New Member Active Laminitis PPID


Hi Brittany,

It sounds like you’re about as stressed as most of us were when we found our way here.  I think it helps to write things down so it’s good you did that.  Don’t forget to add all this to your case history details so we have all the details at hand.

Your first post triggers this welcome from the ECIR group.  I’ll address some the issues and then, before overwhelming you, I’ll add the formal group welcome letter.  There is lots of reading material there, including details for some of my suggestions and comments.  Don’t worry if I don’t  get to every detail that concerns you because others will comment where they feel appropriate.

From your description, it sounds like his hoof problems only began this past year?  When you tested the ACTH, did you test insulin as well?  It’s the high insulin resulting from uncontrolled PPID that causes hoof pain and laminitis.  You need to do everything you can to decrease his insulin, which includes diagnosis, diet (and drugs), trim and exercise if appropriate.  We use the acronym DDT/E to describe this. 

He should be managed as an insulin resistant horse.  It’s quite likely, because of his breed, that his insulin will drop out of the danger zone once his PPID is controlled but you don’t know that yet.  He should be fed the emergency diet we describe until his hay has been tested for safe feeding.  The timothy balance cubes would probably be ideal for him.  They are generally of a low enough ESC+starch; they are mineral balanced; they are easily chewed and easy to digest.  I have five horses, mostly about the age of yours and those cubes make up most to all of their diets.  We’ve found that it generally takes about 3/4 as much weight for cubes as you might need for hay.

Recent studies indicate that pergolide begun during the fall rise is unlikely to be very effective.  Once the rise abates (late Dec), it should begin to take effect.  With such a high ACTH, it’s unlikely to be controlled with 1mg of pergolide but I thought that once before and was very surprised by the results.  At any rate, the goal is to get the ACTH into the high teens to low 20’s before the rise begins again in late June.  You need to wait three weeks between adjusting a dose and retesting.  At the same time you follow his ACTH, you will want to test insulin and glucose.  I would suggest starting that process in mid January which will give the pergolide he’s getting a chance to reach its optimal effectiveness.

Post your hoof photos (there are directions in our Wiki) and radiographs in an album on our case history sub group and we can share our thoughts.  Underrun heels and long toes are our specialty here.

I can’t advise you on the boots as my experience there is limited but I’ve seen that very topic addressed so try searching the messages.


Now for all the details I promised.  Keep this information handy as it will continue to be useful.

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


Hello, seriously overwhelmed new member here. Sorry, I don't have my case history file figured out yet. I'm not even sure where to start, everything seems so complicated. Sorry it's so long.
- 32 year old quarter horse gelding, have had him for 21 years. Active laminitis right now, had x-rays done today and waiting on official results from vet. They also prescribed 2 new meds I am unsure of whether I should give - Isoxsuprine HCL powder and Acepromazine oral liquid, which I saw is on the avoid list here with pergolide. I'm supposed to give it tonight and not sure what to do!
Diet keeps changing because he's a super picky eater, but currently just getting orchard/Timothy/tiny bit of clover mix hay and then 1 lb soaked Timothy pellets and 1/2 lb rinsed, soaked, rinsed beet pulp shreds, and 1/2 cup ground flaxseed twice a day. I can't get him to finish more than that so far in a day. Hay is by far his favorite thing to eat. I've been trying to add the rest of the emergency diet recommendations like salt or soaking, but he won't eat it and he needs to gain weight. I was giving him 1 lb of Triple Crown Senior Gold twice a day, but he stopped eating it and I think it was contributing to the loose stool. Also was giving him 1/2 lb of Tribute Essential K GC Plus twice a day until this past week because it's one of the only things he would consistently eat and take his pill with, but after reading through more info on here it made me nervous. Just got a bag of Triple Crown Naturals Timothy Balance Cubes today to try.
More Info:
- Diagnosed with Cushing's officially this September 2022, though in hindsight I feel guilty for being undereducated/misinformed on the subject and he probably started showing symptoms over the last couple years (started shedding out weirdly, swollen sheath but has always been a little bigger in that area than other horses). When I asked my original vet about it the first time I noticed his hair, he said there may be something hormonal going on but dismissed it and didn't want to run any tests. I guess it didn't alarm me too much because he's always grown a super heavy winter coat, it just used to shed out fine. Wish I would have found this group sooner.
Tested ACTH at 1250 in September, the highest their count went to. On 1mg Pergolide since October.
Timeline that I will try to keep as brief as possible:
Started noticing weight loss in July and on and off sore front feet since then, but not as bad as it has been the last two weeks. He's been laying down a lot. Blew an abscess in front right about 2 months ago and one in front left last week. Thought that was all that was going on right now, but wasn't getting better after a few days and had vet out who said it was an abscess and that it's healing, but also a bout of laminitis. Prescribed Bute 2x a day for 5 days and 1x a day for another few days after.
Also switched farriers in August and have been making progress on his long toes/underrun heels. I don't understand why he was more sound when his feet looked so much worse. He also had an abscessed tooth that ended up being pulled in September that has been a long and complicated process and has caused issues with chewing for the first time in his life.
And got Soft Ride boots for him that got here yesterday, but they seem to be rubbing his heel bulbs badly and made them soft and gummy after less than 18 hours. Actually got two sizes because he's measuring in between sizes and not sure if either is fitting right. I'm at a loss of what to do every way I turn. Any help would be so, so appreciated.
Brittany J in Ohio 2022