Laminitis suggestions

[Laminitis concern]

These are my suggestions if you are prepared to try and save your horse's life.

1. From the start be proactive and xray quickly and expect to xray frequently. Rely on yourself to nurse this horse and remain in control. Do lots of research. Robert Eustace chapters on laminitis.org are good.
2. Get a venogram and determine blood supply to hoof and consider led light therapy for circulation. Reconsider prolonged box rest if small paddock with sand could be added to well bedded box. Movement helps all body circulation, muscles, and mental outlook. Maybe it would have pushed things to a head sooner, but my mare's muscles were under severe strain to compensate for her fronts and despite massage, movement might have helped and her hoof might have regained more circulation.
3. Insist vet communicates well and ask lots of questions. Make sure they've seen a severe case come well and are positive. Many vets have already made their minds up and lack indepth knowledge so change quickly if communication lacks or they can't answer your questions. Rely on the fact YOU have to save the horse. Vets prescribe and often not actively involved. They might not know what is happening nor tell you that.

4. Ensure your farrier and vet work together. get lots of opinions. A farrier cannot work without vet's involvement if they need xrays and your horse needs pain relief.
5. Be wary of farriers eternal optimism. When the going gets tough the farrier bows to the vet and inherently the farrier and vet are at odds.
6. Reconsider using plastic and glued moulded shoes. Is the cradle around frog support or a casket? It has no flex and do the chemicals sweat? In hindsight I would have left mine barefoot as her normal state and put sand down in a 20' x 12' paddock attached to her deeply bedded box.
7. Given advanced portable ultrasound machines in human medicine and the fact they are used to examine metals, can't they be adapted to penetrate and view the veins, arteries, bone, and soft tissue in horses. Vets seem not to take advantage of human medicine. Same with basic human glucose testing machine
8. Keep daily notes and photos. Purchase a stethoscope and keep records of heart rate as sign of pain. Is the horse better or worse? Most vets say if the horse isn't better in 2-3 months they never will improve yet farrier willing to give the process a year.

 

[Laminitis concern]

Navigating Severe Laminitis, Case Study RIP 13 Sept 2021 WHY DID PEDAL BONE DIE? Blood supply or plastic shoe or ???

My 14 yo barefoot 16 hh mare rotated in both fronts and was a milimetre from the sole in one. She was euthanised 4 months later. It was a longshot to have persevered given the severity but she wanted to live, had good foot confirmation, was sensible and looked after herself, I'd been in hospital nursing 20+ years, and severe cases do get thru and can remain sound with heartbars and gel pads and besides I was able to devote my time to her as I am semi-retired.

Sadly my original vet did not communicate her knowledge of laminitis and where we stood. I failed to ask enough questions partly due to lacking experience of laminitis and partly because I was stressed and upset over the situation. It was 5 weeks before first x-ray, however diagnostic tools don't necessarily determine outcomes. My own farrier recommended euthanasia straight away from the x-ray, but the horse was young and wanted to live and i really love that horse.

I changed vets but should have changed again as the second opinion had never healed a severe case and was negative from the start. I recruited a specialist laminitis farrier who at least was willing to try though as things progressed his explanation of both the source of the pain and insistance she was growing a new sole underneath was never confirmed. I am concerned his plastic shoe chemicals caused the perimeter of the hoof wall to retract (which he said was a sloughing sole), were too inflexible, and the frog cradle actually became a necrotic casket that was unhealthy for the frog and pedal bone it was holding up. A full examination after death was never performed though I did prod around and photograph her hooves after she was put down and will talk about this subsequently.

The mare developed more pressure sores and although her droppings were moist and the soaked hay provided water, she drank little and with lack of movement might also have been dehydrated. She was remaining down more and although comfortable once standing (50paracetomol and 2 danelon a day), getting up was more and more painful and despite trying Finadyne pain relief the vets could not get on top of the pain or remedy its source.

I still could not reconcile the difference of opinion as to whether the horse was a sinker to which my farrier said she was NOT (and I felt she lacked the ridge at the coronet band to confirm) and the vet's insistence she had sunk. The pain of the feet increased after each (done twice) farrier episode of trimming her feet (lowering heels and cutting back toe) and applying the plastic Imprint shoes which required her to lift one and stand for periods on the painful fronts. If she'd been left barefoot would she have been spared that or was the plastic shoe actually supporting the sole? I regularly sent photos of her soles and hooves to both the farrier and vet to which the former slways replied and latter did not though a podiatrist from America offered lots of insight.

The second opinion vet came a month after their initial involvement and x-ray and four months subsequent to the laminitis presenting. Despite the mare being comfortable in general, she insisted on immediate euthanasia then and there or she would call RSPCA. The mare was comfortable and the vet only took pulses and heart rate and refused or unable to discuss or analyze what was going on with her feet. Given her insensitive and unintelligent interaction, I refused and RSPCA came and were happy the horse was comfortable but I immediately got a very senior vet booked to reassess her for Monday. Over the weekend I took digital pulses and photos every hour. She was happy in herself and always looked forward to her food but she increasingly lay only on one side over the weekend and despite putting folded horse rugs under her to keep off the pressure sores and difficulty finding a way to adhere a dressing, the silver spray was not enough. A pressure sore on her flank grew very quickly.

Monday I took digital pulses when she was down and they were strong 60. She was reluctant to get up but 30 minutes before the 3rd opinion vet arrived I insisted and once painfully up, she was comfortable. This vet concluded there were NO digital pulses and pasturn was cold. His conclusion was the pedal bone had died and hoof was dying and becoming necrotic. The specialist farrier had also come out of kindness and interest, but said nothing and offered no examination. It was strange that I had got strong pulses when she was lying and now the vet had none. I was too overwhelmed to try them myself but I guess had concluded the enlarging pressure sores over the weekend were indicative of the final negative prognosis. My mare walked out of her stable 15 metres and was put down. I cried for hours.

Before the local farmer came to bury her I took photos of her feet and probed around. The only thing under her flaking sole was the white corium and there appeared to be fresh blood at the toe. The photos were sent to farrier and vet but latter refused to comment. I appreciate photos are 2 dimensional, but I would have thought the vet could have shed some light on what was going on.

The farrier said:

"Hello, the frog plate cradle provides support via frog, digital cushion to the bone column, maintaining the sole elevation which youp can see in the recess between the shoe and sole. Direct loading via the sole would be intolerable constricting circulation and increasing pain. What was happening with the sole was sloughing as l described( sole along with the hoof wall) The paler area at the toe is where part of the sloughing sole has fallen away revealing the deeper layer, closer to the vascular solar corium, from which new sole is derived."

A specialist podiatrist in America said of the photographs:

That’s exactly the outline of the solar rim of the coffin bone prolapsing through the sole , which eventually penetrates as you can see on your other picture which is the corium ( sensitive tissue ) that covers the coffin bone .

I’m sorry you are having to go through all this, and understand exactly the emotional loss you are having to endure.

I don’t find it strange since I have seen this same a scenario many times where most will take the “wait and see approach, or give you false hopes with options that I tried to explain you that wouldn’t work , even talked you out of your only viable option ( tenotomy ) , and now they just don’t have an answer to why things didn’t work out....

Due to the severe rotation the blood supply under the tip of the coffin bone is completely deprived. Therefore , there is no growth at all ( no sole ! , nothing to exfoliate ) , which the sequence of necrotic ( dead) sensitive tissues ( corium ) with a whole cascade of complications such as seromas ( hematomas ) - abscesses with a downhill spiral of irreversible complications.

I’m really sorry you and your horse are having to go through this devastating disease that if not approached appropriately as advice in our previous conversation, your outcome is inevitable.

It has been a very frustrating issue that we have been dealing for many years where vets ( that are not experienced with this type of horses) still feel they can give their opinions, which typically are either pessimistic or non responsive to their recommendations. Basically they just don’t know , if it would be a lot easier if they accept that. Eventually, it’s easier for them to give up and tell you to just euthanise your horse instead of trying to save your horse.

Without blood supply there is no growth , therefore no new sole. What you are seeing there is just the remnants of the leakage from the blood supply that was compromised and severed. If healthy it would be nicely leveled res corium with evident terminal papilla instead of prolapsed corium that was pushed by the displacement of the coffin bone .
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In hindsight I am still confused over the ambiguity of horse professionals and lack of knowledge or solutions. I did not feel a tenotomy was the answer having witnessed excruciating results from hernia and bowel resection in hospital due to complications when it heals and pulls. Looking back I should have insisted on a venogram to determine blood supply and at least have tried the led light therapy. My main source of inspiration during this whole episode was a woman who had saved her pony with laminitis in all fours on her own initiative and whether hers was less severe than mine or the LED light she used and massage helped her get thru, I cannot say but SHE saved her own pony and those experiencing the trauma of laminitis in your face need to take control of the situation.