Finnigan-14 year old Hanovarian/Arab gelding with newly diagnosed PPID and IR


My horse Finnigan is 14 years old. He's a Hanoverian/Arab mix and I've ridden him very low level eventing and dressage. For the past 4 years he's been successfully barefoot. Around June of this year he started getting a little "tender footed". My trainer thought he might need shoes. We decided to have the vet take radiographs of his feet to get a better idea of what was going on. The radiograph showed very thin soles. At this point we didn't know if it was a problem with the farrier, or what was going on, but we decided to get shoes. Initially he was better, but within a couple of days he didn't want to walk. My trainer kept telling me it was nothing so even though I didn't ride him he was still going out in a pasture. Around the first week of July he was diagnosed with laminitis.

The vet I'd used for 6 years said it wasn't a big deal and after a couple of days of stall rest and bute I was told to hand walk him and turn him out in a rehab paddock. Then he foundered. I believe he rotated 7 degrees on one foot and 11 on the other. My original vet casually said she's set him back so I switched. [edited]

My second vet took blood work and found that Finnigan was borderline PPID and EMS (I'll attach radiographs and bloodwork soon). She put him on Prascend, pulled his shoes, put him on stall rest and gradually added hand walking and turnout in a paddock. Eventually we put special shoes on him. After the initial crisis period I kept telling this second vet that it was strange that he didn't want to be hand walked. He's a lovely boy and has always cheerfully done what I asked, but he was very resistant to walking for more than 1 minute without wanting to stop. Because he was walking well and turned well enough she told me he was playing me. I guess I need to add that during this time he had pulses, but they weren't outrageous. It really bothered me that she was so dismissive of my knowledge of my horse, but I wanted to be fair.

Finally, 3 weeks ago, I decided that I had to trust my gut.  I called in a different vet for a second opinion. She took blood and his insulin level came back 4 times higher than normal, but normal for PPID. She put him on 2 grams of bute twice a day for 3 days. He's on 13 tablets of Metformin twice a day now.  He had radiographs done on the morning of the 4th day and the rotation is no worse. The new growth looks good. He's now on 1 gram of bute for 3 days and then I guess we evaluate. The other thing my latest vet said was to continue soaking his hay and I had to tell her that I'd specifically asked the second vet about this and she said it wasn't necessary. Now I'm soaking his hay. I tried feeding him Safe Starch in his rehab pen but he won't eat it. I live in Wisconsin and I don't know what I'm going to do when it gets bitterly cold if he still needs soaked hay.  I was told I could try walking him under saddle for 10 mintes, for the first week and then adding 5 minutes after that. It's going well enough I think. He's not really off and walks, but I can't say he's overly enthusiastic. 

I'm currently boarding at a show barn but they can't meet his needs for several reasons. The only have large, lush pastures or tiny rehab pens. Neither of these are options. The other problem is that, hard as it is to believe considering what I pay for board, you can't count on the farm hands to follow directions. Even though I explained how important it was not to start soaking hay at 7 am and then drain and feed it to him at 3 pm they aren't doing it.  From what my vet said, and the research I've done, it should be soaked for an hour, drained for 30 minutes and then fed soon afterwards. Soaking it beyond an hour the hay starts losing nutrients. When you go beyond 2 hours it starts to ferment. Of course I understand that air temperature etc. are all factors that can affect what's going on. I've explained again how important doing this correctly is, but I'm probably going to have to go later in the day then I prefer and do it myself. For the last 3 1/2 months I've driven an hour, one way, to care for my horse. Between doing almost nothing other than supporting my horse and the anxiety I've felt over trying to make the best decisions I've had some dark moments. I probably don't even have to mention the vet bills. 

On Monday I'm moving Finnigan to a barn that's only 35 minutes away where Finnigan lived previously. The owner has several other horses, including her own who have metabolic issues. I don't know what the rest of the group has found, but it seems like it doesn't matter what you pay for board, you still need to constantly check or do things yourself. I've been told that the owner of the barn I'm going back to has become much more conscientious. 

I had been hoping to move Finnigan to a friend's place that's only 8 minutes away. She has several lovely 5 horse barn and large pastures for her mares, but also has two 1/4 acre attached pastures for her pony. When I first looked at it I thought the grass was sparse enough that it would be a perfect for Finnigan, especially with a grazing muzzle.  Her pony is there by himself, so Finnigan could be his friend. This was wishful thinking. I took another look and although it isn't as lush as the mare's pasture it still has quite a bit of grass. Maybe someday? She takes meticulous care of her horses. The downside to this location is that there is no indoor arena and we live in Wisconsin. I'd also have to soak hay in my basement and bring it on a daily basis because she doesn't have a wash stall, just an outdoor hose. She has a lovely dressage ring and some paths around her and a neighbor's property, but I won't be able to ride for at least 3 months of the year.

This is my situation. I hope it's obvious that I dearly love my horse and I hope that I can ride him again or at the very least that I can buy him some more good years. Thanks for any help or words of encouragement.

Carol M.
Milton, WI
October 2022



Hi Carol,

Thanks for sharing your history with Finnigan.  Your first post here prompts this welcome letter with all sort of information about insulin resistance and PPID and how best to manage horses with these conditions.

You share a lot of useful information in your post, much of which could go into the notes of your case history so we can access it easily going forward.  With our combined experience here, once we see your test results, we will be better able to help you figure out his EMS status.  It’s best if you post the actual reports, rather than relaying a verbal report.  “Borderline” may mean something different to your vet from what it would mean to us.  The radiographs are also very important for us to see and those should go into your photo album.  It’s impossible to know what the vet means by those rotations without actually seeing the radiograph.

Please don’t force any sort of exercise.  There’s a reason he’s hesitant to move forward and that needs to be respected.  It’s good that you keep up the hay soaking until this is sorted out and you have access to appropriate feed.  You can read what we recommend in the emergency diet.  We suggest soaking for an hour in cold water or 30min in warm/hot.  Then rinse to remove the soaking water and dispose of the water where he can’t access it.  How long you hang the hay is not important.  You can feed it immediately or many hours later.  This is a bit weather dependent because a tightly packed net full of wet hay might well ferment at high temps.  Horses don’t mind frozen hay.  There is at least one member who soaks the hay successfully in a cooler overnight with cold water.  When balancing your hay, you would want to test the soaked and dried hay that’s being eaten but, hopefully, you can find a feed solution which doesn’t require soaking.

When telling us how much metformin he gets, remember that there are lots of different formulations.  We need to know what he’s getting in milligrams, rather than tablets.  

I know he’s already done a lot of barn changing but, for the winter, your neighbor’s set up might be perfect.  Close enough that taking care of him will not mean as much driving and, if his hooves do indeed show the rotation you describe, he really should not be ridden.  It takes a full year for a new hoof capsule to grow in and the better part of that should not include being ridden.

Hoping this answers at least some of your questions.  You mention some feeds that aren’t appropriate so stick to the emergency diet.  Post your test results and rads and we’ll do our best to help you help Finnigan.

And now for the welcome letter!

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. 

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

Lorna Cane

Hi Carol,

It's good to see you here. Your perseverance has paid off!

Finnigan is lucky to have you. I think your instincts are good, and the volunteers here can help you finesse his management . Looking forward to seeing your case history and photo album, when you are able to come up for air.

Lorna in Eastern Ontario