Laminitis Conference Part 5

[bellajack]

The Royal Veterinary Laminitis Conference Part 5

Medical Management of Laminitis

The speaker for this section was:
Celia M Marr BVMS MVM PhD DEIM Dip ECEIM MRCVS
She is based at Rossdales Equine Hospital in Newmarket. Her particular areas of interest include cardiovascular medicine, internal medicine, adult and neonatal intensive care and medical imaging.

GOALS:
The primary goals are to minimise structural changes within the hoof, alleviate discomfort and restore function without compounding structural changes, and halt the processes that are driving the laminitis. Additional goals are to assess the existing degree of damage in order to plan corrective farriery and provide an accurate prognosis, plus identify, remove or treat predisposing factors and prevent more attacks.

PREVENTING ONGOING DAMAGE TO HOOF:
The single most important thing you can do for any horse showing any sign of laminitis is put a plank across stable doorway, put down a bed 18" thick, covering entire floor, put horse in stable and shut the door (as far as the horse is concerned, for an absolute minimum of 30 days, even if the horse appears to have recovered a lot more quickly than that. Literally do not allow it to step off thick bedding for at least 30 days.

Support to the hoof can be provided by supporting the frog alone or the frog and sole. There is no clear evidence to support one over the other at this time.

PAIN RELIEF:
Pain relief should be aimed at minimising pain, not completely eliminating it or the horse may move about too much, and phenylbutazone is still the drug of choice and may also help as an anti-inflammatory.

Ice can be used to slow the rush of blood back to the foot and help with pain relief, but needs to be applied to leg from above the knee down.

In horses with severe pain opiates may be necessary and recent drug protocols offer new drug combinations for treatment of very severe and debilitating pain, but these require hospitalisation and cost from £75 to £500 a day for the drugs alone.

HALTING PROCESSES DRIVING THE LAMINITIS:
By the onset of clinical systems drugs aimed at this may be too late.

ACP may help as a vasodilator - efficiency unproven - but will help with stress and encourage the horse to lie down more, so is a useful addition to bute.

Asprin may be of use, both as a treatment and possibly as a preventative (as in low dose in man to prevent strokes, etc.) but more research has to be done.

Drugs to block MMP's being activated could represent a major step forward in future.

ASSESSING DAMAGE AND PROGNOSIS.
The diagnosis of laminitis is based on lameness, pain on use of hoof testers on one or more feet and increased digital pulses.

The severity may vary from foot to foot and the most severely affected foot is used to determine the laminitis category.

X-rays can determine the degree of rotation of the pedal bone and the founder distance, but markers need to be used on the wall of the hoof. Sinkers and marked pedal bone rotation merit a poor prognosis.

ADDRESSING PREDISPOSING FACTORS:
Has mostly already been discussed but also include:

Treating mares with metritis following foaling.

Supporting opposite leg in cases of severe, nonweightbearing lameness in one leg.

Treating Cushings Disease (PPID).

Treating Equine Metabolic Syndrome.

[shiatsudales]

I'd like to re-enforce this and say it can't be followed too strongly. When Rose had her bout last year she spent a total of 8 weeks on complete and utter box rest. Big box (16 x 12) but we deep littered to a depth of a foot and just kept topping up and up. She also wore foam taped to her forefeet for the first ten days.

She was reasonably sound in walk after two weeks and, by the time she came out, was only intermittently lame in trot. She then went on to spend a further two months in her stable overnight and in the big shed (15x15m) during the day. We only started field turn out once the grass had stopped growing in late Autumn and spent a month building her up from ten minutes a day to five hours before taking the plunge and giving her all day turnout and in overnight.

Coming up to the 9months after onset mark she has one band on her hooves that is almost grown out and her feet look totally normal above it, no ridging or unevenness at all. Her x-rays show no rotation or dropping and not even any changes to the pedal bone structure. She is completely sound in all three gaits and I fully expect her to make a complete return to work once foalie is weaned. <crossfingers for healthy foalie>

The laminitis clinic advise keeping them on box rest for a month after they come sound if you want long term, solid recovery.

The main problem seems to be what goes on inside the hoof capsule. Even after they become sound the internal structures are still very weak so if you turn them straight back out again you get internal damage which doesn't bode well for long term soundness. It's why I'd always have the feet of any horse that's had laminitis x-rayed before purchase.

I heard a tale of a horse being put down in my area last summer due to laminitis. The owners had noticed something going on, kept it in for a couple of days then threw it back out again. It went lame again after a few days, they kept it in overnight and chucked it out when it seemed better. This went on for a couple of months until the horse foundered one day, it's pedal bone came through the sole and it was pts within 24hrs of this 'sudden and severe onset of laminitis'. All I can say is that, in my opinion, these people slowly and surely killed their horse over a three month period.

The ACP does seem to make a big difference to calmness and general recovery. We've used it in both cases of lami I've had on the yard and it helps stop them box walk as they adjust to the box rest.

[Biggerside Benwell]

Re-reading all these again and Danny has been in his stable for 7 weeks now, 3 weeks of them sound on no bute but then had a relapse when I was away so had 2 weeks at the beginning and 2 weeks when I was away lame, being weaned off the bute now. No changes on the xrays so into a bigger area on the deep sawdust bed.