Equine Laminitis

We were hoping some new Twittervets would join in this evening…lots of you signed up and we got plenty of RTs about the session, even making it as far as the RVC – thank you all.

There were some useful tips for the newbies – it is a bit confusing at first glance so I’m hoping the lurkers managed to see what was going on…..

Mark Tweeted from his own account, posing as an orange egg it seems, and fuelled by red wine he kicked off with a photo of an acute case of laminitis – the kind of pic that makes you wince….

Pretty quickly it was decided this was definitely an emergency….and Dan made a good point about the stoical nature of ponies

http://twitter.com/DanMcRink/status/193413936903749633

There was some discussion about an Obel Grade, with Mark reminding us that reliability of this scale is limited

http://veterinaryrecord.bmj.com/content/167/2/52.abstract

Moving on, Mark wanted to know how you would approach your questioning in this case (top PPS points!)

Helen and Louise both got the most important risk factor to enquire about….and there were some other useful points made which are important to ask when taking a history for a laminitic, as well as Dan pointing out the usefulness of an open question (tho you would always need to follow this up of course…)

Mark confirmed that typical laminitis risk factors include PPID, IR and obesity but that the evidence for this is lacking and pointed us at this paper…..

http://www.sciencedirect.com/science/article/pii/S1090023311004205

We then moved on with the case, thinking about confirmation of diagnosis and considering other differentials, which most of you were happy with

http://twitter.com/DanMcRink/status/193418672029696000

Mark wanted to know whether you would radiograph the ponies feet and confirmed that although this may not help you prognostically at this stage, it would be important to get a base line picture. Link to a beautiful animation (love this!)

And most of you seemed to know what you are looking for on the radiographs, although don’t forget clinical signs are as important at this acute stage in order to diagnose founder 

We then moved onto treatment options in this acute case, and again you were pretty happy with your analgesia with some good additional suggestions, not forgetting the importance of frog supports and a deep bed

C0004P0232

The link in the next tweet doesn’t embed well but follow it for a nice summary of laminitis

This acute case is likely to need at least a couple of months box rest

Mark then wanted you to think about chronic laminitics, and gave us this picture of a very hirsute specimen!

Ddx for hirsutism is of course a bit of a trick question….

The common confusion around steroids and laminitis was also settled by Mark

We then moved on to confirmatory tests for PPID, as it was clear this was what we were talking about here. Mark wanted a bit more than just resting/fasting ACTH, as this may not help you in this case

A pragmatic Dan suggested his approach

http://twitter.com/DanMcRink/status/193430460951564288

And Mark reminded us about the criteria for EMS and the complications if trying to use certain tests when animal is already stressed or in pain

We then finally thought about EMS related chronic laminitis

Nick was a late contributor but had got the right idea about this

Helen and Charlie also added metformin into the equation

Mark wrapped up with a couple of useful links reminding us of some of the issues around virginiamycin and antimicrobial use

http://beva.org.uk/news-and-events/news/view/229

http://www.bsava.com/Advice/PracticePack/PROTECTPoster/tabid/1500/Default.aspx

Finally there was a reminder that clinical findings are key in cases like these, and extensive tests not always the answer!

Thank you everyone for your contributions, and a big thanks to Mark for giving up his Friday evening. Next #vetfinals will be small animal again, and if you have any requests for topics please let me know!

PS LittleHux gave us a little bit of light relief….the mysterious Tweeter has yet to be unmasked!