When you show me something in the horse world people agree on, I'll show you a chicken with lips.
My goal for this project is to cause people to consider that early diagnosis and treatment of laminitis is important and that when attempts to help horses using HBS/Resection techniques fail, the fault is most likely with the application of the therapy, rather than with the therapy itself.
P3 support (HBS/Resection) is not a cure for laminitis or founder. It provides alternate support for P3 (should the lamellar bond fail) by mechanical means.
I use the term Heart Bar Shoe here loosely. I accept any device capable of supporting PIII without compromising digital blood flow as a "Heart Bar Shoe". At this time my preference is the standard Heart Bar Shoe. With a few tongue depressors this shoe becomes "Adjustable". Some means of insuring no debris collects under the foot causing pressure on the sole must be employed.
In health, the Laminae fix PIII to the hoof wall. When this system is compromised PIII requires an alternate form of support. The Heart Bar Shoe is a good remedy. The goal of the Heart Bar Shoe is to reestablish (when necessary) and maintain a healthy orientation between PIII and the hoof wall.
Though the Heart Bar Shoe provides a simple and direct method of supporting PIII, or perhaps because it is simple and direct, when it is poorly fashioned or incorrectly applied it fails to serve it's purpose. Without a solid understanding of both normal and pathophysiologies, sufficient experience with the procedures to anticipate hazards, adherence to procedure protocols, and the farriery skills to execute the application properly, the use of the Heart Bar Shoe is at best a shot in the dark. For these reasons the Heart Bar Shoe may be it's own worst enemy.
Because few farriers are trained in the application of the Heart Bar Shoe, the introduction most owners and veterinarians have to it is unsuccessful, and does not inspire repetition. Reluctance to embrace Heart Bar Shoe therapy may also stem from the so called "60%-20%-20% formula". This "formula" states that 60% of of those horses who encounter laminitis will survive without any treatment, 20% will survive only when they receive timely and efficacious treatment, and 20% will die regardless of treatment. It is argued by some that the horses said to have survived because of Heart Bar Shoe therapy really owe their survival to their good fortune at having been in the 60% group. This is a difficult argument to refute.
Those who witness the correct application of Heart Bar Shoes to a horse in severe laminitic pain have a difficult time refuting this shoe's value. My understanding of laminitis compels me to react with some form of PIII support. The lameness produced by laminitis is indicative of imminent lamellar failure. A good response is PIII support. A better response is to provide PIII support prior to lameness. I consider application of PIII support prior to lameness (during the Developmental stage of disease) Proactive. Application after discovery of lameness I consider Reactive, and therefore late. I am impressed by the lack of familiarity with concepts such as Developmental Disease and Proactive Care that I encounter when discussing laminitis with vets and owners. Early diagnosis and intervention is significant to the prognosis in laminitis.
Remember that P3 support is not a cure for laminitis or founder. Many cases of laminitis are precipitated by systemic events. When laminitis progresses toward founder lamellar inflammation is increased locally. The reason for this is stressed lamellar tissues produce their own inflammatory agents locally. Effective alternative P3 support will reduce or eliminate this source of inflammation. In this way P3 support can indeed play a role in the recovery from laminitis beyond the purely mechanical.
Just as HBS therapy may be of little value when the causal factors are not mitigated, environmental sole pressure can thwart the best efforts to manage the laminitic foot. Guarantee that there will be no sole pressure!
There are situations where P3 support is not possible. Otherwise, support of P3 by mechanical means is guaranteed when skillfully executed. By this I mean that P3 is either supported or it is not. In most instances some form of support is discoverable. The method employed is not important. Glue it, screw it, nail it, clamp it, and if all else fails, wrap it in disposable diapers.
Inflamminitis is what I call laminitis when I want to make someone who doesn't believe inflammation is a major factor in developmental laminitis mad. I like to make people mad, and I'm good at it!
For many years I have believed that inflammation precedes other lamellar pathophysiologies. I am not yet convinced that this is not the case.
Investigations into just how and why the laminea fail have produced valuable information, that might lead to therapies and drugs that will reduce the incidence and residual effects of laminitis. I don't want to be misunderstood as feeling that this research is not important. However, research into laminitis, and those pathophysiologies precipitating laminitis, seem to have done little to reduce the numbers of horses encountering it.
I would like to see more work published describing developmental laminitis. The information horse owners need is information having to do with managing the disease early. Owners need information about the developmental stage of the disease. They need information about Inflammation and the circumstances that exacerbate inflammation. They need to learn about everything from palpating fatty crests to feeling for fever in the feet. Owners need to learn to recognize developmental laminitis.
There are two important aspects of laminitis owners need to know about. The first is that dietary management is good insurance against laminitis. The second is that when we need to provide alternative P3support we have a variety of methods that minimize the effects of lamellar failure.
If we reexamine traditional therapies with a contemporary understanding of laminitis, I believe we find some very real solutions. For example, I used to stubbornly resist the "Stand them the a creek" or " Put them on cold wet sand" advice. I now stubbornly advise Cold Hydrotherapy. It seems to me that by reducing inflammation early, we avoid the cascade of events that lead to lamellar failure. The numbers of horses who have been spared the trauma of laminitis because of timely use of hydrotherapy are too large to ignore (Cold water therapy works BEFORE you have acute lamellar stress. If you are counting on the support of sand to keep laminae from tearing, you are way too late).
I'm no longer sure there really are moral issues involved in the treatment of Laminitic horses. One could argue the moral question of not treating.
There may be some problems involving integrity.
The daily care giver or Primary Care giver to the acutely Laminitic horse (often the horse owner) is the best source the Vet and Farrier have for gauging the condition of the horse. The therapeutic value of the Heart-Bar shoe is closely related to the amount of pain the horse is experiencing. The Primary Care giver is best positioned to monitor the horse. I feel it is important that this person be aware of the need to adopt a proactive posture toward this therapy. Subtle changes in the horse's demeanor can indicate the need to reevaluate or adjust the therapy.
As important as it is that the Primary Care giver be instructed to observe the horse closely, it is of little value if the Vet and farrier fail to heed the information they receive.
