Thursday, July 11, 2013

The Helpful Farrier: Dimpled Laminitis Treatment Stirs Facebook Furor and Charitable Shoeing

This foot was probably the most viewed, shared and commented on hoof in the world in June 2013.  The only problem was that the people doing all the viewing, sharing and commenting didn't bother to read the details of the case posted by farrier RT Goodrich in California, who found the horse with this unusual hoof wall treatment. (RT Goodrich photo)

It appeared on Facebook on June 7 and it went viral: 422 people left comments and 233 shared it all over Facebook. Then others shared it. It took on a life of its own. Who didn't see it?

“It” was a photo posted by California farrier RT Goodrich. "It" was a hoof that had been dimpled all over with holes. It looked for all the world like a hoof made of Swiss cheese.

RT has shared the story of this photo with The Hoof Blog.

To begin with, RT had never seen the horse before and didn’t know the owner. A friend told him about a neighbor's horse that was in really rough shape and might be euthanized after receiving an unusual treatment for laminitis. The owner was in distress.

After listening to his neighbor’s pleas, RT agreed to go look at a foundered horse that belonged to a friend of a friend--and you know how those usually go. But even RT was surprised when he found a Quarter horse who was severely lame with laminitis but whose hoof wall had been dimpled all over with a ⅜” bit on a power drill. The surface of the hoof wall looked like Swiss cheese.

What he found even more confusing was that there was nothing on the bottom of the horse’s foot. The horse was in pain. The owner said that she did not intend to call the vet again who had drilled the holes. Could RT help?

RT shod the foot and filled in the holes with adhesive. (RT Goodrich photo)

When these things happen, there’s nothing to do but roll up your sleeves and do what you can for a horse that might not get any help unless you do it.

RT said that he thought what he did was safest for the horse, whose owner didn’t have the funds for a full medical treatment, radiographs, and frequent farrier visits. It was far from an ideal situation for the horse, or for the farrier who found himself in a classic "da*ned-if-you-do-da*ned-if-you-don't" situation.

But when RT left, the horse was definitely feeling better and the owner was calmed down.

“This is the second one I've seen (treated like this),” RT said. “The first one sadly ended up in the shop getting dissected.” Some laminitis treatments involve grooving or drilling holes, but they would penetrate the layers of the hoof wall to the laminae, like a partial or localized resection. RT didn't have any information on the rationale for the treatment, or know of any horses that had been successfully treated this way. Maybe some blog readers will have more information.

When RT first visited the horse and met the owner, he did what he could to make the horse immediately more comfortable. “She is a game little mare. I poured Vettec Sole Guard in the back half of the foot and it gave her some relief,” he said.
A heart-bar shoe with pour-in pad and tiny race nails aimed to make the horse comfortable. (RT Goodrich photo)

When he came back, he removed the Sole Guard. “I filled the drill holes with a tongue depressor covered with Equilox; the holes extended from heel to heel and from the coronary band to the ground.

“I shod the horse with heartbars. I don’t like using heartbars without radiographs but in this case I didn’t have the option. I used really tiny race nails. I did a full pour with Vettec Equipak Super Soft. Happily, she walked off. Now we wait. I am not opposed to starting over completely with a different treatment if this doesn’t work."

RT knew that money was a problem, so he did not charge for his work. He said he'd rather have the owner use the money to pursue treatment of the cause of the laminitis, which she did.

Two weeks later, RT updated his case on Facebook, “I am pleased to announce that I spoke to the horse owner today and she told me her mare is getting better every day! She's walking comfortably:)”

And on Friday, July 5: “(I had a) happy call today from the owner of the foundered horse. She's trotting sound! The owner watches her like a hawk so I'm sure she's on the mend.”

What bothered RT (and me), and why we wanted to share this story more than anything was probably the way that people on Facebook responded to seeing the photo. There is no doubt that this is an unorthodox treatment for laminitis, but people on Facebook seemed to use this one photo to unload all their negative thoughts about all people who don’t share their personal approaches to laminitis. They even did it in multiple languages!

“It’s frustrating when so many are quick to respond without reading the initial post,” RT said. To his readers, he wrote, “I don’t really care how you go about it as long as you do your best; get help when you need it and DO NO HARM! I believe we all do this work for the same reason. I don’t care if you duct tape your wallet to the bottom of a foot if it gives the horse some relief. I really think some of you need to gently step off of your soapboxes before you fall off and hurt yourselves!”

Worse, many people assumed that it had been RT who had done this to a horse, since it was posted on his farrier business page on Facebook. That is simply not true: He had found the horse this way, and apparently this is a treatment in use by some veterinarians around the country. According to what the vet told the owner, and the owner told RT, his explanation was that he was drilling the holes “to relieve pressure”. He shod the horse at the owner's request, not as a pushback against anyone or any theory.

A month after receiving medical support and wearing heart-bar shoes with pour-in pads, the mare's hoof shows growth at the top, although the configuration of the hairline is still not normal at the toe. You can see the line where the mare had tried to slough her foot before she received treatment. RT said that some of the holes are re-growing from the inside out and the Equilox used to fill them was popping out.

"There was so much new growth I did not re-fill any of the holes," RT said.
And what about the theory behind punching holes through the outer layers of hoof wall?

Hannah Galantino-Homer of The Laminitis Laboratory at New Bolton Center had this comment:

"(It is) interesting that the area where compression was likely -- the kinked tubules up by the coronary band -- was not touched and (there is) no evidence that any of the holes hit the lamellae or terminal papillae, so (it) seems very unlikely to have any positive or negative effect other than disfiguration and weakening the hoof wall.

These two photos provided by Dr. Galantino-Homer show characteristic kinking of the horn tubules that are so often seen in tissue specimen of laminitis victims. (This is not the horse in California!) "If the horse has significant lamellar wedge formation (which seems likely based on that founder ring), those holes could be many millimeters distant from sensitive tissues (e.g., not at all comparable to trephination of the skull to relieve intracranial pressure - those holes go all the way through).

"Disclaimer: I am not a farrier; I am  basing comments on pathology experience, and not making any suggestions about treatment. I would love to have seen radiographs."

This is one of those cases where we don’t know the whole story and probably never will. What matters is that RT was generous enough to help a horse and horse owner in need. He never dreamed that the hoof picture would cause such a stir; his initial hope had been to share something in case other people come across this treatment.

This case is a perfect example of the way that laminitis works: to beat it, you must both stabilize the horse medically, and address the foot mechanics. Laminitis shows up in the feet, but it takes more than a good trim or a nice pair of shoes before you will hear the owner's happiest message on your voice mail.

RT Goodrich is a farrier by day -- and a musician by night. His North Bay Farrier Service is based in Fairfax, California, where his wife owns Marin Tack and Feed. He’s a good person to know.

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