Autumn Laminitis: Prepare to Prevent--Instead of Treat--Seasonal Flair-Ups of Endocrine Conditions in Horses

This is what a foot looks like after laminitis...could this damage and deformation have been prevented? In Great Britain, a study found that 43 percent of horse owners waited more than a week after suspecting laminitis before seeking veterinary intervention. (Boehringer Ingelheim photo)

If Labor Day is over, can autumn laminitis season be far behind?

This summer's drought has been relieved in some states, but many of the horses in the United States are standing in parched pastures, munching on hay, as they have been all summer. The drought put a quick end to the grazing season in many states, and horse owners have been saddled with increased hay bills.

Horse owners who grow their own hay found that they were feeding it as soon as they baled it. Second cuttings were poor in many areas. And a third cutting probably isn't even going to happen.

Fall rains usually send a dark green growth spurt up through brown pastures and with this signal comes the warning to horse owners that the fall can be just as dangerous as spring for horses to develop laminitis as they gorge on the grass.

This video from the British Veterinary Association's Animal Welfare Foundation is a quick primer on the general disease of laminitis and features veterinarian Ben Mayes, president of the British Equine Veterinary Association.

Recent research has shown us that the lush grass does not, by itself, cause laminitis. If two horses had a grazing contest, it's possible neither of them would develop laminitis no matter how much they eat.

But if one or both horses has an endocrine system vulnerable to cycling hormones that may cause laminitis when and if they are pushed, the results can be a stretched white line, hoof rings, a gimpy gait, or full-fledged laminitis.

The time to be vigilant is now, while it is still technically summer and the nights are still pretty warm. But across the country, night-time temperatures are dipping, and snow will soon be showing up on high peaks of the mountains.

Laminitis is a wholly preventable disease, and in the case of endocrine-related laminitis, it is part of a larger syndrome that indicates the horse may have a problem in the way the body processes glucose, in that the condition of insulin resistance prevents normal glucose metabolism or that circulating hormones are elevated by pituitary pars intermedia dysfunction (PPID).

Is this your perception of a horse with Cushings syndrome (PPID)? While there are still plenty of older horses with the problem out there, the obvious change in hair coat is not seen in the early-teens horses whose blood tests yield information about high levels of the pituitary hormone ACTH. (Photo © Dr. Christian Bingold, Pferdeklinik Großostheim, used with permission)

Some of the recommended management suggestions include evaluating a horse's weight and condition and stepping up the exercise for horses kept at pasture during the fall months when risk is increased.

Another simple thing that horseowners can do is get their hay tested. Some hay can have as much or even more sugar than pasture grass. Soaking hay or feeding lower calorie hay to horses with higher laminitis risk quotients may be helpful.

Additionally, horse owners can ask for help from farriers this time of year. Ask to see or photograph the horse's feet after they have been trimmed--is the white line tight or is it stretched? Are there red spots in the line? Ask the farrier if the hoof wall is smooth and healthy or if it is ridged and has "fever rings" that are telltales of some disruption in the horse's diet or metabolism in recent months.

Finally, testing a horse's ACTH levels is now recommended to be done in the fall. Boehringer Ingelheim, manufacturers of the PPID medication Prascend, has recommended that the testing for Cushing's be done in the fall, when differences in test results would be most evident.

Dr. Don Walsh of the Animal Health Foundation explains the basic tenets of laminitis prevention, including insulin resistance and Cushings syndrom (PPID) in this brief video.

Current thinking and evidence suggests that 90 percent of laminitis cases occur as a result of an underlying hormonal condition(1,2) such as Cushing’s disease (PPID) or Equine Metabolic Syndrome. With this in mind, owners - particularly those with a horse over 10 years of age - are being urged to get their horses tested for Cushing’s as soon as possible if they suspect that the horse may be suffering from laminitis, or even if it simply appears a little foot-sore.

Despite the severity of laminitis, only two-thirds of laminitis cases reported by owners in Great Britain were treated by a veterinarian (3) and, in one study, 43 percent of horse owners waited more than a week after suspecting laminitis before seeking veterinary intervention (4).

Boehringer Ingelheim Vetmedica's data shows that one third of laminitic middle aged horses (defined as between the ages of 10 and 15 years) test positive for PPID (Cushing's)(5).

Over 3,100 horses were tested for Cushings as part of the company's Talk about Laminitis campaign in Great Britain during the spring of 2012. The pharmaceutical company is offering free testing for Cushing's in Great Britain again this fall, thanks to the Redwings Horse Sanctuary, which is providing funding.

Horse owners may have to pay for the ACTH and insulin resistance tests in the United States, but there is no price that can be put upon the peace of mind of knowing more about a horse's potential risk for laminitis.

To learn more:
Visit the Animal Health Foundation laminitis web site and watch more videos there.
Boehringer Ingelheim's "Talk About Laminitis" web site is meant for British horse owners, but most of the information is relevant worldwide; Prascend is available in the USA.
Read "Six Steps to Prevent Autumn Laminitis".
Plan to attend the Laminitis West conference in Monterey, California in November 2012.

References from the text:

1. Donaldson, M.T., Jorgensen, A.J.R and Beech, J. (2004) Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis.  Journal of the American Veterinary Medical Association 224, 1123-1127.
2. Karikoski, N.P., Horn. I., McGowan. T.W. and McGowan, C.M. (2011) The prevalence of endocrinopathic laminitis among horses presented for laminitis at a first-opinion/referral equine hospital. Domestic Animal Endocrinology 41,111-117.
3. Ireland, J.L., Clegg, P.D., McGowan, C.M., McKane, S.A., Pinchbeck, G.L., 2011.  A cross-sectional study of geriatric horses in the United Kingdom Part 2: health care and disease.  Equine Veterinary Journal 43, 37-44.
4. Knowles, E.J., Withers, J.M. and Mair, T.S. (2012) Increased plasma fructosamine concentrations in laminitic horses. Equine Veterinary Journal 44, 226-229.
5. Boehringer Ingelheim Vetmedica. Resting ACTH results of 724 horses aged 10 to 15 years. 

Do you know your way around the inner hoof wall? This wall chart will remind you of the layers of sensitive and insensitive tissue that make up the hoof capsule. Click this text to go to the ordering page.

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.  

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Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.

AAEP Laminitis Research Project Launched: Phase One to Investigate Pasture or Endocrinopathy-Associated Laminitis with Help of Boehringer Ingelheim Prascend® Donation

(This information is an edited press release that was originally provided by the AAEP Foundation)

On Saturday, the American Association of Equine Practitioners Foundation announced the launch of an aggressive $1 million campaign for laminitis research and the start of the first of multiple studies that will occur to help unravel the mysteries of this disease.

Also announced at the AAEP’s 57th Annual Convention was the donation of $200,000 to the AAEP Foundation for support of the first study Case-Control Study of Pasture or Endocrinopathy Laminitis supported by Prascend® (pergolide mesylate), manufactured by Boehringer Ingelheim Vetmedica.

“This project is in response to AAEP members prioritizing laminitis as the most important disease requiring research,” said Wayne McIlwraith, BVSc, PhD, FRCVS. “We are fortunate and very grateful our long-time industry partner Boehringer Ingelheim Vetmedica, Inc. and their new exciting product Prascend® is willing to support research to help us help horses with this devastating disease.”

Professor Wayne McIlwraith

Laminitis remains one of the most frustrating and devastating diseases confronted by equine practitioners. The disease, which has the potential to cripple horses beyond repair, damages the critical laminae structures in the equine foot and has a variety of causes and symptoms.

"Boehringer Ingelheim Vetmedica, Inc. (BIVI) is very pleased to fund this continued research on equine laminitis," says Dr. Jane Smith, director, BIVI equine division. "We truly value the work of AAEP and their Foundation and are proud to partner with them in this research effort."

The Case-Control Study of Pasture or Endocrinopathy Laminitis is already underway under the direction of recognized epidemiologist, Noah Cohen, VMD, PhD at theTexas A&M University College of Veterinary Medicine.

Through the Laminitis Research Project, top equine researchers, AAEP members and horse owners will work together to lay a foundation for the future of laminitis research. With new information about nature of this disease, the AAEP Foundation intends to equip equine practitioners with the ability to prevent and treat horses diagnosed with laminitis.

Veterinarians and horse owners are encouraged to join the effort to eradicate laminitis through their active involvement with the Laminitis Research Project. Horses that are diagnosed with laminitis and have not yet received treatment may be submitted for these case-based studies. Horse owners and veterinarians can also choose to help through fundraising at their equine facility, home, business or veterinary practice.

For more information about contributing to the Laminitis Research Project, visit www.aaepfoundation.org.

 TO LEARN MORE

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.  

Follow Hoofcare + Lameness on Twitter: @HoofcareJournal

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Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.

Prascend® PPID (Equine Cushings Disease) Treatment Approved by FDA for US Horses

Maybe I'm biased, but I thought that the CSI (Cushings Scene Investigation) ad run by Boehringer-Ingelheim Vetmedica in British horse magazines was the most clever horse ad so far this year. It heralded the introduction of Prascend to treat Cushings-suffering horses; Prascend will soon be available in the USA.

The following press release is not an ad, it is published here as a "heads up". Anyone involved in the world of Hoofcare + Lameness is going to hear about this. Farriers and veterinarians will be asked questions by horseowners about this medication, and you need to know about how pergolide has evolved into Prascend®.

Prascend has been available in the United Kingdom for a few months, and Boehringer-Ingelheim Vetmedica has launched an awareness campaign there to urge horse owners to have their horses tested for PPID. I don't know yet what B-I has planned in the USA, but I feel confident in saying that "this is news".

In 2007, this blog reported that a potential crisis loomed for horseowners who were treating the symptoms of their horses' PPID condition with Permax (pergolide). (See links at end of this blog post.) The medication was taken from the market temporarily because of problems with human prescriptions. Before long, it became available again in the compounded form, which many horse owners ordered directly and in different forms.

Compounding pharmacies have been at the center of a controversy in the veterinary industry. At this time, it is too early to give a reliable answer whether compounded (and less expensive) pergolide will remain an option for horseowners as pill-only Prascend enters the marketplace. Ideally, horseowners will have safe and multiple alternatives to keep their horses comfortable.

Much more information will be available at or following the AAEP Convention in San Antonio later this month. 

Everyone can recognize the advanced PPID (Cushing disease) horse. But laminitis and stretched white lines in younger horses may not seem to be related to PPID until much later, when a definitive diagnosis is made. Only careful testing will discern if horses without obvious signs suffer from PPID. (photo provided by Dr. Christian A. Bingold)

Boehringer Ingelheim’s Prascend^® Approved for PPID in Horses

Product is the first and only FDA-approved treatment for the management of PPID.

ST. JOSEPH, Mo. (November 2, 2011) – Boehringer Ingelheim Vetmedica, Inc. (BIVI), has received approval from the Food and Drug Administration (FDA) to market Prascend® (pergolide mesylate), for treatment of clinical signs associated with pituitary pars intermedia dysfunction (PPID), also known as equine Cushing’s disease.

PRASCEND is the first and only FDA-approved product for the management of PPID in horses. (1) Administered in tablet form, treatment with PRASCEND can improve the quality of life for PPID-affected horses by managing clinical signs and decreasing the risk of complications of the disease, including those that have the potential to be life-threatening.

It is estimated that one in seven horses over the age of 15 has PPID (2) and horses as young as seven years of age have been diagnosed with the disease (3). In addition, up to 70 percent of clinical laminitis cases also may be affected with underlying PPID4. The most common clinical signs of advanced-stage PPID that occur in horses are hirsutism (hypertrichosis) or an abnormal amount of hair growth, abnormal sweating, weight loss, muscle wasting, abnormal fat distribution, lethargy, laminitis, polyuria/polydipsia and chronic/recurrent infections.

“Unfortunately, PPID is not a curable disease,” says Dr. John Tuttle, BIVI equine technical services veterinarian. “However, PRASCEND does offer a safe and efficacious treatment option to veterinarians and horse owners that can help reduce the clinical signs of the disease and effectively improve the quality of life of infected horses.”

While PPID is typically considered a late-stage-of-life disease in the horse, Tuttle adds that with horse owner vigilance and regular veterinary care, the disease may be detected earlier.

“Because the early symptoms of PPID may be difficult to recognize, some horses with PPID may go undiagnosed until the disease becomes more advanced,” says Tuttle. “Through regular veterinary wellness exams, oftentimes the disease can be caught earlier. By beginning treatment in the earlier stages of the disease, we are able to reduce the risk of some of the potential complications associated with PPID, such as laminitis, recurring infections, dental disease and other potential issues of uncontrolled PPID.”

Farriers often notice the early signs of PPID in horses' feet while trimming. As Cushings diseases advances, farriers are challenged to keep PPID sufferers comfortable and manage any flare-ups of chronic lamiitis. (Massachusetts farrier Allie Hayes trimming a Cushings-affected pony, photo © Hoofcare Publishing)

Not only can PRASCEND aid in the management of clinical signs of disease, the FDA approval also assures the product has been thoroughly evaluated for safety and efficacy. In addition, PRASCEND has met the standards set forth by the FDA in regard to production to preserve its identity, strength, quality, purity and consistency from batch to batch, and the product has demonstrated stability and effectiveness over time through a variety of environmental conditions.

“We are excited to offer a treatment option for horses suffering from PPID,” says Tuttle. “We encourage horse owners to continue to work with their veterinarians to find the best treatment for their horse and are confident that PRASCEND can help make a difference in the lives of horses suffering from this disease.”

PPID horses may be quite thin under all that hair. Cushings sufferers are also believed to be more highly perceptible to worms than non-sufferers. Many people clip their long-haired horses to be more aware of body condition. (photo © Hoofcare Publishing)

PRASCEND is for use in horses only. PRASCEND has not been evaluated in breeding, pregnant or lactating horses. Refer to the package insert for complete product information or contact Boehringer Ingelheim Vetmedica at 800-325-9167.

(Hoof Blog note: A web address should be available soon.)

Reference:

1.  PRASCEND^® (pergolide mesylate) [Freedom of Information Summary]. St. Joseph, MO: Boehringer Ingelheim Vetmedica, Inc.; 2011.
2. McGowan TW, Hodgson DR, McGowan CM. The prevalence of equine Cushing’s syndrome in aged horses. In: Proceedings from the 25th American College of Veterinary Internal Medicine Forum; June 6–9, 2007; Seattle, WA. Abstract 603.
3. Schott HC. Pars pituitary intermedia dysfunction: challenges of diagnosis and treatment. In: Proceedings from the 52nd American Association of Equine Practitioners Annual Convention; December 2–6, 2006; San Antonio, TX.
4. Donaldson MT. Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis. J Am Vet Med Assoc. 2004;224(7):1123–1127.

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Too Fat? Too Thin? British Court Faces Conflict Over "Abused" Horse with Cushings Disease

Cornell Laminitis Research Beneficiary of Arabian Horse Foundation Grant to Study Genetic Markers in Equine Metabolic Syndrome and Cushings Disease

Equine Pituitary Dysfunction Test Choices Analyzed by New Bolton Center's Jill Beech VMD

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© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.  

Follow Hoofcare + Lameness on Twitter: @HoofcareJournal

Read this blog's headlines on Facebook

 

Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.