should wait until the hoof capsule is stable, typically 6 months after the laminitic event.  Allowing her to self-exercise in a paddock is fine though.

Keep her in boots with pads for now so she can have frequent trims.  Until her toes are backed up and heels are less underrun I would not want to put shoes on.

I've tried to answer most of your questions to the best of my abilities, but I hope others will chime in with more details.  Let us know if anything is unclear.  What follows is our standard welcome letter, packed full of information.  Please take some time to read through it and follow the relevant hyperlinks for your mare.

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 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 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 (look under the Hay Balancing file if you want professional help balancing). 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.

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.

Lorna  in Eastern  Ontario
2002
Check out FAQ : https://www.ecirhorse.org/FAQ.php

• RE pain management, movement, NSAID vs jiaogulan: her last dose of Bute was 10/8 and first dose jiaogulan 10/9. Unsurprisingly last night she was more lame again. What is the current theory on pain management vs. movement restriction, and how much pain is acceptable off NSAIDs? How long should I wait to see if the jiaogulan is improving lameness?
• Differential diagnosis for pain etiology (pedal osteitis vs. laminitis) and treatment of either/both: My current working assumption is the pain is primarily laminitis, especially as she has had visible hemorrhage bilaterally in her WL in recent trims. However, she did have glue-on shoes on briefly (9/28 until I took them off 10/2) and the right shoe was set slightly crooked. Could that cause bruising/exacerbate pedal osteitis? Previous radiographs showed bone loss was worse on LF than RF, but RF is the problem now. How common is unilateral acute laminitis? Should these factors affect my decision to stop Bute and start Jiaogulan? Is jiaogulan contraindicated for pedal osteitis? Any particular rad views I should be sure to get?
• If pain does not improve in the next few days, should I give Bute the morning of her bloodwork and rads appointment to reduce likelihood of pain-related spurious insulin result?
• Will jiaogulan affect bloodwork?
• What, if any, reproductive hormone or other testing should be done, given she does not appear classically metabolic and this correlated with an estrus cycle?
• How do I know when handwalking is ok to start? Pain? Rads?
• Is there a specific podiatry package I should consider beyond boots with cloud pads?

Hi there,

Pilgrim was gradually titrated up to 1 full pill of Prascend. Soon he will have been on that dose for 3 weeks. It was advised to me that I may want to see if he is on the right dose now instead of waiting to retest in January. 

What information is wanted on the bloodwork?  The last bloodwork was sent to Guelph and I didn’t find it very in depth. Should I ask for bloodwork to be sent to Cornell?

This is all new to me and a bit overwhelming (talk of the rise, etc)  If the results come in showing Pilgrim is one the right dosage, what is the next step?

Thanking everyone in advance for their help and expertise!

--

April 2019, (Yahoo Group member 2008)
Langley, BC, Canada

Tula's Case History 

Hello Mikey,

Welcome to the group!  You haven't asked any questions, but I know you have photos to post.  In order to post photos, you will need to join our Case History sub-group, here:
https://ecir.groups.io/g/CaseHistory
Then in the Case History sub-group, go the "Photos" in the menu on the left and open that page.  At the top you should see a blue button that says "New Album".  Click on it and create a new album with your name and one of equines (e.g., Mikey and Domino), and then do the same again for your other horse.  Once you've made the album, open it and you will see a drop down menu near the top where you can upload photos to it. 

Don't forget to add the hyperlink to your albums to your group signature!  You can copy and paste the hyperlinks in to your signature here:
https://ecir.groups.io/g/main/editsub

I strongly encourage you to fill out a Case History for each of your horses, and please include any lab results you have for the metabolic testing as well as any medications they are one and their complete diet.  While Domino has been diagnosed with PPID now, it sounds as though both of your horses likely have Equine Metabolic Syndrome at baseline so close attention to diet and trim are needed.  Also, if you have any hay test results, you can post them with your Case Histories.  Let us know when this is done and we can take a look and help you identify areas where improvements in management can be made.  In the meantime, the Timothy grass hay pellets Clover is getting might be a risky choice for a horse that has a history of laminitis since they will not be guaranteed to be below 10% ESC + starch, which is our cutoff for safe feeds.  But we do have other low sugar options you can try, such as rinsed-soaked-rinsed beet pulp, Triple Crown Natural Timothy Balance hay cubes, or Stabul 1.  Please ask questions if you're unsure of anything!

What follows is our standard welcome letter, packed full of information to help you manage your equines.

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 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 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 (look under the Hay Balancing file if you want professional help balancing). 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.

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.

I noted you referred to him as an IR horse, which was one of my questions.  Is he considered an IR horse at this point?

I have two Morgan geldings! 

Domino my older boy he is 23 years old! He has been thur a lot this year in March he had to have colic surgery to remove a pedunculated Lipoma on his small intestine which they also removed 3 feet of his intestines! He has recovered  great from that but we have also discovered in his recovery that he had really bad ulcers ( which I am still treating) and has Cushing! He has also been a little chunky in the past years but this year after his surgery I was told to put him on just a hay diet! And he lost weight and is looking good! 

My other boy Clover is 12 years old! About 3 years ago I stated to notice was getting a little fat, fast forward to 2 years ago and he had a small bat of laminate which he has healed from and has not had it again! This year he got a bad stone bruise which looked like laminate again but was not!! We also finally got his feet angles right and in the right shoe for him and he is finally back to work and looking good!! 

Both of my boys are not on grain anymore with their issues! 

Clover is on 1/2 scoop 2x a day Timothy grass pellets with his rose hip supplement, thryro-l and insulin wise ( also been trying to giving him as much hay as I can)  

Domino is on Timothy mix first cut hay! In a slow feed hay net dry and then in his tub 2-3 flakes soaked! 

both boys are getting soaked hay too!!

if u need more info please let me know!! 

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