Report of The First International
Conference on Laminitis and Diseases of the Foot
Laminitis is a complex disease of the horse, manifesting changes in the cardiovascular, endocrine, musculo-skeletal, and gastrointestinal systems of the affected animal, as well as agonizing lameness and obvious distress of extreme pain in the hooves. Dr. David Hood, Faculty at this conference, noted, Laminitis is the NUMBER ONE ranked medical concern of horse-owners, even though it is NOT the most prevalent disease in horses. The reason for this concern is that this disease rarely kills an animal, but leaves it to suffer for extended periods, unable to place the load of its own weight on the hooves without the accompaniment of severe pain. The fear that ones own horse might be permanently crippled by this disease, and that we currently have no preventative or effective rehabilitation for affected animals, further amplifies this fear.
The story of how this conference came to be is as fascinating and inspiring as the Conference itself including all the elements of a hot new novel true love, horses, rich people, and an evil force that threatens to cripple and overwhelm the family. It begins with John and Marinanne Castle of Palm Beach, FL, and their horse named Spot, an Appaloosa whom they adored. Spot was lovingly spoiled as rotten as any horse could be apples every day, his own plane, and occasionally ridden by the children at the Pegasus Handicapped Riding Center (when he was in New York on vacation from the heat). John also rode Spot whenever he came home from his international business trips, Marianne had purchased the horse for Johns birthday upon noticing the loving relationship they shared.
One day, Spot was lame. The immediate diagnosis was laminitis, a progressively crippling disease of the hoof in which the affected animal is subjected to paroxysms of agonizing pain. John and Marinanne hired the very best and brightest in the veterinary world to fix Spot, and were horrified to find out that our true understanding of laminitis its causes, mechanisms, and pathologies, are still in the elementary stage. All the money in the world could not bring Spot back to his youthful grace and striking beauty without his good hooves to stand on Spot would never again walk normally much less run in the pasture with his friends or be ridden by children.
At that point, the Castles decided to let Spot be a test case for the orthopedic experts to attempt what had never been done before making a chronically foundered horse comfortable and provide some quality of life with the disease. This included a huge and DAILY amount of effort on the parts of Spots veterinary staff, the farrier, grooms and caretakers, for almost 6 years. Numerous orthopedic devices were designed to allow Spot to walk again, and his devoted owners spent every possible moment with the horse, who ruled his people from atop a bed of soft imported shavings.
John told the attending staff that Spot would tell him when it was time to let him go. So they spent thousands of dollars researching every possible avenue of relief for Spot, any nutritional, management, or therapeutic product that might be the key to a cure. One day in the summer of 1998, at the age of 25, Spot went to his reward.
This story doesnt end at Spots grave for John and Marianne vowed to do what they could to encourage study and progress in research and treatment of laminitis. They made good on their promise to Spot by granting the seed money for the First International Equine Conference on Laminitis and Diseases of the Foot, held this February in Palm Beach, FL at the Ritz-Carlton Hotel.
Horse-lovers should realize that the most amazing thing about this conference was that it even happened much less that the program included presentation of excellent research, the very latest in diagnosis, management and treatment options, and opposing lines of thought. For the first time a disease which strikes fear into the hearts of horse lovers the world over had its OWN headliner! In his opening remarks, University of Florida College of Veterinary Medicines Dean, Dr. Joseph DiPietro, stated the purpose of the conference was to bring ALL interested parties (world class, cutting-edge researchers; farriers and veterinarians out of the front lines with the owners; and even interested owners and trainers) together to focus on the problem, getting the industry on the fast track to better understanding of current issues and knowledge, new treatments, and approaches to control the devastations of laminitis. There were some tough questions to debate, and there is still some controversy over what EXACTLY causes the disease. But this civilized discussion is a characteristic of GOOD SCIENCE, and is the same process that has yielded our many advances in medical and veterinary technologies over the years.
Everyone at the conference had his or her own reasons for attending. My personal reason harks back to my first exposure to this disease. A horse named Dixie Sonata that had eaten a toxic plant was being treated to prevent the complications like laminitis. It was my 4th day there at the clinic, and I was cleaning her hooves, when I found her coffin bone all pink and bloody staring at me from under the dirt. It was the first time I realized that I held a horse with a death sentence in my hands, and it still gives me a shudder across the years. At the time I knew next to nothing about this disease, but it spurred me to learn! Probably everyone attending the Conference has felt this way at some time in their career a sense of helplessness in the face of a problem that seems insurmountable at times, and breaks hearts and herds with its suffering and pain.
Laminitis is defined as inflammation of the laminae of the equine foot, a stark definition in contrast to the animal we see crouched onto its rear limbs, panting with the exertion of maintaining his weight on muscles not designed to bear the load, and grunting with the agony of the pain in his hooves.
The EXACT cause of laminitis in the hoof itself is currently under discussion by scientists worldwide. The normal hoof has a strength of over 400 pounds per square inch (lb/in2), while during the Acute phase of laminitis the damaged hoof can stand less than 100 lb/in2, which means that walking or running this animal can cause the hoof to literally slide off the foot. The structural strength of the hoof is conveyed from the basement membrane of the laminae, which is destroyed in the inflammatory Acute Phase of laminitis, and causes the hoof to separate from its attachments to the P3 or coffin bone of the hoof. Is this caused by Vasoconstriction? Vasodialation? Or Enzymatic destruction? asked Dr. Gary Baxter, Invited Speaker, noting the scope of the research to be presented at the Conference.
However, the pathophysiologic factors that initiate this disease are well known and can include a multitude of causes. Overfeeding, colic, poor and incorrect shoeing, too much spring grass, black walnut shavings, hard work on hard ground, bingeing on grain, injury to the opposite hoof or elsewhere in the body, infectious disease, foaling complications, severe hemorrhage all can start the disease process occurring, and the end result is often the same, according to Dr. Dallas Goble, a Speaker at the conference.
Dr. David Hood introduced the conference with an overview of the clinical development of laminitis as having 3 phases - Developmental, Acute, and either Sub-Acute or Chronic, that correspond to a timeline of prevention, treatment, and rehabilitation measures.
TIMELINE: Prevention ONSET Treatment Rehabitilation
(20-60 hours) of Pain & (20-72 hours) (6 months minimum,
Lameness possibly life-long)
* Taken from Introduction and Clinical Review of Laminitis in Horses, Dr. David Hood, presented at this Conference.
Whether the animal enters the Sub-Acute or the Chronic phase depends on whether the foot begins to mechanically fail, often based on whether the animal received preventative treatment during the developmental phase (20 to 60 hours after the injury or insult to the body), explained Dr. Hood. This is of particular concern to horse-owners whose animals experience a serious injury or clinical condition. Unfortunately, true prevention can ONLY be achieved if the animal is treated during this developmental phase, said Dr. James Orsini, Conference Director, Once the animal is brought in to the clinic demonstrating lameness, warm hooves and elevated digital pulse, only attempts at treatment and rehabilitation are possible.
What can you do? Prevention and early treatment are key do not allow your horses to get into the grain bins accidentally, or to be shod incorrectly (long toe/low heel LTLH syndrome), or to be out on fresh spring grass for long periods. (A book entitled Laminitis Prevention for Horseowners by Dr. Richard Mansmann is available by calling (919) 933-1767.) If your horse experiences any of the above situations from overfeeding to dystocia to hemorrhage, ask your veterinarian if the horse should also be preventatively treated for laminitis. The importance of a thorough physical exam, correct diagnosis of the phase of the laminitis, and immediate treatment are key to therapeutic correction, warns Dr. Goble. Because there are no symptoms in this early developmental phase, this disease is insidious. Dr. Hood cautions that Not all horses that experience colic or overfeeding get laminitis, but these are considered the pre-disposing factors to make the disease more likely to occur and more severe if it does occur. Other factors that seem to increase a horses chances for having severe laminitis include increasing age, Cushings Syndrome, long term diarrhea, and obesity. But if the disease does occur in your horse, Dr. Chris Pollitt, Speaker, said he could not over-emphasize the importance of mechanical support and early treatment to prevent a horse from becoming a chronic case.
The goal of treatment of any laminitic horse is to preserve the normal anatomy of the hooves, to re-establish normal body state, and manage pain in the animal. Tools available to evaluate and monitor the severity of laminitis include X-ray radiographic techniques, laboratory bloodwork, and even CT, MRI and scintigraphic blood flow evaluations. Some of these are very expensive or not available in certain areas. Research into new methods (Laser Doppler Flowmetry, Near Infrared Spectroscopy, and Co-Oximetry) are currently under review at universities in the US, Europe, and Australia, according to Dr. Baxter.
Ethical and humane considerations must be discussed UP FRONT with your veterinarian and farrier. Tell them at what point you would want to stop treatment and discuss euthanasia to prevent suffering of your horse. Even more important is that the horseowner realize that consistency of treatment, personal dedication to care, participation in daily management of the disease, and economic considerations will influence the outcome, noted Dr. Goble. A working relationship between all three is required to provide any avenue of return to health for the individual horse. In particular, pain management is a concern, since if the horse feels too good, he may further injure himself, but alternatively you will not want him to be in agony. You must expect that the animal will lose weight, lose brightness, change his personality, and even be covered with bedsores long before the ultimate outcome can be determined.
The outlook for an affected horse is not as bleak as it once was. Research has demonstrated that of the horses each year that are brought to veterinary clinics with laminitis, 85% enter the Sub-Acute phase in which rehabilitation and even full recovery are possible with timely therapy and treatment. The other 15% proceed to the chronic phase, some of which are unsalvageable to a clinically compensated state, while others can be maintained with significant rehabilitative efforts. Horsemen describe these chronic cases as sloughing of the hoof, or rotation of the coffin bone; this is a horse with a typical crippled gait, expression of pain, and curling, lengthened hooves often called foundered. Even these cases can often be maintained with nutritional & exercise management, regular professional hoof work, pain management, and even surgical intervention, but will never return to their previous level of work or use.
Laminitis has been a concern of horse owners since the descriptions of Barley disease by the Greeks in 350 BC. With this inaugural International Conference on Laminitis and Diseases of the Foot, it is hoped that serious attention and medical knowledge can be focused on this disease, to ease the suffering of future generations of our beautiful friend - the horse.
We have Mr. and Mrs. John K. Castle to thank for their generosity and stimulus to create this conference, whose international scope and in-depth review of our current knowledge set the tone for the next conference to further share our increasing understanding of this crippling disease.
In addition, the following companies provided sponsorship for the conference: Thoroughbred Charities of America, Ltd.; Fort Dodge; Merial; additional support was provided by Adequan I.A., Bayer, Pfizer Animal Health, Storz Veterinary Endoscopy, Abbot Labs, Boehringer Ingelhiem Vetmedica, Med-Vet Pharmaceuticals, Nutramax Labs, Pharmacia Upjohn, Schering-Plough, Shady Side Farm, Sound Horse Technologies, and Wedgewood Pharmacy.
Information on the conference or copies of the Proceedings can be found by calling (877) 307-5225 or at this website: www.slackinc.com/laminitis
Rebecca Gimenez grew up riding horses in Florida, then moved to South Carolina to pursue her BS in Biology from Wofford College and a PhD in Animal Physiology with a concentration in Equine Reproductive Endocrinology. She now teaches Biology at Anderson College, SC; edits a regional magazine; and assists her husband in teaching large animal emergency rescue techniques in association with the American Humane Association. In between, she is an avid trail rider and caretaker of her 12 horses.