Q1. Which is the most common "type" of laminitis
Endocrine laminitis - 61% got this correct
Supporting limb laminitis
Systemic Inflammatory Response Syndrome (SIRS) laminitis
"It is currently thought that around 90% of cases of laminitis have an endocrine cause (Karikoski et al. 2011) , either Equine Metabolic Syndrome or Pituitary Pars Intermedia Dysfunction/Cushing’s,
and that pasture associated laminitis is an endocrine disorder in which horses (particularly ponies) have an abnormal insulin response to the sugars in grass."
Q2. A good daily check that can help early identification of laminitis?
Walking on hard ground/turning a tight circle - 72% got this correct
Checking body temperature/respiration rate
Walking a 20 m circle each way
Asking the horse to back up
"Symptoms of laminitis include:
Feeling “footy” - preference for soft ground
Reluctance to turn"
"Daily checks that can help early identification of laminitis:
- Walk on hard ground e.g. concrete - does the stride shorten, does he/she seem at all "pottery"?
- Turn in a tight circle - normal or reluctant to turn/stiff behind?
- Digital pulses - normal?
- Regional fat pads - cresty neck, bulges in hollows above eyes, enlarged sheath, fat above tail? Hardening of neck crest or increase in any of these fat deposits can indicate imminent laminitis."
Q3. Which blood tests are recommended if a horse has a history of laminitis?
Insulin, ACTH, glucose - 65% got this correct
Glucose, cortisol, ACTH
Insulin, cortisol, TRH
Glucose, TRH, ACTH
Management of laminitis:
"Diagnose the cause – test blood for insulin & glucose EMS plus ACTH for PPID"
Insulin provides information about hyperinsulinaemia/insulin resistance, which diagnoses EMS and indicates laminitis risk.
ACTH diagnoses PPID.
Glucose, although not essential, can add information - glucose can be raised in horses with PPID and in diabetes, which is very rare in horses.
Cortisol used to be considered diagnostic for PPID, but that has since been disproven.
TRH itself isn't tested, but the TRH stimulation of ACTH may be used to diagnose PPID - in which case it is ACTH that is tested.
Q4. Correct emergency treatment for laminitis?
Call vet, remove from grass, support feet if necessary, confine on deep supportive bedding - 93% got this correct
Call vet, allow access to grass, remove water, encourage to walk
Call vet, remove from grass, remove water, confine on bare concrete floor
Leave in field, give antibiotics and pain killers, encourage to walk
"Emergency treatment for laminitis
- call vet (and farrier/trimmer)
- remove horse from grass (but move as little as possible/support feet before moving)
- confine on deep supportive bedding e.g. sand, sawdust, pea gravel
- support the feet if the bedding isn’t sufficient to do this, e.g. with styrofoam, impression material, boots and pads
- give NSAIDs e.g. Bute, Danilon, Equioxx for the inflammation & pain (for as short a time as possible)
- apply cold therapy to the feet to reduce inflammation and pain (but not if cold-induced laminitis/feet cold)"
Never encourage a horse with active laminitis to walk. There is no reason to remove water - laminitic horses should always have access to water. Antibiotics have no place in laminitis treatment, unless a bacterial infection is causing the primary illness leading to SIRS laminitis.
Q5. The Laminitis Site's philosophy for treating laminitis?
Identify and remove/treat the cause, support and realign the feet - 93% got this correct
Give the pills, raise the heels
Find the cause, shoe the horse
Support and realign the feet and the cause of the laminitis will disappear
No explanation needed here - TLS believes that if you identify and remove/treat the cause and support and realign the feet, you'll sort out most cases of laminitis - great that so many people got this one right!
Q6. What is the maximum NSC % generally recommended when feeding a laminitic?
10% - 66% got this correct
Management of laminitis
"Feed low NSC (<10%) diet based on grass hay (+ protein, minerals, vitamins, linseed?) -do not starve"
The idea of 10% seems to have come from the ACVIM consensus statement on EMS - see under Dietary Management.
Q7. Which statement is true?
All/any feet can be affected by laminitis - 95% got this correct
Only the front feet are affected by laminitis
A single foot can't be affected by laminitis
Laminitis in all 4 feet is very rare
Nearly everyone knew that laminitis can affect all/any feet. Endocrine and SIRS laminitis are systemic, they affect the whole body, therefore all 4 feet have a chance of developing laminitis - more details here:
Can a horse get laminitis in any foot? - TLS forum
Q8. Signs of previous laminitis episodes in the feet include:
Hoof rings wider at the heel, stretched or deep white line - 83% got this correct
Hoof rings wider at the toe, tight white line
"Symptoms of chronic laminitis:
Hoof rings wider at the heel
Stretched white line - deep black groove between wall and sole - laminar wedge"
Q9. What are the 3 components of EMS?
Obesity/regional adiposity, hyperinsulinaemia/IR, predisposition to laminitis - 56% got this correct
Diabetes, hyperglycaemia, predisposition to laminitis
Obesity/regional adiposity, hyperglycaemia, hirsutism
Diabetes, hyperinsulinaemia/IR, hirsutism
EMS was defined by the ACVIM consensus statement on EMS as including obesity/regional adiposity, IR or hyperinsulinaemia and a predisposition towards laminitis.
Diabetes is very rare in horses, and horses with EMS very rarely have above normal glucose (hyperglycaemia).
Hirsutism is diagnostic of PPID, not EMS.
Q10. PPID is initially thought to be caused by
The degeneration of dopamine-producing neurons that control hormone production in the pituitary gland - 54% got this correct
Excess cortisol production from the adrenal glands
A tumour in the pituitary gland
A tumour in the adrenal glands
"In a healthy horse, dopamine producing neurons from the hypothalamus release dopamine into the pars intermedia. The dopamine acts as a brake and stops hormone production.
With PPID the neurons are slowly lost (PPID is a neurodegenerative disease - it gets progressively worse) and the reduction in dopamine (there can be up to 9 times less dopamine in the pars intermedia of a horse with PPID than a healthy horse of the same age) causes:
the production of POMC peptide hormones (alpha-MSH, beta-endorphin, CLIP and ACTH) to increase - hormone levels may be more than 100 times greater than in a normal horse;"
It is now known that most horses with PPID don't have above normal cortisol production, and adrenal hyperplasia (increase in cells) and adrenal tumour formation is not commonly seen. Excess cortisol production is associated with Cushing's disease in humans and dogs - not horses, that's why the disease in horses is now called PPID.
Although a tumour or adenomas can develop in the pituitary gland, this is thought to be as a result of the loss of dopamine-producing neurons and the consequent increase in hormone production, so is not the initial cause. A difficult question that over half got right - well done!
Q11. Laminitis in the ................... is particularly suggestive of PPID
Autumn - 52% got this correct
www.thelaminitissite.org/s - see Seasonal Rise:
"Horses that are developing PPID often first present with unexplained autumn laminitis long before coat changes are seen, and any horse having unexplained laminitis for the first time in the autumn should be tested for PPID by testing ACTH". Sorry, should have said "Autumn/fall" to be international!
Q12. Cortisosteroids increase insulin levels - true or false?
True - 83% got this correct
Am J Vet Res. 2007 Jul;68(7):753-9. (PubMed)
Effects of dexamethasone on glucose dynamics and insulin sensitivity in healthy horses
Tiley HA, Geor RJ, McCutcheon LJ
"The study revealed marked insulin resistance in healthy horses after 21 days of dexamethasone administration. Because insulin resistance has been associated with a predisposition to laminitis, a glucocorticoid-induced decrease in insulin sensitivity may increase risk for development of laminitis in some horses and ponies."
And many more examples of corticosteroid causing increases in insulin levels and laminitis here:
http://www.thelaminitissite.org/d.html - under Dexamethasone Suppression Test
http://www.thelaminitissite.org/c.html - under Corticosteroids