b'NEAEP Conference Wrap SPONSORED BYa robotic sling that provides individualPreventing or Managing Acute Lamini- the hoof itself buffers heat remarkably, limb load relief rather than unloading alltis: Act Fast, Seek Ice Water Immersionhe said, so its a real challenge.limbs as existing slings do. No matter the laminitis trigger in a horse,Hoof surface temperature is not a good Another approach he and otherthe response is the same: Dont delay.indicator of the temperature inside the researchers have taken to unload the sup- Chill the feet. Provide pain relief. capsule; the wall might feel quite cold to porting limb is forced recumbency (lyingWe can prevent laminitis if we get ittouch with some cooling approaches, but down): putting horses in a stall or corralearly enough, and even in clinical situa- it takes immersion in an ice water slurry with a low ceiling or roof so they cannottions it has been shown that cooling theto cool the interior of the foot to the extent stand for controlled periods. They veryfeet can help prevent laminitis in horsesthat laminitis can be averted or helped.calmly accept their lot, he said of horseswith colitis, he said. Ice packs are convenient, and we are in which his colleagues have tested thisVan Eps explained the original rationalehopeful that with the right apparatus they approach for up to three days. Van Epsbehind cooling limbs in horses at risk ofmight be useful, he said. But ice pack said the approach might sound ridicu- or experiencing acute laminitis: bloodsystems in our testing thus far have not lous, but knowing what he knows aboutvessel vasoconstriction in the feet, whichbeen near as effective as ice and water laminitis, he feels it might be useful eitherwould limit delivery of blood-borne lami- immersion at cooling the actual lamellae as a preventive or in acute cases. nitis trigger factors ranging from endotox- deeper in the foot.Other approaches involve pain relief.in or bacteria to other compounds withinVan Eps said he did some research with Administering systemic analgesia suchthe body. He cited research in whichcustom-built ice compression systems, as opioids can make horses sluggish,cooling scalps of human chemotherapywhich were very effective but expensive. causing them to move less when, again,patients inhibited hair loss; constrictingThat and the ice water immersion were limb cycling is whats desirable. Regionalthe vessels is thought to limit both chemothe most effective means, he said.techniquesblocking the injured limb delivery to the follicle and follicle activity. The evidence we have suggests that might be the better answer. Cold, though, has these reallythe temperature within the lamellar tissue profound effects on limiting metabolicbelow the hoof wall needs to be less than activity and limiting inflammation, he10 degrees C (50 degrees F)that is the It takes immersion in ansaid, as well as on analgesiareducedtemperature that has proved effective in sensationand enzymatic activity. the experimental trials we have done.ice water slurry to coolDoctors have also used cooling exten- I do think that ice water immersion is the interior of the foot tosively in children with hypoxic ischemicstill the way to go, he added, and there encephalopathy (oxygen deprivation toare commercial systems out there that the extent that laminitisthe brain), he saida similar conditionare designed to allow constant ice and to that seen in foals with periparturientwater immersion and that achieve similar can be averted or helped asphyxia (so-called dummy foals). temps to what we get experimentally.Van Eps said there are also someHe recommends starting ice water laminitis cooling parallels with acute lungimmersion of the hooves of any horse injury in systemic inflammatory responseimmediately at risk for developing acute We need to get them moving, saidsyndrome (SIRS, or sepsis) research inlaminitis, such as horses with colitis, prox-van Eps, but recognizing when they arehumans. In rodent models of this im- imal enteritis, and grain overload, prior to not moving enough (and laminitis is anportant human disease, you end up withclinical signs developing. Keep the limb impending threat) is half the challenge. reduced white blood cells in the lungs ofimmersed for as long as neededhe says He said for this effort researchers needrats that are cooled, indicating that cool- horses have tolerated clinical ice water technology to measure not only hearting can reduce the damage and inflamma- immersion for up to five days.rate and movement in supporting-limb-tory response in organs of septic animals.When do you stop icing the feet? Use laminitis-prone horsessomething exist- In septic horses at risk of laminitis, hesabatement of primary disease as a marker ing wearables dobut also subtle offloadsused microdialysis probes to check glu- for cessation, he said. Along with reso-of the limb; pedometers on limbs justcose metabolism in cooled feet, findinglution of fever and other signs of endo-count the steps and tend to overestimate. indicators of energy metabolism interfer- toxemia, blood tests such as SAA (serum While we wait for technology to be- ence in septic horses but not in septicamyloid A) are ways of determining if the come available, said van Eps, the besthorses whose feet were iced. Cooling hassystemic inflammation has subsided.thing we can probably do for horses ata profound effect on slowing the metabo- Possible untoward effects of cryothera-high risk of supporting-limb laminitis islism of glucose in the feet, and there ispy are increased blood viscosity, enhanced controlled walking or static load cycling,some evidence that (cryotherapy) may bemicrovascular thrombus (clot) formation, as often as every two to four hours. Forc- preventing a secondary energy crisis, heimpaired coagulation, enhanced edema ing them or encouraging them to takesaid, which may be one way it helps slow(fluid swelling) at lower temperatures, some steps or at least unload that limb.laminitis progression in these horses.and immunosuppression. But the only ad-I think theres some development in thatEven in horses with signs of acuteverse effects vets have seen are dermatitis space thats likely to be useful in actuallylaminitis, its not too late to cool the feetand (rarely) frostbite when ice has been in getting rid of this problem. and help reduce disease progression. Butcontact with the skin for too long.h34February 2020The Horse|TheHorse.comNEAEPWrapUp.indd 34 1/3/20 10:54 AM'