fång treatment2 - bivet.nu · factors that might raise the baseline: previous episode(s) of...
TRANSCRIPT
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Acute laminitis –acute treatment
And then?
Ove Wattle
Laminitis?
Cushings
Hoof abscess
bruising
MetritisEMS
Fracture
Myositis
Behandling av fång
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To treat laminitis
• As good recovery as possible
• The horse shall be as comfortable as possible during treatment
• Treatment should be practical
• a reasonable price
Goal
• Treat underlying causes• ”Box rest”• paraffinum liquidium p.o.• Pain controle• NSAID + …….?• Feeding regime• feed forage high• Biomechanical adjustment
Prostaglandins, leukotriener, interleukiner, bradykinin, substanse P, TNF-alfa contribute to increasedneurogenic sensitization and pain
Acute laminitis ≤72 hours from first clinical signs
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Treat underlying causes and laminitis
The horse should be comfortable
NSAID
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Primary inflammatory pain arising from peripheral tissues can be amplified by central secondary hyperalgesia and by neuropathic pain, both characterised by increased pre- and post synaptic neuronal sensitivity and activity at the level of the spinal cord
Pentoxifylline, which have anti-hyperalgesic properties via inhibition of the cytokines tumour necrosis factor (TNF) and interleukin-1 (IL-1) and matrix metalloproteinases, 8.8 mg/kg bwt per os q. 8 hDutton et al. Equine vet. Educ. (2009)
Gabapentin, an anti-seizure drug, for treatment of neuropathic pain, 2.5 mg/kg, PO, q 12 h - to - 3.3 mg/kg bwt per os q. 8 h.
Buthorphanol, Metadone
Williams et al. [2010] intravenous lidocaine had no effect on systemic and lamellar inflammation in fact there was some evidence of a pro-inflammatory effect.
Guedes et al. Vet Anaesth Analg. 2013
Treatment of pain associated with equine laminitis with soluble epoxide hydrolase (sEH) inhibitor, t-TUCB
Epoxidation of arachidonic acid by cytochrome P450 enzymes during inflammation yields epoxyeicosatrienoic acids (EETs). The EETs levels are regulated by soluble epoxide hydrolase (sEH).
Treat the right malady
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It is better to prevent than to treat- identify of horses at risk.
- Eliminate risk factors where possible or intervene therapeutically before establishment of the disease.
- In systemically ill horses, signs of sepsis or endotoxaemia are an established risk factor for laminitis and therefore aggressive therapy aimed at binding circulating endotoxin (polymixin B, plasma) and controlling systemic inflammation (nonsteroidal anti-inflammatory drugs, pentoxifylline) is rational.
- Continuous cryotherapy of the feet in these cases may prevent or at least ameliorate laminitis
Experimental cryotherapy
10.0
20.0
30.0
Chris PollittAndrew van Eps
Horse with laminitis
< 5°C
50 % reduction of metabolism per10 °C ↓
Experimental cryotherapyresults
Chris PollittAndrew van Eps
550 SKrhttp://www.mantorpstravshop.se/
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Factors that might raise the baseline: Previous episode(s) of laminitis, gut flora, deworming, certain feed, hoof trimming/shoeing, transport, metritis, pulmonary-/intestinal-/kidney- diseases, medicines (ex. Cortisone), EMS, PPID, inactivity, endotoxin,
Strength
Clinical symtoms of laminitis
Normal hoof In gallop forces of up to 3 times the horse’s body weight
4 kg oligofructoseraise the baseline
Force, standing horse
Time
To get as good success rate as possible:
Treat underlying disease, and the rest above.“Mild laminitis” rest from work 2 – 3 months“ Rotation or sinking” rest from work 9-10 moths
Let them be without NSAID for 2 -3 days before lighten the restrictions.
Successive changes in feeding regime and other factors that can affect the gut flora, work, etc.
A good farrier and the right OWNER
When do westop treatment?
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Amplified/Exaggerated pulses in the digital arteries
Deficit in coronary band support
Laminitic “ring”
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Sinker
Rotation + sinking
Sinker
Rotation + sinking
Foal “ring”
”Growth rings” mainly due to change in feeding
Laminitic ring caused by dislocation of PIII
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A quick rotationGives a double sole
A slow rotation
Hovben
P III
Dropped sole; ≥ 2 days
Double sole; 3 – 5 weeks
Double sole
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Nort Swedish horse, Obelgrad 3, omproved but 4-5 weeks later Obel grade 4
14 days
When P III penetratesthe sole =Infectios osteitis
PIII infectious osteitis
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PIII infectious osteitis
White line
White line
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5 minutes and a hoof trim
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29 a
12 s
26 s
an
gio
gra
phy
Venous Arteries
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A. Parks, SE O`GradyVet Clin Equine pract2003. Strategi för Verkning/skoning avKroniska fånghästar
Treat the right malady
Hollow wall
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EMS – forskning vid SLU
Foto: Josefin Söder
Pågående och kommande aktiviteter:
• Patientmottagning vid UDS
• Fortsatt utvärdering av oralt glukostoleranstest (OGT)
• Karaktärisering av hästar med EMS
• Behandlingsutvärdering av EMS
• Hemsida för veterinärer (jan 2014) – www.hästmetabolism.se
Johan Bröjer, Sanna Lindåse, Katarina Nostell, kliniska vetenskaper, SLU
Oralt glukostoleranstest (OGT)
Foto: Josefin Söder
• Anpassat för Sverige
• Dynamisk test för IR men ett enda prov krävs
Teknik
• Hästen fastar from kl 22.00 dagen innan
• Uppskatta vikten enligt http://www.hastsverige.se/sida418.html
• Djurägaren ger Dan Sukker glykossirap (0,2 ml/kg) nästa morgon
• Veterinär tar blodprov 60 – 90 min senare
Oralt glukostoleranstest (OGT)
Foto: Josefin Söder
• Ta blodprov i serum‐ eller heparinrör
• Skicka serum eller plasma till klinisk kemi UDS (speciell remiss)
Tolkning av insulinkoncentrationer efter 60 – 90 min: (http://www.slu.se/sv/universitetsdjursjukhuset/klinisk‐kemiska‐laboratoriet)
• Normal: < 400 ng/L
• Gråzon: 400‐700 ng/L
• Insulinresistent: > 700 ng/L
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Thank You for Your attention!