Severe Chronic Bilateral Forelimb Laminitis
ABSTRACT
Transdermal carbon dioxide was used as an adjunct therapy for severe chronic laminitis. Boogie had undergone a deep digital flexor tenotomy in October and bilateral coffin bone curettage in June and July. The perfusion in his right front hoof wasn’t responding. The addition of a rocker pad to the hoof and transdermal carbon dioxide treatments resulted in significant improvement in perfusion and overall clinical stability.
Clinician: Megan Radkin, DVM
Client Information: Boogie – 1997 Quarter Horse gelding
CASE HISTORY AND CLINICAL SIGNS
Initially examined in August for chronic lameness. Radiographs showed evidence of coffin bone rotation. NANRIC Ultimates were applied and the horse began receiving phenylbutazone (2.2 – 4.4 mg/kg) and acetaminophen (20 mg/kg) every 12 hours. He was diagnosed with PPID at this time and began receiving 1 mg pergolide (Prascend) every 24 hours. By October 23 there was no significant improvement and the decision was made to perform bilateral deep digital flexor tenotomy. Left front hoof improved significantly compared to right front.
In the following June, the left front became the more painful foot and a necrotic area of the coffin bone was discovered via venography of the left hoof. Curettage resulted in improvement.
In July, the right front became significantly more painful and an area of necrotic coffin bone was subsequently discovered via venography of this hoof. Curettage alleviated some of the pain for a month but by September he had regressed again. Additional venography of this hoof on September 8 revealed very poor perfusion. Using the modified Obel scoring system his score was 12 out of 15 on this day.
TREATMENT
A rocker pad was attached to the right front hoof to improve mechanics and Transdermal carbon dioxide treatments were started. He received one treatment per day for 5 days, followed by 2 days off, then one treatment every other day for 7 treatments. Each treatment was 20 minutes and was performed on site. The venogram was repeated on September 28 and revealed significant improvement in perfusion. At this point his score was about 2 out of 15 using the aforementioned system. By November, he was trotting short distances in his pasture, and occasionally loping a few strides. He has been able to discontinue pain medication and is now in rocker shoes.
SUMMARY
The venogram on September 8 showed what would typically be a very guarded prognosis. Fortunately, the non-invasive carbon dioxide treatments and an alteration of mechanics changed the outcome of this case. The owner was able to perform the treatments at her farm and witnessed improvement within the first 10 days. After altering the mechanics and starting the transdermal carbon dioxide therapy, Boogie’s comfort and mobility improved. We saw increased vascularity and sole depth. The transdermal carbon dioxide therapy provided a solution we could offer the client on site that complimented the necessary mechanics.
Dr. Megan Radkin obtained her DVM from North Carolina State and has over ten years experience with equine hoof care and farriery. Her practice is a reflection of her passion for the horse’s feet and the mentorship of hoof experts like Dr. Richard Mansmann and Dr. Andrew van Eps, among others. With a specific interest in laminitis, Dr. Radkin strives to collaborate with doctors and owners to find solutions to provide horses relief, to heal and help improve quality of life. Dr. Radkin practices in North Carolina.