Cushings, IR, DSLD

Deirdre O'Malley

My Spanish Mustang mare, Kesa is 20.  She has allergies and heaves & coughs at the slightest thing so needs to take a Dexamethasone tablet almost every day  sometimes she needs several pills when she gets an attack..I've been steaming her hay  .. Not sure if it's making a difference. The cold weather can cause her to heave and cough too.  She is IR, (the vet put her on Metformin) she has Cushings and is on Pracend and developed DSLD last winter!  She has responded very week to Dr. Kellon's treatment for DSLD. She actually will run around every once in a while, but I'm afraid to exercise her because of the DSLD. She was so badly in pain that she couldn't stand for very long.  Joints were the size of small grapefruits! 
I don't know what to do with her! 
She NEEDS exercise because she's FAT!  I'm afraid to exercise her because of the DSLD!  She's not ridable, we would have to do ground work, but i don't know how much to do or what to do with her. Long line lounging? Walk only? For how long ? ?   Is trotting ok? 
I'm terrified to aggravate her joints, but i also can't starve her to get her weight down. I'm just so confused. I feel like I'm slowly killing her, and i love her so much  I live in North Carolina. The vets around here are STUPID! I moved her from Long Island, NY three years ago and she literally fell apart here. No pastures on Long Island.... Nothing but pasture here! I created a dry lot for her, but she grazes at night. I've been feeding her Bermuda Coastal hay, a very little taste of beet pulp/alfalfa pellets soaked (which is for my old goes to keep weight on him)  and  something called Metabolic Miracle which is for Cushing/IR horses...  Its mostly 90% finely shredded, chopped alfalfa with some essential oils and a trace of wheat & soy meddlings.
Please help! I would appreciate ANY input! 

Eleanor Kellon, VMD

First, take a sigh of relief. You have lots of options. Our awesome support team will soon send you a long  message that will get you oriented to how to make the best use of this site.  In the meantime, just a few preliminary comments.

If you don't have an ACTH test you need one. There's a good chance she has PPID.

Order some LungEQ and stop the dex which is bad for both IR and PPID ( and DSLD too for that matter).

You don't have to starve her, just feed her a correct level of calories.

We can help with all this.

Eleanor in PA 
EC Owner 2001

Pauline <takarri@...>

Hi Mustang Lady

Welcome & sorry to hear that you are having so much trouble with Kesa.

She certainly has a lot going on with her, but please don’t feel like it’s your fault- it’s not!  You are doing the best for her you can with what you have at hand. The best way that can help you is for you to fill out a case history on her- giving us as much information that you can.  As she has multiple issues- this will be a bit time consuming for you- but worthwhile in the end.

 As far as the allergies/heaves go, it is not uncommon for PPID and or IR horses to have allergy issues d/t a weakened immune system.  It is quite possible that the dose of Prascend she is on is not controlling her ACTH.  What dose is she on currently and when did she last have a blood test?

Dr Kellon has suggested LungEQ, to help with the allergies & that’s a good place to start. You will definitely need to stop the Dex as that is a contra- indicated medication for horses that are IR/PPID as well as DSLD.(The only caveat I  have to this is- that if the horse is suffering a life & death situation/ anaphylaxis  or  severe respiratory distress  and the vet has prescribed a dexamethasone medication- then give it)  It is well documented that dexamethasone induces insulin resistance in all species, including horses. Even topical dex can do this.

Steaming the hay can be beneficial in reducing dust /spores- so helpful for horses with heaves- but it’s doesn’t reduce the Esc/Starch component – has the hay been tested?  It may be best to start soaking the hay- one hour in cold water or 30 minutes in hot water to reduce the Esc/Starch- that will also help eliminate any dust in the hay.  She also needs to stop grazing at night & be in a dry lot 24/7. Start her on the emergency diet which is similar to the DSLD diet. Here is a message from Dr Kellon regarding this.,,,20,0,0,0::Created,,dsld%2Bdiet,20,2,0,8011468

Also stop the Metabolic miracle- it  is not a suitable product – alfalfa can make some horses footsore, wheat & soy middlings will be too high in starch & essential oils will probably be of no benefit.

 How long as Kesa been on the metformin for? Metformin is no substitute for a correct diet. It can help horses not being well controlled by diet alone. It is insulin sensitizing and for most  (not all) horses dramatically lowers insulin within a few days but effectiveness decreases over time. It also can help with neuropathic pain.

As I’m not overly familiar with the DSLD situation- I will defer to anything the vets have to add.

The following is the new member’s note that brings you up to date with the current management practices for a horse with PPID/IR. There is a bit of reading, but please take the time to read through it & click on the links.

 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.

In order to help you and your equine quickly and effectively, we need you to explain your equine's situation by following the instructions you were sent upon joining. Your completed case history form and ECIR Signature will save days of back and forth questions. If you haven't done so yet, please join our case history sub-group. Follow the uploading instructions so your folder is properly set up and then upload your case history. If you have any trouble, just post a message or email the case history group 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. 



Geelong. Vic

Australia Aug 07

ECIR Mod/Primary Response


 Harry, Jack and Spur's Case Histories