29/09/2013. Goal. To treat laminitis. Acute laminitis 72 hours from first clinical signs. As good recovery as possible

Transkript

1 Acute laminitis acute treatment And then? Ove Wattle Hoof abscess Cushings Myositis Laminitis? bruising Fracture EMS Metritis Behandling av fång 1

2 To treat laminitis Goal As good recovery as possible The horse shall be as comfortable as possible during treatment Treatment should be practical a reasonable price Acute laminitis 72 hours from first clinical signs Treat underlying causes Box rest paraffinum liquidium p.o. Pain controle NSAID +.? Feeding regime feed forage high Biomechanical adjustment Prostaglandins, leukotriener, interleukiner, bradykinin, substanse P, TNF-alfa contribute to increased neurogenic sensitization and pain 2

3 Treat underlying causes and laminitis The horse should be comfortable NSAID 3

4 Primary inflammatory pain arising from peripheral tissues can be amplified by central secondary hyperalgesia and by neuropathic pain, both characterised by increased pre- and post synaptic neuronal sensitivity and activity at the level of the spinal cord Pentoxifylline, which have anti-hyperalgesic properties via inhibition of the cytokines tumour necrosis factor (TNF) and interleukin-1 (IL- 1) and matrix metalloproteinases, 8.8 mg/kg bwt per os q. 8 h Dutton et al. Equine vet. Educ. (2009) Gabapentin, an anti-seizure drug, for treatment of neuropathic pain, 2.5 mg/kg, PO, q 12 h - to mg/kg bwt per os q. 8 h. Buthorphanol, Metadone Williams et al. [2010] intravenous lidocaine had no effect on systemic and lamellar inflammation in fact there was some evidence of a pro-inflammatory effect. Guedes et al. Vet Anaesth Analg Treatment of pain associated with equine laminitis with soluble epoxide hydrolase (seh) inhibitor, t- TUCB Epoxidation of arachidonic acid by cytochrome P450 enzymes during inflammation yields epoxyeicosatrienoic acids (EETs). The EETs levels are regulated by soluble epoxide hydrolase (seh). Treat the right malady 4

5 It is better to prevent than to treat - identify of horses at risk. - Eliminate risk factors where possible or intervene therapeutically before establishment of the disease. - In systemically ill horses, signs of sepsis or endotoxaemia are an established risk factor for laminitis and therefore aggressive therapy aimed at binding circulating endotoxin (polymixin B, plasma) and controlling systemic inflammation (nonsteroidal anti-inflammatory drugs, pentoxifylline) is rational. - Continuous cryotherapy of the feet in these cases may prevent or at least ameliorate laminitis Chris Pollitt Andrew van Eps Experimental cryotherapy 50 % reduction of metabolism per 10 C Horse with laminitis < 5 C Chris Pollitt Andrew van Eps Experimental cryotherapy results 550 SKr 5

6 Strength Clinical symtoms of laminitis Normal hoof In gallop forces of up to 3 times the horse s body weight Force, standing horse 4 kg oligofructose raise the baseline Time Factors that might raise the baseline: Previous episode(s) of laminitis, gut flora, deworming, certain feed, hoof trimming/shoeing, transport, metritis, pulmonary- /intestinal-/kidney- diseases, medicines (ex. Cortisone), EMS, PPID, inactivity, endotoxin, To get as good success rate as possible: Treat underlying disease, and the rest above. Mild laminitis rest from work 2 3 months Rotation or sinking rest from work 9-10 moths Let them be without NSAID for 2-3 days before lighten the restrictions. Successive changes in feeding regime and other factors that can affect the gut flora, work, etc. A good farrier and the right OWNER When do we stop treatment? 6

7 Amplified/Exaggerated pulses in the digital arteries Deficit in coronary band support Laminitic ring 7

8 Sinker Sinker Rotation + sinking Rotation + sinking Foal ring Laminitic ring caused by dislocation of PIII Growth rings mainly due to change in feeding 8

9 9

10 P III A slow rotation A quick rotation Gives a double sole Hovben Dropped sole; 2 days Double sole; 3 5 weeks Double sole 10

11 Nort Swedish horse, Obel grad 3, omproved but 4-5 weeks later Obel grade 4 14 days When P III penetrates the sole = Infectios osteitis PIII infectious osteitis 11

12 PIII infectious osteitis White line White line 12

13 5 minutes and a hoof trim 13

14 29 a 12 s angiography 26 s Venous Arteries 14

15 A. Parks, SE O`Grady Vet Clin Equine pract Strategi för Verkning/skoning av Kroniska fånghästar Treat the right malady Hollow wall 15

16 EMS forskning vid SLU Pågående och kommande aktiviteter: Patientmottagning vid UDS Fortsatt utvärdering av oralt glukostoleranstest (OGT) Karaktärisering av hästar med EMS Behandlingsutvärdering av EMS Hemsida för veterinärer (jan 2014) Johan Bröjer, Sanna Lindåse, Katarina Nostell, kliniska vetenskaper, SLU Foto: Josefin Söder Oralt glukostoleranstest (OGT) Anpassat för Sverige Dynamisk test för IR men ett enda prov krävs Teknik Hästen fastar from kl dagen innan Uppskatta vikten enligt Djurägaren ger Dan Sukker glykossirap (0,2 ml/kg) nästa morgon Veterinär tar blodprov min senare Foto: Josefin Söder Oralt glukostoleranstest (OGT) Ta blodprov i serum eller heparinrör Skicka serum eller plasma till klinisk kemi UDS (speciell remiss) Tolkning av insulinkoncentrationer efter min: ( kemiska laboratoriet) Normal: < 400 ng/l Gråzon: ng/l Insulinresistent: > 700 ng/l Foto: Josefin Söder 16

17 Thank You for Your attention! 17