Frequently Asked Questions
Horse Health
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What is PPID?
PPID (Pituitary Pars Intermedia Dysfunction), formerly known as Cushing's Disease, is a hormonal disorder believed to result from age-related changes in the pituitary gland. It's most common in older horses but has been seen in horses as young as five, and it's one of the most common hormonal conditions we see in equine practice. An estimated 21% of horses over age 15 are affected. Because PPID is progressive, catching it earlier gives us more room to manage it well.
What are the early signs of PPID?
Early signs can be subtle and are easy to miss. They include:
Being prone to infections (skin infections, fevers, cellulitis/lymphangitis — generalized poor immunity)
Change in behaviour
Inability to maintain weight or muscle, particularly along the topline
Lethargy or reduced performance
A shaggy or slow-to-shed coat
Infertility
Fat deposits along the neck crest and elsewhere
Advanced signs are usually obvious. The subtle, early ones are exactly why testing matters.
How is PPID diagnosed?
PPID is confirmed through an ACTH blood test. It's a straightforward on-farm blood draw, and results tell us whether a horse's hormone levels fall outside the normal range for their age and the season. Blood is sent to the lab and within 5-10 days we have results.
Why does the time of year matter for testing?
In the fall, horses with PPID show an exaggerated seasonal rise in ACTH compared to healthy horses. Using seasonally adjusted reference ranges, this makes early or subclinical disease easier to detect in the fall than at other times of year — fall testing can improve the sensitivity and overall accuracy of basal ACTH testing.
Fall is also a useful time to test more broadly: horses may be carrying extra condition after summer pasture, and knowing metabolic status before exposure to higher-risk fall grass can help us prepare and manage them appropriately, particularly if corticosteroid joint injections are part of their treatment plan.
Can insulin testing tell us anything more?
Yes. An insulin test can be added alongside ACTH testing for a more complete assessment of metabolic health, and can identify insulin dysregulation that may not otherwise be apparent. This is worth discussing with us if your horse is carrying extra condition or has a history of laminitis.
Should my horse be tested?
If your horse is showing one or more of the early signs above, or if you've simply noticed changes that don't feel like "just getting older," testing is the way to know rather than guess. Reach out and we can talk through whether testing makes sense for your horse.
How do I get my horse tested?
Contact us at info@inglemereequine.com and we'll help you figure out next steps.
Further reading
For owners who'd like to go deeper, the Equine Endocrinology Group (EEG) publishes consensus recommendations used by veterinarians across the industry:
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Yes. PPID (Cushing's) can present with a wide variety of clinical signs beyond the classic ones including recurrent and chronic skin infections, cellulitis, chronic abscesses, chronic pastern dermatitis, difficulty maintaining weight and muscle conditioning, fevers of unknown origin, sinus infections, and laminitis.
Insulin resistance can also show up in ways that aren't always expected including horses that are underweight rather than overweight, along with skin issues and increased itchiness related to chronically elevated glucose levels. Chronic pastern dermatitis is also seen in these metabolic patients as well as intermittent and hard to define subtle lameness secondary to foot pain.
Staying on top of your horse's baseline metabolic status is one of the more effective ways to prevent secondary issues and reduce the likelihood of an emergency down the line.
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Clipping leg hair is a simple tool for catching problems early. Winter coats can mask subtle thickening in tendons or ligaments that would otherwise be invisible, and long hair can hide cuts, scrapes, and wounds during routine checks unless there's significant bleeding. Keeping legs clipped, generally up to the knee or hock, means daily checks are more thorough and minor injuries are caught sooner.
Clipping also helps prevent skin problems. Horses prone to cellulitis, mud fever, or pastern dermatitis (scratches) benefit from reduced hair length during damp months, since dense hair traps moisture, bacteria, and yeast against the skin while restricting airflow.
Keeping legs clean and dry matters as much as clipping itself. Washing and thoroughly drying the legs before stalling is an important part of preventing skin issues.
How INGLEMERE Equine Can Help
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Cost is something we're glad to talk through with you directly, not as an afterthought, but as part of how we plan care together. We collaborate with clients to prioritize the essential components of a care plan based on budget, with the goal of maintaining medical standards while reducing out-of-pocket expenses, not cutting corners.
That starts with open communication. If you let us know your financial priorities, we can tailor treatment strategies around them including scheduling diagnostic testing to coincide with known pharmaceutical manufacturer programs, and offering professional insight into brand, generic, or compounded substitutions that don't compromise the efficacy of the treatment. Medications can often be prescribed in different formats, and depending on the product, Canadian-made options are sometimes available too. If your horse is on long-term medication, there may also be a nutraceutical option worth discussing.
We already work to offer cost-effective, reasonable care but it works best when we know what you're trying to prioritize and why. That's a conversation, not a form to fill out.
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Routine maintenance is the primary defense against high-cost emergency interventions. Proactive dentistry for irregular or abnormal teeth can prevent acute dental crises, and consistent vaccination schedules reduce the risk of life-threatening conditions like Potomac Horse Fever, West Nile Virus, and Eastern/Western Encephalitis. Managing Rhino, Flu, and Strangles, along with good biosecurity protocols during transport and barn transitions, also helps avoid costly outbreak management.
On the planning side, coordinating visits helps too — shared farm calls distribute travel and call fees, and grouping procedures like vaccinations and dental exams into one scheduled block reduces costs. Routine hoof care is also a foundational part of keeping costs down over time.