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Equine Metabolic Syndrome

By Ashley Phelps, DVM

Dr. Ashley Phelps has over 10 years of field experience as an equine veterinarian. She holds her Doctorate of Veterinarian Medicine from Mississippi State University and in her spare time enjoys doting on her horse, Ava.

Equine Metabolic syndrome (EMS) is a clinical syndrome with increased adiposity, insulin resistance, and hyperinsulinemia, affecting horses, ponies and donkeys. The underlying cause of the syndrome is unknown. Typically, it first develops in horses between 5-16 years of age. Most common breeds affected include ponies, Saddlebred, Tennesse Walking horse, Paso Fino, Morgan, Quarter Horse, and Mustang.

The signs associated with EMS in horses include obesity, increase fat deposition in the neck and tail head regions, laminitis, hyperinsulinemia with normal blood sugar levels, infertility, increased appetite, and altered ovarian activity. For diagnosis, your veterinarian will most usually perform combined glucose‐insulin test (CGIT), which requires blood to be obtained before a dextrose IV solution and insulin are given. Then blood will be obtain at certain time intervals after the injections.
Therapy is lifelong to improve the quality of life of horses diagnosed with EMS. Currently, there are no medications approved for the treatment of EMS in horses. Therapy and other management recommendations by your veterinarian may include:

1. Dietary Management: Restriction of carbohydrates is essential. Often pasture access is eliminated or highly restricted.

2. Exercise: Increasing the amount of exercise, if possible, can help with weight loss. However, if laminitis has occurred, exercise may be limited.

3. Levothyroxine sodium: It is prescribed to increase weight loss and thereby improving insulin sensitivity. It is unlikely to resolve clinical signs alone and must be paired with dietary management and exercise.

4. Laminitis management: Many horses diagnosed with EMS will also have laminits. Your veterinarian may recommend corrective shoes and trimming, pain medication, or dietary changes if laminitis is present.

5. Other Therapies: Chromium, magnesium, cinnamon, and chasteberry (Vitex agnus‐castus) may be recommended for the management of EMS. However, there is limited scientific evidence to support the use of these supplements at this time.

Management of EMS is lifelong but can be rewarding. Working with your veterinarian and farrier can provide many wonderful years with your horse.

Frank, N., Geor, R., Bailey, S., Durham, A., & Johnson, P. (2010). Equine Metabolic Syndrome. Journal of Veterinary Internal Medicine,24(3), 467-475. doi:10.1111/j.1939-1676.2010.0503.x

The PATH Intl. Equine Welfare Committee encourages positive and engaging educational exploration from our readers - we'd love to hear your feedback! Please let us know if you have any questions about our tip or have a suggestion about specific topics you would be interested in learning more about in the future. Email Dr. Ashley Phelps, PATH Intl. Equine Welfare Committee chair. Thank you!

Feeding and Managing the Hard Keeper

By Jessica Normand, PATH Intl. Equine Welfare Committee Member

The term “hard keeper” is often used to describe those horses that have a hard time gaining or maintaining healthy weight. Your veterinarian is the best resource for evaluating the weight – more specifically, the fat and muscle cover – of the horses in your care. He/she will likely use framework such as the Henneke Body Condition Scoring System. Using this method, your veterinarian will do a visual and tactile evaluation of 6 areas of your horse’s body (neck, ribs, withers, loin, behind the shoulder, and tailhead), giving each a score from 1 to 9, then average the results to get your horse’s overall body condition score. Regarding the scores, 1 is emaciated, 9 is obese, and 5 is considered ideal for most horses. You can and should learn this method so that you can keep tabs on your horse’s body condition in between visits from the veterinarian. And of course, it goes without saying that any sudden, dramatic changes in weight warrant a call to the vet right away.

Before we talk about typical hard keepers, it is important to note that feeding the truly malnourished horse is a very different situation and absolutely requires a veterinarian’s guidance. Horses with a body condition score of 3.5 or lower – especially those with body condition scores or 2 or even 1 (severely emaciated) are at risk for Refeeding Syndrome,1 which can be deadly. These horses cannot be fed like a normal, healthy horse. If you care for rescue horses or any horse that is malnourished, please work closely with your veterinarian to design an appropriate feeding program for recovery.

If you have or care for a horse whose body condition score tends to stay around 3.5-4.5 and you struggle to put weight on the horse, there are some important things to evaluate. First, the horse should have a full physical exam by your veterinarian to determine if any health problems are contributing to the weight challenges. These could include dental issues, digestive problems, parasites, infection, pain, metabolic conditions, and more. Your vet will also factor in your horse’s age and what that means for his dental condition and digestive efficiency.

In terms of nutrition, it’s important to think about the horse’s diet as a whole. Forage should be the foundation, and underweight horses should generally get at least 2% of their body weight in forage per day when you’re goal is for them to gain weight (for a 1,000 lb horse this is at least 20 lbs of forage daily). This means it’s important to have an accurate assessment of your horse’s weight, and it’s also important to weigh your hay. The SmartPak website provides this handy Equine Weight Calculator, and it’s easy to find an inexpensive hay scale to hang in the feed room. When you get a new load of hay, weigh a few different flakes from a few different bales, and take the average. For our example horse needing about 20 lbs of hay per day, this means 10 flakes per day if each flake weighs 2 lbs, but only 4 flakes per day if each flake weighs 5 lbs. And keep in mind that the horse’s total roughage requirement can be met by a mix of hay, pasture, and other options such as alfalfa cubes, forage pellets, chopped forage, beet pulp, and more.

Hard keepers often need some sort of concentrate, in addition to the forage component of their diet, in order to get the calories they require for gaining or maintaining weight. This could be a whole, unfortified grain such as oats, or it could be a commercial fortified grain or complete feed. Look for commercial feeds that are 10% or higher in crude fat, instead of the more traditional 2-5% fat formulas. Luckily, feed manufacturers now offer a plethora of lower starch/higher fat formulas. The reason to look for a higher fat feed is that, pound for pound, fat is the densest source of calories. This means that a pound of fat provides more calories than a pound of carbohydrate, so a higher fat feed is a more efficient way to help the horse gain weight. Because sudden feed changes are a proven risk factor for colic, always change hay and grain slowly, over the course of 1-2 weeks. It’s also important to go slowly when increasing fat in the horse’s diet, as introducing fat too quickly can cause loose manure. Other tactics for adding fat to the diet include feeding some stabilized, fortified rice bran, flax seed, healthy oils, or powdered fat supplements.

Once you’ve addressed the total calorie needs of your hard keeper, which will primarily help with fat cover on the body, you should also evaluate whether the horse needs to gain muscle. The most common place for hard keepers to lose muscle is along the topline. This may be a sign that the horse needs more protein in the diet – not necessarily more total (crude) protein, but rather more quality protein, which means providing essential amino acids. Research has shown that amino acid supplementation improved muscle mass in both senior and young horses,2 and there are some inexpensive, quality amino acid supplements available. Look for products that provide lysine, methionine, and threonine, specifically.

This discussion of diet is just skimming the surface. For a more thorough evaluation of your horse’s whole feeding program, consider the excellent online software, FeedXL (, which allows you to plug in all aspects of your horse’s current feeding program, creates a report to help you find the gaps, and shows you how making certain dietary adjustments will affect the results. In addition to evaluating vitamins, minerals, fats, and protein, this tool looks at total digestible energy, accounts for the horse’s workload, factors in his current body condition, and whether your goal is for him to maintain, gain, or lose weight.

Once your veterinarian has performed a physical exam and you’ve evaluated the horse’s diet relative to his workload, also think about his level of stress and overall living situation. Is the horse fed outside with a group of horses? If so, and he is low in the pecking order, he may not be able to consume adequate calories because other horses are moving him off of the hay or away from his feed dish. If this is the case, it may make more sense to separate him at feeding time, spread out hay across a larger area, or change up his turnout group. Also consider whether he’s stressed by other factors around mealtime, such as a noisy barn filled with students and parents, and consider if his feeding schedule can be adjusted.

Feeding and managing your hard keeper up to a healthy weight can be complex and a bit challenging, but you can do it! Work closely with your veterinarian, learn how to body condition score, evaluate the total diet (give FeedXL a try!) and reduce your horse’s stress around mealtime. Good luck!

1 Freeman, D.W., Gilliam, L. (ND) Refeeding the Poorly Conditioned Horse. Retrieved from

2 Graham-Thiers, P.M., Kronfeld, D.S. Amino acid supplementation improves muscle mass in aged and young horses. J Anim Sci. 2005 Dec;83(12):2783-8.

The American Hippotherapy Association, Inc., defines hippotherapy as a physical, occupational or speech therapy treatment strategy that utilizes equine movement. The word hippotherapy derives from the Greek word hippos, meaning horse. The term hippotherapy refers to the use of the movement of the horse as a treatment strategy by physical therapists, occupational therapists and speech/language pathologists to address impairments, functional limitations and disabilities in patients with neuromotor and sensory dysfunction. This treatment strategy is used as part of an integrated treatment program to achieve functional goals.

In 2016, of the 767 PATH Intl. Centers reporting data, 216 centers offered hippotherapy at their centers.

Occasionally, those working at PATH Intl. and its member centers may be asked if we have "hippotherapists." While the term is often used, there is no such occupation as a hippotherapist. Those who conduct hippotherapy sessions are physical and occupational therapists and speech/language pathologists. Hippotherapy is the treatment strategy these skilled professionals use to achieve pre-set functional outcomes for their clients.

African Horse Sickness

Isabel Wolf-Gillespie

In Africa we have our very own endemic equine disease – African Horse Sickness (AHS). AHS is a seriously real concern for every horse owner in most of Southern Africa and the disease affects them everyone directly or indirectly, regardless of whether AHS occurs in their area or not. Most horse owners that can afford to vaccinate are vaccinating their horses, however, impoverished rural communities in Africa most often don’t have the means to vaccinate their horses, mules or donkeys. Even in the very dry desert-like conditions of Africa, AHS occurs infrequently after heavy rainfall. AHS was first recorded in the Yemen in 1327 but the disease almost certainly originated in Africa. It was described by Father Monclaro, a monk, in a 1569 account of journeys into central and east Africa using Indian horses. In South Africa, AHS first appeared in horses that were brought to the Cape of Good Hope in 1652 by the Dutch East India Company. Sixty years after that was the first official, recorded outbreak in the Cape in 1719, in which 1700 horses died. Forty percent of the horse population was reported to have died in the worst season ever in 1854/ 55. Hundreds of years later, we still feel the devastation of this disease. The question about whether governments are doing enough to protect the African equine industry and whether it understands the value of the equine and its associated industries including the rural communities remains unanswered. 

The AHS virus caused over 1000 equine deaths in 2010/2011 resulting in a two-year suspension of all direct equine exports to the EU, costing the local industry an estimated US$150 million. The hacking, companion, traction, draught and transport function of equidae in all sectors of the African community cannot be quantified in monetary terms. The impact of AHS on the industry is devastating, and emotionally the cost is borne in the loss of a friend.

What is African Horse Sickness? African Horse Sickness is a highly infectious non-contagious, vector born viral disease affecting all species of Equidae. It is classified as an Orbivirus of the Reoviridae family of which there are nine serotypes. All serotypes (one to nine) are distributed throughout, although there is a variation in their temporal distribution. It occurs naturally on the African continent, and is characterized by respiratory and circulatory damage, accompanied by fever and loss of appetite.

Host and Vector Animals affected are, all breeds of horses (mortality rate of 70-90%), mules and donkeys. Wild life Equine species (Zebras) are resistant to the disease. The vector host, Culicoides midge, spreads AHS virus.

How do horses contract the disease? AHS does not spread directly from one horse to another, but is transmitted by the Culicoides midge, which becomes infected when feeding on other infected equidae. It occurs mostly in the warm, rainy season when midges are plentiful, and disappears after frost, when the midges die. Most animals become infected in the period associated with sunset and sunrise, when the midges are most active.

Symptoms The disease manifests in three ways, namely the lung form, the heart form and the mixed form.

- The lung (dunkop) form is characterized in the following manner: very high fever (up to 41° C); difficulty in breathing, with mouth open and head hanging down; frothy discharge may pour from the nose; sudden onset of death; very high death rate (90%).
- The heart (dikkop) form is characterized in the following manner: fever, followed by swelling of the head and eyes; in severe cases, the entire head swells (“dikkop”); loss of ability to swallow and possible colic symptoms may occur; terminal signs include bleeding (of pinpoint size) in the membranes of the mouth and eyes; slower onset of death, occurring four to eight days after the fever has started; lower death rate (50%).
- The mixed form is characterized by symptoms of both the dunkop and dikkop forms of the disease.

(Information supplied by the University of KwaZulu Natal and the African Horse Sickness Trust)

In the former Transkei of South Africa for example, equids form an integral part of life for the AmaXhosa people. Their role is to fetch water and wood, be a mode of transport, plow land and herd livestock and give employment opportunities. Equids as a mode of transport, are an environmentally friendly way of travelling, a quality needed in today’s world that should be supported and encouraged. Together with my husband Lloyd, I have been running an outreach project focusing on the social and economic upliftment of the AmaXhosa people. The animal owners often lack the necessary skills and resources, which results in serious abuse and neglect of the animals.

A few years ago we had to move from the former Transkei and our project area has shifted since then to Botswana. It’s a challenge to maintain and grow the project which is funded by ourselves mostly and currently includes AHS vaccinations, internal and external parasite control, wound care, education, and youth and skills development.

If you are keen to get involved please get in touch This email address is being protected from spambots. You need JavaScript enabled to view it..


Equine Protozoal Myeloencephalitis (EPM): Resources for Information

By Ashley Phelps, DVM

Dr. Ashley Phelps has over 10 years of field experience as an equine veterinarian. She holds her Doctorate of Veterinarian Medicine from Mississippi State University and in her spare time enjoys doting on her horse, Ava.

Equine Protozoal Myeloencephalitis (EPM) is a challenging neurological disease caused by Sarcocystis neurona and Neospora hughesi, which can manifest in many ways. Most often clinical signs include:

Ataxia (incoordination), spasticity (stiff, stilted movements), abnormal gait or lameness
Incoordination and weakness that worsens when going up or down slopes or when head is elevated
Muscle atrophy, most noticeable along the top line or in the large muscles of the hindquarters, but can sometimes involve the muscles of the face or front limbs
Paralysis of muscles of the eyes, face or mouth, evidenced by drooping eyes, ears or lips
Difficulty swallowing
Seizures or collapse
Abnormal sweating
Loss of sensation along the face, neck or body
Head tilt with poor balance; horse may assume a splay-footed stance or lean against stall walls for support.

Research is still ongoing to understand this disease better and why some horses develop clinical signs and others do not, despite most horses in the United States being exposed. Diagnosis and treatment of EPM possesses many challenges as well. Below are resources on diagnosis, treatment and ongoing research regarding EPM. 



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