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TOPIC: Botox for laminitis

Botox for laminitis 01 Jul 2009 13:04 #1

  • Katy Watts
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What are your thoughts on this? I suppose it would be less invasive than a tenotomy, but wonder if it could have bad affects if done routinely. Would it make them move differently or less?
Does anyone have full text access? I wonder what else was done that might have confounded the affects.

Journal of Equine Veterinary Science
Volume 29, Issue 7, July 2009, Pages 595-600

A Novel Approach to the Treatment and Prevention of Laminitis: Botulinum Toxin Type A for the Treatment of Laminitis

Daniel W. Carter DVMa and J. Ben Renfroe MDb,
aWest Florida Veterinary Associates, Gulf Breeze, FL
bChild Neurology Center of Northwest Florida, Florida State University College of Medicine, Department of Clinical Sciences, Division of Pediatrics, Gulf Breeze, FL

Laminitis is an inflammation of the lamina of hoofed animals. According to the United States Department of Agriculture (USDA), laminitis impacts approximately 2% of the horse population each year. Because of the severity of the inflammation and chronic pain, it is frequently necessary to euthanize these horses. Surviving horses may be left useless, with resultant economic and social impact on the industry. Current interventions for laminitis are based on supportive care and alteration of biomechanical forces on the digit. The transition from laminitis to laminar failure (founder) is believed to be caused by the “weight of the horse and the forces of locomotion driving the bone down into the hoof capsule.” We hypothesize that an important factor is the torsional forces placed on the distal phalanx (coffin bone) by the deep digital flexor muscle and tendon. The paralyzing effect of botulinum toxin will result in a decrease of these torsional forces and therefore will aid in the prevention or treatment of the sequelae of laminitis. Seven horses with varying degrees of laminitis were evaluated. Each underwent pretreatment and posttreatment radiographs as well as pretreatment and posttreatment Obel grading. Each horse received botulinum toxin type A injected into the belly of the deep digital flexor muscle. In all cases there was radiographic stabilization of pedal displacement from the dorsal hoof wall. Obel scores showed improvement of 1 to 2 grades during the time monitored.
Are you feeding your horse like a cow?
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RE:Botox for laminitis 01 Jul 2009 13:59 #2

I would try that before surgery. More studies need to be though.
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RE:Botox for laminitis 01 Jul 2009 14:15 #3

The idea may well work and indeed is a whole lot less invasive than a tenotomy is. Thing is that the interaction between all structures that make up the equine digit is not fully understood. Even if we stick to tendons only the interaction between them is not fully understood.

I posted several times on this subject (e.g. -with postings by the late Dr. Rooney!- http://www.horseshoes.com/forums/showthread.php?t=202 )

I think that perhaps a trial could be started with a severe club ready to be slaughtered anyway? I'd choose a club over a laminitic case to kind of eliminate the metabolical issues that may play a role in laminitis.


Ronald Aalders
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RE:Botox for laminitis 05 Jul 2009 15:47 #4

  • mwmyersdvm
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Horses are over 10 times more sensitive to botulism toxin than humans so the possibility of overdoseage is great. Length of time of the effect is important and immediate correction of the hoof mechanics is paramount. It is unlikely that these horses were afforded the mechanical correction indicated as I often have results not requiring tenotomy and since this has to be done before the botox would be used, it would often make its use unnecessary. As for expense, I am not sure what botox would cost, but I only charge $600 for a field tenotomy so this may not be a factor. It could certainly give some data as to whether a tenotomy would be helpful as some horse do not get relief from the procedure.

My main problem with all of the 'exotic' therapies for laminitis is that they are done by individuals unaware of the basic mechanics needed fo correction in so many instances.

M. W. Myers, D.V.M.
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RE:Botox for laminitis 05 Jul 2009 17:09 #5

  • Jaye Perry
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mwmyersdvm-Horses are over 10 times more sensitive to botulism toxin than humans so the possibility of overdoseage is great. ..

Thought there were 2 types~~ A & B Botox; one is ok for a horse and one is deadly?:confused:
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RE:Botox for laminitis 05 Jul 2009 21:52 #6

  • mwmyersdvm
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You are correct. The B toxin is the most problematical for horses. I just tend to get a bit overly concerned with all of the exotic therapies that lead us away from basic mechanics for laminitic therapy. I suppose my concern would be better served if I posed the query as to why no one will try to relieve the deep flexor with mechanics but will be willing to try Botox? Why haven't the deep flexor relief naysayers been on this thread to try and negate this data that adds proof that deep flexor relief is most definitely beneficial to the laminitic horse.

Thanks for the assist Jaye.

M. W. Myers, D.V.M.
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RE:Botox for laminitis 05 Jul 2009 22:01 #7

  • Jaye Perry
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mwmyersdvm wrote:
You are correct. The B toxin is the most problematical for horses. I just tend to get a bit overly concerned with all of the exotic therapies that lead us away from basic mechanics for laminitic therapy. I suppose my concern would be better served if I posed the query as to why no one will try to relieve the deep flexor with mechanics but will be willing to try Botox? Why haven't the deep flexor relief naysayers been on this thread to try and negate this data that adds proof that deep flexor relief is most definitely beneficial to the laminitic horse.

Thanks for the assist Jaye.

M. W. Myers, D.V.M.

DDFT tendon and pain response of the muscle(s) go together.

The vets play a major role in the acute/chronic stages of laminitis. Their administrative "medical" judgements are crucial!:)

First mention of Botox i heard of was from Dr. Jim Orsini at NBC. I met Dr. Orsini way before Pat Reilly
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RE:Botox for laminitis 05 Jul 2009 22:50 #8

  • mwmyersdvm
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Jaye Perry wrote:
DDFT tendon and pain response of the muscle(s) go together.

Thanks. My point exactly and this point is often questioned. It is a major reason why some horses simply cannot be adequately treated totally barefoot. It is a reason why heartbars don't always work. The list goes on, but I am glad you agree.

M. W. Myers, D.V.M.
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RE:Botox for laminitis 06 Jul 2009 02:52 #9

  • Gary Hill
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I like Ronalds idea of using a club to experiment with. That is one of the biggest problems I run into and am always looking for advice on what has worked for others?
"As I see it, winners get the money - while losers talk of "individual goals" and similar stuff." Tom Stovall
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RE:Botox for laminitis 07 Jul 2009 02:52 #10

  • wwhite1973
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Dr. Meyers, not meaning to hijack Ms Watts' thread, what are your thoughts about Gabapentin for laminitic horses? I read an article the other day and can't find it. They did say in the article that there were some promising resutls.
Wayne White
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RE:Botox for laminitis 07 Jul 2009 05:55 #11

mwmyersdvm wrote:
I suppose my concern would be better served if I posed the query as to why no one will try to relieve the deep flexor with mechanics but will be willing to try Botox?M. W. Myers, D.V.M.

Well, the botox therapy (if it works at all!) appears less invasive for one. Some may have noticed :D I'm a firm believer in reducing DDFT pull in laminitic cases. However where a tenotomy may be a life saver, it's not exactly a "non invasive procedure".


Ronald Aalders
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RE:Botox for laminitis 07 Jul 2009 11:16 #12

  • reillyshoe
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I do not think the forces on the foot created through a DDFT tenotomy can be replicated through shoeing alone. Moving the breakover point caudally and heel elevation, while sometimes effective, have different effects on the foot
P
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RE:Botox for laminitis 07 Jul 2009 12:10 #13

reillyshoe wrote:
I do not think the forces on the foot created through a DDFT tenotomy can be replicated through shoeing alone. Moving the breakover point caudally and heel elevation, while sometimes effective, have different effects on the foot

Neither do I. What made you post that remark?


Ronald Aalders
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RE:Botox for laminitis 07 Jul 2009 12:48 #14

  • reillyshoe
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mwmyersdvm wrote:
. I just tend to get a bit overly concerned with all of the exotic therapies that lead us away from basic mechanics for laminitic therapy. I suppose my concern would be better served if I posed the query as to why no one will try to relieve the deep flexor with mechanics but will be willing to try Botox?
M. W. Myers, D.V.M.

I am not sure if a tenotomy qualifies as "exotic" or not.
P
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RE:Botox for laminitis 07 Jul 2009 19:21 #15

  • mwmyersdvm
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Actually, I was referring to using heel elevation and breakover relief and not a tenotomy. I find it difficult at times to get this procedure viewed in a positive light. The botox therapy would probably exert a similar effect. Except, the botox therapy could be abused as the hoof mechanics would not be addressed in lieu of the medical treatment. This I do see as a constant problem in my practice.
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