Frequently Asked Questions

Horse Health

  • 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:

    EEG Recommendations: PPID (Cushing's Disease)

    EEG Recommendations: EMS and Insulin Dysregulation

  • 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.

  • 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

  • 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.

  • 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.

Pre-Purchase Exams

  • There's no single "right" pre-purchase exam. A Pre-Purchase exam is a clinical assessment scaled to how you intend to use your new horse. Although every exam (regardless of the use of the horse) starts with a checklist of things we check on every horse, the intensity and depth we evaluate certain systems is an individual choice.    At its core, every exam includes a full physical work-up: auscultation of heart and lungs, cardiovascular and respiratory system assessment,  an eye and ear exam, palpation of the neck, back, and limbs, hoof testers, and a baseline neurologic check, followed by a dynamic assessment — watching the horse move at walk, trot, and canter, in hand, under tack or on the lunge and sometimes all three. 

    From there, the exam goes deeper according to what the horse's job will demand of its body. Flexion tests are a good example: holding a joint in flexion and then watching the horse trot off puts brief, isolated stress on that specific structure, which can reveal subtle pain that wouldn't show up at rest or during normal movement. A horse headed into light trail work may not need as many of these isolated checks as one being vetted for regular jumping or higher-level work. The number and placement of flexions and whether they're repeated under saddle, on hard versus soft ground, or through more demanding gaits like flying changes scales with intended use.

    The goal of the exam is to determine whether the horse has the physical composition to perform the work that is intended by the purchaser. 

    Determining what is needed for a pre-purchase exam starts with a conversation with the purchaser on their intended use of the horse. 

  • Some findings only become apparent under saddle — behavioral signs of back pain, for instance, or reluctance in one direction — that don't show up when a horse is standing still or moving in hand. 

    Being there also means you're part of the conversation as it happens. If something comes up during the exam, a flexion that's a little uneven, a reaction that's worth a closer look, you can see it in real time and talk through what it might mean, rather than receiving a written summary afterward.

    That also means decisions about how to proceed — whether to continue with additional diagnostics, or adjust course based on what's been found — get made together, with your sense of what matters most for the horse's intended purpose factored in as it happens.

  • You don't need to walk in with a fixed list of which scans you want. Radiographs, ultrasound, and bloodwork are typically added based on the intended use of the horse as well as what turns up during the physical and dynamic portions of the exam — if something looks worth a closer look, that's when imaging or lab work comes in.

    It's also worth knowing going in: very few horses come through a pre-purchase exam with a completely clean sheet, and that's normal, not a strike against the horse. The goal isn't a guarantee of a "perfect" horse; it's a clear picture of what you'd be taking on, so you can weigh that against how you plan to use the horse. If you're not sure what level of diagnostics might make sense for your situation, that's exactly the conversation to have with us before scheduling — ask us and we'll help you think it through.