Ask the Vet: Laminitis

Courtesy of AAEP

Question: What is the initial treatment for laminitis that is mild and severe? If a horse is suspected of having foundered and is far from the barn, (for example in a pasture) can leading it to the barn prior to treatment cause more problems?

Answer: very important question, I’ll do my best to give some guidelines.

1) Prompt treatment – Especially in acute onset, I treat laminitis as a true emergency, regardless of time of day (or night). Beginning therapy as quickly as possible is crucial, I feel, because laminitis research shows that by the time clinical signs of the disease are evident, the process has been underway for a period of time—thus, we are already “behind the eight-ball”.

2) Mechanical support – In effect, the horse’s entire weight is suspended inside the hoof capsule by the laminae. When laminitis occurs, that attachment is weakened to some extent. Thus, gravity is exerting a tremendous force against that weakened attachment. It is crucial to provide as much support as possible to the foot and horse to minimize those effects. As mentioned in an earlier answer, sand is a great footing material for these horses, as it conforms to the foot. There are also several brands of boots that are specifically designed for the laminitic foot. Also, wooden shoes (clogs), styrofoam cutouts, or foam blocks are used by many practitioners for the same purpose. In the case of poorly cared-for feet, starting with an appropriate trimming job is important. Finally, a horse that chooses to lay down for long stretches of time helps immensely, by removing their weight from their feet. I placed mechanical support at the top of this list because, in my experience, mechanical support is the most critical intervention I can offer my patients in helping them recover from laminitis. In this same vein, a slow walk from the pasture back to the barn may be tough, but in the long run it will be good for your horse—laminitis generally takes days to weeks to resolve, and during this time its important to limit your horse’s exercise and use of his feet. Thus, the benefit of having him in a nicely bedded stall with water and feed close by will far outweigh the negatives of that first slow walk in from the pasture.

3) Pain relief – Laminitis can be an incredibly painful condition, and oftentimes requires multiple different types of drugs administered concurrently to help the horse handle that pain.

4) Removal of the inciting cause – laminitis can occur secondary to many other conditions; thus managing and treating those conditions is critical. Some examples of inciting causes include carbohydrate overload (whether grain or grass), systemic diseases (pneumonia, enteritis, uterus infections), and endocrine diseases (specifically insulin resistance (IR) and PPID (Cushings). In some cases, the inciting cause cannot be determined 100%–however, prompt examination by a veterinarian can oftentimes identify and remedy the original condition, thus improving the laminitis treatment outcome.

5) Specific therapies for laminitis–laminitis, by dollar amount, is currently the most-studied disease condition of the horse. Over the years, innumerable therapies have been advocated, utilized, and sometimes discarded. Even today, there is debate among experienced practitioners as to which therapies are helpful or not. I certainly have my own opinions as to which drugs/therapies are useful (or not) in laminitis treatment: however, so do other experienced practitioners! What I can say for certain is that there is definitely no “silver bullet” for laminitis treatment–otherwise everyone would do the same thing. This disease is a great example of why it is so critical to form a long-lasting partnership with your veterinarian–you can be more confident in not only their experience in treating other horses with similar problems, but also their rationale for prescribing targeted therapies. As research continues, we will hopefully gain a clearer understanding of the inciting causes of laminitis, and be able to develop more (and better) therapies for the disease.