LAMINITIS II

<BODY> <CENTER> <IMG SRC="ResectM.gif"> </CENTER> <CENTER><FONT COLOR="#150583"><H2>If This Image Isn't Moving, Your Browser Doesn't Support Animated Gifs!</H2></FONT COLOR="#00FF00"></CENTER><P> <FONT SIZE=+3><FONT COLOR="B04074">I</FONT COLOR></FONT><FONT SIZE=+1>n Laminitis the Movie we saw the Heart Bar Shoe used to maintain P<sub>3</sub>'s rightful place in the hoof during acute laminitis.<P> <FONT SIZE=+3><FONT COLOR="B04074">T</FONT COLOR></FONT><FONT SIZE=+1>his is fine and dandy so long as edema, abscesses, hematomas or seromas don't complicate matters.<P> <FONT SIZE=+3><FONT COLOR="B04074">T</FONT COLOR></FONT><FONT SIZE=+1>hing is, the laminae got pretty darn red. Odds are some complications are in store for this foot.<P> <FONT SIZE=+3><FONT COLOR="B04074">D</FONT COLOR></FONT><FONT SIZE=+1>uring that red stage, some, or maybe all of the laminae in the front of the hoof die. Because the Heart Bar Shoe is in place the laminae don't stretch. After the laminae die a seroma forms in the lamellar space. The seroma creates hydraulic pressure which forces the sensitive and insensitive laminae to separate from one another.<P> <FONT SIZE=+3><FONT COLOR="B04074">T</FONT COLOR></FONT><FONT SIZE=+1>he seroma's volume increases, but it has nowhere to go. Both hoof wall and bone are unyielding. The process continues and eventually pushes P<sub>3</sub>away from the wall a bit, but not far.<P> <FONT SIZE=+3><FONT COLOR="B04074">N</FONT COLOR></FONT><FONT SIZE=+1>ow we begin the resection (We should have done this far earlier, but it makes a better story this way, and besides, this is the way it's usually "mismanaged" anyway!). I usually make a transverse cut into the wall 3/4" or so below the hair line. Then I make cuts from each end of the first cut down to the ground surface. These side cuts end up somewhere between the first and second nail holes in most cases. This creates a loose square of horn over the toe. Sometimes this can be lifted off the hoof in one piece. If not, I cut this large square into four smaller squares that can be worked of the horse. Then I follow the laminae up the wall until I reach tiny pin pricks of blood. Since dead laminae don't bleed, this tells me I have removed all the dead tissue.<P> <FONT SIZE=+3><FONT COLOR="B04074">I</FONT COLOR></FONT><FONT SIZE=+1>n this view of the resection only the transverse cuts are showing. When the lamellar space is penetrated the fluid is discharged. Remember, this story is about a seroma. One could encounter dry (or nearly so) dead laminae or a (an?) hematoma or serosanguinous fluid, etc. Another foot might have a seroma under much greater pressure. Then you get the infamous "explosive discharge". These are kind of fun! I frequently do this work for people who have exhausted all other options. The people involved with such an owner are often skeptical about what I am up to. Sometimes after describing what I think might be going on inside the hoof I get a "yeah right!" and some murmuring about my being a quack. I handle this by offering the cutting tool to the murmurer just before the seroma blows. Because they can't keep their grubby hands off, they accept the tool and blithely cut through the rest of the wall, and are greeted by a face full of gick. It leaves a lasting impression!<P> <FONT SIZE=+3><FONT COLOR="B04074">W</FONT COLOR></FONT><FONT SIZE=+1>hile the murmurer is wiping it's face, the horse often sighs with relief. Sometimes the connective tissue below the sensitive laminae will swell up a bit. This is one of the desired results of resection. Sometimes the swelling will be substantial. Some people are alarmed by this. They will even go so far as to apply pressure wraps to the area. This too is great fun. I carry a carton of carpet tacks just for this purpose. I produce the tacks, with the suggestion that they could be used to nail down the swelling. The swelling usually subsides in the first 24 to 72 hrs.<P> <FONT SIZE=+3><FONT COLOR="B04074">I</FONT COLOR></FONT><FONT SIZE=+1> generally don't wrap these feet. Once we had a horse stand right in the middle of his freshly resected foot with his other front foot. It was a painful thing to see (worse for the horse, I imagine). There was blood everywhere. This happened as a result of poor handling. It shouldn't have been allowed.<P> <FONT SIZE=+3><FONT COLOR="B04074">B</FONT COLOR></FONT><FONT SIZE=+1>ack to<A HREF="Movie.html" TARGET="CONTENT">Laminitis the Movie</A><P> <FONT SIZE=+3><FONT COLOR="B04074">T</FONT COLOR></FONT><FONT SIZE=+1>o<A HREF="MovieIII.html" TARGET="CONTENT">Laminitis the Movie III</A><P> <FONT SIZE=+3><FONT COLOR="B04074">B</FONT COLOR></FONT><FONT SIZE=+1>ack to <A HREF="FirstAid.html" TARGET="CONTENT">First Aid</A><P> <FONT SIZE=+3><FONT COLOR="B04074">B</FONT COLOR></FONT><FONT SIZE=+1>ack to <A HREF="pvd.html" TARGET="CONTENT">Top Page</A><P>