Adhering to your veterinarian’s carefully designed laminitis-care plan is critical to your horse’s welfare and well-being

Getting a laminitis diagnosis is a double gut-sinking whammy. Your horse is in severe pain, and you’re looking at an intense period of very stringent care—which is usually followed by a lifetime of cautious management to prevent a relapse.

Horses that have suffered a bout of acute laminitis need one week of strict stall rest for every day their feet were sore, says Andrew van Eps, BVSc, PhD, MACVSc, Dipl. ACVIM, professor of equine musculoskeletal research and Dean W. Richardson Endowed Chair of equine disease research at the University of Pennsylvania School of Veterinary Medicine’s New Bolton Center, in Kennett Square. They also generally need pain medications and anti-inflammatories. And if the laminitis was metabolic in origin—as most cases are—the horse probably also needs food restriction to control insulin and lose weight without exercise. Once these horses are finally clear to start the progressive path back to exercise, they need constant weight monitoring with special diets, limited grazing, and, if their health allows it, regular workouts.

For veterinarians the diagnosis might also be a tough one to make. Giving the bad news is almost always complicated by the fact these medical professionals must then transfer the greatest load of their patients’ care duty over to their owners. That often means their painstakingly designed laminitis-care plans don’t get followed correctly.

“We recognize the problem, and then we try to manage the problem, and the owner then becomes critical in enacting the plan,” van Eps says. “But it’s just very difficult for people to do that.”

It’s not that owners don’t want the best for their horses; on the contrary, it’s often because they want the best for them that they deviate from these highly restrictive plans, says Tamzin Furtado, PhD, of the University of Liverpool’s Institute of Infection, Veterinary, and Epidemiological Sciences, in the U.K. “People are genuinely worried about their horses’ emotional well-being,” she says.

Add the fact that managing laminitic and laminitis-prone horses is usually time-­consuming, intense, and expensive, and it’s easy to understand why this often preventable disease keeps recurring, our sources say.

The Counterproductive Guilt Complex

The biggest reason owners don’t follow laminitis management plans is they feel sorry for their horses when limiting turnout and grazing, for instance, van Eps and Furtado say. Our sources know exactly what that feels like, because they’re horse and pet owners, too.

“We’ve all been there, and it’s just so horrible having to do these things,” Furtado says. “We don’t want to be horrible! And the horses look miserable, and so then we feel guilty, and we just don’t want to (follow the plan) anymore.”

As for van Eps, he struggles with guilt over restricting the diet of his easy-keeper dog—even though it’s vital for managing her arthritic pain. “It’s difficult when they’re standing there at the food bowl wondering when dinner’s coming or if that’s it,” he says. 

People naturally want to overfeed as an expression of love and care, he explains. “It’s almost an innate thing we have, isn’t it?” he says. “So with laminitis, we have to work against that, because feeding—especially in the recovery phase—is so important.”

Calming medications, such as trazodone, can help ease the stress of stall rest and, hence, the owner’s guilt about it, van Eps adds.

“Vets are clearly thinking about the well-being of the horse,” Furtado says. “What’s important is for vets and owners to have a good conversation about the horse’s emotional well-being and to view things more holistically.”

Understanding the Seriousness of Laminitis

Laminitis is generally a preventable disease—and so are its flare-ups in chronic cases—but owners often inadvertently avoid taking the management steps that would prevent occurrences of the painful, life-threatening condition, says van Eps.

“The brutal truth is that the reason a large number of horses and ponies have laminitis is because of the way we manage them,” he says. “It’s not some act of God or mystery. It’s because they’re fed too much carbohydrate-rich food, and they don’t get enough exercise. People think that if they’re fat, they’re happy. They think overfeeding them is doing them a favor, when it’s the opposite.”

Laminitis often creeps up as horses put on weight gradually, and owners tend to overlook the subtle warning signs, he explains. Similar to humans who smoke for decades and suddenly get lung cancer, overweight horses face a silently approaching killer.

“It’s an incrementally building, slow-simmering problem that’s additive over time, and then a straw breaks the camel’s back,” van Eps says. “And then it’s too late to return them to their previous level (of) activity and, in some cases, it’s too late to get them back to a point where they’re ever going to have a good quality of life.

“I think people don’t always realize the gravity of the situation,” he adds. “With laminitis, you err on the side of caution, because once the damage is done, it’s done. So it’s really important to weigh up the long-term good versus the short-term frustration.”

Time and Money Challenges

Managing a laminitic or laminitis-prone horse requires significant time and financial resources. During an acute flare-up horses need frequent care, attention, and supervision while on stall rest. Over the long term they need as much exercise as they can get, along with regular body condition monitoring, low-carb forage, grazing restrictions, and therapeutic foot care.

These challenges alone can lead owners to stray from the management plan, says Furtado. “All these things take time and money, and sometimes people really get bogged down even just trying to make the right hay choices,” she says.

Busy owners can try recruiting help from fellow horse people or barn staff willing to pitch in on a volunteer or pay basis, she says. Once the horse can exercise again, owners can share the horse with another rider or hire a professional to keep up a regular exercise routine.

People can also think outside the box for solutions, she adds. “I’m a big fan of creative ideas that are fun for the horse and the rider,” she says. For example, Furtado takes one of her ponies on a lead when she goes running.

“But the biggest time saver that people can do is set up their fields in ways that the horses exercise themselves, like track systems,” she says. “That’s a really good way of managing weight.”

As for stall rest, Furtado suggests owners try to multitask, setting up a place to read or work in or next to the stall. This keeps the horse company and offers horse-human bonding opportunities, she says.

Media, Social Media, and Peer Pressure

Another reason some owners don’t follow their veterinarian’s laminitis treatment plan is because they’re getting pressure from other people, our sources say. Whether they fear judgment or find themselves influenced by nonveterinary “experts,” owners can make dangerous decisions based on misguided beliefs.

“It’s a massive, massive issue,” Furtado says. “I mean you literally can’t do anything right for doing things wrong.”

To start, both social and commercial media promote unhealthy body condition for horses, says van Eps. Just as advertisers have been criticized for portraying unhealthily thin or Photoshopped human models in their print and online ads, the horse world tends to present plump, round horses as ideal.

“These ‘desirable’ traits can really play into horses’ health,” he says. “As a 2-year-old, this animal may be fantastic and look fantastic, and it’s not until it’s a 10-year-old that it’s a train wreck,” he says. 

Owners already dealing with laminitis might receive online criticism from people accusing them of letting their horses get too thin or compromising their welfare by keeping them confined—even though these owners are following proper veterinary advice, Furtado says.

“People think that if they can see the horse’s ribs, they’ll be judged for not feeding their animal,” van Eps says. “But really, they should be congratulated for keeping the animal in a condition that’s healthy.”

On the flip side, owners might get shunned when their horses develop laminitis in the first place—which is also counterproductive, Furtado says.

Van Eps says he encourages the media, individuals and groups active on social media, equestrian associations, and judges to promote healthier equine body condition to horse owners and to accept responsibility for their roles as influencers. “Vets are definitely already on board,” he adds. “I haven’t come across one vet who doesn’t already feel strongly about this.”

As for owners of laminitic and laminitis-prone horses, they can enjoy the positive aspects of their horses’ care, such as bonding time and providing enrichment, Furtado says. “It’s a really nice way of showing everybody, ‘Actually, I am doing the best thing for my horse, and I’m working with professionals in their best interest,’ ” she says.

Monitoring Programs: A Helpful Solution?

Veterinarians might have more success getting owners to follow laminitis prevention and care programs if it were easier to monitor and visually assess signs of the disease, says van Eps.

When horses have soft tissue injuries, for example, owners tend to respect the rehabilitation program—often because those injuries and their healing progress are easy to follow through imaging.

“We’ve got a good handle on tendon and ligament damage because we can image that tissue in a way where we can come up with very specific recommendations,” he says. “With the lamellae of the foot, it’s not that simple.”

Veterinarians can’t, for example, ultrasound the foot to determine whether it’s healed enough for exercise. “We’re still guessing a little bit,” he says.

That lack of certainty might lead to a weaker message from the veterinarian about the importance of restricting movement. Positron emission tomography (PET scanning), however, is showing promise in revealing the functional status of laminitic tissue. “I think that’s going to give us a better handle on when that tissue is ready to be strained again,” he says.

Veterinarians can also use laboratory tests to pinpoint high-risk horses, says van Eps. Taking insulin and leptin levels can reveal insulin dysregulation and “fatness,” respectively. Some labs—such as his own at Penn Vet—can also measure adiponectin, which is a marker produced by fat cells. Animals with metabolic syndrome usually have low ­adiponectin.

“Adiponectin is a measure not just of fatness, but ‘bad fatness,’ ” van Eps says. “So it’s probably the most useful marker of metabolic health and laminitis risk in horses and ponies.”

Combined with body condition scoring, veterinarians could incorporate these tests into annual or biannual wellness checks to “bring numbers into metabolic health” that provide a more concrete way for owners to recognize the issue and the need to change management, says van Eps. “That might inspire people to have some sense of accountability and feel like they’ve got goals to aim for at the next checkup,” he says.

Collaboration, Not Compliance

The problem of owner compliance might be linked to the term itself, Furtado explains.

“This phrase always makes me cringe slightly because it suggests owners are just being lazy or ignorant or that they can’t be bothered,” she says. “Of course, that is sometimes the case. But more often, it’s a tricky situation … and we need to be supportive in helping people find management options which fulfill horses’ needs (while) keeping both the horse and the human happy.”

In human medicine, researchers have determined patients follow medical plans better when they feel like they’re based on collaborative decision-making rather than just being told what to do, Furtado says. This sets a good example for equine veterinary medicine as well. While veterinarians have expert health knowledge that owners do not, owners know their horses in ways the veterinarians do not.

“Clinicians need to take into account the individual situations of owners and what’s important to them in order to find solutions that work for both,” Furtado says. “The two together, working out what the best way to move forward is.”

Take-Home Message

Laminitis and its subsequent flare-ups are usually preventable, but prevention requires management programs that go against many owners’ preferences, resources, and social influences. As a result these owners often stray from veterinarians’ management plans—and their horses end up having laminitic episodes despite their best intentions. To remedy these frustrating situations, veterinarians can provide concrete veterinary analyses and risk assessments, and they can look for customized solutions for each case through collaborative decision-making with the owner.