New and pretty lost


Hi All
My 18 year old Arab/QH mare is showing signs of PPID. She is currently on thyro L. She was started on 1/2 a prascend. She had bad lethargy. Constantly in the barn with her head against the wall. Vet suggested stopping the prascend. She is now moving around normally. She also has developed anhidrosis. I have questions. Vet says her numbers are borderline. Approximately 1 and 1/2 weeks into treatment her haircoat has gone nuts. Classic longer curly. Can giving prascend to a horse that may not need it cause this? Results below:

ACTH Baseline Equine 101.0 pg/mL 
Insulin Baseline Equine > 200 uIU/mL 

Vet can not give a definite answer as to weather or not she has PPID. I'm at a loss. Where do I begin? What can I be doing to help my mare?

Thanks in advance


Diane M in FL 2021

Lavinia Fiscaletti

Hello Diane,

Welcome to the group! 

When was the blood work done? That ACTH level is positive for PPID, so she really does need to be on pergolide (Prascend) to control the disease. The anhidrosis can be a symptom of uncontrolled PPID, as is the long, curly hair coat. Prascend won't cause the coat to turn funky, even if the horse doesn't need the medication. Titrating onto the Prascend starting at 1/4 mg, then going up by another 1/4 mg every four days, will help to prevent the horse developing the "pergolide veil" - that lethargy, spacey reaction your girl had.The adaptogen APF can also be used to help. Start administering it a couple of days before starting the Prascend. Once she has adapted to the medication, you can stop the APF. More on this in the TREATMENT section below.

Although QH aren't a breed that is prone to IR, Arabs are poster children for it and her insulin level is dangerously high, which makes her EMS/IR as well. More on this in the DIAGNOSIS section below. Uncontrolled PPID can also drive IR, even if the horse wasn't IR at baseline.

Why is your girl on Thyro-L? If it is to treat the high insulin, that doesn't work as high insulin is not related to the thyroid. You need to make dietary modifications to get her insulin controlled. More specifics below in the DIET section.

The remainder of this message contains our Official Welcome, which is full of additional links (blue font) that will provide answers to many of the questions you may have. It's a lot of reading and info, so get comfy, grab a cup of your favorite beverage and dive in. We're here once you surface and have additional questions.

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.

Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Sue Ring

Hi Diane,

Please know you are not alone.  SO many different horses and the people that love them right here, all willing to share, and you are bound to get answers to even your most seemingly difficult questions!!  My PPID 20-yr-old TBred had some difficulty with Pergolide increases, at first, including lethargy and inappetence.  The adaptogen product APF manufactured by Auburn Labs helped immensely, and I still am giving it to him works well for him when paired with the Pergolide.  Lots of information on the product if you just do a search. 

It won't take long for you to get your mare back on the road to feeling good......all good wishes, for you and her!!!
Sue R in NC 2021




Deb Walker

Diane - Just another thing...from my personal experience, and the experience of many here. For years when my vet did regular blood panels, I was told everything was normal. But it wasn't. Even if numbers fall within *normal* really have to use the IR Calculator to see what the results really mean:

Your horse's ACTH and Insulin numbers are very high (assuming normal ranges that people here usually work with) so the fact that your vet said your horse is borderline is just wrong. The unfortunate truth is that even a great vet can have only a general knowledge of what causes PPID, I/R, etc. and they do not have the experience that this group has. It was very hard for me to wrap my head around that with the vet I used many years ago, because he was/is wonderful. But many people have been put in the position of having to educate their vets and I guarantee you will not be steered wrong here.
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:


Thank you so much. I’m still having a hard time wrapping my mind around it. I’m pretty confused. There is so much to learn. I bought a good set of clippers today. Then, I worried because we will have our first cool night tomorrow. I only clipped her neck and chest. But, with her going no sweater I have to hose her every hot day. The long hair stays damp😑
She’s likely to get sick being damp all the time ugh. I’m mad at myself for missing the signs. She’s was sweating
Like crazy, drinking a lot and super itchy. All things I had no idea were signs. I’m already learning so much here. Thanks to this group I put her back on the Prascend. I’ll try 1/4 tablet daily and see.Sent from my iPhone

Diane M in FL 2021

Kelly Kathleen Daughtry

Don't be mad at yourself - you're doing great! Most all of us have been where you are before. You're on the right path to helping your girl. You've got this and this group is a phenomenal resource as you figure it all out. Hang in there.
Kelly & Micah, Clayton NC

April 2016

Case History: 




Joy V

Please don't beat yourself up Diane.  My horse likely was PPID/IR for YEARS before he was diagnosed.  He saw 4 different vets over those years and not one of them suggested testing.  You're here now, and this is the place that will help you help your horse.  Hang in there!!  

Joy and Willie (EC/IR)
Nevada County, CA - 2019

Case history:
Willie's photo album: