Hello. I am trying to learn how to use this website with limited time to research and comprehend how all of this works. I believe I successfully completed the CH and downloaded it on Oct. 19th. , but not sure how to get any personalized feedback with respect to caring for my mare, "Sunday", who went into severe, acute laminitis Sept., 15th. I am trying to follow through and incorporate the info I have found on this website
with respect to emergency diet additions and removals. Sunday has improved over the initial onset of the laminitis but it's been approx.  6 plus weeks now and she is still sore and slow moving. I am giving her
1 mg per day of Prascend (split into a.m./p.m.dose) and she seems depressed but eating. Every time I try to increase the dose by 1/8 mg, she quits eating the small amount of hay cubes and soaked,rinsed beet
pulp I am giving her in order to get meds/supplements down. I would so appreciate feedback, and advice, if possible. I have taken some pictures of her and a couple short videos of her moving (with my iphone)
and wonder if it's possible to download these to your site?

Lavinia Fiscaletti

Hello Gail,

Welcome to the group! 

It appears as if this is the first time you have posted regarding your girl Sunday since you joined. Thanks for filling out the case history, which I found - I'm including the link to it here for reference:

I've added this link to your signature, along with your join year and general location, so that all of it will automatically attach in future posts. This allows us to help you much more quickly. In order to get help, all you need to do is post your questions here.

From blood work results in her case history, Sunday is definitely both IR and PPID. Her glucose has actually climbed above the labs upper normal range, which means she has progressed beyond IR to being diabetic. Until you can get the hay tested, it should be soaked before feeding to help lower the ESC (sugar) level (specifics below in the DIET section). Because she is a QH, a breed that is not as prone to being inherently IR, the very high ACTH is likely a driving force. She will need both a tight diet and a proper dose of pergolide to get the ACTH well controlled into the middle of the normal range to get her IR under control. Losing her extra weight is also going to play a part.

The inappetance Sunday is showing is called "pergolide veil" and is a temporary condition that some horses experience when they start the drug. Adding the adaptogen APF can help:

It is available from many online retailers, and some local tack shops may carry it as well.

The pergolide dose works best when administered as one dose rather than splitting it up into two daily doses. With her ACTH being so high, she will likely need more than 1mg total of pergolide to get it under complete control. Once you get the APF on board, you can start to increase the pergolide dose by 1/4mg increments. Because Prascend is not meant to be broken more than into halves, to dose smaller amounts dissolve 1/2 of a caplet into10cc of water in a small syringe then shake well. Administer 1/2 the contents of the syringe and refrigerate the remainder for the next day.Give this along with the 1/2 caplet she already receives. Raise the dose every 4 days til she is on 1mg all at once. You can reevaluate the blood work after 3 weeks on the full 1mg dose or speak with your vet about raising the dose more based on her symptoms before retesting.

You can create a photo album in the on the case history sub-group and put all pix in that. Then add the link to the album toyour signature and post that you have uploaded the photos. Videos cannot be uploaded here but if you put it up on something like You-Tube and provide the link then we can take a look.

The remainder of this message contains a many helpful links to specific information. Storing it somewhere easy to access for future reference as a  "cheat sheet" might be helpful.

The ECIR 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.

If you have any trouble, just post a message explaining specifically 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, glucose and Leptin. Leptin is the hormone that says "stop eating". Knowing this helps to differentiate if a horse is IR "at baseline" or if an elevated ACTH is "driving" the insulin up. In Europe, substitute adiponectin for the leptin test.

*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.

We ask all members to sign their first name, general location, date of joining and link to the case history and photo album every time they post. It helps us to find your info faster to answer your questions better. You can set up an automatic signature so you don't have to remember to do it. 

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.

Lavinia and George Too
Nappi, George and Dante Over the Bridge
Jan 05, RI
ECIR Support Team


-- Thanks very much! With regards to increasing the Prascend, Give the usual 1/2 mg. and add one half of the 10 cc mixture. Are you suggesting to skip the 1/2 mg caplet in the second meal of the day in order to work up to a "one a day", dose? I am happy to try that and will aquire the APF in hopes that will help!
GAIL and Sunday
Oct 2018


Hi Gail, 

Yes, since Sunday is having some depression and lack  of appetite when you increase her dose, just give her the 1/2 tab in the morning until you can get the APF on board.  Hold the afternoon/evening dose until you've got the APF on board.  Once you've done that, you can start to increase her dose by 1/4 mg in the manner Lavinia describes above.  The APF is very helpful in avoiding the pergolide veil (depression/lack of appetite) that some horses have when first starting the drug.  Let us know how she does!
Maggie, Chancey and Spiral in VA
March 2011
ECIR Moderator/Primary Response


Just wanted to say that APF worked for my horse when he had to start on pergolide. I actually started him on the APF a few days before he was started on a 1/4 mg of pergolide. His pergolide dose was gradually increased up to 1 mg over a 2 week period. He never lost his appetite  and his energy level  never decreased. If anything his energy seems to have increased since going on pergolide. He is now done with the APF and he is still full of energy.
Bonnie Snodgrass 07-2016

ECIR Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album