Laminitis

Laminitis is an ever-present and very worrying threat to native ponies in Britain. It can also (more rarely) affect larger horses, under certain circumstances. The condition can be very distressing and it can prove very refractory to treatment by conventional medical means. In a recent court case, I heard a veterinary expert state that only one in thirty cases recover (thankfully, natural medicine can expect much better than this). Apart from the misery of disease and pain, which may prove difficult to control by the use of conventional pain-killing and anti-inflammatory drugs, there is the added distress caused by long-term grass deprivation and ‘imprisonment’ in enforced stabling and by possible chronic foot changes, such as rotation of the pedal bone.

It is fortunate, for those horses that have been treated in an ‘alternative’ way, that natural medicine (particularly homeopathy, acupuncture and herbal medicine) can often bring rapid and lasting relief, through a process of healing. Stimulation of healing processes is the business of such therapies, rather than attempting to suppress pain (as in the case of anti-inflammatory drug treatments). Results can be outstanding and remarkably rapid, even in those cases which have proved refractory to conventional efforts, for many months. Two such patients, among others, brightened my life, in 2006. Red in Somerset and Squirrel in Berkshire (see Case Histories) are delightful patients who have enjoyed the fruits of an integrated natural medicine and dietary programme, with a rapid return to riding, where all hope had previously long been lost and whose human companions have permitted me to use their cases, for illustrative purposes.
Of course, it is necessary to have a veterinary surgeon to use these therapies in animals and it is a cause of deep regret that vets who use and understand these therapies are rare. Rarer still are those who can properly integrate a combined programme, using all three therapies together in a synergistic manner and who work regularly with horses.

Laminitis – AVMC

Affected animals
In practice, the condition of laminitis is mostly seen in native pony breeds such as Welsh and Shetland. It is not rare among donkeys. We do exceptionally see cases in all types of horses, for some of the reasons listed below.

The signs (symptoms)
A horse that is pre-disposed to laminitis and is in danger of an attack may have a thickened crest.
The first signs of laminitis are thoughtful and stiff movement, sometimes considered just to be an ‘off day’, before the more obvious signs set in. However, the signs are exaggerated on concrete or other hard surface and on tight turns.
In a more advanced case, the pony will tend to shift weight from one foot to another, lean back to relieve weight on the front feet, bring the back feet forward for the same reason, have great difficulty in turning and, in even more severe cases, refuse to move.
Lying down is an obvious (and intelligent) way for a horse or pony to relieve pain or discomfort in the feet and is, therefore, a poor indicator of severity.
A ‘victim’ who voluntarily moves about or even breaks into a trot is not in extreme pain. Even for those who are very unwilling to move, some gentle encouragement to move is important, for circulation reasons and to keep the musculo-skeletal system healthy.

The disease process
The basic local pathology is a sudden disruption of blood vessel function within the sensitive laminae of the feet. These are the structures which generate the horn of the hoof and which ‘bind’ the hoof capsule structure to the foot.

Triggers
The disease occurs in response to certain ‘trigger’ factors. Understanding these possible aetiological factors helps us to control or to prevent the disease and helps in choosing appropriate treatment.
1. 2. 3.
Sudden change in the bacterial population and activity in the large bowel. Unsuitable diet Trauma – bruising or repetitive trauma

Laminitis – AVMC
4. Trauma – penetrating injury 5. Toxins ingested 6. Indirect effect of herbicides 7. Artificial nitrogenous fertiliser application (direct and indirect effects) 8. Heat
9. Frost (direct and indirect effects) 10. Shock / Stress 11. Fever 12. Toxaemia / Septicaemia
13. Anaphylaxis 14. Vaccination 15. Steroid / Cortisone administration 16. Disease, such as Cushings Syndrome

Examples and illustration of each of the above:
1) Sudden dietary changes will cause changes in the proportion of different bacterial populations in the hind gut of the horse or pony. If these changes involve the multiplication of the wrong types of bacteria or are too extreme and too sudden, then there can be a release of endotoxins, which can trigger the damaging effect in the blood vessels of the feet.
2) Examples of unsuitable diets, encouraging incorrect bowel fermentation and therefore higher risk, are:
• Diets containing readily-available sugar, a short-chain carbohydrate that encourages the wrong bacteria in a horse’s, donkey’s or pony’s gut. Molasses or refined sugar, in any proportion in the feed, constitutes a severe risk. A serious risk can also be posed by ‘stressed’ (overgrazed) grassland and lush spring grass, both of which contain a high proportion of non-structural carbohydrate (NSC), which tends to accumulate in growing grass. The feeding of solvent-extracted oils is also to be discouraged.
• The high-quality of lowland or ‘improved grassland’ is a risk in itself, to many native ponies, especially when it has been fertilised with artificial nitrogen compounds. This is especially true, and a danger to any equine species, if the fertiliser has been recent.
• Too much cereal is a danger. It is more natural to feed no cereal at all.
• Hay or straw, which can often be overlooked in the aetiology, are a risk if there is a high nitrogen content. Late hay, made in July, probably

Laminitis – AVMC
represents a lesser risk, provided that it has been grown without artificial nitrogen fertiliser.
• Haylage is often made from just the type of grass that is a real risk to horses and ponies. It is usually grown with artificial nitrogen application. It also encourages different bacteria in the bowel, as a result of its partial fermentation.
3) Trauma from galloping on a ‘metalled’ surface, trotting on a road for a considerable time or trauma from a wrenched shoe, can give rise to the problem. Sudden changes in exercise pattern may also lead to the problem.
4) Penetrating injury, as from a misdirected nail or from treading on a flint or other sharp object or from damaging the horn and exposing the sensitive area can all act as triggers.
5) The ingestion of plant or chemical poisons can cause the bacterial changes described above or can trigger the local response directly.
6) It appears from a collection of observations, that the ingestion of plant material, which has been altered by exposure to herbicides (even if that herbicide is declared ‘livestock safe’ in itself), may have constituted a problem to several patients in my career. Horses and ponies have contracted laminitis, coincidentally with the spray treatment. One particular example is nettles sprayed intentionally or accidentally with ‘glyphosate’, which has been the chemical cropping up most often in this circumstantial context, and which is described as ‘livestock safe’ on the label.
7) The recent application of artificial nitrogenous fertiliser has given rise to some of the most distressing and difficult cases I have seen, in all equines, from large horses to small ponies and donkeys. It may be accompanied by very sudden disruption of the structures of the foot, with rapid ‘sinking’ of the pedal bone (see ‘founder’ below).
Overheating of the laminae has also caused trouble. I recall several patients (predominantly of Arab lineage, which may or may not be a coincidence) for whom over-enthusiastic application of hot shoeing techniques has caused a severe problem.
9) We have seen cases which have started in deep snow or in hard frost. The ingestion of frosted grass can constitute a risk in itself, but circumstances in many cases suggest that ‘frostbite’ may also be an aetiological factor.

Laminitis – AVMC
10-14) These five categories can all work in a similar way, by interrupting and disturbing the normal homoeostatic, digestive and immune balance in the body. It is worth noting that toxaemia or septicaemia can even arise from undue retention of the afterbirth, in a brood mare.
15) The case of steroid-induced laminitis appears to be a separate and well- documented situation. The iatrogenic creation of laminitis in this way, in all classes of horses, is sadly not that uncommon. The risk attached to giving this type of drug to an equine means that its use should be very much a last resort and is not necessary when using natural medicine.
16) Cushings Syndrome results in high levels of circulating corticosteroids, which can predispose to or even cause laminitis, in affected animals. Whether this is the actual mechanism, it is well-established that cases of Cushings Disease are very prone to chronic laminitis.

Christopher Day – Veterinary Surgeon
www.alternativevet.org

Laminitis