With a packed room of veterinarians at the 2008 American Association of Equine Practitioners convention, held Dec. 6-10 in San Diego, Calif., facilitators Jim Belknap, DVM, MS, Dipl. ACVS, PhD, an associate professor in the Department of Veterinary Clinical Sciences at The Ohio State University, and Rob Boswell, DVM, of Palm Beach Equine Clinic in Wellington, Fla., opened discussion about preventing and treating laminitis. Belknap remarked on the latest research showing that laminitis is an intense inflammatory injury of the foot and is no longer believed to be solely a blood flow problem. It is known that even though a horse with imminent laminitis might look normal and as yet show no lameness, inflammatory mediators are already elevated by up to 1,000-fold in the laminae.

With that in mind, Belknap is an advocate of administering very high levels of anti-inflammatory medications (500 mg three times per day of flunixin meglumine) within the first 72 hours. Belknap realizes that this high dose is more likely to lead to some gastrointestinal (GI) ulceration and, thus, it should not be used on every horse. But he stresses that it is critical to get foot inflammation under control and ulcers might be the lesser of two evils. Once the acute stage has settled down, it might be desirable to switch to phenylbutazone for better pain relief.

Ice can be beneficial for the same reason that hypothermia is used in some types of inflammatory injury in human medicine: hypothermia is anti-inflammatory and slows down the metabolic rate (i.e., enzyme activity) of injured tissue.

There might be a great benefit to getting the feet on ice immediately to decrease the activity of deleterious enzymes, such a MMPs (matrix metalloproteinases), and to decrease inflammation. Studies show that the best means of cooling the feet is by using a bucket arrangement or wrapping the hoof in a 5-liter plastic bag or truck inner tube filled with ice and water. Refresh ice continually as needed. The table topic facilitators stressed that no harm can come of keeping feet in ice for 72 hours–as much ice therapy as possible is desirable in averting the inflammatory effects related to acute laminitis. After 72 hours no ice is necessary and, in fact, it might be counterproductive to soften the foot with water soaks. The horse should not be walked during the acute phase