Laminitis (Book Excerpt)

Editor's Note: This is an excerpt from Understanding Equine Preventive Medicine by Bradford G. Bentz, VMD. This book is available from www.ExclusivelyEquine.com.

Maintaining health and comfort of horses that have been diagnosed with laminitis can be a large undertaking, but it is imperative in order to maximize the overall quality of life for these animals. Horses with chronic laminitis or those that have been previously diagnosed with laminitis are at risk of recurrence. For such horse, high-quality preventive medicine is helpful to minimize the likelihood of the development of illness. Illness of any kind in these horses could easily lead to recurrence of laminitis. Good vaccination and deworming are important considerations. Nutrition is an important component of preventive care of these horses. Overfeeding is a risk for horses previously diagnosed with laminitis. Horses that are overweight must be placed on diets to minimize unnecessary stress and forces on the affected feet. Underlying health problems should be addressed appropriately to control these risk factors for recurrence of laminitis.

Regular foot care is imperative. Most horses with laminitis probably do better in shoes. Unshod horses might be more prone to foot pain and inflammation associated with laminitis.  Trimming is usually performed to minimize the length of toe and/or the pull of the deep flexor tendon on the coffin bone. For some cases, good trimming also helps "reorient" the coffin bone to a more normal position relative to the hoof wall.  Shoeing such horses often becomes trial and error to find the most comfortable shoes and orientation of the foot. Commonly used shoes include heart bar shoes, bar shoes, shoes with wedge pads, and regular shoes. Depending on the severity of the laminitis, the degree of rotation, the amount of coffin bone sinking, and time since the last episode of pain associated with laminitis, horses might respond to the above options differently. Horses undergoing painful episodes of laminitis have also responded to specially made plastic glue-on or taped-on shoes with rubber-like cushions that conform to the sole and elevate the heel.

Medical therapy may be necessary intermittently for periods of increased pain associated with laminitis.  Typical treatments used are the same in acute first-time laminitis. Most medical therapy is directed at providing analgesia and decreasing inflammation. Phenylbutazone, flunixin meglumine (Banamine™), and ketoprofen are often used for this purpose. Extended use of these NSAIDs may be associated with intestinal ulceration and kidney dysfunction. For this reason extended treatment using high doses of these medications should be avoided or carefully administered.  Addition of anti-ulcer medications such as omeprazole or ranitidine may be worthwhile considerations. Phenylbutazone appears to be the most dangerous with respect to these side effects; flunixin meglumine, less so but still of significant concern. Ketoprofen may be least ulcerogenic but still should be used judiciously. It is more expensive and is administered by injection.

A final word on laminitis is warranted.  Although emotional attachment may play a large role in your desire as an owner  to continue therapy and attempt to control this condition, I urge you to consider and openly discuss with your veterinarian the need and indeed the humanity of a decision to elect for euthanasia in horses exhibiting chronic pain associated with laminitis.  Making such a decision when your horse is in this condition is difficult. However, I would caution the owner of a seriously laminitic horse against unreal expectations of comfort and complete recovery for horses whose coffin bones are severely rotated or sinking.  Although it is possible for some horses that appear to be severely affected to recover over time, the odds tend not to be in favor of recovery of severely rotated or sinking horses. Indeed, even if recovery is a possibility, I urge you to ask yourself and discuss with your veterinarian and farrier what price you are willing to impose on the horse and how much pain you feel it should have to endure in order to have what may be a limited chance of a comfortable existence.
 

About the Author

Bradford G. Bentz, VMD, MS, Dipl. ACVIM, ABVP (equine)

Brad Bentz, VMD, Dipl. ACVIM, ABVP, ACVECC, owns Bluegrass Equine Performance and Internal Medicine in Lexington, Ky., where he specializes in advanced internal medicine and critical care focused on helping equine patients recuperate at home. He’s authored numerous books, articles, and papers about horse health and currently serves as commission veterinarian for the Kentucky State Racing Commission.

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