New Member(s) Bev & Sariah


Hi all.

So very glad to have been made aware of this group! I have recently submitted my “Sariah Case Study” in the “Bev and Sariah” folder. | Files

First, I must say, wow, at the science and information here! I have begun scouring the many options for learning. I am grateful that my mare is not experiencing symptoms like what some are going through, dang!

My primary goal is to get help in knowing that the proper tests have been done previously and that the diagnosis is solid. And then, of course, to implement more specific tests as recommended and then maximize the necessary interventions. She is due/past due? for a re-test now.  So, I feel a sense of urgency in going into this upcoming appointment feeling better educated than before.

I feel I am blessed with a good veterinarian facility and professionals there, but I realize that my Repro vet specialist may possibly lack some of the specialized knowledge that I may gain here.

We have had a record hot and dry summer in my area and this vet hospital is two hours away (one way) which includes travel through a good-sized city and associated traffic. I have avoided the trip longer than hoped, but realize getting too late in the year is potentially not good either. I understand that the logistics of traveling to this facility have the potential to compound the test results, but I don’t believe my local Vet is set up to do it. There may be another option to consider within 50 minutes (one way) and less traffic. If the need is high enough to do so I will check into it further.

Quick back story:

First, from my mare's birth in 2002 to 2014, she lived in MN on a farm with extremely hard, rusty water with high iron. It was also a hotspot for tick borne diseases. She has not been tested for either of these. No tick symptoms have been observed. She is now in Idaho on High Desert where selenium is possibly deficient, and their feet get hard as stone.

The exploration of what is going on in my mare came to a focal point in mid-2018 during failed reproductive attempts. By Sept 2018, we found an enlarged ovary and the term Granulosis was offered. Her hormones were all out of balance. Talk of removing the ovary was posed, but we opted to wait and see how it changed, if it changed. (I’m sure I am missing some details.) After an injury early in life, her main objective had become that of brood mare. Life gets in the way, and  all too soon her late teens were upon us. As a breeder for 30 years and many success stories with aged mares and pregnancies, and rare bloodlines, age was a familiar obstacle. (PPID, not so much!?!) She currently remains a maiden mare.


By Spring of 2019, when I was again hoping to focus on reproductive potential and options, we were not getting any helpful answers. Clinically she had no symptoms of PPID and physically was healthy, aside from not cycling normally, visibly or hormonally.

After much frustration in trying to problem-solve her lack of obvious estrus and hormonal cycling, in general, in late June/early July 2019 we tested her for PPID, mostly out of process of elimination and as a last resort. Her ACTH was not a large number, but it was positive.

In the following months, I tried everything in the book to get even a quarter tab of Prascend into this smarty-pants old desert-bred Arab mare for more than a couple days in a row. I even tried alternative herbal options, which she liked, but didn’t seem to address her needs sufficiently. (This seemed to be demonstrated when we re-tested in July 2020 and her ACTH was much higher.)

I resigned myself to syringe the Prascend into her daily. She hated it, I hated that she hated it. I still have to keep her confined because I cannot catch her to give it to her if I don’t. It breaks my heart. (She is not my only horse - there are 2 dozen in my care here.) She continues to appear healthy although she still does not cycle noticeably despite living near a stallion. Repro exams have suggested she does cycle to some degree, but not in a normal manner. Lacking details on that at the moment.

Bottom line...I feel like we are missing something!!  Among the many possibilities for insight and feedback, I would appreciate your collective thoughts on timing of, and selection of, tests to do now! Thank you!


Bev & Sariah (PPID) from Idaho, 2021

Sherry Morse

Hi Bev,

Welcome to the group!  You'll be getting a full welcome message shortly that will include links to all the tests you need.  I would recommend testing Sariah for IR (which means non-fasting insulin and glucose) as Arabs are one of the poster child breeds for the conditions and it's very possible for them to be IR with no visible symptoms (my gelding is a very good example of that).  Testing for both IR and PPID should be done at home to minimize the effects of traveling. If you can draw blood or have a good local small animal vet (or a vet tech) who's willing to do that for you and then prep the samples to send to Cornell that will save you from having to haul to have testing done. 

Do you remember if the insulin tests you had done the last two years were done fasting or not?  Were they done after hauling?

Was Sariah hauled for PPID testing?  Just as an FYI, once a horse has been diagnosed with PPID there's no need to continue to do TRH stim testing as you just need the baseline (basal) number to determine if the current dose of Prascend is effective.  The reason for this is that we don't have any studies on what happens to the TRH response when on pergolide - whether we should expect it to normalize or not. 

At this time, given that Sariah is overweight I would treat her as if she is IR as well as PPID and make sure she's eating a weighed amount of food per day (1.5% of her current weight or 2% of her ideal weight, whichever is greater, and that includes both forage and any hard feeds).

As far as breeding - given her history and the fact that IR has been identified as a genetic issue in Arabians you might want to consider it in the same vein as SCID.  Given her history though, the issue may have nothing to do with either PPID or IR.



Thank you Sherry. 
Links to the tests will be super. Poster, prefer that to be in an exemplary manner! I will check with the local vet about a home blood draw for IR and PPID baseline and sending off to Cornell. Both previous tests were done without fasting and she had been hauled 100+ miles to the clinic. I had not been very successful with the pergolide prior to the second test, and had also attempted an herbal intervention for several months, so that was probably an ok retest at the time, but good to know, none-the-less regarding the TRH! (ANY testing done so far was at the hospital 100+ miles away.)  
I feel like the possibility of excessive iron is also very real. Not sure what to ask for to test for that? Maybe that is in the links to come as well. (I lost a teenage stallion years ago to liver cancer. He was a quiet little homebody so was limited in exposures to stress or toxins. Always wondered what played in to that. Maybe the iron...? Maybe exposure to Strangles in utero.)
I have a small grain scale, but nothing for weighing hay. Recommendations? 
Bev & Sariah (PPID) from Idaho, 2021 | Files



Welcome to the group Bev,
I hope you can find a way to NOT haul your mare right before a blood draw. Perhaps you can take her to the vet's clinic or area a day or two before the blood draw? 
Having ACTH and Insulin both tested is always a good idea. This is the time of year that ACTH is on the rise and it often causes a rise in Insulin also.

I found it much easier to get my PPID gelding to take his pergolide (generic Prascend)  because it came in flavored tablets that dissolved easily in water and was pretty tasty. It also was MUCH lower priced than Prascend. Many ECIR member use generic pergolide.  PPID horses commonly need gradually increasing doses of pergolide to control their slowly riding ACTH levels. As ACTH gradually rises it may cause a rise in insulin levels also. 

Below is our new member document. We ask that you explore and read the document. The blue links are clickable and will open new areas of information. A good idea is to actually save a copy of this document or a link to this document so you can refer back to it over and over. 

Use our SEARCH boxes, they are at upper right of nearly all pages. Doing a search within the messages will result in a high number of results. To refine your searching you can open the FILES (see files in column on the left side of this page) and do a search for "alfalfa" in a folder like Core Diet. This will reduce the number of search results.

Starting a "New Topic" is how you can ask a question of the whole group or begin a new discussion. It is sensible to first do a search of the group as you will likely find the answers you need that way.

If you need help with something do not hesitate to ask. We do have an excellent WIKI page (see column to the left) which will give you step by step instructions for  HOW TO DO questions.

Welcome Bev

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.

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 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 (look under the Hay Balancing file if you want professional help balancing). 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.

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. 

Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased

Sherry Morse

Hi Bev,

Links to the test protocols are in the Welcome email Bonnie just sent.  Please be aware that PPID is a progressive disease that is controlled through medication.  In the 20+ years this group has been in existence there has not been any herbal remedy found that replaces medication.

Iron testing is done only through KSU.  Relevant documents:

Many people on the list use luggage scales purchases off Amazon to weigh their hay bags: will bring up a large list of messages on this topic.


Hi Bev, and welcome!

Your concern about tick borne diseases might warrant some testing.  The symptoms of Lyme are not always well defined or obvious.

Martha in Vermont
ECIR Group Primary Response
July 2012 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo



Thank you Sherry, Bonnie, and Martha!
There is much to learn (and to get tested), but the info provided will be a huge help!
I hope to speak with the local Vet today and see what his willingness will be.
Bev & Sariah (PPID) from Idaho, 2021 | Files