Research Paper on Laminitis in the Horse

Introduction

Laminitis is a severe crippling disease of ponies, donkeys, and horses. It is a painful inflammatory disease affecting the tissues (laminae) bonding the hoof wall to the pedal (coffin) (Thomas, 2006, p. 34). Laminitis varies in severity and may lead to lameness or a situation known as 'sinking' which is often fatal. As laminitis progresses, the attachment of the pedal bone to the hoof wall begins to fail. As a result, the pedal bone begins to rotate and tip to the sole. In serious cases, the pedal bone sinks right through the sole (Belknap and Geor, 2017, p. 15). Laminitis is a multi-factorial problem meaning that it caused by several factors including nutritional and even genetic reasons. Serious laminitis or recurring cases reduce the usefulness of a horse and in some instances, it is considered better to destroy the animal than to endure further suffering. Nevertheless, the owner may consider treating the disease, but it is costly requiring a great deal of time and energy from the carer. When treating laminitis in a horse, it is necessary for a nurse to identify the specific cause as it is necessary for outlining the environment and nutritional monitoring techniques to be implemented as well as choosing from the hoof care methods that would be useful in treating the disease.

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Causes of Laminitis

Laminitis is a multi-factorial disease meaning that it develops as a result of several factors. These include overload, nutritional causes, genetic and hormonal among others.

Excessive Intake of Soluble Carbohydrates (Sugar and Starch)

Laminitis may occur when a horse eats excess high-sugar grass, especially during spring or autumn. According to Jensen et al. (2016), frosted or closely grazed grass contains high amounts of fructans, which is a storage sugar type. Being a storage sugar type implies that it cannot be digested by the horse thus it passes through the small intestines to the hindgut where it elicits like changes to the starch overload. Usually, the horse should digest the sugars and starch in the small intestine and fiber in the hindgut (Pollitt and Milinovich, 2016, p. 59). In a situation where excess sugars and starch is pushed to hindgut, the overflow upsets the microflora which, as a result, increases acidity (Pollitt and Milinovich, 2016, p. 63). Consequently, the bacteria that is supposed to use lactic acid dies because it cannot survive in the acidic environment and the accumulating lactic acid will be released into blood due to 'leaky' walls of the hindgut. Laminitis trigger factors also leak out into the blood and reach the foot where they elicit development of the disease (Smith, 2016, p. 67).

Excessive intake of sugars and starch among the horses is common in those kept in paddocks or turned out in frosty or cold weather. According to Potter et al. (2017), grass buried under snow has 15% higher sugar content than is usually thought leading to a risk of the horse grazing on frosty weather to develop laminitis.

Obesity

Obesity is a risk factor for several diseases among human beings and so is in horses. In fact, in Australia and most parts of the developed world, obesity is the main cause of laminitis (Burns et al., 2015, p. 489). Obesity in horses leads to accumulation of internal fats, especially in the abdominal area (Burns et al., 2015, p. 492). As a result, the abdominal region becomes hormonally active triggering hormone releasing factors such as cortisol and other inflammatory factors which potentially cause laminitis at the foot of the horse.

Also, obese or overweight horses exert more strain on their lungs, heart and joints (Potter et al., 2017, p. 373). At the foot joints, the excess weight could lead to tipping off of the pedal bone into the sole leading to laminitis.

Hormonal Causes

Laminitis often occurs as a result of hormones unnecessarily released by the horse. Insulin resistance, Cushing's disease, and equine metabolic syndrome are common conditions leading to abnormal hormone regulation and result in laminitis. For example, 50% to 80% of horses diagnosed with Cushing's disease in Australia have clinical laminitis (Karikoski et al., 2015, p. 945). Also, in Australia and Finland, it has been found that more than 80% of the laminitis cases encountered result from hormonal causes (Angelone et al., 2017, p. 2122).

Essentially, insulin is released into the blood by the pancreas to regulate glucose. However, in an insulin resistant horse, the insulin released does not act to regulate glucose in the blood, rather enters the tissues and binds the cells leaving glucose to enter the cells at a much lower rate that it ought to be (Angelone et al., 2017, p. 2122). The result will be an accumulation of glucose in the blood which triggers laminitis in the foot region.

Other Causes

Apart from excessive intake of soluble sugars, hormonal causes and obesity, laminitis in horses may result from other factors such as physical, illnesses and mechanical. Physically, laminitis occurs when a horse has severe lameness on one limb leading to excessive weight on the other limb. This is due to pressure generated causing blockage of the capillary blood supply to the weight-bearing foot (Kane, 2015, p. 952). Also, mechanical laminitis could result when the horse encounters repeated trauma during driving, riding or jumping on hard ground as well as overenthusiastic hoof trimming (Kane, 2015, p. 953). Illnesses such as respiratory, liver, diarrhea, colic and retained placenta diseases result in the release of toxins which are pre-exposures to laminitis.

Symptoms of Laminitis in Horses

Laminitis in horses progresses in two stages; acute and chronic. Acute is the early stage when the horse begins to show signs of lameness and is uncomfortable; however, no major damage on the hoof has taken place (Bailey, Marr and Elliott, 2004, p. 132). Symptoms at this stage include panting, leaning back on the heels, sweating and showing an attempt to take its weight off the feet (Bailey, Marr and Elliott, 2004, p. 132). The horse will demonstrate a reluctance or inability to move or walk and instead lie down and not willing to get up. When walking on a hard surface or a circle, the horse will be visibly lame characterized by a high digital pulse on the foot (Bailey, Marr and Elliott, 2004, p. 132). When standing, the horse will lean back on to its hind feet in an attempt to ease the pressure on its front legs. When walking, a horse suffering from acute laminitis will place its heels down first instead of the toes because of the pain at the front of the point of frog (Bailey, Marr and Elliott, 2004, p. 132). At acute stage, recovery may be realized if treatment is initiated early.

On the other hand, chronic stage laminitis occurs when the pedal bone rotates or sinks within the hoof resulting in permanent damage. Damage to the foot has already taken place and is not an emergency (Hornig, 2017, p. 5). At chronic stage, the symptoms are as a result of relapse from past attacks. On the hoof of the horse, growth rings will appear on the hoof wall, indicating that laminitis has occurred previously (Hornig, 2017, p. 5). Care must be taken not to confuse this symptom with hoof rings resulting from stress or nutritional stress. Also, the white line in the hoof will appear widened as the heel grows faster than the toe. In other cases, a horse will have a large crest running along its neckline (Hornig, 2017, p. 6). Moreover, the horse will show lameness after shoeing and recurring hoof infections. Sometimes, red bruises within the hoof are visible during trimming (Hornig, 2017, p. 7).

Role of the Veterinary Nurse When Caring For a Horse with Laminitis at the Hospital Environment and Monitoring Techniques to Be Implemented

Laminitis is an agonizing disease. The veterinary nurse can play several roles to help the horse during hospitalization, and these may include pain management, nutrition, and hoof care. The veterinary nurse should manage and reduce the pain of the horse as quick as possible. In the hospital environment, the nurse can reduce the pain by reducing walking on the weakened lamellae. This may be achieved through the use of rest box monitoring technique. Rest box is a confining area where the horse is restrained from movement to reduce destabilization of the pedal bone and reduce pain (Clarke, 2017, p. 24). The nurse should ensure that the bedding within the rest box is deep so that the horse can dig into the bedding and ease the pain. Foam sole supports are also provided within the rest box. Sole support may be done through Styrofoam. Styrofoam involves the use of pre-cut, dense Styrofoam which compresses into the caudal portion of the of the feet to provide comfort to the horse, protection and support (Parks, 2016, p. 365). The nurse should ensure that all the bare areas are well-padded. However, the horse may be bored in the box rest, and the nurse may introduce boredom busters such as introducing playballs and mirrors within the box or using rest box with windows to allow the horse see.

Because laminitis is a painful condition, the nurse will often administer painkillers to the horse. The nurse should then follow prescription instructions to ensure that side effects resulting from prolonged use of the drugs are noted and managed.

Another crucial role of a veterinary nurse when caring for a horse with laminitis is feeding the horse. As discussed earlier, laminitis is caused by nutrition and therefore feeding the horse becomes a crucial area for managing the prognosis of the disease. For example, where the horse has the equine metabolic syndrome, the nurse should feed the animal with low carbohydrate diet to minimize insulin response. The aim is to treat the metabolic disorder and help the horse heal from laminitis. The veterinary nurse should ensure that the horse is not consuming feeds with more than 15% carbohydrates by checking the feed labels (Scantlebury et al., 2014, p. 9). Also, if the nurse plays the role of ensuring that the horse exercises if the cause of laminitis is obesity. The nurse will help the horse lose weight through exercise. This therapy is useful at the acute stage of the disease. Exercise may be achieved through free-lunging on a soft surface (Van Eps et al., 2011, p. 411). The exercise should begin once the pain has resolved and the horse is not demanding pain relief. After the exercise, the nurse should ensure that lameness has not resumed and the horse can walk well.

Similarly, the nurse should ensure to incorporate physiologic concepts of hoof plasticity during management of laminitis in the horse. This may be achieved through natural trimming of the foot with laminitis. Natural trimming realigns the coffin bone comparative to the hoof capsule and the floor (Markwell and Baxter, 2016, p. 427).

Hoof Care Methods and Associated Nursing Care Requirements

Laminitis is a disease affecting the hoof of the horse. Consequently, treatment is better enhanced through hoof care methods although with careful nursing techniques. The hoof care methods for treating laminitis are divided into two; traditional and current.

Traditional Hoof Care Methods and Associated Nursing Techniques

Treatment for laminitis in the horse has evolved but the past hoof care methods used included heat bar and egg bar shoes. The heat bar was thought to provide support for the horse suffering from laminitis. Using heat bar shoe on a draft horse pulling heavy loads significantly reduces laminar disease (Fryer, 2001). However, applying a heat bar shoe requires preciseness and thorough training, as well as x-rays, are required for proper placement. In some instances, the veterinary may use pads.

The heat bar shoe works by exerting pressure on the frog to prohibit rotation and pushing the third phalanx back to where it was located originally. The heat b...