Alexis Black

Hello VETS, I’m looking for licensed veterinarians/technicians answers.
I’m researching into a new veternarian and nutritionist but I live in Central/southern Illinois so they are far and few between.
Here is her history/story:
Past and Current History:
16yrs old, she is top of the totem pole but not mean about it, unsure of breed maybe Morgan/QH, UTD on teeth, chiro, massage, farrier and shots March/April 2020, was malnourished but not underweight when I got her in 2015 just full coat and personality. Farrier chopped her entire heels off and left all toe when I first got her. So we’ve been building since. She is pastured with an unbroke pony sized donkey(got in Aug. 2019- working on gentling) and a 23 yr old retired show mare(bottom of totem pole - bought in 2016). I do not stall and will not stall so this is not an option.
Hay regimen:
She gets 2 flakes of soft and clean grass hay no alfalfa or clover in the AM in hay bags and 2 again in hay bags in the PM that last her all day.
turnout is now at 2-3 hours starting at 4pm(yes I slowly worked up to those hours so she wouldn’t founder not that she’s had a past with that and her xrays are normal) she has a grazing muzzle on the entire turnout time till locked back up in the dry lot at 7/8pm for the rest of the night, then the muzzle is taken off and she is given hay in a hay bag.(will not muzzle over night or turnout over night due to my fencing). They have an acre dry lot with a huge run in barn with a pond they never go in and 8 water buckets and 100 gal tank. My pasture is not big enough and I don’t ever have any help to seperate her from the other two during turnout time so that is not an option either. *will add picture of grazing muzzle I use**I am here the entire time during turnout*
Grain(1 time a day in evening, was giving till she started refusing grain((bc of her thyroL/trihist smell/taste):
1/4 of a 0.5 lb cup of enrich plus
1 scoop purina mineral(2oz)
1/4 basking measuring cup of ground cold mulled flaxseed
(Waiting on Vermont blend and Emcelle)
1tbsp nonidozied salt
2 tbsp of soaked alfalfa(trying to wean her off to only Timothy)
3 tbsp of soaked Timothy
1 scoop thyroL( just started Sunday)
*will post diet vet suggested FYI she is not navicular*
**she also gets trihistamine and thyroL but not in grain bc she won’t eat the grain if it’s in there, vet thinks she has borderline Heaves so we syringe it with sugar free vanilla pudding as she won’t eat molasses or applesauce**
Pasture necessities:
•White salt block(can’t remove)
•Himalayan salt block(can’t remove)
•Trace mineral salt block(can’t remove)
•200# rural king mineral tub(can’t remove bc other animals)
•8 hung water buckets
•100 gal Tarter water trough
•Medium flake Sawdust barn
•Medium sized pond(they don’t go in bc they’re scary cats)
•Lot is dry and solid no wet spots
She is brushed and picked out 2 times a day as well. She also gets massage once a month and chiro when needed. Farrier is set on a 4-5 week schedule as well non stop.
*Bought scoot boots, wore them for for a lil Sunday riding(did not do any loping or trotting only our normal trails). She was doing toe first landings so we are working up to boots I WILL NOT SHOE HER.

Signed, Alexis Black
Joined: Last week(unsure of specific date)
Toledo Illinois

(I have an album made with all of her info on it, thanks!)

Kirsten Rasmussen

Hi Alexis,

Welcome to the group!  In reading your first post, it sounds like you are not here because you have questions about Cushings or Insulin Resistance in Cricket, nor do you have a history of unexplained laminitis?  If that is true, I would suggest joining the ECHorsekeeping sub-group, where you can also ask about finding veterinarians in your area.  All files and photos for Horsekeeping, discussion of non-PPID/IR issues, DIY projects and management techniques go here: 
(Note hoof images/xrays for these equines should be in ECHoof: 

However, if you suspect Cricket has either or both of these metabolic conditions (and it looks like you are taking steps to manage her as if she does), please read through the information below, which explains our Diagnosis-Diet-Trim-Exercise philosophy along with many helpful links to more information, and ask us any questions you have.  You might also get some responses here about a veterinarian in your area.  We also have a list of approved ration balancers in our files; they may not live in your region but this is typically done online anyways so you can contact any one of them.  The list is located here:

Also, if you believe your horse has a metabolic condition, 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.


The ECIR Group 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.

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.

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.

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

Sherry Morse

Hi Alexis,

Just a housekeeping point to start:

Could you please update your signature with both the link to your Case history folder and photos folder: 

If you didn't keep the email with the instructions I'll share them again here:

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

2) Look at the bottom of that page for the window where you've already typed in your name, location and month/year of joining.

3) add the links for both your Case History (CH) and photo folders.
NOTE: When you are adding a link to you Case History or photos, 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!

With that being said, having looked at your CH it looks like Cricket has been diagnosed with IR but I'm unsure what SBLHC stands for, nor what their lab normal range is for glucose.  Can you please provide that for us.  The same for her thyroid test - it appears to be low but to know how low, we need to know what the lab normal is.  Was she tested for insulin and leptin and you just don't have those numbers or did the bloodwork not include those numbers?  To really get a complete picture of how much diet and other management needs to be tightened up we really need at least the insulin number in addition to the glucose.

As far as the hay - I'm going to guess it's not tested?  Do you know how much she's being fed by weight?  Since she's overweight you want to feed her at either 1.5% of her current weight or 2% of her ideal weight IN TOTAL (Hay, concentrate and pasture) whichever is greater.  I would guess from the picture that she's at least 50lbs overweight right now so you want to aim for no more than 20lbs of hay+grass+concentrate daily.  Until you can get the hay tested you want to soak it to make sure you're getting as much sugar out of it as possible.  We don't recommend alfalfa for IR horses as many of them can't tolerate it and we do recommend balancing your minerals to your hay vs. using a commercial mineral balancer.  The Purina Enrich Plus is not recommended due to the fat and sugar content.

Let us know if you have any specific questions with regard to Cricket.