Question: I am the owner of an Appaloosa mare....she is also PSSM. She is having a horrible time with winter laminitis this Montana. I am almost to the point of putting her down. I want to try everything I can. She is blanketed, legs wrapped and hand warmers vet wrapped to her feet. Nothing is helping much. HELP!

Dr. Kellon: You have to address this on two levels. First is the insulin resistance that is the root cause. Join this group and start the emergency diet:
For the cold response, start her on twice a day LaminOx and also get a separate supply of Jiaogulan. Pay attention to her gum and tongue color before you start. If after two days on Laminox her color is not obviously more pink, start adding 1/2 tsp of Jiaogulan to each dose of LaminOx and increase by 1/2 tsp increments every two days until you see that obviously more pink gum and tongue color.
Question: Thank you for getting back to me.  I ordered both items tonight...hope to get them soon.  She is in a lot of pain....using bute.  Is there something better?  Duplo shoes also.  Hoping I am doing everything right.  Last year at this time, she had horrible abscesses in both back feet.  It was been a long road coming back from that.
Dr. Kellon: As long as your vet doesn't have her on bute for some other reason, I would strongly advise you stop the phenylbutazone. Endocrine laminitis and cold induced hoof pain are not inflammatory conditions so antiinflammatory drugs don't treat anything. They are contraindicated in humans with IR and diabetes because they can worsen circulatory issues. If you really objectively evaluate the effects you'll see it's not doing much.

The LaminOx/Jiaogulan provides obvious pain relief for most horses but it can't work with the bute on board - another good reason to stop it.  If she has been on high doses for a prolonged period (over 7 to 10 days) you should reduce it  gradually at the same time as starting the supplements. Go from once daily dosing to once every 36 hours for two doses then once every 48 hours then stop.
If she still needs pain relief it may be trim related or she needs boots and pads, etc. You can use Phytoquench pellets for pain instead.