I'm a newbie on this group, I've referenced the main web site for information for a number of months. I have a 13 year old Arab mare that has IR and cold foundered the past two winters. I got her in November of 2019. I do not feed sweet feed, just a handful of alfalfa pellets for the mineral supplement, and grass hay.
In February of 2021 she foundered. we put her in Soft Ride boots and pain meds ... bute for a few days then then gabapentin for several weeks. Blood tests showed IR, low thyroid so she was put on daily Thyrol-L. Over the summer her hoofs grew out normally and feet became less tender. She no longer needed the SoftRide. She went out with a grazing muzzle for a few hours a day, grass hay and no grain, just the supplement mixed with a handful of alfalfa pellets. In January of 2022 she foundered again, worse than before according to my barefoot farrier.  Boots went back on; I added IR formula from harmany equine as well as the hoof formula, ABF (adaptogen), and continued with the Thyrol-L. I also added a 15 minute session with cold laser boots every night.
https://www.equicareplus.com/lllt---low-level-laser-cold-laser.html
https://www.vet.cornell.edu/news/20190104/regenerative-laser-therapy-proves-beneficial-equine-athletes-cornell-ruffian-equine-specialists

As she continued to be tender-footed, she has been on soaked grass hay (farrier recommended ... i sent my grass hay out to be tested but they lost the sample & I'm not getting contacted by the local person to come take another test as we had planned). She's not n turnout on grass at all this summer. I don't have a good dry lot (Illinois has plenty of rain and all areas have some grass, even the winter area where they hang out has grass growing that her pasture mates nibble on so its always down to a stubble that I keep mowed).

So she is kept in the stall (concrete floor, thick mats, thick pine shavings) during the day (they all come in during the day to the run in area to escape flies). A somewhat larger run with covered area for the nightime.

I hate that she is so confined with little area to move (750 square feet) and separated when her buddies go out to pasture. I worry that she will cold founder again. She has lost much  of the fatty lump on her butt and behind the shoulder, and some of the cresty area. She still has the swelling behind the eyes, although it is less. Her stride is normal now so the tenderness is either gone or much less. New hoof is growing in normally; she still has some "duck bill" growth from founder last winter ... the next trim (every 4 weeks) may take off the last of the growth where the wall separated. She will get additional blood work this fall to see what's going on.
The person I got her from says that my mare's daughter, now about 4 or 5 I think, is now showing IR symptoms.
Any suggestions are greatly appreciated.
Thank you,
Jean Hurrle
--
Jean Hurrle in Illinois; 2022

Hi Jean,

You need to read the information provided in your welcoming message, get lab test and put up a case history.

In the meantime, read this about how winter weather can cause hoof pain in metabolic horses https://wp.me/p2WBdh-M3 .
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Hello Jean

Welcome to the group! 

Below I'll be sharing our welcome letter that Dr Kellon referred to.

1) Put her onto the emergency diet (linked below and on this page: https://www.ecirhorse.com/DDT+E-diet.php - you need to scroll to the bottom half for the details). Soaked and well drained grass hay for an hour is part of it but there's more. Although you are feeding a small amount of alfalfa as a carrier, please cut that out (as mentioned below that it is not recommended for most). Suitable carriers are mentioned below under the DIET section.

2) As for testing your hay, we recommend Equi Analytical/EA. https://equi-analytical.com/ - they also cover how you can take a hay sample (https://equi-analytical.com/feed-and-forage-analysis/taking-a-sample/):
- Hay probe - more accurate. You can borrow from your local county agri office sometimes or local coop: https://ecir.groups.io/g/main/message/235368 
- hand grabbing samples - you can get by and it's better than not testing: https://ecir.groups.io/g/main/message/198634
- You want the 603 (trainer) test - this uses wet chemical method (more accurate) for every item.

3) Diagnosis/ testing your mare. This is actually in the first section of our DDT/E protocols below. We recommend to test for non-fasting Insulin, glucose and also for endogenous ACTH. At 13, your mare is worth testing for the last one (which is for cushings/PPID).

4) Dry lot/ enrichment: Some random ideas for you and you don't have to explore all at once! Rome wasn't built in a day.
- you could put a buddy in with her for part of the day. Someone not rowdy. https://ecir.groups.io/g/main/message/274397 
- Split her soaked hay into 2 or 3 slow feed nets at opposite corners.
- Bonnie Snodgrass has great luck with an "Action Hoe" that is apparently quite easy to get in the US: https://ecir.groups.io/g/main/message/274397 - this may be a good way to easily maintain your lot/remove the bits of grass that grow back.
- If you describe your dry lot here, members may be able to chime in with ideas how you could improve it balancing with cost effective ideas. Eg. maybe a layer of gravel/sand. Personally I have found these work best if you put some kind of landscaping/textile fabric down below as it will save you renewal costs by keeping the gravel/sand in place. I had to convert 750 square feet and it seems to be about 69 square metres.

5) Thyro-L can help jump start weight loss but it is not suggested for long term. Usually once IR is under control any thyroid issues will resolve.  We usually recommend weaning off of it as it will not help with insulin levels. Weaning recommendation from Dr Kellon: https://ecir.groups.io/g/main/message/265797 

Hang in there, you are in the right place and there are some things you can definitely work on right away. Ask us if you have questions!

Here is the real dirt/welcome letter:

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 etiquette, what 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.

EXERCISE: The 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. 

--

Sorry, I misunderstood the instructions for joining. Should I have put up the case history first? I read much of the material. I apologize for the long email out of order. Not sure how much reading is needed before posting  here so I'll just read others accounts for the time being.
I have posted up a first draft of case history with tests from 2022 and earlier thus year. I'll add info and initial x-rays. 
Lots of helpful information, thank you
--
Jean Hurrle in Illinois; 2022

CaseHistory folder_jean & Shorty