The Laminitis coordinator

Your farrier convinced you that your horse needs these very special shoes. The vet left you an impressive amount of painkillers, vasodilator and antidiabetic drugs. The homeopath, the biomagnetic therapy practitioner and the acupuncturist promise that your horse will quickly recover, if you apply their specific therapy. With both vitamin supplements and detoxification treatments you try to do your bit. And yet, somehow, your horse becomes laminitic over and over again. So, what’s going wrong every time?

Broad consideration

The main reason why a horse won’t properly recover from laminitis is because the problem isn’t addressed in an integrated and comprehensive manner, which is unfortunately too often the case. However, doing so will often be just enough to make the difference. Still, it is only natural that each practitioner will try to tackle the problem based on their own skills, knowledge and experience, using their specific diagnostic tools and techniques. The more often that this proves to be successful – whether solely thanks to their treatment or not – the more they will be convinced that their approach is the right one and the only necessary one. Less and less will they take the whole range of contributing factors into consideration.

Coordination

In the fight against laminitis there should always be someone who takes care of coordinating the entire process of prevention and treatment. The best person for that job is you. You see your horse every day; you know his peculiarities and his usual behavior; you can read him like the proverbial book. You see things that someone else wouldn’t see. After the horse himself, of course, it is you who has the greatest interest in a positive outcome. If you succeed in establishing a coherent treatment or prevention plan this could very well be the essential link that will lead your horse to recovery. You are the laminitis coordinator.

Five essential factors

There are five mutually-influencing factors that impact a horse’s chances of complete recovery from laminitis. So it is important that, as the laminitis coordinator, you ensure that each of these factors get the attention they deserve:

1. Management of underlying health problems;
2. Healthy and natural nutrition;
3. Sufficient and adapted movement and exercise;
4. Housing that stimulates movement; and
5. Proper hoof care. 

1. Management of underlying health problems

Laminitis is not a hoof disease, although the most obvious and severe symptoms can be found in the hooves. It is a manifestation of problems in one or more parts and functions elsewhere in the horse’s body. It is therefore a systemic disease. Although laminitis is almost never the result of one single cause, often a main culprit can be identified. However, eliminating this main cause alone will not be effective when other (partial) causes remain unresolved. Your job as the laminitis coordinator is to make sure that the vet, or any other qualified therapist, successfully eliminates these underlying causes. Underlying health problems that can cause laminitis range from endometritis to sepsis, from influenza to ‘Monday disease’ and from hormonal problems to colic, and many more.

2. Healthy and natural nutrition

Healthy and natural nutrition is indispensable in the treatment and prevention of laminitis. The closer we stay to the natural needs of the horse, the more balanced its digestive process will be and the healthier and stronger the horse will become. Digestive problems will be minimized. The laminitis coordinator ensures that the horse gets the right food and an optimal feeding regime.

Starch, sugars…

One of the most important ways to ensure healthy and natural nutrition is by minimizing the intake of starch, simple sugars (glucose and fructose) and double sugars (sucrose). These carbohydrates play an extremely important role in the development of laminitis. Shortly after the horse has consumed them, specialized hormones – called incretins – are secreted. These incretins cause the pancreas to produce more insulin that, in turn, prevents blood sugar levels rising too much. Excessive intake of starch and sugars therefore leads to increased insulin levels. This is undesirable and harmful; especially so for insulin-resistant horses that fail to respond normally to the hormone insulin. Prolonged increased insulin levels can be the cause of so-called pasture-associated laminitis, or worsen the severity of an existing case.

… and fructans

An overload of starch, sugars and fructans – the so-called non-structural carbohydrates (or NSC) – can cause acidification in the large intestine, which is another infamous cause of laminitis. Acidification leads to the destruction of essential bacteria and microbes in the large intestine and thereby to an increase of toxins. Excessive amounts of these toxins can cause blood clotting inside blood vessels, which results in reduced blood flow to the hooves. The laminitis coordinator needs to be eagle-eyed on the intake of NSC.

Nutritional advice

The simplest and most important nutritional advice is: give your horse coarse and stemmy hay that is low in NSC, clean drinking water and a salt lick. If you have reason to think that your horse is missing vitamins or minerals, get it tested and seek expert nutritional advice about supplementation.

Toxins The laminitis coordinator is also alert to toxins that originate outside the body and which can contribute to the development of laminitis. Toxins can be found in mould, fungi and yeasts in food (hay, haylage, silage) as well as in toxic plants and in contaminated drinking water. The most efficient way by far to get rid of toxins is by: relying on a well-functioning liver, kidneys, urinary system and intestines; providing movement; offering a high fibre diet for the intestines; keeping waste product levels low; and, of course, by making sure no new toxins are introduced. Sounds like a job for the laminitis coordinator.

Mouldy hay can contain toxins (photo: Kate Light)

Weight loss A fat horse is not normal and not healthy. Being overweight is an important factor in regards to laminitis. If your horse is too fat you need to help it to lose weight. Make sure the weight loss is gradual, however. Rapid weight loss – especially in Shetland and Welsh ponies, Haflingers and donkeys – can cause hyperlipidaemia, which can result in vasoconstriction – itself another potential cause of laminitis.

A fat horse is not normal and not healthy (photo: Deanna Ferwick)

3. Sufficient and adapted movement and exercise

A laminitic horse ‘knows’ how much and what kind of movement it needs (gait, speed and distance) to aid the healing process. Stabling deprives the horse of this opportunity. Box rest is not a solution, it is in fact one of the partial causes. As the laminitis coordinator you carefully (!) encourage your horse to move by:

• Hand walking;
• Groundwork or games;
• Offering social interaction with other horses;
• Creating several locations with hay, water and salt licks at a fair distance from each other;
• Fencing off a track in the meadow or sand school with electric fencing, or creating a paddock paradise.

Taking a stroll in a paddock paradise (photo: Marja van Run)

5. Proper hoof care

Before we look at what proper hoof care is, let’s first look at what it isn’t. It has been known since some time that shoes have too many disadvantages and their use is strongly discouraged. Despite this, therapeutic shoeing is often used in an ill-advised attempt to treat laminitis. Naming but a few of the disadvantages of shoes here:

• They decrease the flexibility of the hoof (‘the hoof mechanism’), limiting both the supply of oxygenated, nutrient-rich blood and hampering the removal of deoxygenated blood and waste products.
• When a horse is shod, the hoof wall cannot be maintained with a rasp or knife in between shoeing appointments. The hoof wall can quickly become too long and will then start pulling on the connection between the hoof wall and the coffin bone – called the lamellar connection – like a lever.
• Horseshoes are nailed, screwed or glued to the partially detached hoof wall. The shoes stress the growth of healthy tissue and the new connection keeps being torn loose by the mechanical force they create – frustrating the hooves’ attempt to recover precisely by growing a well-connected hoof wall.
• When a horse it shod the sole will not be able to harden sufficiently. A solid sole will provide more protection to the rotated coffin bone that is pushing against it from the inside.
• Sole flexibility is reduced when hooves are shod, increasing the chance of sole bruising. Sole bruising will make horses reluctant to walk – whilst sufficient movement is so important for the healing process.
• Shoes with raised heels are sometimes used to reduce the tension of the deep digital flexor tendon. However, they also increase the pressure on the tip of the coffin bone and the lamellar connection at the front of the hoof. What’s more, the deep flexor muscle tension will, in any case, simply adjust to the new position. This causes the forces exerted by the tendon to return to the old level of intensity quite quickly.
• Shod horses cannot feel the surface they walk on. They stumble more often and occasionally slip. For laminitic horses this is very painful and may result in less movement that would be beneficial for them.

Now turning to proper hoof care. A trim will stimulate natural healing and will greatly contribute to an effective cure for laminitis when:

• Damaged, diseased and necrotic tissue is removed;
• The hoof is balanced;
• The heels are kept low;
• The pressure on the quarters (sides) of the hoof is taken away, to stimulate the healthy development of the hoof cartilages;
• The hoof wall at the front of the hoof is trimmed to prevent it from touching the ground, so that the lamellar connection will not be further compromised;
• Pressure on flares in the hoof wall is relieved, as it generates excessive stress on the lamellar connection;
• The sole will not be trimmed, to maintain protection for the coffin bone as much as possible;
• The bars are shortened to minimize pressure on underlying sensitive tissues; and
• The frog keeps its shock-absorbing function.

A dedicated laminitis coordinator has acquired the know-how that is necessary to evaluate the work of his hoof care practitioner on the aforementioned points. Even better if you have followed a trimming course so that you can contribute by picking up the rasp and hoof knives in between their visits.

Again: coordination

Experts and specialists can be found for each of the areas described above. Watch out for the pitfall of having ‘two (or five) captains on one ship’. Different care providers, giving conflicting advice, will certainly not accelerate the healing of your horse. We are talking about your horse here, so it is you who decides what happens and nobody else. Make sure that anyone that is involved in the recovery of your horse follows the same line. Ask them critical questions. Make clear communication agreements and set goals. Everyone should know what the expectations are. Do what you can and don’t get frustrated when some things are beyond your capabilities. Find help to increase the possibilities.

Try, observe, adapt

A laminitis coordinator is flexible. Have a continuous improvement mind-set: constantly try to optimize the circumstances and treatment for your horse. Close observation of your horse will reveal the results. When needed, you will adapt the chosen strategy. A checklist that will certainly help you with these observations can be downloaded here.

Who’s next?

Now that your horse has found a laminitis coordinator in you, it is good to realize that every laminitic horse needs one. Next time you see a horse suffering from laminitis or circumstances that might provoke its onset, let the owner know that you can help them find out how to (finally) help their beloved animal to recover from, or avoid this crippling disease. They too can be the laminitis coordinator that their horse needs to stay healthy.