Healing from the Ground Up: Laminitis, Metabolism & Bodywork - Alicia Harlov

So I typically have the guests kick off the show by having them tell us who they are and what it is they do. My name’s Leisha Harlob and I am a full time hoof care provider in the northeast of Massachusetts, so right on the seacoast, right under Maine and New Hampshire. And I also own a hoof rehab facility where we take in horses that have a hoof based lameness. So typically, I would say that 90% of the cases we take in are navicular related. But we’ve also taken in cases of laminitis, ring bone mystery, lamenesses where they couldn’t figure out what was going on, chronic abscessing and ligament injuries, tendon injuries that are based in the hoof.

And we rehab them to ideally soundness before they go back home to their owners. But a lot of times we just get them a good head start before they head home. Sweetie and I reached out to you like a couple weeks ago because I have gone down this laminitis negative Palmer angle rabbit hole. We had a 7 year old worn blood through not abnormally overweight he’s a hunter so he’s around but not really what we’d say like metabolic. There are no fat pads on this one and he just had a full blown laminitic episode and we basically it was not caught for four days because he didn’t do any of the classic leaning back off the humps like we thought he was tying up.

And then he got diagnosed with navicular. Like they took X-rays and they diagnosed it with navicular and then two days later he had to get both DDF TS cut to reduce the pain. And you know, yeah, it just ended up being like really traumatic. And I really haven’t experienced any laminitis or anything in a horse ever. And so one, we didn’t even know all the symptoms and but also numerous vets looked at this horse and didn’t even suspect it was in the feet.

So yeah, after that I went down this super rabbit hole of, of all of that. And I was like, I think I should just have Alicia back on to talk about the all of this stuff. And so I guess to start, we should just talk about what is laminitis? Yeah. And you know what’s so funny is I just actually recorded a podcast episode on this two days ago where that was my first question to group I was interviewing.

And laminitis in its most essential definition is inflammation of volley. So itis is inflammation and laminitis is inflammation of the lamb. The reason that isn’t as simple as just like it’s sitting defying that in every case is that some forms of laminitis are not actually due to inflammation, but due to an elongation of the lamina. So we say laminitis and we say it’s inflammation of lamina, but really it can be a change in the lamina where the structure of lamina is no longer strong. It’s there’s some compromise to it.

That’s that the integrity has been compromised and that can lead to a breakdown. So it’s not always inflammation, but really it just means that there’s something wrong with the lamina in the huff and that can lead to as a catastrophic results if it’s not dealt with. Yeah. So what? What is the lamina?

If I’m looking at the horses hoof, can I see it? Can I how? What is it? Yeah. So the lamina is inside the hoof, so you wouldn’t be able to see it by looking at the hoof.

It is the connection between the dorsal wall, the hoof wall of the horse, and the coffin bone. So there’s an epidermal in dermal lamina that connect kind of like a zipper or like really strong Velcro, and they hold that coffin bone to the hoof wall and keep everything compact and tight and connected in that horse. And what’s really amazing is this bond is so strong that it’s essentially supporting the entire weight of the horse. At any moment, what we can see as horse owners or anybody who picks up a hoof is the white line, which is the extension of the lamina connection past the coffin bone. So what grows down past the coffin bone is that white line connection that would be a projection of where that lamina is.

And that’s where you can see between the sole and hoof walls that really small. It should be a small line, unless there’s some kind of compromise to that lamina connection that will project that idea of that connection down to the. Ground. So then how does all of this connect to? Because it’s the cough and bones that rotate right when a force is going through full blown like laminitis.

So what is the mechanism causing that? Is it just because these things become unstuck so it just falls? Or is there something else happening inside of the hoof? Yeah, so that’s a more complicated answer than even just saying that the coffin bone rotates. I’m smiling like I smiled when you said that, because I would say that there’s even daily arguments about this kind of thing in fear groups between different kind of hoof care approaches.

But really what’s most commonly accepted that I would say in the veterinary world as well as the hoof Care World is that there’s two different kinds of rotation that can happen. When we’re thinking about founder, we’re thinking actually displacement of the hoof wall in the coffin bone. So we have what we would say is phalangeal rotation, which is what you’re talking about, where we have a rotation of the coffin bone out of alignment with the short pastor bone and a long pastern bone. So P1P2 and then P3 is the coffin bone. If those are all aligned, you could draw a straight line for straight through the center of all the bones.

You would say that’s straight phalangeal alignment. And if you have those burgs too that are straight and then the coffin bone seems to be tipping down out of alignment, we would say that horse has phalangeal rotation. I would say that’s actually not the most common. I know for a fact it’s not the most common laminitus or bounder case that I see. The most common that I see is what we call hoof capsule rotation.

So as we were talking about that lamina connection that’s like that zipper or like Velcro have the dorsal wall, the hoof wall in the coffin bone. If they’re connected like Velcro or if they’re connected like a zipper, they should be parallel. So on a radiograph you should see ideally the vet will mark up the wall of the hoof so you can see it clearly on the radiograph. So you should see that line of the hoof wall and then you should see the coffin bone and they should be in the exact same parallel direction. A lot of times we might have that short pastern bone, long past or long pastern bone, short pastern bone, coffin bone that might even be in a straight alignment.

They’re all lined up, but hoof wall has deviated away from the coffin bone. So that lamina connection has still been compromised, that lamina connection or the lamina might have elongated like we were just talking about earlier or it’s just not connecting well and keeping that those structures together. And so we’re seeing this displacement of the bone even though the actual alignment looks straight. So it’s in terms of what’s happening really, it’s just that the structure is not able to hold together because it’s been compromised by some kind of trigger. And there’s various triggers that can lead to that.

And each of them are handled a different way and each of them can have very different outcomes. You can even have, if we’re not just talking about rotation, you can even have a horse that has acute sinking where there’s a straight alignment of the bones and it might even look like the dorsal wall, the hoof wall and the coffin bone are parallel, so it looks like the lamina is still connected well, but the hairline or the top of the coronary band and the top of the coffin bone at the extensive process has a displacement. So that caught the extensive process has dropped where everything else might look normal. And that’s where a marker at the hairline is very helpful to see if you measure that, how many centimeters or millimeters hopefully has is between them. And that can help you determine if that coffin bone is actually just like the entire lamina connection around the entire coffin bone has basically failed.

And then bone is just sinking straight down without looking. There’s a change in the actual rotation of the bone. So those are just some of the things. And I feel like each of them we could talk for hours about, but just give that general overview. OK so then I guess my question then becomes how does diet and exercise and whatnot play a role in this?

Because like I said the horse. Although now since the laminitic episode the horse became a non sweater which we have realized now means he had some metabolic issues. But again, not once did a vet tell anyone that was the case. And and I’ve had horses stop sweating because they go from living in New Hampshire to living in South Carolina and just the shift in climate has for a season they stop sweating. And these aren’t metabolic.

Yeah, I guess you know what 2 parts. What are forces that are going through these issues, most likely getting in their diet that’s triggering them and then post episode, what is the right diet for that type of horse? Yeah, we’re talking about laminites in general. You’re right, like 90% of laminated cases are due to a metabolic or endocrinopathic concern. So that is the vast majority of laminitis cases.

And the very first thing really, I would argue, I’m not a veterinarian, but I would argue that anytime a horse comes up lame, especially in the front feet, the first thing I want owners to do is pull blood work. Because Doctor Alicia Nolfi is a podiatrist that I’ve had on my podcast before, and she has said that assume everything is laminized until proven otherwise. And because laminized can be so devastating if you catch it very early, you can keep that laminic connection strong and prevent further damage. So even if it seems like the horse is just barely changed in their attitude, maybe they’re a little bit hesitant to pick up trot or a little hesitant to pick up canner. Or if you notice when you turn them out, normally the hurt the horse when you let them go will gallop off or just can it her way.

If they’re just kind of like walking off where you turn them out and there’s just a change in their general demeanor, that can be something where it’s an earth, there’s some indication of of inflammation in there. So if 90% of the laminized cases that we see are metabolic, the fastest way to determine that is through blood work and that would be testing non fasted insulin. We have so much research that has just been published even within the last few years about proper ranges and they’re so much smaller than what we originally had thought. Doctor David Rendell is the past president of the British Equine Veterinary Association and he would say that really we want non fasted insulin to be in the single digits or teens and anything higher than that we should really start to to be suspect of it. And anything above 21.6 showed an increased risk of laminitis in a four year study they did with ponies, which is much lower right now.

That normal range goes up to 40. And for PPID or Cushing’s is what it was previously called. You test ACTH and the same kind of thing. ECR group that you find Cushing’s and insulin resistance group says that should really be within the teens to low 20s year round, even during the seasonal ride. It’s all a lot of people I think would assume they got this blood work and it looks like it’s within lab range.

Their course isn’t metabolic, but I would treat every lamb eyes case as if it is metabolic until it’s absolutely proven otherwise. And what that would be like you said, is diet and exercise. And obviously of course is lame. Exercise is not going to be the first thing we can do. But diet, the ECR group, like I mentioned before, has an emergency diet.

So, you know, the second, of course, is in any kind of pain or especially with an acute episode, you pull them off of grass, pull them off of grain, soak all their hay until you can get your hay tested or it might be something where that’s not practical. The test, you get a different load every week or whatever. So then you keep soaking the hay until the horses sound and you stick to the very basics of making sure they’re getting salt, making sure they’re getting a little bit of flax for omega-3 is you can feed around 10 grams of magnesium. There’s some correlation between feeding magnesium and having the horse able to process sugars in their body a bit better. And you can keep their safe vitamin and mineral products to keep feeding them.

But the emergency diet is just making sure that they’re getting the absolute necessity so that you’re ruling out anything that could be causing pain and that should be fed in a metabolic safe carrier. And there’s a lot of things, a lot of feeds that I think that owners don’t realize can actually trigger a metabolic course. Some of the safe carriers that we that I use are something like non molasses to beat pulp. I use Speedy beat. It’s a non-GMO product from the UK.

I’ve had really good results with that and it tends to be a lot cleaner than some other beat pulp. And I’m not like sponsored by them and I don’t get paid by them. I just Timothy balanced cubes is a forge cube that’s formulated by the ECR. Some ECR members that kind of looked into what they could do for a safe product, a grass hay pallet like Timothy grass or teff grass or orchard grass hay with nothing else in it. In some things that can be a sneaky trigger other than the sweet feed or molasses grain is.

Some horses are incredibly sensitive to alfalfa. I’ve had some horses that on my property that can’t even have a few bites of alfalfa pellets without becoming very footsore. I have horses that seem to have issues with soy or flaxseed of it honestly, which is crazy because I never thought that would be an issue. If there’s a feed that’s more than 10% protein can trigger some horses. Excess protein in a very sensitive metabolic horse.

Also excess fat. And that might seem obvious, but some people, especially if a horse has cushions or PPID, they might actually become a harder keeper and look a little thin or just not. They don’t have the fat pads that you’d assume in a metabolic course. And so a lot of owners will think that they need extra calories and the first thing that they might grab is an oil. Sometimes metabolic courses can’t handle any oil.

It’s just too concentrated about fat. You’re not feeding a large amount. So the ECR emergency diet kind of strips away anything that could be causing those triggers if it is diet related. And once the horse is more comfortable, then you can start adding back things back in one by one to see if any of those end up triggering a horse long term, if you want me to get into that. Yeah, sorry, I know this is such a big topic.

So we could. So long term, if you do have a metabolic horse, unfortunately, really they should be completely off of grass, fresh grass pasture, not grass hay. There are there’s a whole website calledsafergrass.org, which was created by Katie Watts, who did extensive testing on the safety of grass for her own metabolic courses. And she tested when the sugar levels were lowest and what conditions raised and lowered the sugar in the grass, such as mowing versus a drought season versus when it’s been cold overnight or when it’s been rainy, all these different things. If grass is in shade versus is not in the shade.

And so people can explore that if they really want to. But in most cases, I don’t think that owners are going to be micromanaging their horses grass turn out to that degree based on the weather and the. And so the easiest thing for owners if they really want to prevent laminitis in the future if their horse has had a metabolic concern is to not ever have fresh grass again. Obviously there are grazing muzzles as well. And if your only turn out is grass, I would prefer a horse to be outside than living in a stall.

So there are ways that you can work to make sure that there’s a less of a risk. The safest is to find a dry lot, build a track system, do something that the horse isn’t grazing. I tend to encourage my metabolic horse owners to avoid grain and use something like one of those grass hay pellets with a vitamin mineral balance or so many good ones. And really the best thing would be to test your hay is supplement what the haze deficient in. If you can’t do that, there’s so many good ones in the market.

There’s Vermont blend, there’s Mad Barn products, there’s horse Tech has a lot of great ones, Arizona Copper Complete, Colorado mix, Lone Star Trace, there’s California trace. Plus. There’s just so many products, you know, that are made for with metabolic courses in mind where there’s not any added molasses or sugars, iron that can exacerbate that. And there’s so many other like little nitty gritty things like the ECR group has a lot outlined. But for example, a lot of metabolic course owners avoid feeding glucosamine because injectable glucosamine seems to have an effect on insulin.

And while it’s not certain if that’s true of orally fed glucosamine, some owners have anecdotally said that they have noticed that they’ve had sore horses when their horses are on glucosamine and then they’re fine when they’re not. There’s a lot of just little things like that where if a horse is really struggling after the very basics of removing the main triggers, then the ECR group has a really great support system to try to find some of the other triggers that could be from diet. But obviously it’s not always diet related and that’s where it can get a little bit more tricky. Yeah. And yeah, we actually in South Carolina, we’ve been getting a lot of rain and typically our grass is actually unless you seed with rye or grass is pretty low sugar because it’s just coastal.

And the we’ve had a an issue because we’ve gotten so much rain. We get our rain early in the mornings and then the sun comes out and so the photosynthesis is creating more sugar in the grass. And so we’re like anytime now someone is coming to be with a random behavioral issue, I go call the vet and get some blood work drawn because I’m not hecking around anymore. But it’s not typically something if you have even easy keepers. The grazing muscle tends to keep everyone just because.

And the grass doesn’t grow all that great down here either, so once they eat it down it’s usually gone. But. You know what’s so funny is that I have a client who snowbirds down in Florida over the winter and her metabolic horse is always fine with the out with the grazing, even sometimes without a grazing muzzle grazing in Florida and then up here the second she comes back up she’s sore again. Not that I’m telling all the metabolical that’s to turn their. But yeah, no, it is just based on where you are in the United States, the things that can and may not trigger your horses, just all going to be so different.

It’s really worth people looking into. Although podcasts are great for general speaking, it’s general. So I guess switching gears a little bit every so often, couple of years, I see trends in the horses that come into training. And a couple years ago it was, there was a lot of asymmetry and the way horses were going. And now I’m noticing I’m getting a lot of horses with negative Palmer angles.

And I had one who I’ve been rehabbing for two years and I actually just found out she had negative Palmer angles. Like it wasn’t even, I knew she had a little high low, but I’d assumed that was just how she was built from racing. And yeah, so I wanted to chat about one. What is a negative Palmer angle actually? And why do forces like develop them?

Yeah, a negative Palmer angle is where the coffin bone in the hoof, the back of the coffin bone is closer to the ground than the front of the coffin bone. In a healthy huff, typically you’ll have a coffin bone that is slightly positive. So the bottom of the coffin bone is if you’re drawing a straight line from the ground and then a straight line on the bottom of the coffin bone, that angle is slightly positive, usually anywhere between 3° and 8° in a normal huff. So if you have a horse that has a negative angle to that cough and bone, it can come with a lot of issues and it can also be a symptom of some issues. I should say that the negative palmar angle, it can be used for all four feet.

Typically we’ll say negative plantar angle for the hind feet and palmar angle for the front feet. But really the negative palmar angle can be used interchangeably for all four. There’s a few different reasons that this can happen and I can’t even begin to exhaust all of them. But I would say that a lot of people assume that if their horse has negative angles that they’re you know, if they’re not into hoof care, they might assume that their farrier is just doing a bad job. And I’ll say that I will say my area has some incredible farriers.

We have there’s if you throw stone, you can hit five amazing farriers. And so I can almost guarantee you that if your horse has negative angles, it’s probably not the trim or the farrier in my area, because they’re so well educated, they’re not wanting to, they know what angles should be. So most owners will think, oh, I’m assuming my farrier is just trimming too much heel and leaving too much toe. And that is 1 ‘cause you can have a trim where maybe somebody’s so focused on getting the heels back to the widest part of the frog to get that frog engaged that then maybe they’re lowering it so that cough and bone is no longer positive or upright in that hood capsule. But I would say that the cases that I most commonly come across, they don’t have a pore trim at all.

And they actually wouldn’t even have enough sole depth by the toe to correct the angles with a trim. So that to me says that it’s not even necessarily that the trim is incorrect. It’s that something else is going on in a lot of times what I see and it becomes this cyclical, like a perpetual issue is there’s a Body Issue higher up. So for example, if we’re looking at the hind end, if the horse has some stifle pain or has some issues with their SI or some pain in their their hamstrings or back end where they’re trying to relieve that pain by standing with their hind legs just slightly. I mean, you might not even notice it a horse regularly, it might not be dramatic, but they’re standing with their hind legs slightly underneath them to try to take some pressure off of their stifles or try to relieve feel like how we might stand.

If our back hurts, we kind of shift our hip or cock our knee or whatever just to relieve some pain or pressure. Horses will do that too. But if they do that perpetually, then they can end up crushing their heels a bit because their weight is now over that heel instead of over the center of mass in that foot. And that can with that excess pressure on that heel. It’s not necessarily that the heel is actually growing less than the toe, but it’s that the forces on the foot are allowing the toe to grow normally, but the heel is having improper feedback where it’s either being worn or it’s being compressed in that area and you’re getting these negative angles that have absolutely nothing to do with the trim.

And just chasing the trim or just doing corrective shoeing and wedges will not ultimately get to the root cause of what’s causing the pain and you might end up having worsening issues over time. When really that horse needs a work up of its hind end higher up to see if there or body work or stretch or something and proper training where they’re able to use their body more correctly and strengthen that hind end so that they’re able to utilize it properly, stand better, have a more postural rehab in there and get those, get their weight off of those heels and allow their hoof to grow in better. So I would say that those are that’s one of the most common things I see. And often if I see a horse where even just looking at it, sometimes you can see their front of their hoof capsule might almost look like a bell, like it’s bull nosed and that’s one sign that coffin bone is tipped. Or if you’re looking at the hairline on the hoof, it might look like it’s pointing straight up to the sky.

And you can assume that is showing that the heels are quite low in comparison to the toe. The first thing I’ll tell owners is have a body worker out some issues higher up in the hoof, higher up, sorry in the body before we start running the whole because you can chase your tail trying so many different shoeing packages. It’s crazy how you can start trying all these things when really it might just be that they need some really good body work. Yeah. And as we wind this down, just a little anecdote, but I’ve had this mare for two years, maybe a little longer, and she came to me with the most bizarro shoeing setup I’ve ever seen, like hind shoes on the front seat and pad, wedge pad on this foot and normal pad on this foot and then pads behind and what?

And I go, the pads behind are a little excessive. She should be able to like walk and four steel shoes relatively. You know what, we’re not that rocky here. And so I ended up she ended up pulling shoes constantly and I couldn’t figure it out to the point where like she would wear out the holes, the nail holes of the shoe and the shoe would come off and all the nails would still be in her feet like that. Clearly some weird mechanical issue in the way the source goes and so through.

So basically from that point, it was a year and a half of corrective Podiatry, body work and training and like a lot of training, a lot of in hand work to improve her posture up front and her thoracic slang and everything else. And not only have the feet gotten better, every time the farrier looks at her, he’s Oh my God, this is so much better. But actually her girthiness went away and I never treated her for ulcers. And there were just a few other things, like her sensitivity to brushing went away, and just all of these things where you really start to realize how interconnected it really all is. And I think we hear the term no hoof, no horse quite a bit.

But I don’t know if people realize actually how much goes on in the feet and how much goes on in the body that correlate to the feed. And it’s all just, yeah, but you totally can just chase your tail, try to figure out what the heck is wrong when it’s. Oh, God, this horse just actually walks funny. And we need to correct the way it walks. And.

But yeah, it can be really hard when they’re like ripping their foot off every five days because they’re pulling a shoe. And. But yeah, so now she’s just getting out competing now for the first time in a couple of years because she’s finally good. And it does take. She was a pretty extreme case, I think, But like, it does take time and absolutely.

But yeah, this has been a very informative conversation. I feel like we touched upon a lot of stuff. How do people follow along with you and what you’re doing and all of that good stuff? Yeah, so we have our social medias, the Humble Hoof Cross, Instagram and Facebook, and then the Humble Hoof podcast. I also have a podcast and we only talk about hoof health and soundness.

So if you’re a little bit obsessed with that kind of stuff, we have, we’re coming up on 7. Years. Oh gosh, congratulations. It’s insane. I can’t even believe that I’ve been talking about hoofs for seven years longer than that.

It’s just recorded and that’s available on any podcast platform or at the humble hoof.com/blog, which is odd, but it’s under the blog tab. We have all the episodes there. Cool. Thank you so much for joining me. Yeah, thank you for having me.