Aw what a lovely horse! I like your muzzle its such a fun colour.
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Oh man, sounds metabolic for sure. Or at least you’ll have to manage her that way.
@JB might be able to chime in with some resources for education or maybe a starting point while you wait for the vet - they’re full of great information. At the least, I’d be switching her off the 12% IIWM.
EDIT: if you have the option to send her to a barn that is set up for and regularly manages Cushings and IR and such horses, DO IT. “Regular” farms often cannot easily accommodate these horses, so a place with a drylot and setup for slow feed hay etc etc etc is going to give you SO much peace of mind. You’re about to go on a crash course of equine nutrition, and foundered horses don’t have much of a margin for error. Hedge your bets and get the barn on your side! Good luck!
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The simplest things you can change right now is to soak hay to remove as much possible sugars and change to a low NSC grain (below 10%). I have one pony who had laminitis after his vaccines and became foot sore once I put him on grass for the mornings (even in a muzzle). So I treat him like an old foundered pony and changed his grain to Integriti (Purina) which is guaranteed to be less than 10% NSC and I soak his hay in a tub for a few hours to remove any sugars. He is also in a dirt paddock with 0 grass for 14-16 hr/day. I’m going to pull blood and get more rads on him in the spring to reassess him. I do a few more things for his diet such as giving him a chromium supplement in the am to help level his sugars and give him 5000iu of vitamin E, probiotics and a general vitamin supplement as some vitamins decrease when you soak the hay. But your vet can for sure let you know if they think you need to add anything to their diets.
I’m sure your vet can do more once rads and bloodwork is pulled. I just though to mention some simple changes you can do right now 
They won’t do any harm in case its not as bad as your vet finds out after his exam.
I keep my guys at home so can manage this. It can be a little more tricky when you board out as others have mentioned, prevention is key.
Yes. If you can buy hay that tests under 10% you are well ahead of the game. When my mare foundered I found 1 place that stocked low NSC hay. I also fed beet pulp and a low-starch complete feed…
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If grass is actively growing, mowing actuall reduces sugar because it starts using more sugar to grow back. But most of the US grasses aren’t growing now, or not very much, depending on where you are.
Over-grazed/too short grass is high in sugar because it’s concenrated, so the question is - is there less overall sugar intake because there’s less grass to eat, or is there so much sugar there that there’s more being eaten?
Thsi time of year is the tail end of the seasonal rise in the northern hemisphere so the ACTH test is good for checking for PPID. if you wait too much longer, you’d want to wait until at least early December and do the TRH Stim test
At her age, PPID is likely, and IR/EMS often comes on the heels of that, so you want to test for both. For the IR test she needs to be fasted for a good 12 hours - forage only, not a no-food fast
What month was the 2nd founder? Founder in Feb, where I assume grass is simply not growing up there LOL could mean she’s also triggered by cold, which is a beast to manage
As for diet, that’s been pretty well covered. If she’s PPID-only, no IR, then there’s a little more leeway in NSC, around 12% vs 10% But it also depends on how much of the thing you’re feeding. The hay for sure needs to be tested low, I can’t imagine being able to soak unkown quality hay up there over the Winter 
If her weight is good, then a ration balancer is fine. If she needs weight, you have to find a suitably low NSC feed, so it depends on what you have access to.
www.ecirhorse.org is a great place to join, tons of info.
ECIR has FB page as well - page, not group, so you can’t post questions but you can comment under things they post https://www.facebook.com/ECIRGroup
Those 2 places have lots of info on the IR/EMS side of things
And the Equine PPID (Cushing’s) group is really good as well if it turns out she has PPID
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@redandwhite I find that people are curious about the grazing muzzle but I’ve never had the impression anybody thought I was mean. I explain why the muzzle is necessary (to keep the horses from getting too fat) and let them see that the horses can eat through the muzzle. I also point out that they’re in good weight and not starving. Actually, I’m the only person who thinks I’m mean for doing this to my horses! 
Your mare may not need a grazing muzzle since she’s already thin. Or, if you do need to use one, be sure to bump up the calories some other way.
Please keep us posted. I think we’ll all be interested in what your vet says.
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The barn that has other cushings horses is a no-go. I asked my barn owner about it and she had enough to say about it to keep me well away. I could consider taking her to my parents but then she’d be alone, and I’d need to put the fence back up. There’s some grass there but it’s a gravel paddock mostly. Not the best solution. Going to look at two more word of mouth places. I just want her to be somewhat happy for a few years.
Anyone used medications like prascend? Previcox? What’s normally given for this type of thing? Does it help?
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Sadly, there are too many people who think muzzles are abusive and cruel They either ignore the cruelty of allowing a horse to become obese and founder, or they think you’re a bad owner for not having a track system with the perfect hay such that your horse can walk miles a day between hay and water and eat all he wants without a muzzle
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Prascend is for PPID and it absolutely helps for the vast majority of horses.
Previcox (firoxocib, there’s generic, and there’s Equioxx for horses), is an NSAID used for pain management
There’s no drug to help IR/EMS, that’s very much based in dietary/movement management
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My friend’s horse has Cushings and has been on Prascend forever. It definitely helps her a lot. She has her levels checked yearly, and she is able to be turned out on grass.
Same horse has also been on Equioxx (and then moved to a less expensive NSAID) as she is 31 and a bit creaky.
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what a gorgeous dappled girl! She looks like a dream pony.
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Great- found her a place ill be checking out on monday evening. looks perfect- willing to give meds, give my specific grain, follow instructions, nice safe paddock without grass and a shelter. hopefully this place works out for her. I’m going to be quizzing my vet about what else is necessary- there’s a lot of information here but I dont know if I need to be testing my hay, soaking hay, etc or if she’s “not that bad” or if I should be doing it anyway. I’ve never had to soak hay before- will a boarding barn typically do that? I assume it’s an upcharge which is fine but I hope they’ll do that if it’s necessary? i know it’s dependant on the barn, i just havent seen it done before.
I have so many questions. really looking forward to the vet visit. Will keep you updated on what she has to say. thanks for all the information everyone im still combing through it
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I think it was mentioned upthread to test the hay she is getting for sugar and starch (NSC) but I don’t think anyone said how. If you have a local feed mill, they might do it for you. I do mine myself; I use EquiAnalytic in Ithaca, NY. They have a great website. If you need help and call the lab, the people there are very nice and helpful.
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There is one place near me that offers a complete nutritional profile on all their hay. I used them when my mare had laminitis. My local feed store will also arrange their hay to be tested. You should check with your vet but it since some hay has very high sugar content, you might want to find a supplier with a low NSC hay so that it doesn’t need to be soaked.
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If there’s enough hay at the barn for at least a few months, it’s worth testing it. Ideally you’d have a hay corer which many agricultural/extension agencies have to borrow (or rent), to core into a random sample of bales, but if you can’t, then you’d need to break open that random sample and grab a handful from the middle of the middle. Even if you couldn’t break open those bales all at once, you could grab samples each day as bales are opened to feed, and then once you have your bigger sample (like from 10-15 bales) then you can do all the next steps.
if she’s ONLY PPID, it’s not as big a deal
But if, as it seems, she’s IR/EMS, it’s a very big deal if the hay is too high in NSC and especially starch.
Some do, some don’t. If you’re at the barn every day, you can do the soaking, and then set it up to be fed
If you find it’s low enough, no soaking needed
www.equi-analytical.com is a great place with lots of info, and where I recommend testing.
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Grass hay can range from 5 % to 25% NSC. You can’t tell by looking at it. Local to me, the coarse first cut grass hay that is low protein and minerals can be freaky high in NSC because of our long cool wet springs. People do give their ponies laminitis attacks thinking it “looks safe.”
Hay is the major part of the diet, so if that’s not right, just cutting back on oats won’t do much.
If your hay is low NSC you don’t need to soak.
Soaking is a major annoyance, it’s messy and it’s cold in winter and hard to feed if it’s below freezing. You need to rig up something like a laundry basket to hold a hay net in a big bucket so you can soak the whole thing for half an hour? an hour? Then drain and then hang the net. I haven’t done it myself but have seen others do it. There are all kinds of online discussions about the best way to MacGyver a set up. You do need to dump the water, so near a drain or washrack is useful, you can’t dump in the barn aisle or outside in the yard without causing a mess. Need to think it through for your particular barn.
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Yes. Even in the summer it is a major annoyance. I put hay in a nibblenet, then soaked it, then flipped it over and soaked it some more, than drained it and fed it. I’m in a co-op barn so it was basically all on me. The low NSC hay was more expensive but infinitely easier and my mare found it more palatable than the soaked hay.
Ask your vet if soaked beet pulp could be used as a hay supplement/replacement if you can’t find low NSC hay. I fed Speedibeet which doesn’t need to be soaked for that long and which has a sugar and starch content is less than 5% combined.
I believe that beet pulp is considered long-stem forage. It might reduce the amount of hay that you need to feed.
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And you also have to soak for every meal, you can’t soak several days in advance because the hay will go moldy. And if the horse doesn’t finish the wet hay, you’d need to discard it (since being gluttons and having metabolic issues seems related in horses, the ones with soaked hay tend to power through and clean it up )
It’s the kind of tedious job you can’t expect a boarding barn to include in their normal charges.
I should have added a bit more. SOME horses have been getting Metformin to help manage glucose levels, or Thyro-L to help manage weight, but there’s no uniformity in either of those helping, unlike pergolide (Prascend) helping PPID.
Forgive me if I missed it but I have a horse that got laiminitis after receiving corticosteroids for ear inflammation.
Then, her right front foot was too long (trouble finding good, barefoot farriers) and I stupidly caused her to road founder.
Basically, I just keep an eye on her weight, don’t feed starch or sugar other than grass and hay and give a good supplement “Vermont SupplementL”.
She’s fine, but I learned my lesson. There is some medical literature linking steroid laminitis with Cushings manifesting later in life.
Good, balanced hoof care, activity and healthy food. No steroids for her, ever.
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