Re: Dr Kellon/Dr. Clougher - need help re significant increase in triglycerides


Hi Nancy,
I’ve been following all of your updates carefully. I really appreciate the details you have provided so that I am aware of everything I need to monitor with my two boys. I was wondering if their were subtle signs that you noticed around February 8th that in hindsight might be something I should be monitoring. 

I’ve noticed that Elliott is super annoying in the pasture with our herd (more so than his usual) when his insulin is very high  But he also displays similar but less intense behaviors in the herd when his insulin is well regulated.  I’ve thought about this a lot because I have several children I work with who are diabetic and have ADHD that display similar behavioral issues in times where they have high glucose AND when their glucose is too low.  So Elliott’s ADHD like behaviors are something that I am very tuned into  (And yes, if Elliott was human, he would meet all the criteria for ADHD).  Something else I’ve tuned into is that when his insulin is normal or close to normal he is much more focused in therapy sessions with the kids rather than constantly looking for more stimulation (unzipping my jacket, grabbing my phone from my back pocket, licking a tree, attempting to grab items from the trees on our sensory trail, and countless other annoying behaviors).  Although we have addressed these behaviors with training, they completely disappear when his insulin is normal.  Like I said, it’s the subtle signs that I feel I need to monitor. 

I was also wondering if you could see the fat in Vinnie’s blood when it was pulled at the vet hospital.  Elliott’s samole when his first laminitic episode started was filled with fat  

Again, thanks for all of your updates.  They are super helpful!

Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
Joined 2019

Re: Recent bloodwork concerns

Sherry Morse

Recent bloodwork concerns


I recently had Bloodwork done on my PPID IR horse and am concerned by the results. Most concerning is his ACTH and Insulin (and resulting ratios). He is only on 1mg Prascend. He has been on as much as 2mg in the past, but ACTH has always been well controlled on any dose and it was more just a matter of symptom control. I plan to immediately increase his dose to 1.5 mg and then recheck. He has also been on some hay that I knew was too "rich", but we had an ice situation that kept me from getting his usual hay in. He is back on his usual (less rich) hay now. To be honest, he really seems to be doing well and I was a bit surprised by his bloodwork. He's shedding better than ever and his thrush is mostly under control, which is tough this time of year. He's definitely heavier than I would prefer because of the hay situation, but not awful. Is this plan enough or do I need to be more concerned:
Increase Prascend to 1.5 mg
eliminate "rich" hay and get back to usual hay
start a low intensity exercise program
recheck ACTH and Insulin and probably take some hoof rads in a few weeks? month?

I did a case history and uploaded his most recent hoof rads. The case history shows the scary G:I ratio, RISQI, and MIRG. The rads are 1.5 yrs old and were just taken as a precaution. His front feet are often battling thrush and I see signs of tenderness because I know him (moves with reservation on certain footing, slow to pick up feet for picking), but he doesn't react to hoof testers and Vets have said his rads look good. I'm interested to see what others think.
Jennifer Grossi
Charlevoix, Michigan

Re: Stabul 1

Julanne Baker

Julanne in Florida 2020

Re: Horse Laminitis/Jackson/Gelding M/ 12 yrs/ Missouri Foxtrotter - Looking for help and recommendations.

Sherry Morse

Re: Case History & Photo Album uploaded

Sherry Morse

Hi Carrie,

All good!  If you want Lavinia to have a look at the trim it may help to do a post with "Lavinia request for markups" in the title so she knows you have photos posted.  Lillie is adorable and I think in terms of amounts being fed you're on the right track (I came up with no more than 5.4kg total per day based on her ideal weight).  I can't remember if you said you were soaking her hay at this point (which might not be a bad idea because we've seen NIR hay analysis be off quite a bit from wet chem results).  And are you rinse/soak/rinsing her beet pulp?

Re: Lavinia - request for mark ups

Lavinia Fiscaletti

Hi Toni,

Thank you for putting up the pix. You did everything right :)

Have you ever had any radiographs done?

When was Ella's last trim and when is she due for her next one?

Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Re: Creating case history file

Sherry Morse

Hi Carrie,

Yes, it's there now. One last step - you need to update your signature

1) Go to this link to amend your auto-signature:

2) Look at the bottom of that page for the window where you entered your name and location

3) Add the link to your Case History ( and make sure you make it "live". Adding a space after your link or hitting enter on your keyboard will turn it blue.

4) IMPORTANT: Scroll to the bottom and hit SAVE

Re: Lavinia - request for mark ups

Sherry Morse

Hello Toni,

Welcome to the group! Thank you so much for getting your case history started and pictures posted!  I know you were specifically asking Lavinia for trim advice but looking over your case history it sounds like Ella was diagnosed as both IR and PPID.  The timing of her laminitic events indicates one or both of those conditions is not under control. 

Looking at her pictures Ella appears to be at a good weight right now but 6 on the Hennecke scale is fat, not a normal weight.  Normal - particularly for an IR horse is in the range of 4.5 to 5.  If she has weight to lose she should be eating 1.5% of her current weight or 2% of her ideal weight in total (hay and concentrates) per day.  Were she mine I'd aim for the 20lbs a day total for now, which means cutting back on either her hay or grain intake (or both).  Purina Wellsolve and the Outlast are both not recommended for IR horses due to the total ESC+starch content so I would look to remove both of those from her diet and decrease her hay to make it and beet pulp total the 20lbs.  Are you rinse/soak/rinsing the beet pulp?  Soaking her hay?  Has her hay been tested?  These are just a few things that can be done to help get her diet under better control now.

With all of that in mind, what follows is our general welcome letter which has a LOT of information in it.  So get comfortable, grab a cup of your favorite beverage and let us know what questions you have once you've read it.

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.

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.

If you have any technical difficulties, please let us know so we can help you.

Horse Laminitis/Jackson/Gelding M/ 12 yrs/ Missouri Foxtrotter - Looking for help and recommendations.

Deborah Bos

First noticed signs of laminitis Monday, April 5.  Called vet.  Laminitis diagnosis confirmed by observation and pulses .  Has been stalled, padded, and iced once or twice a day.  Started emergency diet today, Friday.  Vet has not ordered blood work and no therapeutic trim or shoeing yet.  Said to wait.  Currently has shoes and was trimmed every 5 weeks.  Last shoeing March 8.  Horse seems to get more sore every day.  

Lavinia - request for mark ups


Hi Lavinia,
This is my first time posting so we'll see if I got this right. 
I have everything uploaded and I'm not sure if I need to do anything else in order to request these.

Toni and Ella 
Pacific Northwest 2021

Case History:
Ella's Photos:



Case History & Photo Album uploaded


Hi, just letting you know I think I'm up & running see links below
March 2021

locked Re: Equi-analytical 604 analysis on Timothy Balanced Cubes and Amino Trace +

Sandra Draibye

Before Covid the local post office accepted the hay - they won't now.  I have more than enough paperwork to do in other areas of my life - I suspect that Ritchie Smith charges more for the tests to cover their admin costs - but I have never compared the rates - the US exchange rate also varies and complicates that analysis.
Sandra on Vancouver Island, B.C.
December 2018

Re: New & Updated Case History help please


Re: Wellness Ready instant insulin test

Deb Walker

I'm with you Shevawn. It has just become too cost prohibitive for me to keep running bloodwork.
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:

Re: Creating case history file


Thank you Lorna. I. hopefully have got there now. I thought I was ok on computer but even staring at the apge many times I hadn't worked out I wasn't a Case History member !! Thanks 
March 2021

Re: Creating case history file


Hi Sherry,
I think this is in place now. 
I'll add photos , hay report & blood test results soon.

Thanks for the help I tohught I was already a Case History member  & so had looked up & down that Case History flippin page many times. Hopefully I'm up & running now .
March 2021

locked Re: Equi-analytical 604 analysis on Timothy Balanced Cubes and Amino Trace +

Lorna Cane

I used to do the paperwork myself , but some of us have also packaged up the hay and simply sent it off, successfully.
But if there's no charge by Ritchie Smith that is obviously the way to go.
Do you then need to buy product from them, or is it simply a service offered?
Very nice if it's the latter.


Lorna  in Eastern  Ontario
Check out FAQ :

locked Re: Equi-analytical 604 analysis on Timothy Balanced Cubes and Amino Trace +

Sandra Draibye

You need a special permit to get hay across the border - has always been the case according to the post office - but since Covid the US border has gotten stricter in its interpretation.  Ritchie Smith Feeds is a laboratory in Abbotsford that has the necessary permits.  I send them the sample, labelled for equi-analytical - they assure me they do not repackage or otherwise touch the sample - but they do the paperwork and get the sample to equi-analytical and email me the test results.  
Sandra on Vancouver Island, B.C.
December 2018

Re: Wellpride Omega 3 Fish oil for horses

Nancy C

Can you link to the study please, Shevawn, so we can have a look?

Here is post from Dr Kellon on Wellpride

She also recommended using algae based omega-3 caps in the above thread.

Here is a post from Kathleen on fish oil. She is a researcher in the EFA human world.

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

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