Abstracts / Journal of Equine Veterinary Science 31 (2011) 562-609604

misleading, as it gives the appearance of successful treatment. Ifthe hyperinsulinemia is not corrected, then continued stretchingand damage occur in the laminae. As time goes on, further boutsof acute laminitis inevitably occur and the cumulative damageeventually leads to permanently abnormal, crippled feet.The good news is that this result can be avoided by early recog-nition and prompt intervention. If instituted early in the diseaseprocess, normalizing the blood insulin levels can reverse thedestructive changes that occur in the feet of hyperinsulinemicanimals. Both physical and radiographic evidence supports thisobservation.Pre-emptive Management: When these hoof changes are seenby hoof caregivers, the owner must be notified and encouraged tohave their veterinarian measure the horse's fasting blood insulin.Proper care, which includes a low-glycemic diet, increased exer-cise, and appropriate medications when needed, can bring theinsulin level back down into the normal range. By normalizinginsulin levels and providing proper trimming and hoof care,laminitis can be prevented and a normal hoof regrown.Conclusions: Prevention is always preferable to treatment whenit comes to laminitis. This form of the disease causes slow changesin the foot which can be reversed if detected early by farriers, hooftrimmers, and veterinarians, and then managed appropriately.

Medical acupuncture for equine laminitis

Lisa Lancaster DVMColorado State University, Medical Acupuncture forVeterinarians Course

Take-Home Message: Acupuncture is a safe and effectiveadjunctive therapy for acute and chronic laminitis. Acupuncturecan also be beneficial when included in standard laminitisprevention protocols in at-risk hospitalized patients.Introduction: Acupuncturedthe insertion of thin, solid, flexibleneedles into specific anatomic locationsdcan be used as part ofmultimodal therapy for equine laminitis. Acupuncture is acces-sible for all equine practitioners, whether you choose to do ityourself or find a colleague to be part of your case managementteam.Acupuncture Effects: Acupuncture has regulating influences onmultiple organs and tissues, including those commonly involvedin laminitis such as the musculoskeletal, gastrointestinal, andimmune systems. The effect varies with needle point location. Afew of the most well-documented effects include generalizedhomeostatic influences, such as normalizing gastrointestinalmotility, and regional influences on specific tissues, such as bloodflow changes and release of muscle spasms.Mechanisms of action: Neuromodulation is involved in manyof acupuncture's effects. Acupuncture works on multiplephysiologic pathways and processes at local, segmental, andsuprasegmental levels simultaneously. Mechanisms includemechanoreceptor activation, vasoregulatory modulation, andneural signaling influences at multiple levels of the nervoussystem. Endocrine and immune regulation is associated withactivation of different regions of the brain that can be influencedby specific acupuncture needle placement in the periphery.Clinical Applications in Laminitis: Although there is not yetclinical research on acupuncture for the treatment of equinelaminitis, sufficient evidence of its general effects in veterinarypatients supports its use in laminitis. Two well-researched,evidence-based applications of acupuncture include the treat-ment of pain and inflammation, making it nicely suited fortreating foot and body pain as well as comorbid conditions in

laminitis patients. Acupuncture can reduce nociceptive as well asneuropathic pain. In chronic laminitis, acupuncture can beeffective in treating myofascial pain syndromes that typically aredifficult to treat using conventional therapy.Acute vs. chronic laminitis: There is no textbook point formu-lation that will work in all cases. However, there are somegeneralizations that are clinically useful. In both acute andchronic cases, there can be value to using classic acupoints aroundthe hoof, in addition to other anatomic points on the limb thatmay not necessarily appear in textbooks. In chronic cases, therehas often been significant damage to the musculoskeletal systemas awhole, with neuropathic pain being involved beyond the foot.In complicated disease states, theoretically the needles could beplaced in many locations. But there are several considerationsthat go into point selection and the “dosing” of acupuncture.Withdiscretion as to the number and location of needles placed, theclinical response in laminitis patients is enhanced if the practi-tioner can choose wisely and get the most out of each pointchosen.Conclusions and Clinical Relevance: Acupuncture can be usedin conjunction with standard protocols, both medical andsurgical. The safety profile and lack of contraindications makeacupuncture worth trying in all laminitis patients. Like any clin-ical method, it does not work 100% of the time. Initial responsegenerally is seen within the first 2 or 3 treatments, making thecost of a therapeutic trial within reach for many horse owners.Veterinarians know the necessary anatomy and physiology tobegin adding acupuncture to their treatment regimens afterlearning some basic needling techniques and point selection.Complete acupuncture certification courses are available, but theyare not absolutely necessary for a clinician to begin adding thisimportant modality to equine laminitis cases. Laminitis treatmentrequires a team approach, with cooperation between veterinar-ians and farriers. It is not a stretch to add an adjunct veterinarianto the team who specializes in acupuncture. If you find a way toadd this into your multimodal therapy you are likely to seeenhanced results in many of your cases.

Case management: support limb laminitis

Scott Morrison DVMRood and Riddle Equine Hospital, Lexington KY

Take-Home Message: Foot support systems can be used to helpunload the lamellar interface and shift weight to different regionsof the foot, but there is no substitute for physically unloading thelimb. Keeping the stall deeply bedded to encourage recumbency,use of a sling, and frequent hand walking (if possible) are alsobeneficial.Support limb laminitis is a common complication of prolongedunilateral weight bearing. Several factors are believed to increasethe risk and severity. Foot type and conformation and the degreeand duration of pain in the opposite limb are all believed to affectboth the incidence and severity of laminitis in the supporting foot.Perfusion to the foot is dependent on constant cycles of loadingand unloading. Thus, severe lameness that results in the horse'sinability to intermittently shift its weight between feet puts thesupporting foot at risk for perfusion deficits, lamellar fatigue, andsubsequent laminitis.Foot support systems can be used to help unload the lamellarinterface and shift weight to different regions of the foot, butultimately there is no substitute for physically unloading the limb.Keeping the stall deeply bedded to encourage recumbency, use ofa sling, and frequent hand walking (if possible) are also beneficial.