I recently found the ECIR group, I would like some help to my mare in moving forward to get her healthy again.

Sendy, mare, 18 years, welsh part bred, 380 kg
She has hoof and body pain after several epizodes of endocrinopathic laminitis. 
In June 2021 she had the first epizode of laminits, The treatment was succesful and without changes on the hooves. Her diet consisted only of a limited dose of hay with minerals and vitamins (without grass, grain...low sugars). But in the following period she had other episodes of laminitis (with a worse course) without a change of management. Cushing syndrome (PPID) was diagnosed (146pg/ml ACTH), insulin resistance has not been confirmed. The treatment of Prascend (pergolide) began in October 2021 (31pg/ml of ACTH in January 2022). 
But she is still not stabilized. She has good and bad times. Hoof pain returns at irregular intervals (refusing to walk, frequent lying down, etc.). For pain she receives Equipalazone (phenylbutazone). Hoves have transformed (sinking and rotation of hoof bone on x-ray). Special hoof trim every 4 weeks performed by veterinarian, no effect even the barefoot boots.
We don´t know why hoof pain keeps coming back without a change in management. We´ll test insulin resintence and do new x-ray again. We are considering the possibility of gluing plastic ortopedic horseshoes after x-ray. Other options are examination of the reproductive organs (hormonal disbalance) or endoscopy digestive system (ulcers).
actual diet: soaked hay in the slowfeed net (maximum 7 kg per day), mainly for mixing drugs - small handfull Pavo speedi beet, mineral-vitamins supplement, spirulina, ginseng
actual management: small padock with shelter, without grass, high sawdust bedding
It is very frustrating situation for her and for us. I wonder how I can help her from the pain of hooves and all body. 
Thank you for your ideas and advices, especially for your time.

Bobbie Day

Hello Sarka,
We are happy to have you here. Since you are a new member, and this is your first time posting I will be sending along your welcome message. The message covers a lot of territory so take your time reading it over, we realize it can be a bit overwhelming at first but you're in the right place to help Sendy.
I will do my best to address your questions, but rest assured we have a whole team on board, and very supportive members that can also be helpful.
I'm not sure where you're from but in your welcome message there are blue hyperlinks that will take you even more into the subject, we leave no stone unturned here!
There are also links for country specific information.
First off if Sendy is reluctant to move, please don't force her, if she is hurting and its painful for her to walk then let her rest, just be sure there is feed and ample water close by, we only encourage movement when the horse is ready.
Secondly, we discourage the use of NSAIDS, its counterproductive in laminitis, instead try Jiaogulan (if your able to source it), I have included more information about that here. It may be that she has some abscesses brewing. In that case the Bute would keep them from making their way out, the J-herb will help with that, but we just want to be sure your trim is in good shape and your able to trim on a shorter cycle as it will encourage growth.
Jiaogulan Doses and Precautions.pdf (
Pain Relief Alternatives to Bute and Banamine (
Why NSAIDs & Icing Are Not Recommended .pdf (
It is not advisable to treat with ulcer meds while on Bute, please see this article on the subject. It may be that she is getting ulcers if she has been on it for a while.
Impact of concurrent treatment with omeprazole on phenylbutazone‐induced equine gastric ulcer syndrome (EGUS) - Ricord - 2021 - Equine Veterinary Journal - Wiley Online Library
Have you had your hay tested for sugars and starch? If so, please post the results in your case history so we can comment further. Along with all her blood work results, photos of her feet, all x-rays and body shots help too. A complete case history will really help us to advise you. Are you experiencing cold temperatures? We advise to put horses in fleece lined wraps and socks when the temps dip below forty degrees, horses often suffer from cold induced pain. Do you have padding in her boots? That helps too, we really don't advise putting shoes or other appliances on as the horse will need to be kept on a tight trim cycle and it makes it hard to accomplish and can be quite costly.

I hope I have addressed your immediate concerns but please reach out to us with more questions, there always are!  


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 Šárka,

One thing that jumps out at me is that Sendy's ACTH was still high in January.  Collectively, we have found that keeping it in the mid-teens to low 20s YEAR-ROUND leads to a better outcome.  I would increase the pergolide dose and retest after 3 weeks to see if ACTH has come down far enough.  At this time of year in the northern hemisphere it should be at its lowest.  At the same time, retest insulin and glucose.

It's very possible the hoof pain now is due to abscesses that resulted from the autumn laminitis.  Testing insulin and glucose will indicate whether she is still experiencing laminitis, or whether the pain more likely to be abscess related.  If your vet is doing corrective trims, abscesses can mobilize.   This is very painful but adding Bute or any other NSAID slows or stops the abscess mobilization, so they never fully resolve.  Cold weather can make pain worse in horses with compromised circulation (due to high insulin, poor trim mechanics, or permanent hoof damage) so warming up the horse and it's extremities can help, as Bobbie already mentioned. 

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


On Tue, Mar 29, 2022 at 01:08 PM, Bobbie Day wrote:
Pain Relief Alternatives to Bute and Banamine (
This link doesn't take you to the correct article.  Can you re-post? Thanks
Alice A
March 2021, Custer, SD 
Case history:   .
Peanut's photo album:  .


Hi Alice,
Try this.  I searched the files on “pain relief”.

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