Endocrinopathic Laminitis

ABSTRACT

Transdermal pharmaceutical carbon dioxide was used as an adjunctive therapy in a case of severe endocrinopathic laminitis in a 22 yr old Warmblood gelding in an attempt to increase the speed of sole depth growth and thereby improving recovery time. Both front feet remained unstable with increasing palmar angles for several months before this therapy was introduced. Both the combination of derotation shoeing and use of the transdermal therapy likely played a role speeding up the recovery of this horse.

Clinician: Kirsten Tillotson, DVM, MS, DACVIM
Client Information: Vriendlie - 22 yr old WB gelding

CASE HISTORY AND CLINICAL SIGNS

Vriendlie was retired from upper-level Equitation competition due to hind limb suspensory desmitis. He developed Equine Asthma and had been maintained on low level corticosteroid therapy for several years. Five days prior to presentation of bilateral forelimb pain, he had had the second of 2 hip injections one month apart  with corticosteroids. At the time of presentation, he had a body condition score of 6 out of 9. It was later determined that he was also in the early stages of PPID. This culmination of factors most likely lead to the development of severe laminitis. The mismatched conformation of his front feet further compounded the disease. The left front, the more upright foot, was more severely affected and remained unstable for more than 3 months. Standard treatments for laminitis were used including bedding with sand, ice therapy, NSAIDS, Gabapentin, ulcer prevention, pentoxifylline, and management of the feet including corrective trimming and shoeing. At 4 months from the onset, a de-rotation shoeing using Redden ultimates was performed and transdermal CO2 therapy was added to the treatment plan.

Transdermal carbon dioxide was started on July 4. Both forelimbs were treated once daily for 5 days followed by every other day for 3 treatments and then every third day for 4 weeks. Serial radiographs were taken every 2 weeks. It was hypothesized that sole depth would increase at a greater rate with the aid of the transdermal carbon dioxide. After the first 5 days, there was minimal change in sole depth however over the next 2 shoeing cycles, the sole depth progressively increased compared to previous shoeing cycles. It has now been one year since the initial signs of laminitis and he is doing well.

SUMMARY

Laminitis has a large spectrum of presentations and the outcome can be hard to predict. However, production of sole is a key factor in success. This horse made significant improvement in sole depth after the de-rotation shoeing and treatment with transdermal therapy where he had been stagnant in his recovery the month prior. It is likely that these two therapies worked together to improve this horse’s condition.

Dr. Tillotson has background in microbiology from college. She graduated cum laude from Colorado State University’s College of Veterinary Medicine and Biological Sciences in 1998.  She then completed an internship at Alamo Pintado Equine Medical Center in Los Olivos, California. In 2002, she completed a residency in equine internal medicine. During her specialty training, Dr.  Tillotson completed a clinical master’s degree program focusing on infectious disease, specifically clostridial enterocolitis in neonatal foals. In 2004, she became Board-certified in the American College of Veterinary Internal Medicine (ACVIM). She has over 20 presentations and articles and is published in major scientific journals including the Journal of the American Veterinary Medical Association, Equine Veterinary Education, Veterinary Pathology, and the Journal of Equine Veterinary Science. She also completed CSU’s course in Veterinary Acupuncture, as well as the International Veterinary Acupuncture Society’s certification exam. Most recently, Dr. Tillotson has furthered her interest and education in Equine Acupuncture from the Chi Institute in Florida. 

Most people call her KT or Dr. KT. She grew up in Southern California showing hunters and jumpers, a passion that she continues. She and her husband, John Kiefer, have settled in Roxboro at Willow Creek Farm with a menagerie of pets most of which are rescued.