Need help for my Haflinger mare with Laminitis


Hi all, my beautiful Haflinger mare came down with a bout of laminitis a week ago Saturday. She has been laying down only at night. She is in a small paddock getting soaked Timothy hay, a ration balancer along with Insulinwise, bute and a thyroid med the vet put her on to get some weight off of her. She seemed to be making a tiny bit of progress but last night she never laid down and she seems worse today. I am desperately trying to know what to do. I hate the prospect of losing her and I know my vet will suggest putting her down!
Kathi Duvall in MD 2019


Hello Kathi,
I lived in Maryland for about 30 years. Listen, do not give up on your horse! This group helped me get my horse thru Laminits. What I learned is that owner's (like me) hate to see their horses in pain. Many vets get bombarded by their customers fears and worry and just advise the owners to let the horse go. My personal thoughts are that a lot of laminitis cases are put down that would recover with the needed care.  

Do you have your horse in "THERAPY BOOTS"? There are several boots designed for horses who are experiencing hoof pain. The thick insert pads inside the boots will support the horse's soles and aid to relieve their pain. sells the CLOUD Therapy boot. I used this boot type for my horse. It's OK if your horse lays down as long as they are eating/drinking/peeing/pooping. Your horse will get a lot of relief from boots.

 Below is our new member welcome and instructional document. My advice is to immediately start with the Emergency Diet. If there is any form of sugars or starches in you Balancer STOP feeding it. Insulinwise will not improve the situation and can be stopped. We want you to read all the sections below. Give them an overview, including the TRIM section. 

If you can't get boot immediately you can get thick, soft supportive pads and duct tape the pads to the bottom of the hooves. Shoes are NOT useful because they do not support the soles and sole support is all-important.

If you haven't already joined the case history sub-group please get that done. Creating your case history folder and case history document will let you share your horses health/diet/blood tests, etc, with our moderators.

Welcome to the group! 

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.

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 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 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: 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. 


ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album

Cindy Giovanetti

Please don’t let your vet put your horse down until you’ve had a couple of weeks to study and try the protocol recommended here.  We’re pulling for you.




Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19

Candice Piraino

Hi Kathy! You have made a huge step into rehabbing your horse: coming to this site! Let's try to see what has triggered your laminitis episode and make sure to mitigate it as best we can to prevent further ones from occurring!

Let us know when you have uploaded your completed case History so we can provide you with more custom advice and get your mare back on her feet and feeling like her self!

Hugs to you and your mare. It can be overwhelming, but try to take one bite at a time!


Primary Response Team

September 2018, Summerfield, FL

Shark's Case History:

Shark's Photo Album: 

PHCP Barefoot Trimmer @



Hi Kathi,
Dont give up! I care for a Tennessee Walker who was developed laminitis and it took about 2 1/2 months before I saw a dramatic turnaround with her pain level. I used the Easycloud therapy boots as well. You are in the right place. These knowledgeable folks will help you!
Phyllis W in OH 2020,,,20,2,0,0


Hi Kathi,
My Haflinger gelding came down with laminitis about 2.5 years ago. I found this group at that time and I swear this is what saved him. I followed the emergency diet immediately and have stayed on top of it to this day. He has not had any bouts of laminitis since there and is doing great today! So don't give up! Stick with this group and the recommended diets and protocol and hopefully your mare will stay as healthy as my Haffie is today.
- Bev and Majestic
May, 2017
Prescott, Arizona


Thank you! I am working through all the recommendations here and want to get my horse’s profile done. It’s kind of overwhelming with all the information in this group so I need a large block of time to work on that but I plan on doing that this weekend. Having a full time job is rough when you want to be a full time care giver to your ailing four legged baby!
Kathi Duvall in MD 2019

Lorna Cane

Hi Kathy,

It is overwhelming,for sure.
But lots of people have had success attacking the situation in small time bites,as they arise.....half an hour here,half an hour there. Choose  most important things first.
Pretty soon the picture begins to take shape, and you haven't had to put it off until you can find several hours together. Can be less daunting.
The case history isn't an all or nothing deal, so you can add information as time allows.This gives the volunteers a chance to read at least some of your details,in order to give you a leg up.
Just a thought.


Lorna  in Eastern  Ontario
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