Managing Acute and Chronic Laminitis

Belknap (who co-hosted TheHorse.com’s Webinar on Understanding Laminitis) said the latest research points to laminitis as an intense inflammatory injury of the foot, and it is no longer believed to be solely a blood flow problem.
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To a packed room of veterinarians at the 2007 American Association of Equine Practitioners Convention in Orlando, Fla., Jim Belknap, DVM, PhD, Dipl. ACVS, an associate professor of veterinary clinical sciences from The Ohio State University’s Galbreath Equine Center, and Rob Boswell, DVM, a practitioner with Palm Beach Equine Clinic in Wellington, Fla., opened the table topic discussion about prevention and treatment of laminitis.

Belknap (who co-hosted TheHorse.com’s Webinar on Understanding Laminitis) said the latest research points to laminitis as an intense inflammatory injury of the foot, and it is no longer believed to be solely a blood flow problem. It is known that even though a horse with imminent laminitis might look normal and show no lameness, inflammatory mediators are already elevated by up to 1,000-fold in the laminae.

With that in mind, Belknap is an advocate of very high levels of anti-inflammatory medications (500 mg three times per day of flunixin meglumine, or Banamine) within the first 72 hours of insult (a cause of laminitis) or onset. He said he realized this high dose is more likely to lead to some gastrointestinal (GI) ulceration and, thus, it should not be used on every horse. But he stressed that it is critical to get foot inflammation under control, so ulceration might be the lesser of two evils. Once the acute stage has settled down, it might be desirable to switch to phenylbutazone for better pain relief.

Ice might be beneficial for the same reason that hypothermia is used in some types of inflammatory injury in human medicine: hypothermia is anti-inflammatory and slows the metabolic rate (i.e., enzyme activity) of injured tissue. There could be great benefit to immediately ice the feet to decrease activity of deleterious enzymes such as matrix metalloproteinases and to decrease inflammation. Studies show the best means of cooling the feet is by using a bucket arrangement or wrapping the hoof in a 5-liter plastic bag or truck tire inner tube filled with ice and water. Refresh the ice continually as needed. The discussion facilitators stressed that no harm can come of keeping feet in ice for 72 hours–as much ice therapy as possible is desirable in averting the inflammatory effects related to acute laminitis. After 72 hours, no ice is necessary and, in fact, it might be counterproductive by softening the foot too much. The horse should not be walked during the acute phase

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Written by:

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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