1	Laminitis Common Causes Practical management And Prevention
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3	What is Laminitis: Laminitis is inflammation of the laminae leading to compromise of the coffin bone/hoof wall bond Chronic laminitis/founder is failure of the coffin bone/hoof wall bond causing displacement of the coffin bone (rotation or sinking).
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5	Causes?
6	Causes?
7	Pathogenesis Decreased blood flow to laminae Enzyme damage – activation of tissue damaging enzymes Glucose utilization – inhibition of glucose uptake by cells of laminae
8	Normal Anatomy
9	Major Players Dorsal hoof wall
10	Major Players Laminae
11	Major Players The Sole
12	Major Players Deep Flexor Tendon
13	Founder Cases
14	Diagnosis Clinical signs – “walking on egg shells”, reluctant to move, “treading”/shifting weight, increased respiration, parked out, reluctant to pick up one foot Radiographs Clinical exam – increased digital pulse, sore to the hoof testers
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16	Treatment in the Acute Phase Examination of the horse (is the horse sick?) External examination of the foot Radiographs Foot support Medication STRICT stall rest (treat them like a horse with any other serious orthopedic problem, i.e. fracture, serious tendon problem)
17	Examination of the Horse Obesity?
18	Examination of the Horse Abnormal Fat Deposits?
19	Examination of the Horse Abnormal Fat Deposits?
20	Examination of the Horse Abnormal Fat Deposits?
21	Examination of the Horse Cushings Disease? Ribs showing Long, dull hair coat
22	Examination of the Horse Increased Digital Pulse
23	External examination of the Foot Abnormal rings in feet Sore to hoof tester pressure
24	External Examination of the foot Sinking at hairline Bone coming through the sole
25	Radiographs Bone rotation Boney column sinking
26	Foot support
27	Medication Antiinflammatory Agents Banamine Phenylbutazone
28	Medications Antiinflammatory Agents Ketofen DMSO
29	Medications Isoxsuprine for increased blood flow to the foot Acepromazine for vasodilation
30	Medication Thyro-L for low thyroid hormone treatment (usually a secondary condition to insulin resistance or cushings disease) Pergolide for Cushing Disease treatment
31	Strict stall rest
32	Strict Stall Rest Stall rest is an extremely important part of therapy in the early stages of treating the disease. Movement increases the force placed on the laminae
33	Forces on the Laminae 1.) Hoofwall – pull at laminae during movement 2.) Deep Flexor Tendon- negative force, pulls at laminae during movement 3. Weight of horse – negative force, pushes boney coulumn down 4.) Sole/frog – positive force/supporting structure 5.) Extensor tendon – supporting structure
34	Forces on Laminae Force=Mass times Acceleration , Keep the horse quiet and you will reduce the amount of force placed on the laminae, reduce the weight of the horse and you will also reduce the force on the laminae
35	Treatment for Chronic Laminitis Decrease pull of deep digital flexor tendon Unload front of foot Decrease inflammation Ease break over Protect sensitive tissue Support bone column
36	Treatment of Chronic laminitis (Founder)
37	Treatment of Founder Unload front of foot Support bone column Ease break over
38	Treatment of Founder
39	Treatment of Founder
40	Practical management If known, treat underlying cause, i.e. Cushing’s disease or Equine metabolic syndrome
41	Management of Chronic Cases Thyroid supplementation Pergolide Daily exercise Weight reduction Low carbohydrate diet
42	Manage Insulin levels Treating the conditions associated with insulin resistance will help lower the chances of recurrent laminitis Thyro-L and Pergolide will help horses with insulin resistance
43	Insulin resistance Insulin resistance is associated with: Obesity Diet: high carbohydrate Disease: Cushing’s disease
44	Weight reduction, Use grazing muzzles
45	Exercise can be started when the horse is comfortable enough to be off of pain medications. It’s an important part in weight management and glucose level management
46	Weight control
47	Weight Control Good quality grass hay that has been tested for Nonstructural Carbohydrate content Manage pasture so the horse does not consume too much grass Stall rest to keep the horse off the grass during dangerous grazing hours
48	Reduce Sugar Horses at risk of laminitis should not be allowed to graze during the cool seasons (spring and fall). The grass during this time period is higher in non-structural carbohydrates (NSC=the enemy). Provide a grazing muzzle or dry lot. Test hay for NSC Soak hay to reduce the NSC
49	Reduce Sugar If allowed to graze, avoid grazing during hot times of day, 12-4 pm. Stressed grass stores NSC Dry grass = more dry matter per mouthful, therefore concentration of NSC is higher Sugars are used during the night, NSC is lowest from 3 am to 10 am
50	Reduce sugar NSC content of hay is dependant on many factors. Don’t guess…..test. You cannot tell NSC content by looking…test. Graze in early morning. Keep grass mowed to prevent heading.
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52	Devastating Disease
53	Devastating Disease
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