Avon Ridge Equine Veterinary Services

12/11/2025

A common (and concerning) trend I’m seeing more and more on social media involves horse owners whose horses have been prescribed a short “course of ertugliflozin.”

These conversations and comments often start the same way: the medication was given for a short period, things improved briefly, and then the horse “relapsed” and the drug was restarted.

It’s as though insulin dysregulation is a switch that can simply be turned on or off.

It’s not.

Insulin dysregulation in horses is a complex, chronic condition that affects multiple metabolic pathways. Sudden or abrupt withdrawal of SGLT2 inhibitors (like ertugliflozin) can sometimes lead to a rapid increase in insulin concentrations — and in some cases, worsening lamellar damage in horses who still require time to recover. These horses often need weeks to months for their lamellar tissues to fully heal, even after clinical signs improve.

Yo-yoing horses on and off these medications based on how they appear day-to-day — or keeping them on indefinitely without proper oversight — is a misguided approach that often causes more harm than benefit.

Don’t do it!

▪️ Diet and Farriery: The Major Part of the Equation

SGLT2 inhibitors are powerful tools, but they are not standalone treatments.

For meaningful recovery from laminitis, these medications must be used alongside appropriate dietary management and expert foot care.

Every horse is different. Dietary recommendations must be tailored to the individual’s breed, body condition, management system, and medical history. It’s important to put the right dietary measures in place to help reduce the risk of preventable side effects while using these medications.

At the same time, collaboration with skilled farriers remains vital. Corrective trimming, sole support, and regular reassessment ensure that the metabolic progress achieved with medication translates to structural stability and comfort at the hoof level.

▪️Start with the Basics: Baseline Bloodwork

Before starting treatment, baseline blood tests are essential not optional. They provide critical information about liver and kidney markers and allow us to detect potential side effects early. You need to know what you’re starting with before you can treat safely.

▫️ SGLT2 inhibitors have been a genuine game changer in equine medicine.

They can dramatically improve insulin concentrations, promote recovery, and give laminitic horses a chance at a normal life again.

But their safety and success depend entirely on the advice, monitoring, and management that surround their use.

When prescribed thoughtfully (with dietary guidance, regular bloodwork, and coordinated farriery) these medications can transform outcomes and prevent unnecessary suffering.

🩺 If you would like a more tailored plan to help your horse recover from laminitis or practical advice to help prevent recurrent episodes contact us on 0427 072 095 or book an appointment online: https://avonridgeequine.com.au/book-an-appointment/

10/11/2025

📅 Save the Date – Equine Info Night at Murdoch
Tuesday 18 November | 6pm

Murdoch University is hosting a free evening for horse owners covering three super practical topics we see all the time in WA:

• Annual ryegrass toxicity
• Respiratory disease
• Tetanus

You’ll hear directly from experienced equine vets and specialists, with time to ask questions and chat.

Calling all horse owners of Perth! 🐴

Join us for a complimentary information evening at The Animal Hospital at Murdoch University!

With the prevalence of Annual Rye Grass Toxicity (ARGT) within the Perth region, hear from Professor Guy Lester about this topic, staying informed and recognise the signs, as well as two other hot topics!

✨ Topics & Speakers:
Dr. Valerie de Boer: Coughing, Wheezing, and Snorting—What Your Horse’s Breath is Telling You?
Professor Guy Lester: From Pasture to Poison—Understanding Annual Ryegrass Toxicity
Dr. Izzy Entwisle: No Horsing Around—Tackling Tetanus

Arrival from 6.00pm for food and refreshments, followed by information sessions commencing at 6.30pm.

Registrations are essential via this link https://www.trybooking.com/DGZSP

It is a great opportunity to learn from the experts, ask questions and connect with fellow horse enthusiasts.

We can’t wait to see you there!

05/11/2025

Let’s play “Guess The Tests”! 🤣 (as in plural… as in there’s more than 1!!) Winners get bragging rights!

Answer below 👇
Answer:

You’re looking at (almost) everything needed for two key tests I run very often: the Oral Sugar Test (OST) to assess insulin dysregulation, and the TRH Stimulation Test to evaluate for PPID.

We can perform both tests during the same visit, which means:
✅ less travel
✅ less stress for your horse
✅ lower overall cost for owners.
There is even a published protocol supporting the combined use of these tests when clinically indicated.

The tubes in the photo are important too —
• Red top serum tubes are used for measuring insulin
• Grey top (fluoride oxalate) tubes stabilise glucose so we can accurately assess how your horse responds to Karo Syrup

• The 1 mL syringes sitting beside the tubes contain Thyrotropin-releasing hormone used to stimulate the pituitary during the PPID test.

At this time of year, I typically prefer the TRH stimulation test over a baseline ACTH, because many horses with PPID can have ACTH values that within the “normal” seasonally-adjusted ranges — the TRH stim helps us pick up those cases sooner.

I also see some comments mentioning “insulin resistance.” Technically, the Oral Sugar Test is assessing the post-prandial insulin response — how high insulin rises after administering a known amount of oral carbohydrates.
Insulin resistance is another component of insulin dysregulation and a potential risk factor for laminitis in some horses, but it requires a different testing protocol to diagnose specifically.

Ultimately, the test we choose depends on the question we’re trying to answer — PPID diagnosis? Hyperinsulinemia assessment? Insulin sensitivity? Laminitis risk? Is the diet appropriate? But most importantly, interpretation and advice must always be individualised rather than following a generic “recipe-based” approach for every horse or pony.

And yes — it is confusing 😅
But don’t worry — geeks like me live for this stuff. 🤣

01/11/2025

Like the nerd I am, I was genuinely excited to wake up at 4am on a Sunday to present at the internationally renowned 2025 ECIR No Laminitis Conference on the use of SGLT2 inhibitors in horses.

Our understanding of these drugs is advancing at an incredible pace, and I was grateful for the chance to share some of the latest long-term clinical data and a few new (and perhaps slightly controversial) insights that are helping shape how we use them in practice.

The more we learn, the more my own approach to using these drugs has shifted over the past year — it’s such an exciting space to be involved in right now, especially knowing that this progress is allowing us to help more horses safely and effectively.

ECIR Group - Equine Cushings and Insulin Resistance

22/10/2025

Excited to be part of Equestrian Western Australia Welfare Wednesday Series!

16/10/2025

A huge thanks to the Murdoch University team for an excellent CPD night in equine medicine and surgery. Brilliant talks, great company — except for Dr Dolinschek, who unfortunately sat next to me and lowered the bar ever so slightly. 😂

Equine Services at The Animal Hospital, Murdoch University
W.A Veterinary Equine Dentistry Pty Ltd

12/10/2025

👀 Silent Risks in Sport Horses: Rethinking Subclinical Laminitis

A recent study presented at an equine sports medicine conference reveals surprising findings about metabolic health in sport horses. While insulin dysregulation (ID) is well recognised in EMS-type horses and ponies, its prevalence in sport horses may be under-appreciated. 

⚠️ Key takeaways:
• Among 180 horses evaluated (including those referred for orthopaedic/ sports medicine and from performance farms), 23% were diagnosed with ID.
• Only 10 % would have been flagged by a simple baseline insulin measure — demonstrating the need for APPROPRIATE testing.
• Radiographic assessments found that 48% of the first 100 horses had at least one marker of laminitis; 14% had multiple markers.
• Physical appearance (body condition or cresty neck) did not strongly predict which horses had ID — visual cues alone can be misleading.

‼️ This research suggests that a significant portion of sport horses may quietly be at risk of metabolic dysfunction and early hoof changes — even if they look lean and fit.

✅ Early detection through proper testing—not just visual assessment or baseline insulin levels—is vital. Radiograph interpretation should also go beyond simply assessing P3 rotation to identify more subtle, early indicators of laminitic change before clinical signs appear.

📞 For more information about early diagnosis and management which uses an evidence-based approach, contact us on 0427 072 095 or book an appointment online: https://avonridgeequine.com.au/book-an-appointment/

05/10/2025

⚠️ Part 2: Subclinical Laminitis — The Damage You Can’t See (Yet)

“He’s never been lame”… “He’s never had laminitis before” …. “This has come on so suddenly”

Laminitis doesn’t start the day your horse becomes lame. In fact, microscopic changes within the hoof can begin long before any obvious signs appear — this early, hidden stage is known as subclinical laminitis.

During this phase, the laminae inside the hoof capsule are already under stress. They may be inflamed, stretched, or losing structural integrity, but the horse remains comfortable enough to appear sound. Over time, this subclinical damage weakens the bond between the hoof wall and pedal bone, setting the stage for the sudden onset of painful, clinical laminitis.

🐴 Also, remember that horses are prey animals and it is not in their nature to show outward signs of pain until it becomes unbearable.

⸻

🔬 Understanding subclinical laminitis

Subclinical laminitis often occurs in horses with underlying metabolic disturbances, such as Equine Metabolic Syndrome (EMS) or insulin dysregulation. Elevated insulin levels can cause changes in the laminae, disrupting their strength and elasticity.
Environmental or dietary triggers — such as lush spring pasture and unmanaged metabolic issues — can tip a horse from subclinical to full-blown laminitis very quickly.

Because horses in this stage often appear outwardly normal, it can only be detected through careful examination and proper diagnostic testing.

✅ There are now proven, scientifically backed strategies to detect subclinical laminitis in your horse and early intervention could make all the difference in preventing a devastating episode of laminitis.

🩺 For more information on how we can help your horse, get in touch with us on 0427 072 095 or book an appointment online: https://avonridgeequine.com.au/book-an-appointment/

05/10/2025

‼️ Part 1: Recognising the Early Signs of Laminitis

I’m fortunate to work with many proactive clients who understand that laminitis prevention starts long before a horse shows any outward signs.

Proper planning of diagnostic tests, and careful interpretation of those results, are the key to keeping horses sound and healthy.

⚠️ In recent weeks, we’ve seen insulin concentrations in some horses rise two to four times higher than they were just a month ago — a stark reminder that seasonal changes, pasture growth, and individual factors can quietly push horses toward laminitis risk without any visible warning.

By identifying these changes early, we can intervene before structural damage occurs.
Unfortunately, not every horse is monitored this closely — and for some, the first sign of trouble is already too late.

⏰ These are some of the early indicators of laminitis that every owner should be aware of 👇

• Strong or “bounding” digital pulses in one or both front feet or hind feet.
• Subtle lameness on firm ground compared to soft ground or reluctance to walk on firm, rocky ground.
• Shortened stride or mild stiffness when turning or moving.
• Weight-shifting between front feet while standing, or a reluctance to move forward freely.
• Subtle hoof changes — flaring, wider growth rings at the heels, or “dished” hoof walls.
• White line widening, seedy toe, or tiny red spots in the sole.
• Reluctance to stand for farrier appointments in a previously well behaved horse.
• Spending a lot of time laying down or reluctance to move around with paddock mates.

Even mild or fleeting versions of these signs deserve attention — particularly during this time of year.

⚠️ Early detection saves lives

By the time a horse becomes overtly lame, significant structural change may already have occurred within the hoof capsule.

Early recognition, combined with proactive, well-planed blood testing, allows us to make informed management decisions — from adjusting diet and turnout to implementing medical therapies that protect the laminae before they fail.

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

📬 Stay up to date with the latest veterinary advice and download our FREE LAMINITIS GUIDE: https://avonridgeequine.aweb.page/p/f601bfc8-8447-4101-bc10-07d1ae83c550

04/10/2025

Dr Izzy clocked up a couple of hundred km’s yesterday visiting patients for sand colic prevention consults, wounds, lameness investigations, metabolic assessments and respiratory exams!

24/09/2025

Operation: Great Escape 🐾 These two little rebels have their own ideas about today’s vet visit!

21/09/2025

🧠 Behaviour Medications in Horses: Are We Asking the Right Questions?

When a horse shows dangerous, anxious, or reactive behaviour, it’s tempting to ask, “What can I give to calm them down?” But the first question we should be asking is: “Why is this horse behaving this way in the first place?”

A comprehensive 2023 review published in The Veterinary Journal makes this clear: behavioural issues rarely stem from a single cause. Instead, they are often the result of pain, fear, poor training, confusion, frustration, or unmet behavioural needs.

🧩 Effective treatment starts by understanding the underlying problem—not just suppressing the signs.

The review highlights that while behaviour-modifying drugs can help in some cases, they are not a replacement for correct diagnosis, thoughtful management, or appropriate training. These medications should be used as part of a broader, welfare-oriented treatment plan—not as a shortcut.

⚠️ One medication still commonly requested in horses is reserpine (Rakelin). However the review clearly states:

“Tranquillisers such as reserpine reduce the performance of normal behaviours and decrease responses to external or social stimuli… and are not typically recommended as part of a modern behaviour modifying program.”

This is echoed by leading veterinary behaviourists, including Dr. Gemma Pearson, who warn that drugs like reserpine and acepromazine (ACP) blunt movement without treating anxiety—potentially masking distress rather than relieving it.

✅ Instead, we now have access to more targeted, newer medications. These drugs support emotional regulation and allow the horse to process training, especially when stress is too high for learning to occur. But even these are only effective when paired with proper veterinary diagnosis, welfare-based care, and behavioural modification.

📣 Bottom line: If your horse is “acting out,” don’t ask what drug you can give—ask why they’re struggling in the first place.

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

Ref: Carroll, S.L., Sykes, B.W. and Mills, P.C., 2023. Understanding and treating equine behavioural problems. The Veterinary Journal, 296, p.105985.