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The veterinarian-farrier team in management of horses with chronic laminitis: case examples
Abstracts / Journal of Equine Veterinary Science 33 (2013) 860-883
fetlock, and cannon region must be included to cool incoming arterial blood. A water interface against the limb overcomes the conduction barrier of the hair coat and negates the difficulty in getting consistent contact of a heat exchanger with the uneven surface of the equine distal limb. Immersion of the limb from the upper metacarpus/ metatarsus distally in an ice and water mixture effectively achieves this, though constant ice replenishment is laborintensive. In a recent study [9], an ice and water slurry, applied over the foot to the level of the proximal pastern (using a 5 L fluid bag) or the mid- to proximal-cannon region (using a wader-style vinyl boot) achieved rapid cooling of the hoof to around 11 C (approximately 24 C decrease), and the 2 methods were not significantly different over the 2-hour treatment period. In contrast, gel boot application caused only a 2 C decrease in lamellar temperature. In fact, we have tested several application methods that use gel or ice packs, and in general they perform poorly. A system capable of cooling all 4 limbs effectively, that allows ambulation, and is linked to a refrigeration system would be ideal for hospitals. Unfortunately, most of the currently available cooling cuff devices made for the equine distal limb are either untested or unable to reduce temperatures within the digit to the desired levels for laminitis prevention without major modification. Side Effects and Contraindications: The equine distal limb appears resilient in the face of continuous hypothermia, and there are no reports in the literature of complications directly related to therapeutic hypothermia of the equine distal limb. Prolonged exposure to cold and moisture is associated with the development of “immersion foot” or “trench foot” in humans, with local swelling and pain that may progress to blistering of the skin, nerve damage, and gangrene. There are anecdotal reports of dermatitis of the pastern and maceration of the coronary band in horses, particularly when digital hypothermia has been extended for more than 5 days, but in most cases it resolves with no or minimal treatment once the cooling is ceased.
References [1] van Eps AW, Leise BS, Watts M, Pollitt CC, Belknap JK. Digital hypothermia inhibits early lamellar inflammatory signalling in the oligofructose laminitis model. Equine Vet J 2012;44:230–7. [2] van Eps AW, Pollitt CC. Equine laminitis: cryotherapy reduces the severity of the acute lesion. Equine Vet J 2004;36:255–60. [3] Van Eps AW, Pollitt CC. Equine laminitis model: cryotherapy reduces the severity of lesions evaluated seven days after induction with oligofructose. Equine Vet J 2009;41:741–6. [4] Parsons CS, Orsini JA, Krafty R, Capewell L, Boston R. Risk factors for development of acute laminitis in horses during hospitalization: 73 cases (1997-2004). J Am Vet Med Assoc 2007;230:885–9. [5] Cohen ND, Parson EM, Seahorn TL, Carter GK. Prevalence and factors associated with development of laminitis in horses with duodenitis/ proximal jejunitis: 33 cases (1985–1991). J Am Vet Med Assoc 1994; 204:250–4. [6] Cohen ND, Woods AM. Characteristics and risk factors for failure of horses with acute diarrhea to survive: 122 cases (1990–1996). J Am Vet Med Assoc 1999;214:382–90. [7] Slater MR, Hood DM, Carter GK. Descriptive epidemiological study of equine laminitis. Equine Vet J 1995;27:364–7. [8] Alford P, Geller S, Richardson B, et al. A multicenter, matched casecontrol study of risk factors for equine laminitis. Prev Vet Med 2001; 49:209–22.
879
[9] Reesink HL, Divers TJ, Bookbinder LC, et al. Measurement of digital laminar and venous temperatures as a means of comparing three methods of topically applied cold treatment for digits of horses. Am J Vet Res 2012;73:860–6.
058 The veterinarian-farrier team in management of horses with chronic laminitis: case examples R.S. Pleasant, and T.D. Burns Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA Take-home message: When veterinarians and farriers encounter cases of chronic laminitis, they should utilize the expertise of each other in order to provide the best possible care. Veterinarians and farriers often encounter cases of chronic laminitis in their respective practices. Successful management of these cases requires a “whole horse” approach and is maximized by a co-operating veterinarian–farrier team. The primary goals are to prevent recurrent bouts of laminitis and to rehabilitate and maintain the horse’s feet as best possible. It is the veterinarian’s responsibility to recognize and address risk factors for further laminitis events, such as obesity, insulin resistance/hyperinsulinemia, and pituitary pars intermedia dysfunction. Failure to do so invariably results in recurrent bouts of laminitis and cumulative damage to the lamellar apparatus. The veterinarian can assess these risk factors via body condition scoring and endocrine testing. Rehabilitation and management of the feet involves regular physical and radiographic examination, and appropriate trimming/shoeing. Physical examination evaluates hoof growth patterns, horn quality, coronary band compression, etc. Lateral and dorsopalmar radiographs demonstrate the position of the distal phalanx within the hoof capsule and serve to guide trimming and shoeing by the farrier. The goals for trimming/shoeing are to relieve load/stress on the lamellae and realign the hoof capsule and distal phalanx. The exact methods/techniques used to achieve these goals are not as important as following proper principles, and are generally dictated by the farrier’s expertise and preference.
059 “How-to” case presentations on managing the laminitic hoof Travis D. Burns Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA Take-home message: There are several methods of managing/treating the laminitic hoof. The treatment goals remain the same, regardless of how each veterinarianfarrier team applies the various methods to accomplish these goals.
fetlock, and cannon region must be included to cool incoming arterial blood. A water interface against the limb overcomes the conduction barrier of the hair coat and negates the difficulty in getting consistent contact of a heat exchanger with the uneven surface of the equine distal limb. Immersion of the limb from the upper metacarpus/ metatarsus distally in an ice and water mixture effectively achieves this, though constant ice replenishment is laborintensive. In a recent study [9], an ice and water slurry, applied over the foot to the level of the proximal pastern (using a 5 L fluid bag) or the mid- to proximal-cannon region (using a wader-style vinyl boot) achieved rapid cooling of the hoof to around 11 C (approximately 24 C decrease), and the 2 methods were not significantly different over the 2-hour treatment period. In contrast, gel boot application caused only a 2 C decrease in lamellar temperature. In fact, we have tested several application methods that use gel or ice packs, and in general they perform poorly. A system capable of cooling all 4 limbs effectively, that allows ambulation, and is linked to a refrigeration system would be ideal for hospitals. Unfortunately, most of the currently available cooling cuff devices made for the equine distal limb are either untested or unable to reduce temperatures within the digit to the desired levels for laminitis prevention without major modification. Side Effects and Contraindications: The equine distal limb appears resilient in the face of continuous hypothermia, and there are no reports in the literature of complications directly related to therapeutic hypothermia of the equine distal limb. Prolonged exposure to cold and moisture is associated with the development of “immersion foot” or “trench foot” in humans, with local swelling and pain that may progress to blistering of the skin, nerve damage, and gangrene. There are anecdotal reports of dermatitis of the pastern and maceration of the coronary band in horses, particularly when digital hypothermia has been extended for more than 5 days, but in most cases it resolves with no or minimal treatment once the cooling is ceased.
References [1] van Eps AW, Leise BS, Watts M, Pollitt CC, Belknap JK. Digital hypothermia inhibits early lamellar inflammatory signalling in the oligofructose laminitis model. Equine Vet J 2012;44:230–7. [2] van Eps AW, Pollitt CC. Equine laminitis: cryotherapy reduces the severity of the acute lesion. Equine Vet J 2004;36:255–60. [3] Van Eps AW, Pollitt CC. Equine laminitis model: cryotherapy reduces the severity of lesions evaluated seven days after induction with oligofructose. Equine Vet J 2009;41:741–6. [4] Parsons CS, Orsini JA, Krafty R, Capewell L, Boston R. Risk factors for development of acute laminitis in horses during hospitalization: 73 cases (1997-2004). J Am Vet Med Assoc 2007;230:885–9. [5] Cohen ND, Parson EM, Seahorn TL, Carter GK. Prevalence and factors associated with development of laminitis in horses with duodenitis/ proximal jejunitis: 33 cases (1985–1991). J Am Vet Med Assoc 1994; 204:250–4. [6] Cohen ND, Woods AM. Characteristics and risk factors for failure of horses with acute diarrhea to survive: 122 cases (1990–1996). J Am Vet Med Assoc 1999;214:382–90. [7] Slater MR, Hood DM, Carter GK. Descriptive epidemiological study of equine laminitis. Equine Vet J 1995;27:364–7. [8] Alford P, Geller S, Richardson B, et al. A multicenter, matched casecontrol study of risk factors for equine laminitis. Prev Vet Med 2001; 49:209–22.
879
[9] Reesink HL, Divers TJ, Bookbinder LC, et al. Measurement of digital laminar and venous temperatures as a means of comparing three methods of topically applied cold treatment for digits of horses. Am J Vet Res 2012;73:860–6.
058 The veterinarian-farrier team in management of horses with chronic laminitis: case examples R.S. Pleasant, and T.D. Burns Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA Take-home message: When veterinarians and farriers encounter cases of chronic laminitis, they should utilize the expertise of each other in order to provide the best possible care. Veterinarians and farriers often encounter cases of chronic laminitis in their respective practices. Successful management of these cases requires a “whole horse” approach and is maximized by a co-operating veterinarian–farrier team. The primary goals are to prevent recurrent bouts of laminitis and to rehabilitate and maintain the horse’s feet as best possible. It is the veterinarian’s responsibility to recognize and address risk factors for further laminitis events, such as obesity, insulin resistance/hyperinsulinemia, and pituitary pars intermedia dysfunction. Failure to do so invariably results in recurrent bouts of laminitis and cumulative damage to the lamellar apparatus. The veterinarian can assess these risk factors via body condition scoring and endocrine testing. Rehabilitation and management of the feet involves regular physical and radiographic examination, and appropriate trimming/shoeing. Physical examination evaluates hoof growth patterns, horn quality, coronary band compression, etc. Lateral and dorsopalmar radiographs demonstrate the position of the distal phalanx within the hoof capsule and serve to guide trimming and shoeing by the farrier. The goals for trimming/shoeing are to relieve load/stress on the lamellae and realign the hoof capsule and distal phalanx. The exact methods/techniques used to achieve these goals are not as important as following proper principles, and are generally dictated by the farrier’s expertise and preference.
059 “How-to” case presentations on managing the laminitic hoof Travis D. Burns Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA Take-home message: There are several methods of managing/treating the laminitic hoof. The treatment goals remain the same, regardless of how each veterinarianfarrier team applies the various methods to accomplish these goals.