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There is life after laminitis

This article first appeared in issue 18 Apr/May 2014 edition of Equestrian Life magazine. To see what's in our latest issue, please click here.
 
Laminitis article
 
 
By Andrew Bowe
 
Andrew Bowe BAppSc, known as The Barefoot Blacksmith, is a master farrier specialising in the barefoot rehabilitation of horses with acute or chronic lameness. He is based at his property Mayfield in north-eastern Victoria. Visit www.barehoofcare.com.
 
 
Laminitis article
 
Photo credit: Andrew Bowe.
 
 
A group of horses recently went out to muster a small mob of cattle from the steep hill country of Mayfield in the foothills of north-eastern Victorian. So what’s the big deal, you may well ask. At Mayfield, we regularly rehabilitate horses with serious laminitis using the principles of barefoot rehabilitation based on the research of Professor Bowker from Michigan State University (as outlined in the previous article). Some of the patients, once recovered, get put to work on the farm as part-time trail horses and part-time stock horses. The big deal is that all of the horses pictured here have recovered from life-threatening laminitis. Euthanasia had been recommended in each case and they only came to Mayfield as a last resort. All are back under saddle, working regularly and working soundly. In fact, the more they work, the stronger they get and the better they go. 
 
Serious laminitis has traditionally been considered incurable, so treatment has been palliative and the “kindness” of euthanasia has been the expected and accepted outcome. Some of the biggest names in the long history of domestic horses have been euthanased due to laminitis. Horses that managed to survive serious laminitis have mostly been consigned to a life in the paddock, unable to return to full working soundness; their hooves just mere shells of what they were prior to suffering the disease.
 
In recent years, huge advances have been made in how serious laminitis can be managed. Prognosis is now governed to a large extent by management protocol, not by how deformed the hooves have become. Full recovery (back to the level of soundness before the pathology) can be achieved as long as the underlying cause is removed and physiologically correct treatment is not delayed.
 
Despite this new information having being widely available for several years, uptake has been slow in some quarters because fundamental parameters of this “new” treatment directly contradict long-held beliefs. Theory that challenges established knowledge always has more merit when it can be shown in action; working in real-life situations. What better way to show the possibility of recovery from serious laminitis than to document living, ridden proof? 
 
Back to Mayfield. All of these horses have come a long way since their darkest days of laminitis. Ayla suffered a bout of “road founder’’ as a result of being ridden long distances at speed along hard roads on shod hooves and she ultimately penetrated on both fores with significant necrosis in the corium beneath the pedal bones. Radiographs of her front hooves taken just prior to penetration showed the pedal bones literally ripped away from the hoof capsules.
 
 
Laminitis article
 
A radiograph of Ayla's near-fore. The pedal bone should be parallel to the hoof wall.
Photo credit: Andrew Bowe.
 
 
Bella was typical of a pony with chronic laminitis due to spring grass intolerance, but she suffered an acute episode after unseasonal rain produced lush feed in mid-summer. Her hooves were already significantly deformed, with very high heels and run-forward toes. The latest insult tipped them over the precipice. She was reliant upon heavy-duty medication and, despite the best efforts of corrective farriery, she had been regressing constantly. 
 
 
Laminitis article
 
Radiograph of Bella's near-fore.
Photo credit: Andrew Bowe.
 
 
Tilly was another chronic case further complicated by an extended series of abscesses (due to a sub-tropical environment) that prevented her hooves from being trimmed because she was simply too sore. Over-long hooves, excess body weight and a flush of spring grass and the laminar attachment ‘broke’ in all four hooves.
 
 
Laminitis article
 
Radiograph of Tilly's near hind.
Photo credit: T.McCallum.
 
 
Blossom had a longstanding infection that was driving a continual laminitic episode. The pedal bones in her front hooves sank and then penetrated. 
 
 
Laminitis article
 
Radiograph of Blossom's near-fore.
Photo credit: Andrew Bowe.
 
 
The main issue arising from these radiographs is the pristine condition of the pedal bones. Whilst the hooves in each instance are in precarious positions relative the hoof capsules, there is no significant chronic damage to the bones themselves. Full recovery is possible. Quite simply, the correct spatial relationship between the pedal bone and the hoof capsule needs to be restored.
 
Ayla and Bella are now the two hardest-working mounts on the property. Ayla is the number one stock pony and will work all day and be ready again for work the following day if needed. Bella is kept busy doing everything and anything that her keen young rider asks of her, from chasing breakaway cattle to jumping anything in her path to finesse at pony club. Tilly is young and has only recently joined the Mayfield ranks so is slowly but steadily easing into her working life. As for Blossom the Clydie, she is not really designed for stock work, but try telling her that!
 
How then were these horses restored to soundness from such dire positions? Each followed a program of rehabilitation that aimed firstly to remove the cause of the disease, then return the hooves to physiologically correct parameters, and finally to change lifestyle factors to facilitate the growth of a healthy new hoof capsule. 
 
It is hard to write succinctly when discussing laminitis recovery. It is a big story. Even though laminitic patients share common clinical symptoms and therefore require a generic management protocol, they are all slightly different and specific treatment needs to be customised accordingly. There is no one size fits all.
 
Removing the insult
 
Even though laminitis most definitely manifests in the hooves, we can’t fix in the hoof that which isn’t coming from the hoof. For recovery to proceed, the underlying causative insult needs to be identified and eliminated. Laminitis is most often caused by incorrect diet, but not always. The underlying cause can be elusive. Blossom, for example, showed no sign of recovery until an elusive infection (liver abscess) was diagnosed by Mayfield’s “resident’’ vet, Dr “Pos” Thompson (Progressive Equine). It was then cultured to find an effective antibiotic. The author cannot stress loudly enough the importance of veterinary involvement in all laminitic cases. 
 
Correcting the hooves and restoring comfort
 
Laminitic hooves are pathological and need correction to relieve pressure from the broken laminar attachment. Pivotal to this is totally removing the walls from weight-bearing (this is the basis of the change from traditional hoofcare that is driving the turnaround in success rates – as outlined in the author’s previous article).
 
Diet 
 
Laminitic patients need to be changed to a temporary emergency diet that focuses on restriction of non-structural carbohydrates (sugars). No matter the source of the original insult, there has been an upheaval in the insulin delivery system that needs to be stabilised, even if the patient didn’t develop laminitis from too much green grass. First up, the patient needs to be taken off grass, even the shortest of grass. Secondly, there can be no grain, no processed grain-based feeds, no apples, no carrots, no molasses, no licorice, no sugar cubes and definitely no bread. And no ifs or buts!
 
The bulk of the diet should be a constant supply of low-quality dry grass hay. Horses have an efficient digestive system that is designed to retrieve as many nutrients as it can from poor quality, high-fibre herbage (they are, after all, adapted to a semi-arid environment). Grass hay comes closest to the ideal. It is important to know, however, that not all hay is created equal and not all hay is suitable for consumption by laminitic patients. Unimproved pasture based on native grasses or grassy weeds is best, whilst species to avoid include ryegrass, clover and cereal crops. Hay should be soaked to further decrease its sugar content (via osmotic leaching) and its intake should be regulated by using a slow feeding system such as a haynet with small weave. 
 
Hay grown at Mayfield for consumption by laminitic horses is not only based on relatively safe pasture species, but is processed late in the season when it has matured past its best; not so good for cattle but ideal for horses.
 
A benign hard feed also needs to be fed to act as a carrier for various supplements that aid recovery. Oaten chaff is probably the best for this, but it needs to be soaked in a large volume of water to leech excess sugars and also to allow any grain to sink away from the chaff. Remember, grain is definitely off the menu. If a patient needs to increase body weight, a safe conditioner such as soy hull pellets, beet pulp or coconut meal (copra) can be added to the chaff.
 
Various supplements are added to the benign hard feed for optimising cellular recovery, removing toxins and providing pain relief, such as essential fatty acids (via flaxseed, chia or sunflower seed), salt, magnesium, seaweed meal, msm, vitamin E, a hind gut buffer and probiotics. Numerous herbs are also added for a variety of reasons, including cleavers, rosehips, hawthorn berries, chamomile flowers, nettle, slippery elm, marshmallow, St Mary’s thistle, dandelion, celery seed and cinnamon. The powders of white willow bark and devil’s claw are used for pain relief. Anecdotal evidence is emerging that suggests prolonged use of phenylbutazone (“bute’’) inhibits healing at the cellular interface of the broken laminar bond. These herbs appear to be a suitable substitute.
 
Once the hooves have sufficiently stabilised after four to six months, the patient needs to be weaned off the emergency diet and onto a safe long-term diet with better mineral balance. Be aware, however, that this does not mean allowing a convalescing patient access to green grass. There should be no access to green grass at least until full hoof recovery has been achieved, which may take up to 12 months.
 
Movement
 
Movement may need to be restricted early in the recovery process to protect the precariously delicate laminar attachment, but full healing is ultimately reliant upon much movement. Horses are prairie animals designed to move large distances constantly. This is their healthy state.
 
Unfortunately laminitic patients can’t be just turned loose into any large paddock. Their diet still needs to be strictly controlled. To promote movement, yet still restrict the overall surface area of ground they have access to, a workable compromise can be a loop paddock, which is simply a continuous laneway that calls upon a horse’s innate desire for movement. 
 
 
Laminitis article
 
This photo shows one of the Mayfield loop paddocks. Small on surface area, big on movement.
Photo credit: Andrew Bowe.
 
 
Loops may not be possible for areas that have deep sand or are prone to mud. In these situations, patients may need to be turned out into larger paddocks wearing a muzzle. Some people may think muzzles are cruel, but at the risk of anthropomorphising, the horses seem happier out in a large area with a muzzle on than shut up in a small area without one. A good way to manage muzzles is to lock a patient up at night without its muzzle on and with access to hay, and then let them out muzzled during the day. To be kind, hay should be fed just prior to the muzzle going on, so the stomach is satisfied at least for a short while.
 
Hoof protection
 
When a horse is ridden, a large amount of pressure is put on its hooves. An old analogy from the racetrack suggests that every ounce in the saddle equals a pound on the hoof. For horses recovering from laminitis, this is even more of a concern because their pedal bones are compromised. They are weakened by osteoporosis and have inadequately thin soles. Their hooves need protection, even on supposedly benign surfaces such as sand arenas. The choice of hoof protection must consider weight-bearing distribution. Laminitic hooves need to be supported by the back half of the hoof where there is no bone. This is why the best option by far for protecting a recovering or recovered laminitic hoof is a hoof boot with a fully contouring soft pad. The surface area of support can be further increased by filling the contours at the rear of the hoof with soft impression material.
 
What about shoes?
 
Rigid metal shoes seem to be contraindicated for a laminitic horse. When there is no frog support, the laminar attachment is being forced to endure excessive tearing pressure that prevents recovery. Furthermore, the same tearing forces are actively eroding structure from the dorsal surface of the pedal bone. Remember the aim is full laminar recovery. If shoes are needed, compromise seems to be the order of the day. Wide webbed plastic shoes with a wide bar that supports the frog may be the best option.
 
Ayla and Bella both wear tips, another option that protects the pedal bone yet still allows the frog to remain supportive of the horse above (please note that tips cannot be used on hooves with active laminitis). All of the recovered horses at Mayfield wear hoof boots when ridden on gravel roads (boots go over tips). No chances are taken with their pedal bones.
 
 
Laminitis article
 
Easyboot Epics - put on over the tips - for gravel road riding.
Photo credit: Andrew Bowe.
 
Ongoing prevention
 
All horses that have recovered from laminitis should be treated as if they are susceptible to rich grass. Better safe than sorry. Their body condition scores should be maintained between 2.5 and 3.5 and their grazing closely managed.
 
 
Laminitis article
 
This is Ayla in mid summer with a condition score of around 2.5, with just the hint of ribs.
Photo credit: Andrew Bowe.
 
 
Unfortunately there is an industry-wide obsession with keeping horses too fat for their own good. This may sound like a foreign concept to many, but ribs are good! Hooves need to be maintained regularly to keep heel overgrowth in check, pedal bones aligned and weight-bearing correctly through the entire ground surface of the hoof, not just the hoof wall.
 
In conclusion
 
Living with the aftermath of laminitis requires careful management, not just of the hooves but the whole equine system. But with timely and considerate treatment, they can be restored to ridden soundness and remain that way for years to come. The Mayfield horses shown here are living proof.
 
 
Laminitis article
 
Photo credit: Andrew Bowe.

 

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