Coronary Bandy Dystrophy and Cushings


My horse has been battling coronary band dystrophy (cbd) since 2014 and is on 500mg of prednisolone mon, wed, fri to keep at bay.  He just had his annual vet visit and he tested positive for Cushing, insulin and glucose are both normal.  He was last tested in 2018.  He is a 19 yo Dutch warmblood gelding, living in Pennsylvania and gets 1 lb of buckeye grow n win balancer, Timothy/orchard grass hay, cal trace plus, 5000 iu smartpak smart & simple vitamin e and cosequin with msn, currently turned out at night and stalled during the day and now on prascend.  

The reason I requested the test be done as there was a significant event line (his hooves are all lines from the cbd, but these are more significant) that correlated with the switch to night turnout and another about the same distance apart, no other ppid symptoms. The vet does not think the event line are sugar related, but more dew/wetness related.  Other than the cbd causing the soft mushy sometime infected heels and frogs he has not had any other lameness, he is tender on rocks.  The cbd tends to flare up in beginning of August almost every year and clears up mostly by January.  

My vet also told me there was no need to change diet as he is not IR and the prascend is all required.  From what I have read on the ecir website I don’t think that is the case?…Also the test was done the end of August, which it says not to do, but I think that is just for the potential of a false negative?  Since it came positive that is not an issue, is that correct?

Thank you in advance for any advice. 
Rose Michele in Bucks County, PA
Joined in 2021

Sherry Morse

Hi Rose,

You'll get a full welcome letter shortly but did you get the actual numbers back from your vet for insulin, glucose and ACTH or just a 'don't worry, it's normal' message? Were the insulin and glucose tests done fasting or non-fasting?  What test did yo have done to determine if he was PPID?

The fact that he has been having hoof issues would lead me to wonder if he's been PPID longer than you've known than he is, but that's neither here nor there - all you can do is manage him moving forward.



I did not get any actual numbers and was just told they were normal.  After reading more on here I figured I was going to have to ask for the actual results.  I do know it was not a fasting test.  This was not the first time he has been tested, but I guess the test are not always reliable.  
Rose Michele in Bucks County, PA
Joined in 2021


Hi Rose,
Welcome to the ECIR group!  I knew nothing about CBD so I did some reading.  It definitely seems like something that might be worse with uncontrolled PPID, just as your experience with the fall flares tells you.  I’ll be interested in following how he does on pergolide.
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


Candice Piraino

HI Rose,

Welcome to the group! 

Please request the actual lab results from your vet. Its always good to have for your records anyways :) Please complete a case history at your earliest so we can provide more detailed help for you and your horse. It helps us get a bigger picture and more into the weeds! You can upload the lab results as well once you create the case history. We also love to see current xrays and photos of feet, which can also be uploaded. Feeding our recommended diet will only help your horse, even if it turns out he is not IR after review of the particulars from your lab report. But since you are having foot issues, I would definitely begin the Emergency diet and start from there at a minimum. Keep your California Trace Plus and ensure your base carrier is ECIR approved (ESC + starch = <10%).

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. 


Candice Piraino

Primary Response Team

September 2018, Summerfield, FL

Shark's Case History

Shark's Photo Album 

PHCP Barefoot Trimmer


Maria Duran

Hi Rose,

I am sorry you are dealing with CBD, I have known two horses with this pathology and it´s quite distressing. As you have been adviced, controlling PPID is imperative to keep immune response healthy, also delivering the right nutrients, so that hoof horn and connective tissue grows propperly.

I will share with you what worked very very well for these two horses, but none of these were affected by Cushing, so the treatment must be approved here before you try if you like to.

The hooves had bad cracks (Lavinia and Dr. K know) and huge hoof rings along the hoof wall. The coronary bands were very descamative and inflammed. The heel bulbs and frogs were absolutely rotten and smelling horrible.

We applied Panolog daily over the clean tissue, this included the coronary band all around, and every crevice within the rotten frog and heel bulbs, also the central sulcus. This was done twice per day during the first week, then once daily.

This is the product just in case you can find something similar

And the composition:

  • Nistatina 100.000 U.I. (equivalentes aproximadamente a 22,73 mg).
  • Sulfato de neomicina 2.500 U.I. (equivalentes aproximadamente a 3,68 mg).
  • Tiostreptona 2.500 U.I. (equivalentes a aproximadamente 2,78 mg).
  • Acetónido de triamcinolona 1,0 mg.
Because it has a corticosteroid in the formula and antibiotic/antifungal ingredients, you need to ask your vet and here in the group.

In both cases we noticed quick improvement in the smelly frogs and heel bulbs and the tissues began to heal, but the CBs didn´t improve until much later, we first saw they were less scaly, but inflammation didn´t improve until almost the end of the treatment, just so that you know what was normal for these two horses.

Once the frog and heel bulbs looked like the infection was gone, we kept that with hoof stuff applied twice per week, placing it deep in the central sulcus and colateral grooves. We also applied Field paste in the crevices although they looked fine.

The CB seemed to be fine after a month but was dry, it didn´t look totally normal, but was a different type of skin problem that we associated to the CB being dry. 

For this we applied Omnimatrix for rehydration and healing (I love this cream)


-Centella asiatica

-Echinacea purpurea

-Calendula officinalis

-Hamamelis virginiana

-Malaleuca viridiflora

-Lavandula angustifolia

-Thuya occidentalis

-Salvia lavandulifolia

-Arnica montana


Was important too to keep the horses hooves dry and clean, no mud or moist and have a tight schedule of trimming to avoid pressure and stress in the coronary bands.

They are healthy now although we know the episodes can return, but as I said, these horses are not metabolic.

Hope it is of some help and something to try instead of oral corticosteroids.

María Durán Navarro 
Dec 2017
Madrid (Spain)

Plutón´s Case History
Plutón´s Photo Album


Hi Maria,

Thank you for the reply, I thought there would be a slim chance anyone else on here having experience with cbd, let alone a treatment that worked in two different horses!  I have spent countless hours looking for cases with positive outcomes and have never found any.  I will definitely be sharing this with my vet and look forward to all the info here to start the healing process from the ppid.  
Rose Michele in Bucks County, PA
Joined in 2021 | Files


Hi Candace,

Thank you for the welcome.  I am reviewing everything you sent me, but I have a few questions.  I did just create Vesper's own case history, I am not sure I entered the bloodwork results correctly.  Diet wise, the only ration balancer I should be giving him is the CalTrac plus?  He is not overweight, do I add calories through hay and beet pulp, can I add hay cubes?  Vesper currently gets cosequin with MSM, from the do not feed list I see MSM and glucosamine.  My vet said he was not insulin resistant, just positive for ppid, should I stop the cosequin?  I did notice an improvement with arthritis after starting.  Sorry, last question, where I board the hay is from the same supplier, but not always from the same field, cutting or even farm, so I cant really test the hay, how do I balance minerals?  Thanks in advance for any input.
Rose Michele in Bucks County, PA
Joined in 2021 | Files | Album

Sherry Morse

Hi Rose,

You might be interested in reading this article then:

My impression is that if you're having issues with this it's probably more than just the single condition that's a problem.


Hi Rose,
Warmbloods are not often insulin resistant at baseline but they can become insulin resistant with uncontrolled PPID.  It’s wise to keep track of the insulin readings as you continue your ACTH testing.  It’s the high insulin that brings on laminitis which is what tends to bring people here.  With my own WB, I never needed to make the sorts of diet adjustments we recommend for IR but I kept him on the carefully balanced diet which is good for all horses.  He was able to be turned out and, as I have iR ponies which need hay low in s/s, he ate that as well.  I never soaked his hay if the hay went slightly above 10% s/s.

The idea behind balancing the hay is that you will be adding only what you need to his diet because the hay happened to be lacking there.  If you sample the hay that is used and have that tested, you can get a better idea which pre-mixed mineral supplements will serve your needs best.  As the hay comes from the same general area, continuing with the same supplement will most likely be fine.  If you know how to do this, you can do it yourself or we have people who were trained by Dr. Kellon who can do that for you for a reasonable fee.

For more calories, ideally you would increase his hay.  Beet pulp works well but it is labor intensive as you need to soak and rinse out/off the extra sugar and processing iron.  You can feed cubes, ideally Triple Crown Timothy balanced cubes.  They are made of hay with has been analyzed and supplemented appropriately, bound together with some beet pulp.  I generally add enough water to soften them although I often put dry cubes into a dispensing toy.  Four pounds of these, dry, provide the equivalent in calories of five pounds of hay.

There are other products we tend to use for arthritis.  As he isn’t IR, I’m not sure what the risk is of continuing the Cosequin.  I use Mov-Ease from My Best Horse and Devils Claw containing supplements.

The 0.5mg dose of pergolide you are giving may not be enough to control his PPID.  We usually consider 1 mg as a good starting dose.  Ideally you would retest his ACTH after three weeks of being on a chosen dose and make a decision about how well the dose is controlling his PPID from the results.  If you test right now, you’ll know how well controlled the ACTH is at the peak of he fall rise.  Ideally you will want his results to be in the midpoint of the reporting range during the time of the year not in the rise - the mid teens to the low twenties - with a bit of leeway for the rise.  Generally, we would test just before going into the rise (to be prepared for the rise), mid winter (to see how they fared coming out of the rise) and any other time you have concerns.

By the way, the rise I keep referring to is a normal phenomenon in preparation for winter.  It begins with the summer solstice and ends with the winter solstice but the months of Sept and Oct are generally when it’s the highest.  All horses experience it but PPID can cause it to be exaggerated.  The higher the ACTH gets, the more likely for insulin levels to be an issue.

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


Sherry Morse

Hi Rose,

You did enter the bloodwork in the right place. Do you know if the bloodwork was done fasting or not? would be useful reading for you on this point.

If you feed hay cubes they should be Triple Crown Natural Balance Cubes and they are fed at a 3:4 ratio to hay.  Many of us board and we use a commercial balancer because of the hay issue.  There's a list of those in the files:

As far as pain relief you can look at using something like Phyto-Quench from Uckele or even just Devil's Claw or HA.