Hello Dr. Valentine (and all of your wonderful board members). I hope the New Year has had many happy and wonderful days for all.

I have a new Hanoverian mare that came to me somewhat underweight and very "flat" looking (muscle wise). She is 20 and a very kind, lovely mare. She has very bright eyes ... but to me they kind of look like they are buldging (like humans gets with certain illnesses). But she has been "healthy as a horse".

I have had her on about 28,000 calories (plus) during the winter with 20% coming from fat. All hay is Arizona grown Alfalfa and she was getting 18-20# a day .. the rest of the calories came from beet pulp and grain.

It took a while, but she finally put the pounds on, and she is not on the fat side of life (with a cresty neck - hard - and some fat pockets), but oddly, you can still see her ribs.

She worked pretty hard this weekend, harder than she should have and she is now sore in her right stifle and her left front. The left front is sore ALL OVER not just in the typical spots that would give rise to the fear of laminitis. All x-rays look GREAT, perhaps demonstrated a founder from way before.

My new trainer is very fearful of IR and believes that between the crest, fat pockets and sore foot, she is IR. The Vet (who I have the utmost respect for) is also concerned about some metabolic issues arising.

However, neither them bothered to ask about her diet that led up to her current weight. I wasn't in the mood to argue, and decided for last night, to err on the side of caution - pull her off everything except some of the Low Starch feed the barn has and soaked grass hay. I tried to address leaving her oil in place, and the trainer and vet weren't receptive (so I decided to back off - for then).

I believe that the sore front foot has more to do with the harder work, on a harder footing, no real muscle and then also compensating for the stifle. But again, to err on the side of caution, I will have her put in heart bars and support pads today.

Am I being unrealistic? Could the crest and the fat deposits simply be from getting too many calories?

Doc B, I am not a fan of grass hay (at all). If this is some metabolic issue, can I keep her on my diet - alfalfa, beet pulp (no molasses), oil and Strategy (or I can even get her a lower starch feed) OR am I asking for problems?

Also, the supplements they have for horses who supposedly have IR, can you recommend one?

Dianna, the issues of insulin resistance (IR) in horses are complex and, in my opinion, not well understood at this point. It is certainly true that there are horses that are easy keepers and prone to becoming obese and to developing IR and laminitis. IR is also a component of horses with Cushings. There are some who worry that just feeding fat to horses causes IR - in my opinion this worry is not justified by the almost 15 years of high fat and low starch and sugar diets for horses. But, of course, if even one horse on a high fat diet develops laminitis that can be used as evidence for the "dangers" of feeding fat.

For this mare, the first thing I would suggest is to test her for Cushings. This is not the easiest condition to diagnose with blood testing but many cases will show up. Talk to your veterinarian about this. I am more concerned about Cushings, given her age and body condition, that of IR due to metabolic syndrome. If she is Cushings you can treat with pergolide as well as diet.

In the meantime, it is not going to hurt to just have her on grass hay until you see what is going to happen with the sore foot. I am with you, though, in wanting to get her onto at least a small amount of alfalfa, beet pulp, and oil (no Strategy - that is high enough in starch and sugar that it is not ideal for really starch sensitive horses such as Cushings horses or IR horses). Aim for about 1/2-1 cup oil per day. I have fed many Cushings horses an EPSM type diet with no IR related issues at all.

As to the supplements, some may be useful although the science behind them is a bit shaky. Hormonize seems to help some horses, as does Quiessence. Talk to your veterinarian about this as well. And good luck with her!

Thank you. She is making nice progress. I'll talk to doc about getting some blood pulled. She doesn't really strike me as a cushings horse, but I guess anything is possible.