Logo by Cynthia Johnson
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Logo by Cynthia Johnson |
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Care of the Hooves and Feet "Advanced"Case Report of Foundered Insulin Resistant Mare RT Social Sunny: Ode to a Foundered Horse Submitted by Purdylady, 9/28/2008
Jennifer L. Montgomery September 28, 2008 RT SOCIAL SUNNY: INTRODUCING THE PROBLEM Sunny, a nine year old Quarter horse mare was spiraling down fast from a laminitic episode that left her with rotated coffin bones ready to penetrate through the bottom of her soles. Her owner was desperate and looking for anyone who would be willing to help her horse recover from this disease. Traditional farriers and veterinarians were already used in an attempt to care for Sunny to no avail. Now it was time to look to other sources outside of the traditional treatment of founder to try and save Sunny’s life. Laminitis is a painful condition that manifests itself as inflammation inside the hoof capsule. The outside hoof wall is attached to the internal coffin bone by tiny laminae that act like Velcro to secure the internal structures of the hoof. When laminitis occurs, the laminae are weakened and begin to rip away from the hoof wall allowing the coffin bone to rotate down and away from its original position. This is called founder. In extreme cases, the coffin bone rotates far enough to penetrate through the sole of the hoof causing tremendous pain. (Seeley, 2007) By x-ray, Sunny’s coffin bone was 20 degrees rotated and could be seen peaking through the sole. From a clinical standpoint, she was doomed and would have been humanely euthanized but with new strategies using natural barefoot trimming, she had a final chance at beating the odds. Sunny’s original founder occurred in 2005 or before. She was overweight and did not have the proper diet or hoof care to keep her sound. She was sold and her new owner attempted to rehabilitate her but life circumstances prevented her from completely helping Sunny. Sunny did well while in the care of this owner but when placed in the next owner’s care, she had another laminitic episode and this is where the introduction of the barefoot trim as an alternative method was used on Sunny. CONTEXT AND FRAMING THE ISSUE: TRADITIONAL OR NATURAL? Natural barefoot trimming is a relatively new concept in horse hoof care. Most horse owners trust a farrier to care for their horses’ hooves where it is common to use metal shoes to protect the hooves and have no knowledge that a barefoot option exists. How did this concept evolve? If horses are born with inferior hooves then why were iron shoes not nailed on hooves until the 6th century by European horsemen? By the 13th century horseshoes were commonplace and the manufacturing of iron horseshoes was widespread. (Bellis, 1997) When over ninety percent of domestic horses are having lameness issues, why are horse owners not asking if the shoes were causing these problems? Instead they keep nailing them on like they have been for centuries because it is said “Without them, horses’ hooves would fall apart.” (Breningstall, 1992) The natural barefoot trim movement did not start with one person’s philosophy that horses could go without shoes. It evolved as more horse owners were dissatisfied with their horses always becoming lame after a period of time with shoes on. These horse enthusiasts wanted to find out if it was possible to keep horses barefoot and sound at the same time. Within the last five years, groups were formed and actively participated in by people from around the world in chat and message boards all over the Internet and doing research on live wild mustangs and horse cadaver feet to prove their theories. (Ramey, 2007) These same barefoot proponents also discovered that barefoot trimming could also help pathological hooves such as foundered hooves. Splinter groups such as Equine-Founder@Yahoo.com formed to help horse owners have a place to go to seek information about helping their horses. Owners who had success with the new barefoot method provide support for new members seeking assistance. Previously the veterinarian in charge put pads and hospital plates on Sunny to help correct the founder and make her more comfortable but her feet continued to deteriorate. Normally veterinarians use the advice of traditional farriers when equine clients have hoof problems. The normal protocol for founder/laminitis is to heavily medicate the horse with pain inhibitors and place corrective hospital plates and pads on the hooves for support. The thought is that the hoof needs the stability of the shoe to keep the coffin bone from penetrating when all it is really doing is allowing the coffin bone to rotate down further. With the additional height of the plate that had a large open area in the middle of the shoe, the coffin bone would most likely erode as the tip punctured through the sole of the hoof and reached the ground. The hoof was also not trimmed to lower the heels because it was thought that the deep flexor tendon running up the back of the hoof would be strained. The picture presented here with the traditional method now has the horse in even more pain because the hooves essentially resemble a woman wearing high-heeled shoes. Also the front part of the foot degenerates since the coffin bone is compromising the circumflex artery that runs across the bottom of the coffin bone and now the toe has no blood flow to encourage proper healing. In essence, most foundered horses in Sunny’s condition are not rehabilitated but rather given a death sentence and are humanely discarded. GENERATING ALTERNATIVES: NEW SCIENCE ALLOWS MORE OPTIONS Sunny’s prognosis was grave in July 2007 when she reached Mulvane, KS. Her urine was blood-tinged brown due to her need to lie down continuously to alleviate her pain and that was compromising her internal organs to the point her kidneys were shutting down. Through a directive leadership approach, the hospital plates were removed the first night she arrived for care and immediately she was more comfortable. (Harvard Business Essentials, 2006, pg 16) Sunny’s owner had given the go ahead to have all the decisions made by the care giver so that she could receive treatment quickly. The most important tool that was used to determine her immediate needs was the fishbone diagram in that her physical problems had to be treated individually before concentrating on her hooves. The fishbone diagram pointed backward to the body systems that needed to be assessed to be able to implement a change in direction for her care. The major categories that were investigated before continuing forward with her care included: blood work, diet, environment, and hoof care. In the first days, a veterinarian was called out to draw a CBC to determine if Sunny was critical and if her body systems were shutting down. Once that was determined to be satisfactory then her diet was managed. An equine nutritionist was consulted to determine what feeds would encourage her body to heal. Probiotics, natural herbs for pain management and mineral supplements that would encourage healthy immune system recovery were a part of her new diet. The next big step was to study what was the best alternative for her hoof care since Sunny had such a severe case of founder that not many farriers would even be willing to take a chance on her. Her outward appearance did not offer much hope to wary outsiders since she looked emaciated and had body pressure sores from laying down a large percentage of her days. Still others, including her care giver, thought there was still a glimmer of hope as long as Sunny continued to eat and attempt to walk. Sunny only had three alternatives. Her care could be taken over by a certified journeyman II farrier who wanted to try a new farrier method using Steward Clogs to support the diseased hoof. (EDSS, Inc., 2003) The second option was to implement the natural barefoot trim and use the advice of trim professionals from around the country who were having good success with foundered horses. Or the last option was to simply have Sunny humanely euthanized to end her suffering and save everyone a lot of time and money as well as heartache. Each alternative was feasible and genuine. Using a traditional farrier was a calculated risk since they will go by veterinarian protocols when evaluating a founder case. The outcome of regular farrier protocols is not very successful for horses with major coffin bone rotation. The second option of trying the barefoot method was one that is fairly new and risky in the sense not many people endorse it yet simply because they have not seen it work first hand. Many farriers are not trained to understand how the barefoot model works so therefore they are not helpful in utilizing this technique. The care giver was willing to trim the hooves on her own without any outside assistance if need be, however this held a high level of risk since it is difficult to trim a horse that is in constant pain unwilling to stand. The last alternative of euthanasia would have been one that would have been acceptable but nonetheless would not become an option until the first two alternatives were exhausted first. EVALUATING ALTERNATIVES: BEING AN ADVOCATE The next course of action involved making the choice of using an educated farrier’s choice to use the Steward Clogs on Sunny or to choose the barefoot trim route. A basic decision tree best describes the decision making process that occurred to evaluate the alternatives. If Plan A didn’t succeed after a period of time, two clog resets, then Plan B would be pursued. Plan C for humane euthanasia wasn’t a consideration at this point since only positive alternatives were up for debate. The probability for the Steward Clogs had only been tested on approximately 350 horses with marginal success whereas the barefoot technique has been studied on hundreds more horses with growing successes. Financial considerations were not a factor since Sunny’s owner would pay any cost to keep her alive. Intangibles such as reputation of the farrier versus the incompetence of the care giver in being able to perform the barefoot trim on a seriously lame horse were also factors up for debate. The risk involved the loss of money if Plan A did not succeed at $165 per reset and materials. Just keeping Sunny alive each month was roughly a cost of $250 just in supplements and feed not to mention the amount of time spent cleaning her wounds and attending to her needs. Brainstorming with natural hoof care providers via the Internet was an amazing way to gather real time information about other horses that were similar to Sunny. A small number of veterinarians, like Dr. Robert Bowker VMD, PHD, continually studies hooves and their anatomy and teaches hoof care practitioners how to properly care for hooves. (BalancedHorse.com) A mantra that is repeated frequently is that if a certain farrier protocol is not being successful then it is acceptable to change and go to Plan B. If what you are doing is not working then change to something else. So with this understanding the choice was still not as simple as it might have seemed. Intuition played a real part in deciding what move to make next as well as gauging how Sunny felt from day to day. Her declining health played a huge part as to the urgency of what decision needed to be made. CHOOSING ALTERNATIVE: CHOOSING TO GO NATURAL Flowcharts on Sunny’s monthly progress decided the next logical way to proceed. A middle ground was initially chosen and the Steward Clogs were applied against my better judgment on August 7, 2007. The understanding was that they were to be reset every four weeks with the heels trimmed and to evaluate the condition of the hooves at that time. The farrier was lax in returning in a timely manner and the second reset was done seven weeks after the initial application. Sunny was not improving but continued to grow a very high heel with a lack of toe growth and she was constantly in extreme pain making it difficult to follow Plan A. An executive decision was made to saw the clogs off and switch to Plan B on October 22, 2007 and from that point on Sunny continued to improve. Pictures of her hooves were emailed to other hoof practitioners for critique and subsequent feedback was used to trim the hooves in a productive way. Exercise and diet were key in helping the rehabilitation process along with weekly barefoot trims using a pneumatic sanding tool to ease the difficulty of the trim process. There was no wrong way to proceed from this point and to use a “gut feeling” about what parts of the hoof needed trimmed. A constant learning environment evolved for all who were involved including the others who gave instruction. Discussion of Sunny’s entire case history can be viewed on Superhoof.org CONCLUSION: THE LEARNING CURVE Sunny’s hooves continued to slowly improve throughout the winter months but not without frequent bouts of abscessing and lameness. As time went on she was finally able to trot for brief periods of time every day and her hooves showed marked improvement. She was able to be turned out in a large pasture with two other horses so she could move throughout the day. Exercise is necessary for hoof blood flow and healing. The prognosis was positive…until the spring grass in April started sprouting. It was at that time that Plan C had to be considered since it was determined through process of elimination that Sunny was insulin resistant, a diabetic condition in equines. Any amounts of excess sugar passed through the fructans in the spring grass were detrimental to her health and that started the entire laminitis process over. It was a scramble to gather information about how to change her diet and help her avoid eating the spring grasses. In one month Sunny lost over 400 pounds and she was in extreme pain. Plan C had executive power now and had to be exercised. It was no longer a learning process of how to heal the hooves and trim correctly but rather how to end the suffering of a horse. Ethically I had no other alternative to consider other than humane euthanasia. It would not have been fair to ask Sunny to be subject to that pain for another year and then possibly have this same scenario happen every year thereafter. Although the outcome of this horse’s life was ultimately death, she still serves as a great learning tool and example for other horse owners who are dealing now with the same disease. Sunny had too many strikes against her but she did not die in vain but gave others hope throughout the decision making process that she would one day be able to walk soundly. Many people mourned with the caregiver and her owner afterward but said that they appreciated sharing her successes and struggles. REFERENCES: Balanced Horse.com, Evolution of the Bare Hoof, Retrieved on September 26, 2008 from http://www.balancedhorse.com/bareevolution.html Bellis, Mary, (1997) Horseshoes, Nails, Saddle, and Riding, The History of Horseshoes, Retrieved on September 25, 2008 from http://inventors.about.com/library/inventors/blhorseshoe.htm Brassard, M., & Ritter, D. (1994). The memory jogger II. Salem, NH: GOAL/QPC. Breningstall, F. Thomas, (1999) Pulling Shoes for Winter, Rural Heritage, Retrieved on September 26, 2008 from http://www.ruralheritage.com/village_smithy /winter_pullshoe.htm EDSS, Inc., (2003). The Steward Clog, Product Abstract, Retrieved on September 27, 2008 from http://www.hopeforsoundness.com/edss/store/new/clogabstract.html Ramey, Pete, (2007) Hoof Articles by Pete Ramey, Retrieved on September 25, 2008 from http://www.hoofrehab.com/hoof%20articles%20by%20Pete%20Ramey.htm Harvard Business Essentials. (2006). Decision making: 5 steps to better results. Boston, MA:Harvard Business School Press. Schmidt, S. R., Kiemele, M. J., & Berdine, R. J. (1999). Knowledge Based Management. Colorado Springs, CO: Air Academy Press & Associates, LLC. Schwalbe, Kathy, (2004) Information Technology Project Management, Thompson Course Technology, Canada, p. 286 Seeley, Keith, (2007) Founder – What is Founder, Professional Farrier Services, Retrieved on September 27, 2008 from http://www.keithseeley.com/Founder-2.htm |
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