Laminitis is unlike any other equine disease. The complex cascade of events that causes the soft tissues (laminae) within the hoof to swell, weaken and die begins before outward signs are apparent, and once the process has been initiated, it is extremely difficult to halt. What's more, a severe case of laminitis is likely to leave behind a permanent reminder: founder, an internal deformity of the hoof that occurs when the supporting laminae loosen their grip and allow the coffin bone to rotate downward.
Advances in research over the past decade or so have provided many insights into the progress of laminitis, and practitioners have used these findings to develop more effective ways to ease horses' pain and lessen the forces that threaten to pull hooves apart from within. Indeed, horses who once would have been considered lost causes now have favorable odds for surviving laminitis. Still, the condition continues to challenge researchers in the lab, veterinarians in the field and owners facing the prospect of lifetime care for a compromised horse.
For all that is known about laminitis and founder many questions remain, particularly when it comes to expectations and outcomes.
"Laminitis is one of the most complicated diseases there is," says William Moyer, DVM, who has treated hundreds of foundered horses in the past 30 years, first as a farrier and then as a veterinarian. "You can't always accurately predict what will happen from one day to the next, much less a month or a year from now," he says, and that can be a harsh realization for anyone dedicated to caring for a foundered horse, one forever changed by the disease.
Of course, through the knowledgeable counsel of veterinarians and farriers, it's possible for any of us to make well-reasoned decisions about a foundered horse's care, and many times, those decisions will yield positive results. Just as often, however, even the most-determined course of action will seem to have little or no effect, and there will be no apparent rhyme or reason for its failure. That's when many begin to feel the frustration of making critical decisions about a horse's long-term care without substantive scientific facts for guidance.
Lacking concrete answers in such situations, Moyer says he offers the best advice he can, based on his three decades of experience. Yet what he has to say isn't always what owners want to hear.
"All I can do is try to prepare them for the potentially rough road ahead," Moyer explains, and that usually involves taking a hard look at an owner's expectations for a horse's health and future in light of the likely realities of the situation at hand. Here are four areas of concern Moyer most often explores with owners who simply want to do what's best for a foundered horse.
A Cause, A Cure
The expectation: It's necessary to identify the original cause of a foundered horse's condition in order to initiate treatment.
The reality: Treatment can proceed even when no obvious agent or event emerges as the trigger.
"There is a very strong and completely understandable desire among horse owners to know what happened," Moyer says. "But there are times when we'll never know what caused a horse to founder."
Of course, there are times when the inciting incident is obvious and the course of treatment clear-cut. For instance, a horse develops laminitis immediately after colic surgery or as a result of an all-night grain binge. Then there are cases when efforts to identify the cause could prevent laminitis in other horses. For example, if two horses on a farm are stricken a few days after a new shipment of shavings arrives, it's worth ruling out the possibility of black walnut toxicosis.
In just as many other instances, however, the condition's cause is elusive. It isn't directly related to a horse's management or his health status, yet it's tempting to look for something--or someone--to blame. "At times I hear 'Oh, I just dewormed my horse, so the dewormer must have caused it," Moyer says, observing that a single incident does not make the case for a causal link. For example, he says, if a horse develops laminitis after receiving single injection, the two events are not necessarily associated, and it's important to avoid misdirecting blame.
Only the Best Will Do
The expectation: Choosing the most effective treatment regimen for a foundered horse is simply a matter of knowing as much as possible about the available options.
The reality: The reason so many options exist is that there is no one best way to manage a foundered horse. What works for one horse may not work for another, and in many cases, only time will tell whether a treatment is effective.
When your horse progresses from painful laminitis to disabling founder as many do, you'll naturally want to educate yourself on the various treatment techniques and management strategies available. You'll find no shortage of options or opinions on how to maximize a foundered horse's comfort. A few hours spent talking to your veterinarian, farrier and friends, reading magazines and textbooks and logging on to the Internet will yield volumes of worthwhile--and occasionally worthless--information. As a result, you'll likely find yourself debating the merits and drawbacks of therapeutic measures ranging from the backward application of shoes to tendon cutting to standing your horse in ice water for 12 hours a day.
Which measure is best? Unfortunately, no one--not even the top minds in laminitis research--knows for sure. "There have been no controlled, scientific studies comparing one management technique to another," says Moyer. "So at this time, there is no basis for saying that one technique works better than another," even if it has been beneficial for other foundered horses.
"You'll get a lot of advice from everywhere, and everyone will have a story of what saved a horse they know," Moyer continues. "By all means mention it to your veterinarian and farrier, but please don't expect it to work for your horse just because it worked for someone else's. I know firsthand how frustrating it is," Moyer concedes. "You can treat two horses in exactly the same way, but have two very different outcomes."
Of course, there are some ways a veterinarian and farrier can narrow treatment options based on certain characteristics of a horse's condition. For example, X-rays of the horse's hoof may reveal severe rotation of the coffin bone, indicating a need for more support than a lesser rotation might. But such evidence only suggests a direction for treatment. The real test is how the horse responds over time. "I do think that there is something out there that can help every horse," Moyer says. "The problem is that something is different for every horse, and you won't know what it is until you happen to try it."
This reality check applies not only to specific treatments, but to the horse's long-term management as well. Whether a foundered horse will be better off in a field or in a stall, on deep bedding or thick mats, shod with bar shoes or left to go barefoot is not easy to predict. "If there was one surefire way to manage a foundered horse, we'd all be doing it," says Moyer.
The expectation: A foundered horse who's responding to treatment will steadily improve until he returns to normal.
The reality: A foundered horse's progress may vary greatly from day to day, and even when he seems to have fully recovered, he's more likely to bear some evidence of having suffered from the destructive hoof disease.
We're all aware of stories of horses miraculously returning to their original form after an episode of profound laminitis and founder. These tales warm the heart and lift the spirits of those facing similar challenges. However, they also can present a very skewed picture of what we can expect about a horse's recovery--a process that, more often than not, will leave us feeling as if we're caught on an endless roller-coaster ride as we experience the inevitable highs and lows of improvements and setbacks that are likely to occur on a recurring basis.
"Regardless of how a horse looks when first examined, his response to treatment as well as the final outcome of his condition can't accurately be predicted," says Moyer. Over the course of a few months, a horse may grow new hoof that eventually looks normal. He may even be able to return to his previous duties. But appearances are deceiving, Moyer reminds us. "People only see that a horse is sound, and that is great. But it doesn't mean that the internal structures of the hoof have recovered.
"Treatment of a foundered horse can only be considered an attempt to allow the horse to exist comfortably with structural damage," Moyer continues. "You can diminish pain and possibly prevent more damage, but you can't reverse what has been done."
That's the primary reason why Moyer recommends that owners take a foundered horse's progress one day at a time, particularly in the first days and weeks after treatment has been initiated. Have hope, by all means, he says, but have a plan in mind in case a horse's condition takes an unexpected turn for the worse.
"Even after a horse seems to have recovered, he's likely to experience any number of other foot problems--a recurring abscess, a hoof-wall separation or abnormal hoof growth" Moyer says. Certainly, problems of this sort can be remedied, and they'll be that much easier for an owner to deal with when it's expected that they'll arise.
The expectation: You will do whatever it takes to see that your foundered horse recovers.
The reality: Caring for a foundered horse can take an enormous investment of time and money, as well as emotional fortitude.
If dedication to helping your horse recover were enough to make it happen, every foundered horse would quickly return to soundness. Of course, no one wants to stand by and see a horse suffer. Yet it can be extremely difficult to nurse a horse through laminitis and then founder. Recognizing what lies ahead can help you take stock of your resources so in the face of any eventuality you're well prepared to make the best decisions for yourself and your horse.
Consider first, the investment of time. "Successful management of a foundered horse requires some form of daily, and at times, demanding work," says Moyer, whether your horse lives on your premises or is boarded elsewhere. From administering medication to changing hoof dressings to simply assessing how your horse is feeling, you'll find yourself spending many hours each day at the barn. There is no substitute for daily visits and one-on-one attention.
Financially, laminitis may be the most expensive equine disease to treat, and its unpredictable nature makes it virtually impossible to budget for long term. The cost of an initial veterinary visit for a case of acute laminitis can run between $100 and $500, depending on your location, the diagnostic efforts required and the course of treatment prescribed. For a horse that survives, there will be follow-up veterinary visits, analgesic medications and frequent appointments with the farrier. A conservative added-cost estimate for minimal care for a foundered horse is $200 a month.
If complications arise, expect your financial outlay to increase too. Trips to university clinics or specialists can cost thousands of dollars. So can custom-made therapeutic shoes. X-rays may need to be taken several times during the year at a cost of at least $200 a session. It is not unheard of for an owner to spend $10,000 in a single year to treat a complicated case of laminitis. And even then, there are no guarantees for the horse's survival or future soundness.
Finally, be prepared for the emotional toll that caring for a foundered horse will take. Can you live with the uncertainty of not knowing what you'll find at the barn each day? Are you prepared to do what's best for your horse--even if that means euthanatizing him? Answering these questions calls for some introspection: The emotional drain is difficult to imagine unless you've gone through it, and no one can tell you whether you have what it takes to deal with the situations you're likely to encounter.
Research may one day yield preventive measures for laminitis and founder, but for now the best that owners, veterinarians and farriers can do is manage the aftermath in a way that best serves the horse.
"I wish there was more I could tell owners," says Moyer. "It's hard not to sound negative, but caring for a foundered horse is incredibly difficult." Nevertheless, having the right mindset and honest information going into it can ease some of the burden and help to bring about a successful outcome."
This article originally appeared in the August 2001 issue of EQUUS magazine.