Laminitis Prevention and Intervention in Hospitalized Horses

Laminitis Prevention and Intervention in Hospitalized Horses

Photo: The Horse Staff

Horses hospitalized for serious surgical or medical conditions are at an increased risk for developing laminitis as a complication of their injury or illness. Thus, preventing laminitis or intervening early in these animals is key, according to James Orsini, DVM, Dipl. ACVS, associate professor of surgery and director of the Laminitis Institute at the University of Pennsylvania's New Bolton Center. Orsini described his research on the subject at the 6th International Equine Conference on Laminitis and Diseases of the Foot, held Oct. 28-31 in West Palm Beach, Fla.

First, said Orsini, veterinarians must identify at-risk patients, such as those with a non-weight-bearing lameness or a systemic inflammatory response syndrome (SIRS, such as pleuropneumonia). "Treating the primary problem is an absolute imperative in laminitis prevention and early intervention," he explained.

Take a performance horse with a non-weight-bearing lameness, for instance: He might have suffered a fracture or a catastrophic breakdown of the suspensory apparatus and is stressed, exhausted, and painful. Compound that condition with the likelihood that he's on a high-carbohydrate diet, and you have a recipe for laminitis development.

"The first order of business is to stabilize the patient medically and mechanically (i.e., using a bandage, splint, or cast to help him avoid developing a contralateral limb lameness) and provide pain relief while the injury is fully evaluated and the patient prepared for surgery," Orsini relayed.

If the injury cannot be stabilized, or if an instability develops (such as an infection or implant failure), the horse's risk for developing supporting limb laminitis grows. Orsini recommended veterinarians monitor these animals closely for at least four to six weeks post-surgery to ensure no complications occur.

The next step in laminitis prevention in the stabilized patient is pain management to encourage loading on all legs. Non-steroidal anti-inflammatories (NSAIDs) are the first-line therapy, but opiates and other medications such as local anesthetics (lidocaine) or alpha-2 agonists (e.g., sedatives such as xylazine) might also be useful. Potential side effects of opiates, however, include anxiety, restlessness, and ileus (a lack of progressive motility in the gastrointestinal tract). Thus, other pain relief options might be needed and could include epidural analgesia, fentanyl (an opioid), transdermal patches, gabapentin (an anticonvulsant used to treat neuropathic pain in humans), and alternative therapies such as acupuncture or physical therapy.

"None of the currently available choices is the be-all and end-all of pain management in horses," Orsini added. "And rarely is just one drug or treatment modality adequate on its own in the severely painful patient."

The third laminitis prevention and/or intervention aspect is protecting the lamellar structures in the loaded limb. To achieve this, veterinarians should limit strain on the dermal-epidermal "bond" by applying hoof mechanics such as a heel wedges or glue-on shoes. Veterinarians also need to protect and cushion the solar surface of the foot for comfort (because of the increased pressure and weight-bearing or coffin bone sinking if the laminitis cascade has already begun) as well as more evenly distributed weight-bearing. This can be achieved by avoiding hard surfaces, providing an optimal depth of stall bedding ("Enough to cushion but not so much as to hamper movement," Orsini suggested), and applying a glue-on shoe packed with cushion material.

Orsini listed other prevention and intervention suggestions, including applying cryotherapy (cold therapy), employing multimodal anti-inflammatory therapy, monitoring SIRS-affected horses, and promoting good gastrointestinal health. No matter the approach, he concluded, "All hospitalized patients should be closely monitored until their condition is stable and they are well on the road to recovery."

About the Author

Alexandra Beckstett, The Horse Managing Editor

Alexandra Beckstett, Managing Editor of The Horse and a native of Houston, Texas, is a lifelong horse owner who has shown successfully on the national hunter/jumper circuit and dabbled in hunter breeding. After graduating from Duke University, she joined Blood-Horse Publications as Assistant Editor of its book division, Eclipse Press, before joining The Horse.

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