Tuesday, November 29, 2011

Laminitis: Diagnosis and treatment

Here's the hard part: How do you know that your horse has laminitis?

The first signs include:
  • shifting the weight from foot to foot
  • pounding digital pulse
  • heat in the hooves
  • reluctance to walk in a circle
  • lameness or stiffness of gait
Side comment: Some of you may remember that a while back Coriander went lame and a possible diagnosis was laminitis. Thank goodness it was just an abscess, but it presented much the same way, he was lame with heat and a pounding digital pulse. Sometimes different problems have very similar symptoms.

If you know the horse has had an event that would trigger laminitis, is displaying the signs, and you've caught it within 24 hours of onset you need to ice the hooves. I'm not talking about cold hosing the legs for 20 minutes 2 times a day, I'm talking fill a muck bucket or tank full of ice water and have the horse stand in it for 48 hours straight (keep replenishing the ice).

I'm not kidding.
Chris Pollitt did a lot of research with cryotherapy (ice) and proved that prolonged exposure to the cold works really well to stop laminitis in its tracks. The theory is that vasoconstriction caused by the cold slows down the activity in the hooves enough that it gives the body a chance to right itself before more damage is done.

Now for those of you worried about your horse getting frostbite, Dr. Pollitt says this, "fortunately, cold-induced pain is not a problem in horses; they seem to lack cold nociception in their distal limbs. Horses in the current study showed no cold-induced injury or any clinical signs attributable to cold-induced pain, despite extremely low ice boot and tissue temperatures. Continuous aplication of ice and water to the equine distal limb for 48 h seems safe, effective, and well tolerated by horses."

Fascinating.

I've also heard good things about For Love of the Horse's MMP Stop Solution, if given within 48 hours of the trigger it has also been known to lessen the damage from laminitis.

While you are icing or using something like MMP Stop you also need to treat the cause of the laminitis. If the horse is IR you need to restrict their access to sugar, that means putting the horse on a dry lot, using a muzzle on grass, and soaking your hay if you know it's high in sugar. If you don't know if your horse is IR but you suspect they might be, get them tested. It's a lot better to know now, before they have issues, than to find out later when they do.

If the laminitis was caused by SODS then the horse probably has an infection that will need to be treated with antibiotics and a bunch of other stuff that only a vet can help you with (Always feed probiotics if you have to put your horse on antibiotics- they kill the gut flora.)

Unfortunately if your horse looks like this:
classic laminitis stance
it's already too late to ice or use the MMP Stop, the damage is done. Now you'll need some heavy duty pain killers and anti-inflammatories along with a pretty strict maintenance regimen to get that horse feeling okay again.

At this point in time you'll start hearing about rehabilitative shoeing, but that's for the next post...

If you've seen any other laminitis symptoms please let me know in the comments, if I get enough I'll make another post putting your experiences together. For instance, Kristen said this about when her horse was affected: Laz's laminitis was caused by Potomac which lead to endotoxemia...his sheath was SWOLLEN too during his high fever which is a clue to look for fyi.

17 comments:

  1. Good information about the ice. Unfortunately, I don't think I could get Dusty or any member of the herd to stand in a tub like that. Hadn't heard about the MMP Stop Solution either. Thanks. I hope I won't be needing this information once Dusty is healed. Fingers crossed.

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  2. Appropriately, today in my Equine Science class we had a basic overview of laminitis. It was interesting, but most things were common knowledge for horse people and it was a bit dumbed down since it's an intro level class. I had a question for you though - in my class, it was stated that to prevent laminitis, you should avoid working your horse on hard surfaces. I know that this would be true for horses in shoes working on asphalt because the hoof is peripherally loaded and with all the concussion coming through the shoe to the laminae, but what about barefoot horses? It's often recommended to walk/trot on pavement to stimulate a horse with bare feet. Your take on this?

    And we also had a lecture with a farrier/vet yesterday who commented that horses have the ability to shunt the blood flow to the horse's hooves/limbs when they are cold so while I haven't heard that before (not 100% sure if that is all that different from vasoconstriction), according to him that is why it is recommended to ice their feet.

    Can't wait for the next post in this series!

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  3. I have heard from a couple of friends who've had horses with laminitis (or barely avoided it) that they seem to really go after a free-choice magnesium supplement while healing up, which is also interesting.

    I think if you know a horse well, you can spot the tenderfooted symptoms early--but the trick really is to not risk it at all. I have read that horses in the wild have been observed 'self-treating' by standing in icy creeks, but I don't know if that's truth or myth. I have seen a couple of horses suffering from terrible laminitis standing in knee-deep lush pasture while their clueless owners look on. True story: once someone I knew with a badly foundered mare (exhibiting the classic stance, fat as a hog, etc.) had a farrier out to trim her. The mare passed out during the trim (totally collapsed) and the farrier said, "Oh, she's just being dramatic." They made her stand tied as a punishment for collapsing. It just makes you want to weep.

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  4. GHM- I don't know that I could get a horse to stand in a tub that long either. I'm contemplating trying to get a hold of one of the authors and asking how they did it. I hope Dusty is good from here on out too.

    TBA- They call that road founder and I would agree with your assessment on shod horses. I think if a barefoot horse is landing heel first on the pavement that it might actually be good for the digital cushion, especially for a young horse. I'd keep it in moderation though, pavement is still a hard surface. My shins can attest to that.

    I did read something similar to what the farrier alluded to, I'll have to see if I can find the reference for you. The first thing I thought was duck legs, cause it's sort of similar.

    Fetlock- I'll have to remember that about the magnesium, interesting. Legend has it that "old timers" used to tie their horses in icy creeks and streams when they showed signs of laminitis and that it did the trick.

    My jaw is on the floor about that poor mare. I'm wordless...

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  5. Will a horse really stay in an ice bath for 48 hours?

    I knew a pony who foundered (fully recovered now). He was such an easy keeper that it was very difficult to keep his weight down. A day or two before he foundered, I noticed that his belly was distended. I called over the barn manager and voiced my concerns. The pony looked tremendously fatter and his sides felt like pressurized balloons. I learned that he foundered a few days later.

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  6. I just checked their paper again- it seems they used stocks to keep the horses in the ice water.

    That's really interesting about that pony, thanks for sharing.

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  7. Smaz, we recently had a founder at my barn (turns out the mare is IR, which is no surprise considering she's a chunky QH) and she stood in a huge tub of ice water for two days with no problems. She was tied in her stall and she never tried to get out of the tub.

    A few years ago, one of my friend's horses had enteritis and I was the night nurse for him. Since his fever was so high, we had to have his front hooves in ice water to prevent laminitis, as well. We just had two regular 20-quart water buckets that we kept filled with a water/ice slurry and he, too, was tied in his stall and was very, very good about keeping his hooves in the buckets. But I think it's easier when they're not feeling well--this poor guy had an IV, a gastro-nasal tube that was constantky snorking up stomach acid, etc. He was NOT a happy boy, but he had zero energy to protest because he felt so crummy.

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  8. So it would seem that if the horse is hurting enough they'll stay in the ice on their own. Makes sense, probably feels a lot better.

    Apparently it's rare for a QH to be IR, it's usually an arab, mustang, paso fino, and the like kind of thing. Breeds that developed on sparse grasses.

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  9. I would agree with the ice/tub set up. Another way to do it, but this would be if on your property and not a boarding facility. Quickly dig a low WIDE hole (about the size of two tubs so entire body of horse can stand in there and move around slightly) and fill with sand/pea gravel, water and ice and allow horse to stand in there. It may be easier for horse to stay put in that set up.
    I filled diapers with ice and kept Laz wrapped in those over his hooves around ankles for 48 hrs and changed the ice every 3-5 hrs. THE most exhausting 48 hrs of my life. Did it help? I don't know...the laminitis still came but perhaps it would have been worse?
    Regarding the IR test, it's important to note that you need to take the results of blood work and put into Dr Kellon's IR calculator to see if it still comes out as IR or non IR or as an unreadable test which many do as well. Kudos to you for another great post!!!! :)

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  10. Hmmm also I'm wondering this. Frizzle pointed out to me awhile ago about the campping dry bag for when we do our White Lighting soaks. I wonder if those filled with water ice could work just as well as the tub soaking??? Would be WAY easier for horse/owner and maybe just as great?

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  11. Kristen- thanks for the thoughts and info. I think the dry bags would work if you got some high quality ones. I bought some cheapies and they tore the first time I tried to use them. Got what I paid for I guess.

    Don't discount that 48 hours of hard work, I bet your efforts DID make a difference to Laz.

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  12. The bags might be worth a go, I know some of mine would never just stand there in a bath of ice water, not a chance! But this theory is sound, I have heard a few times that ice treatments have made a real difference in healing joints but not for laminitis, i will have to do more research on this!

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  13. Yes, the more I think about it the more I like the dry bag idea.

    Icing has been proven to work for laminitis- Pollitt induced laminitis in each horse and then iced only one leg. The hoof that was iced was significantly better off then the hoof that was not. They were able to have each horse be a control and test subject.

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  14. YES, the dry bags work for icing!! I have a set of the medium-toughness ones from Bass Pro Shop and they are going gangbusters even after months of use. I just throw them on, buckle the top, and then put an Ace bandage around the leg to make a tight seal.
    Candy uses the same brand all the time for icing and has another one of her foundered clients using the dry sacks for icing.
    Judy just bought a heavy-duty set for Tiff and they are SO nice--and they have these straps that you can put over the withers like suspenders, lol.

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  15. Also interesting re QHs not getting IR--I know of one definite confirmed case and one that was absolute textbook IR--the poor mare had every single symptom there is (and had foundered by the age of four!). I printed up a bunch of info for the owner, as well as feeds that would be good for her horse (it was on SWEET FEED!!), etc. The girl was all, "My horse is NOT IR!!" Apparently, even the vets suspected that the mare was indeed IR and suggested testing, but the girl refused. Such a shame; the mare was drop-dead gorgeous and had been some ridiculous amount of $$$ (like at least $20,000). Too bad she ended up with such an idiot owner. :-/

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