Abscess or laminitis


Hello everyone,
First I wanted to say thank you so much for this group. I have found it so helpful and supportive. I have a 19-year-old mare who foundered about 5 years ago. My mare's name is Cactus Flower. Cactus has made significant improvements over the years and has great sole growth now. I found out about her IR at the time she foundered. She is currently taking Metformin ( 3 x a day)  and Insulinwise 2x a day. It seems to be very difficult to manage her insulin. Her last blood test ( 3 weeks ago)  indicated that her insulin level was 80. I spend a lot of money on the vet and the Farrier who has her in rocker shoes which helps.  She is on Teff Hay and I use Perina Low Solve pellets as a delivery system for her meds. For the last week, she has been very lame on her right front with not wanting to put weight on her heel. My farrier thinks she might be working on an abscess. My vet says that she is prone to abscesses due to the dead laminet. She has had many! Is there something I can do to minimize the abscesses? Will, she eventually overcome the abscess-prone stage? I would appreciate some clarity and shared remedies.  
Terry Aperule
Stagecoach Nevada

Bobbie Day

Hello Terry,
Welcome to the group, since this is your first post, I will be sending along your welcome message which I will include below.
It sounds like your poor girl is having a hard time but we're here to help. I do want to address a couple things you have mentioned, however.
First thing would you be sure to do a case history and include all her test results so we can comment on that? And pictures of her feet, x-rays if available.
The group advocates (which you can read in more detail in your message below).

DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.
1 DDT Overview.pages (groups.io)
Abscesses can be brought on by both diets, trim or a combination of both. We recommend to start off with the emergency diet and remove any triggers that may be causing the problem in the first place. You could try jiaogulan which is good for circulation. But we don't usually recommend if the horse is wearing shoes because it does encourage hoof growth thus requiring more frequent trims which most people can't manage if the horse is shod. Balancing her diet would give her the minerals she needs to build strong healthy feet.

Jiaogulan Doses and Precautions.pdf (groups.io)
Jiaogulan and Laminitis.pdf (groups.io) 
And we want to empathize to you that Bute or other NSAIDS do nothing for laminitis pain since it is not an inflammatory response, in fact it will discourage the abscess from exiting.
Pain Relief Alternatives to Bute and Banamine (groups.io)
You don't mention the dose of Metformin your horse is on, I will include more information on that here.
Metformin 08.08.20 FINAL (groups.io)
Can you get her to eat beet pulp? It would be better that a bagged feed since most are higher in starch and sugar than we like to see, just be sure that it is molasses free and you rinse/soak/rinse well. I would also (as detailed below) start soaking her hay, if your hay is the culprit you will often see immediate results.
One more thing, we don't recommend Insulin Wise, we haven't seen that it really helps, you can read more about that as well. I think it comes with a money back guarantee. You would be better off spending your hard earned money on trying to get her diet tightened up and getting your hay analyzed so you know what exactly what your Cactus Flower is missing from her diet. 
Review of InsulinWise Study.pdf (groups.io)
As promised here is your welcome message, there is a lot of reading to do! So relax with a cup of coffee or whatever your drink of choice is and let us know if you have any additional questions, we're here to help you with Cactus Flower.


Welcome to the group! 

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. 

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response 



Kirsten Rasmussen

Hi Terry,

As Bobbie mentioned in your welcome letter, seeing a Case History will help us advise you.  For a start, no Purina product is safe for an IR horse, and even small amounts can make a difference.   Can you switch your carrier to rinsed/soaked/rinsed non-mollassed beet pulp, Stabul 1, or Triple Crown Naturals Timothy Balance cubes (these can be soaked to make a wet mash that holds supplements well)?  There are other safe options in this list:

Generally abscesses are due to diet (ongoing dietary infractions causing elevated insulin and internal damage) and trim mechanics.   If you don't have current radiographs I would advise getting at a minimum laterals on all 4 hooves.   We have advice on getting good rads here:
A full round of hoof photos--ideally with shoes off but if that's not possible just take photos with shoes on--would also help us advise you on issues with the trim:
Photos/images can be uploaded to the Case History sub-group.

The effect of Insulinwise is so low that the consensus here is that it is not worth the money.  As you'll see, Dr Kellon has reviewed the study results:   https://ecir.groups.io/g/main/files/Insulinwise/Review%20of%20InsulinWise%20Study.pdf
Basically, it is not going to make a significant difference for any horse.

You are right to be concerned with an insulin of 80 uIU/ml.  It is at the level that acute laminitis can occur, and even if you manage to avoid an acute episode, it is high enough to be chronic sub-clinical laminitis, meaning that there will be ongoing damage to the lamellae her hooves.  Poorly connected or stretched lamellae coupled with peripheral loading caused by shoes will lead to extensive sinking of the bones in the hoof.  It's likely this has already occurred.  We do advise pulling shoes, correcting the trim mechanics, and using boots with padding to support the hoof for healing internally.

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