Unfortunately back

Shevawn Romine

Have had a good  several years with no laminitis - know protocols from previous bouts.     But 16 year old PPID/EMS/IR mare Cassie is now having another bad flare.   Not sure what triggered,   heat is extreme,  never in pasture without mask (although totally dead).  Only change was in hay - supplier no longer carrying CA bermuda that she had done better on than timothy.   Had it tested right away,   very low ESC+Starch , protein about the same as the timothy so was elated. But Crest became hard and large.   Soaking hay didn't make a difference, so have stopped feeding it and gone back to CA bermuda.   Blood work has just come back,   ACTH = 215 where top of range =30 and Insulin 146 where top of range=40.   Vet advised to double Prascend - 1 pill 2X day , syringing vs. hiding in anything.   Also starting on Thryo-L for 60 days,  1 scoop 2X day.  Retest in 6 weeks.     Questions for the group - any chance the capsules I put the prascend in were not dissolving in right spot in gut for med to work?  (I put one in water, and it kept it's form but was gummy ,   whereas one of my supplements in a capsule I dropped in water totally dissolved in a couple minutes)     Anyone else have trouble with Teff hay, I thought it was to be the greatest for EMS although hard to find?   I am not sure why vet did not recommend Metformin.    Any new advances in something to put on feet to keep more comfortable?   She has been quite rotated from the past,  but comfortable barefoot until this flare.  Trimmer glued on plastic shoes due to ground being like cement in her track,  but no comfort.    Am giving every supplement out there (Phyto-Quench,   Remission,   Reversatol (expensive+)  ,  hoof supplement.     Thanks for any insight.
Shevawn and Cassie
03/2015   Gordon, TX
CH folder:  https://ecir.groups.io/g/CaseHistory/files/Shevawn%20and%20Cassie 
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=76832


Hi, Shevawn.
Welcome back. So sorry Cassie is having a flare.

Have you looked for Cassie's old case history in your computer files? It was originally a MS Word 2010 document. It would be a huge help to ECIR volunteers and moderators if you would update Cassie's case history with information from your last version in October 2019 and today.

If you can't find it and need to start a new form, you can get the process going by checking the Wiki, here:
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Kirsten Rasmussen

Hi Shevawn, 

You really need to get that ACTH down.  If you are going from 1 Prascend to 2 Prascend, they need to be given at the same time of day to have an increased effect on ACTH.  Otherwise you are effectively giving a max dose of only 1 Prascend, which has the same effect on ACTH as 1 Prascend 1x a day (but doubles the expense!).  Make sure you titrate up the dose by adding 1/4 pill every 3-4 days.  After 3 weeks on the new dose you need to redo bloodwork to make sure it's enough to control the ACTH.  I suspect it will not be enough.  Since the seasonal rise is underway this is critical.

Adding Metformin now, dosed at 30mg/kg 2x a day, should also help get her insulin down, which will stop or at least slow the laminitis progression, and relieve some pain.

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


The mods or Dr. Kellon can provide more detailed advice, but I read that your vet advised you to give Cassie 1mg Prascend 2 times a day.  The ECIR group does not advise twice a day dosing vs. once a day. She definitely needs more pergolide with those numbers, but you should titrate up to 2 mgs or more once a day. There is no research that demonstrates twice a day dosing is better. 
The Thyro-L will not affect her insulin. It can help a horse lose weight, but if her weight is fine, but the hard crests are the only symptom, the thyro L may not do anything at all for those. And after 60 days of administration, her thyroid will depend on it and you will need to slowly wean her off of it. 
Lavinia will have to comment on the shoes. Comfort in her feet will come from removing triggers as you know and I am thinking once you get her ACTH back into an appropriate range, her comfort will increase. My advice is to see if you can manage boots on her if the shoes are not padded and her sole, etc. is exposed. If the shoes are just on the walls, then she is now weighting her walls which are laminitic and not what you want, but will Lavinia will have better advice.
Remission is simply very expensive magnesium. You can achieve the same thing with mag ox. If her hay is balanced with supplementation, you won't need most of the supplements you listed and can discontinue. Pergolide costs are going to increase, so you want to discontinue supplements that aren't doing anything positive.
Regarding capsules, if you are certain she is eating her treat, then the Prascaend will dissolve when it hits the acid in the stomach. I don't think that is your problem, the issue is that she needs more pergolide per dose.  PPID is a progressive disease, meaning it needs increased prascend or pergolide mesylate compound over time to continue to stay in check.

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 .


What is the reason for putting your horse on thyroL?   As you did not mention anything about a weight issue.  I’m just curious about the reason.  

Janet M. OH 2021

Sherry Morse

Hi Janet,

Many vets mistakenly believe that Thryo-L will lower insulin even though studies have shown this not to be the case in IR horses.