Change in Practice
For equine practitioners, the threat of laminitis is never too far out of mind. Despite myriad advances in veterinary medicine, combating this deadly disease is often an unfair fight. We gathered some of the country's most renowned veterinarians for a conversation on the current state--and future--of laminitis prevention and management.
Dr. Timothy Ober, DVM:
We see horses with metabolic issues every day in our practice.
Dr. Richard Mitchell, DVM, MRCVS, Dipl. ACVSMR:
Many horses, probably as much as 20-25% of horses over the age of 15, are predisposed to PPID, or Cushing's Syndrome.
Dr. Peter Heidmann, DVM, DACVIM:
A big part of what I do is seeing horses with insulin resistance, endocrine problems, obesity problems, Cushing's disease; the end result of many of those things is high insulin.
Dr. Mitchell:
It sometimes can be difficult to detect, but high insulin levels can lead to more serious issues, such as laminitis. Also, the general health of the horse may be at risk.
Dr. Ober:
Some of them show the symptoms in an obvious way. The ones that concern us are the horses that don’t show the outward symptoms of metabolic disease. They may be fit and in competition and preparation and they don’t show the classic patterns. There’s trouble lurking if we are not aware of it. Some of the medications that we might choose to use in treating a horse with a given diagnosis, might not go well in a horse that has an underlying metabolic problem.
Dr. Mitchell:
I’d be concerned about secondary effects of high insulin levels and equine metabolic syndrome, and what balance might be tipped by the use of glucocorticoids.
Dr. Heidmann:
Now we know so much more than a decade ago, and more than even five years ago about how to intervene, but you have to know what the insulin is doing in order to be able to intervene. One of the big challenges in veterinary medicine is we’re not able to get results in a timely fashion.
Dr. Ober:
Right now, [blood testing] involves obtaining the sample, and sending it off to a laboratory by FedEx and waiting 2-4 days sometimes for a result.
Dr. Heidmann:
That can be a life-or-death timeframe for some of these animals, so having the ability to measure patient-side can really be a game changer.
Dr. Vernon Dryden, DVM, AJF:
With the possibility of having a lateral flow onsite test to basically tell us what our insulin levels are, it’s going to change the way we practice for these metabolic horses.
Dr. Heidmann:
If I can walk up to a patient and say, ‘Gosh, it looks like he’s probably got high insulin. He’s got a cresty neck, big fat deposits', and being able to find out then and there, it’s a big difference in our ability to get ahead of the problem without over-treating or under-treating.
Dr. Dryden:
To be able to do a simple blood draw, in real time, make decisions on real time scenarios, and also identify horses that may have not been diagnosed otherwise, we can save a lot of lives and prevent a lot of cases of laminitis.