• 15 Year Old Mare
  • has never been lame since I have owend her (April 2022);
  • has no clinical signs of PPID other than since being on pergolide has lost some weight and muscle
  • is in work about 6 days a week training with ground work and jumps as my daughter rides her to train for competing in eventing (my daughter is 11 and hasn't done her first show yet but will be this year)
  • is underweight (BCS of 3/4)
    • weighs about 735 and should be closer to 800ish
    • 14.1 hands
    • I do have what I feed her in my case history but am happy to provide a synopsis of it: 
      • 4 flakes of teff hay (not sure about weight)
      • 10 pounds of Standlee alfalfa pellets (under 10% NSC)
      • 1 scoop platinum metabolic am and pm as directed by product
      • 1 scoop of vitamin E am and pm as directed by product
      • 2 ounces of flaxseed oil
      • 1/4 cup of copra cool stance
• Diagnosed with PPID July 2022 in Arizona; 1193 ACTH (no glucose or insulin tested at that time)
• Moved her to Texas in August 2022 so vet in AZ did not want her on pergolide until after move
• Testing in August 2022:  ACTH 1082----Glucose 105-----Insulin 132
  • Put on 1mg prascend
  • still not diagnosed by vet as IR but put her on 10% or under NSC feeds
• Retest in October 2022 after being on prascend about 6-8 weeks 
  • ACTH 209----Glucose 70----Insulin 33
• Retest end of January 2023
  • ACTH 405----Glucose 78----Insulin less than 2 
    • but she was fasted for testing which is incorrect for Insulin and Glucose is my understanding

Here are my questions: 

1. Should I increase the pergolide? 

• Definitely disappointed with the ACTH.  I was going in the right direction from 1193 (July) to 209 (October) but am now back up to 405.  Vet has not recommended going up from 1mg of pergolide yet as she has concerns with Libby's Insuline BEING LOW.   But she admits that we should retest for insulin and glucose and not fast this next time around. 

2. Should I switch her to Alfalfa? 

• Right now she is on 4 flakes of Teff hay. 
• Where I am boarding her offers Teff, Timothy and Alfalfa. 
• I do not have any analysis of the hay where I am boarding her. 
• But given she is underweight and she has not been diagnosed as an EMS/IR horse, I am thinking I would like to give her the alfalfa because: 
  
  • she seems to like alfalfa better
  • she is not an EMS/IR horse 
  • she could use the better nutrients, including amino acids that alfalfa has--as I understand it, alfalfa is better nutritionally for her given it has more protein and she needs to build muscle
  • I could also likely do 2 flakes of Teff and 2 flakes of alfalfa as an option (they feed her four times a day, one flake at each feeding)

3. I am concerned about the super low insulin result at the end of January 2023.  Should I be or wait to be concerned until I retest her?  The vet is utterly perplexed as she does not seem to follow what she says is a typical PPID horse:  she is underweight, low insulin and no other clincial signs except the weight/muslcle loss.

--
Lisa B., Dallas (area) TX, 2022 (Lady Liberty, Mare 15 YO)

https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Lady%20Liberty

Lisa, Dr. Kellon or one of the mods will likely answer you from much more experience than me, but since you are already feeding your mare 10 pounds of alfalfa pellets, I would not be adding more to her diet. Alfalfa is higher in CA and you are going to end up with skewed CA/Phos/Mag ratios. Do you have any idea how much a flake of teff at your barn weighs?  I would personally have concerns over the limited long stem forage she is getting. 
Alfalfa has more protein but not necessarily more of the essential amino acids that horses need. Those are Lysine, Methionine, and Threonine. Alfalfa is typically higher in those amino acids, but to feed enough to increase those proteins, you are going to be into almost straight alfalfa , which is going to make for a very unbalanced diet for her. The three above aminos are limiting aminos, which means that if there are not enough of them in the diet, the protein chains that they are part of cannot be made by the horse, and that results in loss of muscle, topline, etc. 
I feed a local grass hay that I have bought for years from the same fields and this year, the protein in it was 7.4% About four months ago, I added the three limited proteins via HorseTech's Nutrino, or Uckele's Tri Amino and it has made a huge difference in the appearance of Juniper, my PPID/IR mare who is also 14.1 like your mare.She is also IR so I have to be very careful in what she eats, but she currently gets 2 lbs of soaked beet pulp with a pelleted balancer that includes the three limited aminos , flax, Vit E, probiotic/psyllium, and the Tri Amino which adds another 10 g. Lysine, 5g.Methionine, 2g.Threonine. She gets in nets and on the floor of her stall or outside 16 lbs of hay through the day, and she weighs around 975-1000#. She has visible ribs but a good topline. She is currently on 1.5 mgs Prascend and her ACTH is 23 as of Dec. 2022.  

I would recommend you use a limited amino supplement to help with the topline. The PPID is not controlled so that needs to be addressed. The IR number on this last test seems very odd. Remember that PPID does NOT have to be accompanied by IR, they are two separate diagnosis that can sometime overlap and IR can be driven by PPID. I would consider retesting her insulin and glucose separately following the guidelines in the ECIR homepage ( hay,only, no grain or pellet meals for four hours before blood draw) and see if you can get a number that seems within reason.

Your concerns are valid and for a horse in work , who is going to start eventing , she will need to have an appropriate diet and caloric intake for that work load. 
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Hi Lisa,
It looks like you joined a while ago, but did not receive a Primary Response message from the volunteer team. Usually, when someone posts to the group for the first time, they get a personalized response + the pro forma primary response message included.

Just to cover bases, I am going to include our pro forma "primary response message," below.

But first, to answer your questions, as best I can.

1. You are concerned about Lady Liberty's body condition score. It's GREAT you have created a case history and included the link in your signature. THANK YOU!!  It would be EVEN BETTER if you could take some photos of her, create a photo album in your case history folder, so WE can see how she looks NOW. In addition, if you could look back at your lab results, and include the lab (Antech's) reference range for the tests, that would help.

I suggest you take some photos and add them to an album in your CH folder.  The general horse world has become accustomed to seeing overweight horses as "normal," and is therefore uncomfortable seeing horses at a healthy BCS. Gypsy vanners and ponies usually have very efficient metabolism; to me, a horse of that type, with an attentive owner like you, is less likely to appear bony and underweight than a Thoroughbred getting the same diet and exercise, or a horse on a poor diet. In other words,  I would like to see what LL looks like, just to be sure the BCS number is not a bit skewed by what others might be telling you. (And feel free to message me privately, if this upsets you, or I am off base.)  Here is our body condition scoring guide, just for reference.  
 https://ecir.groups.io/g/main/files/Case%20History%20Tools/Tools%20and%20How-To%20Help/Body%20Condition%20Scoring%20Guide.pdf

2. Having said all that, UNCONTROLLED PPID CAN lead to weight loss that defies normal feed and exercise protocols. PPID is a weird disease. It can make some horses IR and overweight, as a side effect, and in other horses, it can lead to being underweight. Your CH says the vet in Arizona suggested LL showed signs of IR, but could not determine if it was a primary condition, or was secondary to uncontrolled PPID. (See, this is how PPID can be so confounding and frustrating. It makes some horses fat, and some horses skinny, and sometimes, the same horse is fat, until the disease progresses and then that same horse becomes skinny!! Trust me. THAT horse is here at my farm, RIGHT NOW.)

3. Based on your blood tests, RIGHT NOW, I would be more concerned with ACTH results, than insulin and glucose, especially when the test was non-fasting. ACTH of 405 at the end of January suggests that LL needs MORE pergolide to control her PPID. 

4. Diet: Please read the diet information below. Read it several times. It is almost never wrong to feed a horse a low sugar/starch, high forage diet. Some horses may need MORE forage than others to fulfill their energy needs, but all horses need a forage-based diet, with the right balance and ratio of various minerals and other nutrients. Since we do not have LL's condition fully sorted, I would avoid dramatically increasing alfalfa in her diet. Yes, horses need protein, but protein is not the magic wand for underweight horses. Alfalfa can be tricky for IR and/or PPID horses.

Your CH shows she is getting PP Metabolic support. I assume it is this product.  https://www.platinumperformance.com/platinum-metabolic-support/emetp--keppmet--set.html#product-tabs  If so, nothing in that product is actually supporting LL's current condition. If anything, that product is targeted at IR horses, for owners hoping some granules in the feed bucket will help their horse lose weight. That is NOT your concern for LL right now.

5. If you do not have analysis of the hay available, there is no point in fussing about amino acids.  You do not know how much calcium, lysine, methionine and threonine are in the hay, the alfalfa pellets, or LL's total diet. Those are the essential amino acids that create protein. There are specific levels of each, and specific ratios or proportions of each, relative to the other, to create protein. 

Alfalfa is highly palatable (yummy!) to horses, but it has too much calcium, and usually, more protein, than the horse needs. Excess is excreted in the horse's urine. So you may be flushing your efforts down the toilet (or into the shavings) by increasing alfalfa, without knowing the nutrient profile of everything else in her diet. 

If you want to learn more, geek out and become truly informed about the various nutritional components in a horse's diet, I HIGHLY recommend Dr. K's NRC+ nutrition course. It forced me to dredge up my high school algebra skills (ouch!!) and left me feeling much more confident to scrutinize feed bag and supplement jar labels and the vague nutrition claims of people leaning on the fence at the barn. It made me an INFORMED CONSUMER of nutritional products and advice.

6. If your boarding facility has a reliable supply of the various hays available (teff, timothy, alfalfa), it would be worth sampling 20 bales of each type, and sending the samples for testing.

If you can't sample the actual hay, it would also be worth getting an inexpensive fish weight scale https://www.walmart.com/ip/Ozark-Trail-Electronic-50lb-Scale/55503819?wmlspartner=wlpa&selectedSellerId=0&wl13=4&adid=2222222227755503819_117755028669_12420145346&wmlspartner=wmtlabs&wl0=&wl1=g&wl2=c&wl3=501107745824&wl4=aud-1651068664546:pla-294505072980&wl5=9026078&wl6=&wl7=&wl8=&wl9=pla&wl10=8175035&wl11=local&wl12=55503819&wl13=4&veh=sem_LIA&gclid=Cj0KCQiAofieBhDXARIsAHTTldoYKtNwvsCWU9w45wfqZnAIaR303MIFOiRSfk3kCc2i8oI_k5WeC-waApQIEALw_wcB&gclsrc=aw.ds  (full disclosure, I live at Walmart ground zero, Fayetteville, Arkansas, so I tend to search for items in their stores). Take 5 "typical flakes," of the hay at your barn. Put one in a hay net, or similar, and hang from the scale. Note the weight. Repeat with each flake. Determine the average weight of "a flake" of the Teff hay. And the timothy hay. And the alfalfa hay, from those 5 samples.  Then you could at least look at the Dairy One databases and get "average" information about the nutritional content of the hays you can feed LL.

(Keep in mind, most nutritional information about hay and pasture focuses on the components needed to ADD weight to beef cattle and other livestock whose value is based on their weight at the time of slaughter. This information is studied in great detail by feed companies and University agricultural programs. Because FAT cows = more $$$. It doesn't matter if the cows are "healthy," or "fit for performance activities." But horses have different needs. 

6. For now, such a low insulin result probably needs to ignored. There were questions about the testing process (fasting, or not, etc.)  But the ACTH result is most pertinent and concerning. That plus the body condition score you are reporting suggest ACTH is NOT under control and that suggests LL would benefit from an increase of pergolide, followed by retesting in about 3 weeks. 

For now, take a look below

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. 

--
Cindy Martin, KPA CTP
ECIR Group MOD
Mad Dog Ranch
Nov 2009
Lincoln, AR (USA)
Burley - Reuban - Scout - Grace Case Histories

Hi Lisa,

I just read your post and wanted to tell you about my experience giving Teff hay. I was giving it to my gelding because a woman at the stable was giving it to her horse and was telling me how good it was. Well, I sent a sample off to Equi-Analytical for testing and it came back at 19% which is well above the recommended 10%.

--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa )
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )

Thank you Laura.  I have never tested hay before and really want to do this; did you purchase a hay probe for testing?  How long did it take to get your results back?  How often do you test the hay?

***Sorry you do not need to respond.  I just found the file on this site about testing hay.   

But did you actually purchase a hay probe for testing and do you consistently test now? 
--
Lisa B., Dallas (area) TX, 2022 (Lady Liberty, Mare 15 YO)

https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Lady%20Liberty

On Sat, Feb 4, 2023 at 08:09 PM, celestinefarm wrote:

Uckele's Tri Amino

Dawn:  THANK YOU!  This group is so supportive.  May I ask some follow up questions? 

• What pelleted balancer do you feed Juniper? 
• What brand of beet pulp do you use?
• What probiotic/psyllium do you use? 

 I don't know what a flake at her barn weighs.  But I know that someone responded and gave me ideas on how to weigh it.  So I am going to look into that.  
--
Lisa B., Dallas (area) TX, 2022 (Lady Liberty, Mare 15 YO)

https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Lady%20Liberty

Thank you Cindy.  

Absolutely I can include the lab's references.  Did you mean in my email/post?  Because I have uploaded the lab results to my file and I think they are on the actual document I received back from the vet and uploaded to my file on this site? 

I will absolutely take some pictures and would love your input on her BCS.  I did the best I could looking at her and looking at the material about BCS on this site before I filled out my case history sheet with a determination of what I thought her BCS was.  

Yes you have the correct platinum metabolic product.  A vet suggested that and what you typed makes sense.  Since IR is not her issue right now, it really is the uncontrolled PPID, I am not sure why, when I critically think this through, it was suggested and why I bought it. 

Where can I find this course from Dr. K?  I saw some information about hay testing and balancers---I will read this and try to figure out how to test the hay.   But I think in the meantime I need to put her on a good balancer and take some courses....I am in this for the long haul.  This horse is family and I need to do what I can do to help her be a healthy and happy pony.  Right now, I feel like I am failing this creature.  I have read so much on this site but I feel like I don't know what to do to get her healthy.  I am going to increase her pergolide slowly starting today and get her up to 1.5 mg of pergolide.  She had the veil when I first put her on it so I am aware that I will need to adjust this slowly.  Thank you for all your feedack. 
Lisa B., Dallas (area) TX, 2022 (Lady Liberty, Mare 15 YO)

https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Lady%20Liberty

I would like to add here that all hays grown in irrigated areas also need to be checked for nitrate which can cause hoof pain and other problems.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Hi Lisa,
The moderators and Dr K will have the best advice but I wanted to share with you that my horses both tested MUCH lower than yours but they are on 12mg and 8.75mg of pergolide to keep them down to the low 20's for ACTH.  I don't think 1 mg is going to get you there.
Hopefully, Dr Kellon will weigh in but my guess is you need to increase the pergolide and test your hay and I would stop the alfalfa... too much calcium  And Teff can be notoriously high in iron which is also not good for PPID.  I hope you have a vet that will work well with you on this.  Good luck.
--
Linda in Grass Valley, CA  2020  Midnight and Ostara
https://ecir.groups.io/g/CaseHistory/files/Linda%20Midnight%20OStara

First, 2 is a perfectly normal insulin for fasting. The only time insulin is too low is if glucose is abnormally high at the same time. Pergolide controls PPID, not insulin, although uncontrolled PPID may increase insulin.

Not all PPID/EMS horses are overweight - less than 50% actually. What is her breed? Horses that are not prone to EMS may never develop high insulin with PPID as long as they are treated. Weight loss and muscle loss are actually very common signs of uncontrolled PPID

Obviously she tolerated alfalfa but it shouldn't be more than 10 to 20% of her diet depending on the calcium level in the Teff. Grass hays can provide all the protein a horse needs if they are a good quality. You really need to test it but I'm betting the muscle and weight loss if from PPID.
--
Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Lisa, 
I am currently feeding KISS from Thorne Bottom Farm because it complements my hay on analysis of my hay. I have, over the years, used or tried a lot of different supplements, ( I also used to breed Morgans and had ten horses of all ages at one time). I"ve found this one works very well for my two current mares who are 22 and 21. It is pelleted in small pellets and is very much in keeping with Dr. Kellon's approach to feeding more than the RDA's, keeping ratios of minerals correct, etc. The biggest plus is they will eat it and it doesn't contain extras such as wheat middlings, they don't need because they are IR. But it may be totally inappropriate for your mare because of her forage values. 
I am currently using  Speedi Beet , again, because my fussy mares will consistently eat it , whereas normal beet pulp such as is available in Michigan because we are a large beet producing state is acceptable to them for a week , then they won't eat it. Be aware, that Speedi Beet is high in iron and that iron requires numerous soak and then rinse to reduce. It is also 2.5 times more expensive than US produced beet pulp flakes because it is grown and processed in Great Britain and then micronized into flakes before being shipped to one or two importers here in the USA. The plus is that it soaks in warm water in ten minutes into fluffy meal , which makes rinsing not that big a deal. I'll confess, I only do a soak, then rinse then add water back. Some of the members here found it took several rinses to reduce the iron down into the 150 range. But my mares eagerly eat it with a little added FiberForce from Cavalor added to it and their supplements and have done so for the past two years. 
Both mares are PPID/IR and when the seasonal rise was in full swing and cold arrived in November, both started experiencing water, and some gas with manure passage. I normally have used a combo of psyllium with probiotics added, but had  briefly discontinued due to rising cost.  I ended up trying Horse Tech's WaterWorks and within two days, all water passage stopped and manure has been well formed, moist and normal, even with this recent cold snap. Again, it's expensive but it worked really well for what I needed it for. There are far less expensive probiotics available through different companies targeted for different problems. Be aware that research on probiotics and equine microbiome is still very limited , so what works for me may not for someone else.

If you want to try beet pulp, you can typically find either Standlee beet pulp , or Midwest Agri beet pulp. IMO, beet pulp shreds without molasses is easiest to soak and rinse, beet pulp pellets take a long time to soak.
For people in boarding barns whose management cannot soak beet pulp for you, you can soak a quantity at home once a week, and freeze meal sizes in baggies to leave for staff to thaw and use. 
Do not feed it dry. Yes, it is in commercial horse feeds fed dry, but it has been processed into the pellets, etc. of the feed.
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .

Yes, I purchased the probe directly from them.

--
Laura and Pabatsa in California
Feb 2012
Case History https://ecir.groups.io /g/CaseHistory/files/Laura%20a nd%20Pabatsa ( https://ecir.groups.io/g/CaseHistory/files/Laura%20and%20Pabatsa )
Pabatsa's Photos https://ecir.groups.io /g/CaseHistory/album?id=1740 ( https://ecir.groups.io/g/CaseHistory/album?id=1740 )

Hi Lisa,
Thank you for all the work you’ve done with your case history.  I think what others are asking for is the lab standards to be added to your CH form.  The actual lab reports are super to have but they generally get used for data confirmations - in case an entry looks wonky somehow.  Otherwise we would just assume that you don’t have access to them.  With your tests, the lab standards appear to mirror those used by Cornell (which are the most common), but that isn’t always the case.

My horse, Logo, was PPID but not IR.  Now I have two PPID horses and 3 IR/PPID ponies.  The thriftier the breed, the more genetically inclined the horse is to be IR and taller horses seem to be protected to some degree by their height.  Logo was 17.2h and a WB so it was no surprise that he wasn’t IR but, in your horse’s  case, I can see where there might be confusion.  I always associate PPID with weight loss and lack of topline.  After that, I think there must be a unique set of symptoms for each PPID horse.   I’d been a “frequent tester” for quite awhile and thought I might learn which symptoms might be Logo’s so I could make some requests for dosage changes based on that.  It seemed like it might be impossible at first but gradually I began to notice some symptoms which disappeared when the dose of pergolide was increased.  Seeing the ACTH increase after the initial decrease doesn’t surprise me.  There’s a lot of hormonal balancing going on and it takes awhile to find a new normal.  I would go ahead and ask for a dose increase, perhaps to be followed by another.  Too much pergolide is virtually unheard of, partially due to its cost.

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Thank you Linda.  I have a vet I am working with but most vets I have run across do not have the specialized knowledge to answer my questions.  I do not blame them.  I know vets have to be responsible for so much health knowledge that it is hard to expect them to keep up with all of this.  
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Lisa B. and Lady Liberty, Dallas (area) TX, 2022 (Mare 15 YO)

https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Lady%20Liberty

Thank you Dr. Kellon.  To answer your questions, she is a gypsy vanner crossed with a curly pony.  I will continue to read your articles on testing hay.  I want to get it tested but I am a new horse owner and new to this whole world of ppid.  I have never owned a horse before Lady Liberty.  So I am a bit overwhelmed and doing the best I can.  I appreciate your response.  Unfortunately I believe with the alfalfa pellets, I have blown your 10-20% guidance of alfalfa.  She gets about 50 percent of her diet from the alfalfa pellets.  :(  
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Lisa B. and Lady Liberty, Dallas (area) TX, 2022 (Mare 15 YO)

https://ecir.groups.io/g/CaseHistory/files/Lisa%20and%20Lady%20Liberty

You could replace the alfalfa pellets with Triple Crown Naturals Timothy Balance Cubes and kill many birds with one stone - they are carb safe and already mineral balanced.
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Eleanor in PA

www.drkellon.com  BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."

Love it....thank you Dr. Kellon. I have never fed cubes before. I have read some should be soaked? Should these? Also would it be a 1:1 ratio for replacement.....so if I give Lady Liberty 10 pounds of alfalfa pellets, I should give her 10 pounds of these cubes? 

Lisa, the Tmothy Balance cubes are a one inch cube, so smaller than most, and usually nice and soft. I feed them dry, even to my 11 hand Shetland. Occasionally you will get a bag with some hard, longer cubes, but Ontario Dehy, the producer, does a great job with their consistency. 
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Kim 10-2014

Clover, SC
ECIR Group Moderator 

Grits and Bella: PPID, IR; Dually: IR (sold); and Eeyore (deceased, but not PPID related)

Case History https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Grits%20-%20Eeyore%20-%20Dually

Photo album Grits https://ecir.groups.io/g/CaseHistory/album?id=1314
Photo album Eeyore https://ecir.groups.io/g/CaseHistory/album?id=6586&p=Name,,,20,1,0,0
Photo album Dually https://ecir.groups.io/g/CaseHistory/album?id=9046&p=Name,,,20,1,0,0
Photo album Bella https://ecir.groups.io/g/CaseHistory/album?id=64978