Seeking help for my pony

Mandy Charmam

I’m a new member and was wondering if you provide  some advice,
I’m interested in what is the best thing to use for pain relief during bouts of laminitis.

Quick background info. My pony has been on percolate for a long time. I
Earlier this year the vet retested and advised that he perhaps did not need to be on it anymore. I followed this advice which was disastrous and over the last 6 months he has become laminitic and with all cushioning systmpoms re-emerging.

Three months ago we put him back on pergolyte again He is in a lane, is on the laminitis crises diet and has hay soaked. He is still in pain though. I recently had his feet xrayed and they showed significant rotation, with suspected circulation issues. His hoof care is good through.
I’m looking for some pain relief for him while I get the vet on the job .

I recently had him clipped due to the heat and it is clear that he is under weight and perhaps is not getting enough protein - advised to feed low gi pellets and fibre beet. (Was feeding speedi beet, seaweed meal, linseed, digestive eq, mag and vit e). Have now added gi cues,  changed to fibre beet.. also added lucerne hay and ad lib soaked pasture hay which has been tested as low sugar.

Anyway, I wanted to check this advice..and also find out if there is anything I can use for pain relief while I get the vet on the job. 

I was also thinking about the circulation problem... thinking pain relief migh help him move a bit more and get frog working to strengthen circulation.

Interested in anything I can do to help

Mandy C, Macedon Australia, 2022

Mandy C, Macedon Australia, 2022

Maxine McArthur

Hi Mandy
You’ll be getting a long welcome letter with heaps of information shortly, but just wanted to comment that the KER Low GI cubes are high in starch andvNOT safe for a laminitic pony. Please don’t feed them.
Soaked grass hay is safe, ditto beet pulp. Teff hay can also be soaked until you can analyse it. 

More to come! 
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response


Trisha DePietro

Hi Mandy. Welcome to the group. What follows is our welcome letter and in it, you will find, our protocol, not only for diet, but diagnosis, treatment, exercise and trim. There is alot of information here. Within each category, you will find blue links which will take you deeper into a topic. We are here if you have more questions! 

Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.


DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

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

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

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 equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.


There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

Trisha DePietro
Aug 2018
Dolly and Hope's Case Histories
Dolly's Photos 
Hope's Photos 
Primary Responder

Sherry Morse

Hi Mandy,

If your pony is having an endopathic laminitis event NSAIDs are not going to help.  You can read about alternatives here: however the goal here is NO laminitis which means eliminating whatever is causing the issue in the first place.

It sounds like your pony is PPID and as such requires lifelong medication to keep ACTH under control.  Stopping pergolide will cause ACTH to rise which can be accompanied by a rise in insulin which is where the laminitis comes from.  Have you had bloodwork repeated for ACTH and insulin since the pony has been back on pergolide? 

If you can post pictures of his current trim as well as x-rays that would be very helpful for us to help you.  The keys to getting pain controlled are (as outlined in the Welcome Letter you were already sent):

  • Diagnosis - you know he's PPID but do you know what his current ACTH and insulin levels are?  If they are elevated he needs more pergolide (for ACTH) and tighter diet control (for insulin)
  • Diet - Maxine's already commented on the current diet.  We do not advise lucerne as it can cause issues in some horses so best to switch to the pasture hay.  Do you have the actual test results for that hay?  If not, keep soaking it but we also do not recommend ad-lib feeding
  • Trim - this is where seeing current pictures and the x-rays can help us help you see if there are places the trim can be improved for more comfort
  • Exercise - but only once the pony is comfortable
Is your pony in boots right now?


Hi Mandy,
Pain control is at the front of everyone’s mind when they encounter laminitis, with good reason.  After the first few days of a laminitis attack, when NSAIDs might be helpful, the best thing to do is uncover what’s triggering the attack and remove it.  Provided the diet is spot on, the trim would be next to investigate.

I believe that the Lucerne hay is the same as our alfalfa which, although low in sugar and starch, can cause foot soreness in some IR horses.  Soaking alfalfa hay does not solve the problem.  I would stick to the soaked grass hay for now to eliminate possible factors.  If you have your hay tested, using wet chemistry techniques, you will know whether you need to continue to soak the hay, if it’s protein is high enough and what might be done to better balance its mineral content.

The fact that pergolide was effectively controlling his ACTH and he was apparently not laminitic until after you stopped it suggests to me that you will be able to find that place again.  You may need more pergolide going forward as PPID is a progressive disease.  Testing is always advised to assess where you are with his dose.

I would suggest posting those recent X-rays so we can assess them and offer suggestions for improving his trim.  It helps to have photos to go with them as described in the Trim section of the Welcome Letter Trisha sent you.

There are herbs which will increase the circulation but you don’t want to give them until his trim is appropriate as they will increase hoof growth as well.  And you don’t necessarily want your pony to move more than he wants to on his own.  Laminitis interferes with the system that attaches the hoof wall to the hoof and applying more pressure to a trim that isn’t completely correct will act to further leverage the two apart.  

These are just some thoughts about what you might consider doing to get your pony on track to experience less pain.  Boots and deep bedding are what we advise in the meantime.

Martha in Vermont
ECIR Group Primary Response
July 2012 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


Mandy Charmam

Thank you so much for all of this. 

Hay has been tested and I can upload results. Apparently, according to Carol Layton  nutritionist suitable but low in all minerals etc. I have been following Lami crises diet but adding in two handfuls of zero and about four handfuls of Lucerne.. I can stop this. I am concerned about his weight as he is losing muscle and looks underweight . He is 29 and 9hh Shetland. 
I know Carol Layton a nutritionist so wondering if I get her to check diet...or is this something U guys do? 

I am waiting for x-rays to be emailed from farrier so will upload them when they arrive. Advice about trim would be good. Farrier said to go to vet to get a Venn something to check blood flow. While he's left fore has worse rotation he is actually a lot more sore on the right fore.  This is a reverse of previously.  I think farrier  worried this may be obstruction of blood flow ...

Yes he is booted. This appears to help but he is still super sore ..this has been going on for sometime now and I'm at a loss for cause as there has only be slight improvement since I restarted pergolyte 4 months ago. He is in dirt yard with minimal grass. This is part of his lane system but concern about grass meant I have fenced it off. 

Should I get vet back to do testing again ? Along with this Venn thingy ...

I'm not very techy. So all the uploading may be an issue. I'll see what I can do.. 

Mandy C, Macedon Australia, 2022
Mandy C, Macedon Australia, 2022

Sherry Morse

Hi Mandy,

What 'lami crisis diet' are you following?  How much does your pony weigh now?  How much is he being fed?  The muscle loss could be a sign that the current dose of pergolide is not enough so having the vet back to check ACTH and insulin would be a good idea so you can get his medication adjusted if needed.

Carol is familiar with our protocols and can help you with diet if she has your hay test results and all other information about your pony.  The reason he may be more sore on the right is because he's shifting weight off the left or it could be he has abscesses brewing on the right that are bothering him right now. 

What kind of boots do you have him in and what padding are you using?  Have you tried adjusting padding to see if it helps? I wouldn't necessarily bother with a venogram at this point but trim based on x-rays to get his toes back and don't touch his soles.

If you have issues with uploading a case history or pictures just let us know where you get stuck.

Mandy Charmam

hello - he is 190 Kgs... 

I'll go and weigh his feed now so i can tell you how much I am feeding. I have also reached out to Carol . I had arragned her to do this for me earlier in the year but then didn't follow through due to variou slife crises and COVId madness..
anyway can change that now. I imagine I weigh hay before I wet it - dumb question do you even weigh hay?  

I will arrange vet to come although right now I have Covid so will need to wait until I'm out of isolation. 

boots are fusions - are too big but I use pads - they look a bit like he is wearing his bigbrothers gumboots. I usually cut up a yoga mat (4 cm wide) but have just run out so am using the foam jigsaw puzzle squares and putting two in - not as good as yoga mat. 

I will see if I can set up a case file for him. 

thanks for support.

Any idea where I can get Ukele phyto-quench in Australia - looks like a great product. it would be great for my mental heal;th to be able to give him something for the pain. I can try my feedmerchant - they do have a big line in herbals. when I searched in Australia though I couldn't see any mention of this. We are often behind everyone else in these things.. 

Mandy C, Macedon Australia, 2022

Mandy Charmam

Sorry the crises lami diet is what i call your diet recs for crises ...

what is beet pulp? - is that Speedibeet ? Is Fibre beet Ok? we can't get timothy hay or Teff hay here 
Mandy C, Macedon Australia, 2022


Hi Mandy, I hope you get some help with your pony. I am in Australia also and if you hunt around, sometimes you can find Teff hay (there is some grown in South Australia, I believe so you may get lucky). Also Rhodes is an option if you can source that at all, although that tends to be grown mostly in Queensland. I am in the Hunter and have lucked on a couple of growers - one doing Teff and one doing Rhodes. Our feedstores are also stocking Teff because of increased demand from people with laminitic horses!
NSW Australia
Jan 2022

Saskia DOB 30/9/2013

Maxine McArthur

Mandy, for beet pulp, you can use Speedibeet or Hygain Micrbeet. Fibre beet is a bit higher in energy so the plain beet pulp would be safer. 

Yes, weigh the hay dry.

Phytoquench is not available here, unfortunately. 

If you are a Facebook user, you may be able to find sources of teff or Rhodes or other low-sugar hay on local horse groups. That’s how I found my current supplier. 

Edited to add: Country Park Animal Herbs have plain powdered Devils Claw, which can be used for pain relief.

Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response


Mandy Charmam

Thank you all once again. 

Good ideas re hay. We do grow own and it has been tested as suitable although I'll add it to the case history just to double check. I am told though it isn't high in nutrient value. Fizzie is thin. What do I feed him to safely put on weight? 

At the moment I am following your emergency diet, (I will add details to the case history too). Will this help with weight gain or perhaps I'm just not feeding enough ?? I'll add the diet info and then you'll be able to help... Stay tuned ..I've also asked for help from Carol Layton here in Oz ... 


Mandy C, Macedon Australia, 2022

Sherry Morse

Hi Mandy,

Until we have more details we really can't comment about your feed program. How tall is your pony?  How much SHOULD he weigh?  How much is he eating now (weight of hay and hard feed?) What is his ACTH level right now?  How much Prascend is he on?  We need to know all of those details in order to be able to help you.

Mandy Charmam

Makes perfect sense. Will get you info ..have booked testing with vet and will get copies of his earlier tests ...stay tuned and thank you so much for being there .. Don't feel so alone now. Hugs 

Mandy C, Macedon Australia, 2022

Kirsten Rasmussen

Hi Mandy,

You've mentioned weight a few times now.  One factor in difficulty gaining weight can be inadequate control of the PPID.  That's why checking ACTH is so critical.  It should be checked at least 1-2 times a year because you need to make sure the pergolide dose is high enough to control the disease at that stage in time.

To weight hay, use a digital luggage scale hanging from the hook in a doorway or ceiling beam.  Hang a big plastic feed/muck tub on the scale, zero out the scale, then fill the tub with hay until you reach the desired weight.  To maintain current weight, feed 2% of body weight.  So if your guy is 190 kg, about 3.8 kg of hay per 24 hours will maintain that weight.  To encourage weight gain, increase this number.

Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

ferne fedeli

I use a scale I bought from Valley Vet several years ago & jusr hang my Nibble Net hay bags from it to weigh the hay.  I weighed the bags first, of course, so I know exactly how much the total weight should be.


Ferne Fedeli  Magic & Jack   2007

Point Arena, Mendocino County, California
Case History




I used to weigh hay with a fishing scale after loading the hay in the largest size TubTrugs.  I have since found that it is vastly easier to use a vintage platform scale, and to weigh the hay on that.  I still use TubTrugs to hold the hay.  They hold exactly one full day's feeding of hay for my Norwegian Fjord.  This method is much easier because hanging the tubs to weigh them eans I cannot get a day's hay into them.  Much less splitting of flakes and fewer weights have to be taken.  I then take the day's hay and split it into three parts to go into an automatic feeder.

Gail Russell 8/30/2008 .

Mandy Charmam

Thanks so much for all your support. I weighted hay and he is getting 2.5 kg. I think the hay is poor quality though for nutrient value which is what Carol told me. 

I have now done a case history and provided Hay analysis and xrays. 

Vet is coming tomorrow to retest as per your advice. 

I will get photos of feet and Fizzie's body snaps and upload by tomorrow. 

thank you all so much. you have been so generous!!!
I wish I had done this earlier. 


Mandy C, Macedon Australia, 2022

Sherry Morse

Hi Mandy,

A bit of housekeeping.  Please add the links to your case history and photo album to your signature so we don't have to search for them.  To do that:

1) Go to this link to amend your auto-signature:
2) Look at the bottom of that page for the window where you have your signature. to type in your name, general location, and year of joining.

3) Copy the links to your case history and photo album into the line below your location.  You may need to add a space after each link or click enter to make the link live (turn it blue):

4) IMPORTANT: Scroll to the bottom and hit SAVE!

Body condition shots would be VERY helpful as a 9 hand pony I would expect to weight about 350-400lbs at most yet you're saying Frizzle is thin at 190kg (418lbs).  To maintain that weight you would need to be feeding more than you are so sorting out what his ideal weight should be is very important. If 190kg is in fact Fizzle's ideal weight he should be eating 3.8kg/day (hay plus any concentrates).

Bulges over the eyes indicate he is IR as well as PPID so getting insulin and glucose as well as ACTH would be a good idea.  His trim needs attention as well - actual photos will be easier to evaluate but he appears to have long toes and a ski-tip on the right front coffin bone and some significant bony changes in the left front foot as well.