Hi, Just hoping for some guidance and hope please. 6yo PRE Gelding footsore after being out in the paddock for a week. Removed from paddock immediately to a dry lot on 17 November with low sugar tested hay. Continued to deteriorate. Given bute, lupin hulls and soaked hay and seen by vet for xrays on Monday 21 November. Had sinking and rotation. He was put in boots with pads by the trimmer and in sawdust. Fronts were put in an ice slurry for 72 hours on vet and trimmer advice. Insulin levels not as high as feared. He was moved to a deep sand yard on 23 November and trimmed on 25 November per discussions between vet and trimmer. Was on 3 days bute (5ml 2xpd) and then previcox plus ulcershield. 3 weeks later (still on bute) on 8 December he deteriorated and was lying down in pain. Was removed from soaked low sugar meadow and put on soaked rhodes and speedibeet (removed lupin hulls) and by evening was walking and pain improved. Was put on panadol 2xpd along with gut supplement and herbal Metabolic-S and as improving. Also started Alleviate (Devil's Claw) on 16 December. Trimmer checked him on 17 Dec and did not need to trim. He had a Bowen session on the same day. He was doing OK walking around and seemed to be improving. He started rejecting his hard feeds over the weekend (Panadol and alleviate were in them). By yesterday he was extremely lame and sore on his fronts (one in particular looked like a potential abscess and he did not want to weight bear) and was given bute 10ml am & pm and again this morning on vet advice. Vet has been this morning, and he is really sore but moving around a bit and eating a drinking, interacting with the vet and being engaged. He is laying down every couple of hours. I am just really concerned given his size (16h) and weight and also that we seem to be progressing but then we have a set back. I am also not sure how to manage his pain correctly as I thought he would have been tapering that by now or does it just take longer? I am also reading that bute is not the best but he is in a lot of pain. I thought we had also eliminated the causes so I am not sure why he is still in so much pain. It has been suggested he just has a low pain threshold but I thought he would have been improving by now. To complicate matters my usual vet who saw him first and my usual trimmer who works closely with him are both on holidays so I cannot get the original xrays or the Insulin results for the new vet to make a comparison. I am very worried that any decisions I make now are going to be critical. Would appreciate any advice (vet will return to do xrays but they are talkjng about shoes and clogs etc which is hard for me to get my head around).  Thank you so much. 
Annette WA 2022

Bobbie Day

Hi Annette and welcome to the group!
It sounds like you have a lot going on at the moment, we'll (all) do our best to get this sorted out for you and your horse. We know how hard this can be, I will be attaching your welcome message below which covers the ECIR protocols. Pay special attention to the emergency diet and testing section. There are also blue hyperlinks that will take you even deeper into the subject for even more reading. If you could get a case history started on your horse with some details such as (any available) test results, hay analysis, x-rays, etc. It would help us to help you. Fill out as much as you can, you can always go back to add things in as we go along.
Before we go on to the message, I would like to address a couple of things.
Given bute, lupin hulls and soaked hay and seen by vet for xrays on Monday 21 November. Had sinking and rotation. He was put in boots with pads by the trimmer and in sawdust. Fronts were put in an ice slurry for 72 hours on vet and trimmer advice.
We do not recommend NSAID'S, if your horse has an abscess brewing it can actually keep the abscess from exiting, which will most likely keep your horse from getting any relief, horses with abscesses collecting can be very, very lame. So, it's important to NOT give him bute or any NSAID'S. Instead, you can source some Jiaogulan to help with circulation. The same thing with icing, if your horse is metabolic in nature, icing will not help. Instead, you need to do the opposite and keep him warm. I have included some additional information here.
Pain Relief Alternatives to Bute and Banamine (
How to Taper Off NSAIDS.pages (
Why NSAIDs & Icing Are Not Recommended .pdf (
It's also important to note that NSAID'S and ulcer medications are not recommended to give together.
See this study
Vet has been this morning, and he is really sore but moving around a bit and eating a drinking, interacting with the vet and being engaged. He is laying down every couple of hours. I am just really concerned given his size (16h) and weight and also that we seem to be progressing but

We advise that you NOT force any movement, let him lay down as much as he wants to. Just be sure that food and water are within his reach, rest is the best thing for horses in crisis. If he does have an abscess, he will get relief once that makes its way out. We realize it's very traumatizing seeing your beloved horse in that much pain but we need to determine the trigger for all this and remove it so he can recover. 
It's good you've started him on Devil's Claw. We also have Australian mods and members that may have additional recommendations. We also have a country-specific safe feeds list that you can also refer to. As soon as you can get copies of your test results, please let us know. It's always a good idea to have your vet send them directly to you, please see our testing recommendations in your welcome message below. The more information you have the better we can help you, hang in there!


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
ECIR Group Primary Response

Kirsten Rasmussen

Hi Annette, while you're waiting to get test results and xrays from the vet, you could work on taking some hoof photos.  Some of this pain could be due to the trim mechanics since you said his insulin wasn't very high.  Here's instructions on how to take, name, and upload hoof photos:
We strongly advise no shoes or clogs and using boots with pads for comfort Becayse a fixed appliance can prevent the frequent trim adjustments he will need for the first phase of recovery.  Usually we want to see the trim touched up every 2 weeks by either the owner or the trimmer.

We are also going to need a Case History when you can get that organized, but take the time to read through Bobbie's welcome letter and try to implement everything that is recommended there for horses with EMS.  Focus on diet and diagnosis, which I think you've mostly addressed, but just make sure.

Unfortunately if it's an abscess, all you can do is encourage it to exit by stopping NSAIDS, adding jiaogulan, and soaking or dry poulticing (if soles are thin, don't soak).

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

Snickers' Case History
Snickers' Photo Album