Horse Care Plus

10/04/2026

A good read for those whose horse has a recent PPID diagnosis.

🐴 A HIGH ACTH DOES NOT MEAN YOUR HORSE HAS PPID (“Cushings”)

There is an important difference between an high blood test result and a diagnosis.

The horse matters more than the number.

This is where pre-test probability becomes incredibly important.

Imagine we test two horses:

One is a 22yo pony with history of laminitis, delayed coat shedding, muscle loss and other clinical signs strongly suggestive of PPID.

The other is a 9yo horse with no characteristic clinical signs of PPID.

Even if both return an ACTH concentration above the laboratory reference interval, those results do not carry the same diagnostic meaning.

The current BEVA PPID guidelines specifically state that the pre-test probability of PPID is low in horses under 10 years of age. In this age group, other explanations for the horse’s clinical signs should be investigated, and PPID testing should generally be reserved for horses with multiple compatible clinical signs that genuinely increase suspicion of the disease.

This matters because the lower the probability that a horse actually has PPID before we run the test, the greater the potential for a positive result to be a FALSE POSITIVE.

In fact, using published diagnostic-performance data, the BEVA guidelines estimated that during the autumn seasonal rise, around 80% of positive basal ACTH results in horses with a low pre-test probability of PPID could be false positives.

That is a really important number.

Why do I find this concerning?

I am increasingly seeing horses under 10 years of age being diagnosed with PPID and started on lifelong pergolide treatment based on a single ACTH result, sometimes without convincing clinical signs or further investigation.

Starting a young horse on lifelong medication based predominantly on one abnormal laboratory value, when the horse has a very low pre-test probability of actually having the disease, is simply not good veterinary practice. More importantly, it’s often bad news for the horse.

The problem isn’t simply that the horse may receive pergolide unnecessarily.

Once we attach a diagnosis of PPID to that horse, there is a risk that we stop asking the more important question:

If it isn’t PPID, what is actually going on?

An incorrect diagnosis can mean that another disease or management problem responsible for the horse’s clinical signs is overlooked or treatment is delayed. This concern is specifically raised in the BEVA guidelines, which note that false-positive PPID results may lead to unnecessary lifelong treatment and failure to identify and treat a potentially important alternative diagnosis.

ACTH is an extremely useful test when investigating PPID, but a high ACTH concentration on its own does not confirm that a horse has PPID.

ACTH is a biologically variable hormone. Its concentration can be influenced by many factors completely separate from PPID, and this needs to be considered before interpreting a result.

ACTH is a diagnostic tool. It is not a diagnosis.

An elevated ACTH should prompt us to look at the whole horse: age, clinical signs, history, breed, season, concurrent disease and the circumstances surrounding the blood sample.

Sometimes all of those pieces fit together beautifully and PPID is the logical diagnosis.

Sometimes they don’t.

When the laboratory result and the horse in front of us don’t match, the answer shouldn’t automatically be “start pergolide.”

The answer should be “let’s investigate further.”

🩺 Contact us on 0427 072 095 or book an appointment online: https://avonridgeequine.com.au/book-an-appointment/

09/12/2026

With the welcomed addition of Dr Carol Shwetz DVM to this work I’ve been very quiet on the pelvic collapse front….not because there hasn’t been work happening but because joining all the dots together with the breadcrumbs horses bodies leave us has become a recognisable pattern. One that has formed quite the data set for collecting information and recognising patterns. With the formation of Etica Equine Charitable Trust to under take this mammoth task in collating the data. We are lucky to have two academics on the board of trustees to oversee this study.

Organising all the data points and understanding what might be happening at what point is a massive task! The changes we are seeing from hooves to lumbar and up the connections of soft tissues is truely quiet the chain of action and reaction. Compensation seems to play a huge role in the way the body adapts to such a mechanical failure of the skeletal system. The changes to soft tissues are notable and obvious in dissection.

I value working as part of a team so much because this work is truely overwhelming at times. If you follow me on patreon, I’ve been very honest about the toll of the work. This is going to take a community of collaboration. For more information on our pelvic study, check out the Etica website www.eticaequine.com

I have done an updated video on patreon discussing some of the new discussions happening around what the bones are recording and how dissections are leading the conversations.

https://www.patreon.com/Becks_nairn/posts/pelvic-collapse-169186730

09/06/2026

If you ever wondered what damage choke episodes can cause this is a fantastic post to review with the photos. A good visual of the importance and why we need to go slow when reintroducing horses back onto their regular feed program❤️‍🩹

09/05/2026

As horse owners it is our responsibility to ensure we are aware and familiar with potential signs of illness or disease. Please share , this vet is located in Saskatchewan.

09/01/2026

The widest part of the frog is the seam where all of the structures in the hoof capsule come together around P3:

Wall (blue)
Frog (yellow)
Heel bulbs (green)
Sole (red)

09/01/2026

08/03/2026

07/28/2026

Robbing Peter to Pay Paul.

Our attention needs to move away from the 2 dimensional idea of toe length vs heel height and move to the 3 dimensional idea of whole hoof development. The digital cushion is highly regenerative and has the ability to support the entire horse on an elastic cushion instead of relying on the strength of lever and pulley function of the ddft and skeletal attachments. The body is meant to be supported more by the muscles, not by the skeleton. The foundation of this support is the digital cushion. The strength of the digital cushion relies on its depth. Its depth/strength relies on the weight distribution of the horse. The weight distribution of the horse relies on the shape of the frog and heels along with the relationship of the wall to the peripheral edge of the sole. This healthy ( healing ) distribution comes from continually shaping the heels properly to get the horse to lean back comfortably…and keeping the horse leaning back comfortably keeps the heels and frog shaped properly and the weight comes off the toe.

Horses do this for themselves in nature. People come up with all sorts of ways to avoid attempting to simulate nature…because it’s inconvenient. Nature does it daily. How often do you do the work? Some people would rather pursue egoic goals, and take advantage of the horse’s youth, thinking they will avoid the inevitable breakdown of the horse. Or do they know?

The horse will not likely be sustainably functionally sound until it’s structurally sound. In order to be structurally sound the hoof capsule must be fully live. In order for the hoof capsule to be fully live it cannot be deviated from its growth origins ( coriums ) at the coffin bone. This cannot be faked by externally shaping the hoof capsule to balance it around the coffin bone. The regenerative, new, live, undeviated horn has to be grown in while the degenerative old, dead, deviated horn is grown off. The shape of the hoof capsule will eventually match the shape of the coffin bone.

A perfect fit…a perfect foot…
for that horse. This needs to take into account the bone erosion and morphology.

IMO, chronic toe loading is the leading cause of most lameness. Improper and/or infrequent frog and heel trimming is the leading cause of toe loading. When you consistently leave the heels longer than the calloused live sole at the seat of corn
( to gain “ heel height “ ), you put their weight on the toes. Every mm of elevation from the heels 👠 puts a proportionately greater amount of weight on the toe. Think about a 1000 lb horse floating on a 1/2 mm of blood between the bottom of their coffin bone and their sole. How much elevation in the heels would cause a reduction in blood flow under the toes on a 1000 lb horse. Chronic pressure and lack of blood flow causes bone erosion. Sole thickness and coffin bone erosion are usually measured in mms. The bone erodes little by little ( less than a thin sheet of paper at a time ). We don’t recognize it until it’s a mm ( 10 sheets of paper ) in many cases, one mm of vertical bone loss at the tip of the coffin bone = several mm of horizontal bone loss ( from the tip toward the palmar process). This is relative to the weight distribution of the horse. 1 mm of vertical height at the heels = ( approx ) 2 cms of horizontal compensation at the withers on a 15 hh horse. This goes for dorsopalmar balance as well as mediolateral balance.

I recently read a post where someone said the fetlock joint prevents the horse from straining their ddft. I don’t believe this. The fetlock joint shares the strain with the coffin joint. The fetlock just takes the brunt of the strain if you elevate the heels to reduce the ddft strain at the coffin joint…until it can’t anymore. Once the fetlock has too much morphology from strain, the horse has arthritis and the strain returns to the ddft. Eventually the ddft fuses with the lost leg joints and the horse’s lower leg is cast in a conglomerate of bone and tendons with minimal blood flow or ability for flexion.

The elevation has to come from between the bottom of the coffin bone and the frog corium. This is where the digital cushion resides and it has the regenerative ability to gain depth. You can literally pump it up with the horse’s own weight. This relies on proper heel and frog shaping so the horse wants to lean back. When more attention goes to the proper shape of the heels and frog instead of their guesstimated height, the horse will lean back and build digital cushion depth and strength. The more engaged the soft tissue becomes, the deeper and stronger the digital cushion gets and the more the horse can engage their core. True collection comes from engaged ( collected ) feet.
Their feet can build. Let the horse’s weight work as nature intended…for them instead of against them.

07/26/2026

This is a 52kg tumour we pulled out of a young TB(7)

He had a relatively fresh set of shoes on, let that sink in……
They are not built to show pain, they soldier on. His stomach was full but his kidneys appeared to be in renal failure and full of pus, his heart was scarred on the internal lining yet he died chewing hay as he was euthanised. The internal necrosis was horrifying, dying from the inside out and he kept eating hay.

We had a woman attending the dissection who weighed 52kgs. This was only the main mass, the tumors were everywhere. It was wonderful to have academics on this dissection and the first one to add to the conversations. I’m glad this horse didn’t take his secrets to the grave but moving forward a collaborative effort is needed to improve welfare for horses.

To watch the video

https://www.patreon.com/posts/52kg-tumour-from-102668261?utm_medium=clipboard_copy&utm_source=copyLink&utm_campaign=postshare_creator&utm_content=join_link

Therese from Equi-ed, your a hero for getting this underway in Ireland. Your awesome team of supportive people around you made this week run smoothly.

Collaboration not competition.