Advancements in the Treatment of Laminitis February 24, 2007 University of Rhode Island Lisa Connor

Overview Laminitis –Causes –Treatment –Advancements –Heroes –Future Outlook/Need for Funding

What is Laminitis? Pain and inflammation of the sensitive laminae of the foot

Why is it debilitating? Sensitivity in Laminae Separation & Rotation Triggering Event

Circulatory Effects Dr. Christopher Pollitt American Farrier's Journal Normal circulation laminitis

What causes Laminitis? Nutrition (carbohydrate overload) Toxemia Mechanical overload (contralateral effects) Stress Hormonal Imbalance (Cushing’s Disease) Drug Induced (sensitivity to corticosteriods)

Applying Physics horse's weight (gold) upward ground force from concussion (red) rear-ward pull of the deep digital flexor tendon (green) The laminae (blue) The forward & upward pull of extensor tendon (purple) 40% 60%

U.S. Statistics USDA/APHIS Equine 98 Study  28.5% of polled operations in 28 states confirmed laminitis within their boarding/training population  Highest incidence in Spring/Summer

Goals of Treatment Prevent further development Reduce the pain or hypertension cycle Reduce or prevent permanent laminar damage Improve laminar capillary dynamics Prevent movement of the distal phalanx

Common Approaches Determine cause & correct condition IV fluid therapy Cryotherapy Radiographs NSAIDS (Bute, ketoprofen) Promote vasodilation ( Acepromazine, isoxuprine, pentophyline and nitroglycerin) Frog support

Mechanical Aids The heart-bar-shoe through its contact with the frog engages weight bearing (*supports bony column*) –natural approach in the treatment of several pathologies of the foot (crushed/under-run heels, quarter cracks, and laminitis) –helps prevent rotation and or sinking of the coffin bone

More Mechanical Aids NBHoofcare.com Styrofoam padding Digit Support System NBHoofcare

Alternative Practices Venograms confirm degree of blood supply Deep digital flexor tenotomy (usually for salvage cases) –Restores natural angle with ground surface Study over 10 yr. period n=37 77% survival after 6 mos. 60% survival after 24 mos. Dorsal hoof wall resection –Prevent & treat abscesses Prosthetics Barefoot trimming & holistic therapies

The Problem with Laminitis Within the multitude of treatment options ~ NONE are UNIVERSALLY EFFECTIVE Pathogenesis is poorly understood Contradicting theories –Heat vs. Cold (Cryotherapy) –Use of heartbar shoes vs. styrofoam pads or barefoot trimming –Vasodilation vs. Vasoconstriction during onset

Advancements in Technology A veterinarian can see where blood flow is compromised due to damage, swelling, or poor hoof structure, and thus decide what mechanical support and/or surgery he needs to provide in order to restore blood flow to those areas. Venogram

Research/Initiatives Involvement of Circulation (Hood et al, 1993) –Vasoconstriction causes decreased perfusion to nutrient laminar capillaries The Glucose Connection (Bailey, 2000) Connective Tissue Connection (Pollitt & Daradka, 1998) National Animal Genome Project –(gene map for horses)

Steps to Conquering Laminitis Foundational Knowledge Today$10M in Research Funds Collaboration between Veterinarians, Farriers, and Scientists alike 5 Years Laminitis remains the second largest killer of horses, behind colic.

Beloved Heroes Patricia McQueen photo Foolish Pleasure, 1975 Barbaro, 2006 Secretariat, 1973

The Road to Preservation