When Debra Ladley first noticed her 18-year-old retired hunter gelding, Jack, was experiencing sudden lameness, she thought what most horse owners do – that there was a hoof abscess brewing.
When Jack's discomfort didn't resolve after a couple of days of anti-inflammatories and no abscess popped from the foot, Ladley called in her horse's care team to dig deeper into the problem.
“It became very clear that it was a bigger issue and then we started intensive, intensive icing,” said Ladley. “Our local vet said as much ice as you can do, that's the best thing, so we iced both of his front feet, although the situation was more acute and required the most attention in the right front.
“We iced him pretty much around the clock during the day and then, up until the night time … half hour on, half hour off, half hour on, all day long. We had two freezers going with as many ice boots as we had collected around the farm.”
Ladley is located in Pennsylvania but her local veterinarian was able to consult remotely with Rood and Riddle Equine Hospital's Dr. Raul Bras, who is part of the clinic's renowned podiatry department. Bras said that icing to address laminitis has become an important tool in the toolbox of veterinarians, farriers, and horse owners.
The confirmation that cold could be used as a laminitis treatment is the result of research funded by the Grayson-Jockey Club Research Foundation in the late 2000s and early 2010s. It's still being studied today as researchers and veterinarians perfect best-practice about how and when to use ice in different situations.
Laminitis has a variety of causes and is a notoriously painful condition that can sometimes prove fatal to horses. It occurs when the tissues that attach the hoof wall to the internal structures of the foot, including the coffin bone, become damaged and inflamed. That attachment occurs through the interlocking of finger-like soft tissue projections on each side, and a disruption to that connection can be catastrophic, and in extreme cases, can result in the fingers separating.
Laminitis has been connected to endocrine, sepsis, and mechanical causes. Horses who have been through a period of stressful illness may experience the disease; it can be brought on by grain overload, or possibly secondary to another injury which requires the horse to offload extra weight onto supporting limbs.
Ladley said in Jack's case, she was stumped about the cause. In hindsight, there had been more rain during that part of the summer and she wondered if that may have changed the sugar composition of his pasture, mimicking a grain overload, but otherwise his routine and health had been unchanged. She also recalled the air quality in Pennsylvania was bad around that time due to Canadian wildfires, and while Jack didn't appear outwardly bothered, she didn't know if the smoke created internal stress.
The key to addressing laminitis is speed. Damage to the lamellar structures is considered by veterinarians to be irreversible, so minimizing that damage is the goal. Cold therapy is most commonly suggested by experts in the same way Ladley knew to use it – at the earliest signs that something is brewing – or preemptively, in cases where horses have gotten into the grain bin or are fighting serious systemic infections.
Bras said that many people believe that cold will prevent laminitis or keep it from worsening because they think it's reducing bloodflow to the tissues in the hoof. That's not quite right.
“The horse has such a complex blood supply anatomy, like the arteriovenous shunts and all those kinds of things, they actually regulate their temperature in their feet,” said Bras. “That's why you see all those horses in Iceland standing on ice and they don't freeze. And that's why you can do cryotherapy as well.
“But the biggest thing about the cryotherapy is actually to decrease or slow down the metabolism in the blood in the hoof capsule.”
Bras said it's the enzymes and inflammatory factors being carried in the blood that are causing the damage, and the cold slows their action down. It probably also provides some anti-inflammatory benefits to make the horse more comfortable. Ice should be applied for at least 72 hours, as constantly as possible – which is tough to do outside a clinic, especially because melted ice has to constantly be refreshed. Ladley said the farm where Jack lives was able to provide him an army of support, with staff from all corners pitching in to keep him on his schedule in that critical timeframe.
At one time veterinarians thought that ice could only be used preventatively, which was tricky since it was impractical to do constant icing on every hospitalized horse who had experienced colic or a fever with the anticipation they could eventually be at elevated risk. Now, vets realize that it's worth doing in the acute stages of the event, too.
Bras says he has also learned more through the years about how to effectively apply the ice. The cold apparatus should go up to the mid-cannon bone for maximum effectiveness, and he's found that using an ice water slurry with the right type of ice boot will actually get the limb colder than straight ice. He also prefers to leave the ice on rather than removing and reapplying, and is not concerned about skin damage for the 72-hour period.
“I tell people you've got to pick your battles,” he said. “I mean of course, it's not the ideal thing for the horse but he's going through laminitis. I'm willing to risk a compromise to insensitive structures and hope to save the internal sensitive structures that provide the blood supply and drive hoof growth.”
Sometimes patients will remain comfortable after the ice is withdrawn at the end of the 72-hour period, but others may become sore. At that point, Bras thinks it's ok to reintroduce the ice in hopes a little more time will beat back those inflammatory mediators. The 72-hour recommendation was based on the way one research study was set up, but Bras says the tricky part about applying academic research to practical cases is you aren't limited to the same time or scale confines the researchers were.
Ice isn't going to be the magic cure long-term, either. Bras wants to follow up that initial period of treatment with a meticulous examination of the foot to check for coffin bone displacement or rotation, followed by corrective shoeing. Then, veterinarians have to try to pinpoint and address the trigger, if there was one, that started the laminitic episode.
“It's a useful finding that gets used a lot but now we're in the stage of perfecting, how to think about it and how to use it,” said Bras.
As for Jack, Ladley hopes the worst is behind him. He's well into a corrective shoeing program together with Ladley's local veterinarian and Bras, who overnighted the first set of supportive shoes to her when Jack's episode began. Ladley suggests that large barns like the one where Jack is stabled have a small freezer on hand to chill ice boots, just in case.
“Obviously we had veterinary support, we had drugs, we had everything else,” said Ladley. “So It wasn't like [the ice] was the only thing we did, but I do think it was a very impactful piece of the puzzle.”
The post Research In Action: Ice For Laminitis Just One Piece Of A Complex Puzzle appeared first on Horse Racing News | Paulick Report.
