Re: Nuggy in severe pain

Pauline <takarri@...>

Hi Sabine,


Welcome to the group!  Sorry to hear that you are having trouble with your horse.  To give you the best help with Nuggy, we really need to get some more details.  To get those details, we ask all members to fill out a case history on their horse.  You will have to join the case history subgroup here:  and then all of the information you'll need to fill out the CH is in the wiki here: 


If you have any trouble, just ask and help is available.


Meanwhile, I will give you some details about our philosophy called DDT/E, short for Diagnosis, Diet, Trim and Exercise, and address your concerns as best as I can,.  Once you get your CH filled out, we'll be able to be much more specific with answers to your questions.


DIAGNOSIS: Is done with blood work. We recommend having blood drawn to test for Insulin, Glucose, Leptin and ACTH. ACTH is used to diagnose PPID (Cushings) while insulin, glucose and leptin are used to diagnose Insulin Resistance (IR). The samples should be drawn at home and NON-fasting as fasting will produce artificially low results and are a holdover from human testing protocols. A horse can be only IR, only PPID, neither or both. PPID is managed using medication & attention placed on the diet while IR is managed through diet & exercise.  

Not being from Canada- I’m not familiar with which lab does what- but upon researching the file I came up with this message

“ From Smithers, it takes a minimum of 37 hours from pick-up to delivery to Guelph from Smithers.  If the samples are well-frozen, and sent with lots of ice, it should be okay, but the potential for sample degradation in hot summer temperatures is quite high. This is the reason I don't send to Cornell, as there is an extra step getting across the border.  Idexx is just fine for insulin and glucose; they won't do a send-out for leptin at this time. For those using Idexx for ACTH in western Canada, sometimes they send to Guelph, sometimes California, sometimes MSU, so it is worth a phone call to the lab first to see where the blood will be going”


Hopefully one of our Canadian members will step in and clarify.

Cold induced laminitis could also be an issue  if you are dealling with uncontrolled PPID/IR - so the more details we have on breed etc- it will become less of a guessing game.  More information can be downloaded from here –it’ free.


In the meantime try socks and boots for him to make him more comfortable.


 Regarding the Bute- Bute is not recommended after the first few days of laminitis as it interferes with healing so you would be  wise to stop it- but if stopped too quickly there can be a rebound effect. To go off bute you would need to extend hours between dosing as well as reduce the that eventually he'd be at a smaller dose every other day etc until the horse is bute free. For Example

START: 2 grams bute once a day
DAY 1 through 3 of Taper: 2 grams every 36 hours
DAY 4 through 6 of Taper: 2 grams every 48 hours
DAY 7: 1.5 grams every 48 hours
DAY 8: 1.0 gram every 48 hours
DAY 9: 0.5 gram once, then stop


This message here explains it much better :



For more information on alternative pain relief:


Pergolide plus attention to the DDTE is the treatment plan for horses that have PPID.  If they are just Insulin Resistant- then no pergolide required- just the DDTE needs to be in place,



Diet: Forage based and supplemented based on the the hay analysis. We recommend starting Nuggy  on the emergency diet that was sent to you when you joined.

It is only a temporary solution until you can get your hay tested. EquiAnalytical is one lab recommended for testing.  You want the #603 Trainer package for $54.

The goal for sugar and starch in all of your feed stuffs is under 10% combined.  Once you have tested your hay, contact one of the folks on this list to help you balance the excesses and deficiencies--6th file down in this folder: 

Your ultimate goal is to feed a low carb (grass hay that tests under 10% sugar+starch) diet with the minerals balanced and to replace the fragile ingredients that are lost in the hay curing process add ground flax seed and Vitamin E in the amounts listed in the emergency diet.  While you are in that Diet Balancing folder, look at the first file called "Diet Balancing--KFG's view from the soapbox".  It's a great overview of how and why we balance!  

 Equalizer is not really a suitable product- the fat content is a little high & it had added iron. Here’s a message I found about that product:,,%22equilizer%22,20,2,0,2687065

What you don't feed on the IR diet is every bit as, if not more important, as what you do feed!  No pasture.  No sugary treats, including apples and carrots.  No brown/red salt blocks which contain iron and sometimes molasses, and interfere with mineral balancing, so white salt blocks only.  No products containing molasses.


And here for a partial list of things to avoid:


Regarding the hay- I’m not familiar with soft core hay- can you please elaborate on what type of hay it is and what you meant by it feeling wet?

As long as this hay is clean, until you can get it tested or find a more suitable supply you will need to soak it - for an hour in cold water or 30 minutes in hot water to remove ~30% of the sugar content. Make sure you dump the soaking water where the horse(s) can't get to it.  


There are some herbs that may, in time, help support your horse- but they are in no way a stand alone treatment.  Chastetree berry is one of the more popular ones that have been touted as an alternative medication if the horse has been diagonosed with PPID (cushings) – but it doesn’t work for the long term- it may help perk the horse up for a few weeks/months- the effect is not long lasting – It is used mainly in conjunction with pergolide to help horses shed their coat- or for mares with issues.

 Acupuncture/acupressure is the same- a great supporting tool to be used in conjunction with implementing the DDTE, but not a stand alone cure.

 You need to get some blood work done and find out what the cause is- whether it is endocrine related- PPID/IR  endotoxic related (due to the hay??) or mechanically related due to trim or cold-  That’s where filling in a case history is so valuable.


Trim: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot.  Though important for all horses, it's essential for an IR and/or PPID horse to have a proper trim in place since they are at increased risk for laminitis.  Look on the following pages of our website for more information about a proper trim.

Here: and here:  


You are welcome to post hoof pictures and any radiographs you might have so that our hoof guru can to look in see if you have an optimal trim in place.   Here's a site that explains how to take good hoof photos:   

It’s great that you are both attentive with her hoof care & are padding & booting her. It may still be a good idea to send in the Xrays & hoof photo’s so we can ensure that you are doing everything you can. I know it  can sometimes be a bit awkward when dealing with hoof care professionals that are already doing a great job, but my thought on this that it doesn’t hurt to have a fresh set of eyes to join in the discussion. We all learn from each other. 


Exercise: The best IR buster there is, but only if the horse is comfortable and non-laminitic. If there has been laminitis, we recommend no riding or exercising in tight circles until at least 1/2-2/3 of the hoof damaged by laminitis has grown out (at least 6-12 months, sometimes longer). Also recommend the use of boots and pads as needed for comfort vs shoes/appliances as frequent realigning trims will be needed, which is difficult to do if there are shoes. We also recommend using NSAIDs sparingly as they interfere with healing and can allow a horse to do more than its fragile feet are ready to handle.

If he wants to lie down- then allow him to do so- just make sure he’s not eating the straw bedding as well.


That highlights the main points of our philosophy. There is tons of information on our website, in the files and archived messages. Don't hesitate to ask any further questions that you have!  

We ask all members to please sign each time they post, with their name (first is fine) date of joining, and general location (helps us to source products for you) and add the link to your case history. 


If I have missed any of your questions, or if you have more, please ask


Hang in thereJ






Geelong. Vic

Australia Aug 07

ECIR Mod/Primary Response

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