The treating veterinarian, Kevin May, DVM, recommended Bute, Acepromazine twice a day, and Banamine as needed for pain. Touché was fitted with Ric Redden Ultimate Shoes on her fore feet, which were both causing her very noticeable discomfort. A laser (850 nm Thor DD) was used daily to stimulate all acupuncture points surrounding the coronary band. The Thor Cluster Probe with a 69 diode 950 nm 15 mw output was applied on both sides of the fetlock and on the heel and front of the pasterns. Laser treatment was followed by electrical stimulation administered using the Theroquine Electrical stimulator for 45 minutes on each pastern daily.

Laser and electrical stimulation was administered by the San Diego Equine Therapy Center. Treatment lasted for 30 days and resulted in an absence of any detectable pulses within 60 minutes of each treatment. However, pulsing would return the day following each treatment.

The Ric Redden Ultimate Shoes were re-bandaged in place daily. After approximately 30 days, as the pulses decreased, therapy was reduced to every other day, then every third day as pulsing ceased. Pulses were checked a minimum of four time's daily for a period of approximately three months total. If pulsing was detected, laser treatment and electrical stimulation treatment was administered.

After approximately six weeks, the Ric Redden Ultimate Shoes were replaced with reverse shoes with two wedge pads. After pulses stopped completely the pads were reduced to one wedge and six weeks later were changed to a reverse shoe. Radiographs were taken two weeks post-onset and again at eight weeks post-onset by Gary Amaral, DVM. Radiographs showed zero rotation in either foot.

Touché’s diet at onset was changed from Alfalfa Bermuda mix to Bermuda Hay only. The mare initially was in such pain and so depressed that she would not eat. Alfalfa was slowly introduced back into the diet as she slowly progressed. Touché was considered to be at a good weight and in good condition therefore weight loss was not considered. She was housed in a deeply bedded barn stall for comfort.

While Touches' laminitis appeared to be resolved, she never became fully sound again. She was able to do very little exercise, hand walk, hot walking, or turn around in very soft paddocks. While radiographs were negative of any abnormalities, she continued to show discomfort, especially on hard and even surfaces.

Second Episode Of Laminitis
On March 1, 2000 Touché’s head begin to swell around her right eye and cheek. This edema would increase and decrease each day and did not appear to worsen. Touché’s veterinarian, Kim Sergeant, DVM felt that a thrombosed right jugular vein was the cause of the swelling. In April 2000 Touché’s head began to swell on the right side to such an extent that this ½ Arabian mare had to wear a draft size halter. At approximately the same time, Touché’s farrier had recommended putting the mare’s shoes on normally.

Within a day Touché then suffered another bout of laminitis. She was a grade-3, reluctant to move, with bounding digital pulses medial and lateral on both fore feet, which were very warm to the touch. It was considered that her shoes were causing her pain. Therefore, her shoes were gently pulled, toes squared off and Ric Redden Ultimate Shoes taped back in place. However, this time there was no noticeable pain relief.

Bute was given twice daily and Banamine IM for pain. Dr. Sergeant ran a full blood panel and prescribed thyroid powder for a slightly low-functioning thyroid. Laser and electrical stimulation therapy was applied as before, but produced little decrease in pain or pulses.

After three days with no relief and symptoms worsening, ice therapy was introduced. Touché’s fore feet were kept in ice water for 20-minutes at a time, followed by 30-minutes out of the ice water, for up to eight hours per day. Ice water therapy was able to provide some pain relief. Laser and electrical stimulation therapy were also administered. Pulses would diminish or decrease each day by evening, but would reoccur just as strongly the following day. The mare became very depressed.

Due to the thrombosed right jugular vein and the increased swelling of the head and face, Bute and Banamine IM were reduced. Ketofen was administered, but did not seem to make Touché any more comfortable. Kim Sergeant, DVM took ultrasound readings of the right jugular vein to assess blood flow and found it to be massively occluded with essentially zero blood flow. Dr Sergeant also took radiographs of both front feet and fortunately there was zero rotation in either foot. Due to Touché’s substantial pain and increased depression, both the Bute and the Banamine IM were increased. However, in addition to the the right-sided swelling of Touché’s head and face, the left side of the mare’s head now also began to swell.

At this point, nothing seemed able to halt Touché’s rapidly failing health and depression. We felt helpless to stop her continuing downslide. Touché became totally reluctant to move out of her ice water. While on a break out of the ice water, she herself would replace her feet in the ice water. Her appetite began to decrease. At this point euthanasia was seriously considered.

Response To NitrOxide
On April 26, 2000 we decided to try a new nutritional supplement called NitrOxide.  NitrOxide is a specially formulated combination of nutrients designed to improve blood flow by promoting the body’s production of the vasodilating substance, nitric oxide. NitrOxide is an all-natural product that contains no herbs, hormones, stimulants, or drugs.

30cc of NitrOxide powder together with 1-ounce of water mixed to the consistency of slurry in a 60cc syringe, was administered orally on the evening of April 26, 2000 on an empty stomach. All feed was held for approximately 60 minutes post-dosage. Touché at this stage was barely able to move from her hay to her water.

At 6:00 a.m. on April 27, 2000, 12-hours after receiving the first serving of NitrOxide, Touché was found standing in her stall, her hind legs relaxed, and comfortably bearing her normal weight on her front legs. She walked up to her hay and walked around the stall almost normally. Her feet were no longer warm and pulses were absent in both fore legs. A second serving was administered at that time on an empty stomach. No other treatment was given that day or the next. Pulses were checked around the clock with zero pulsing detected.

NitrOxide continued to be administered twice daily at 12-hour intervals on as empty stomach as possible. As of today May 5, 2000, Touché has not had any Bute, Banamine IM, Ketofen or any other painkiller since April 25, 2000.

Touché continues to wear Ric Redden Ultimate Shoes taped to her feet. On April 29, 2000 she was active enough to knock off one of the shoes, as a result she had mild pulses on that foot. The NitrOxide was administered and laser therapy was applied to the acupuncture points around the coronary band and simple ice packs were placed on each foot while the other was being treated with laser therapy. Immediately following laser treatment, all pulsing stopped and was not detected again for two more days.

Upon the return of pulsing, laser treatment was applied in mid-afternoon, following which pulsing was reduced, but not completely eliminated. NitrOxide was administered that evening and within 15 to 20 minutes, pulsing was undetectable.

Due to Touches' fiery disposition she is not a quiet patient when she is feeling well. While still confined to her bedded stall she is a weaver and pacer and has been bucking in place. Her activities have caused her to tear off her Ric Redden Ultimate shoes numerous times, sometimes with mild pulses returning. However, with the administration of NitrOxide and simple laser therapy, 20-minutes after receiving NitrOxide, pulsing has diminished completely. At times it has seemed as if she is in less discomfort than she continued to display between her first and second attack of laminitis.

Prior to using NitrOxide I was beginning to feel like we were losing the battle. Therapies that had worked so well during my mare’s previous attack of laminitis were not effective enough. This time Touché was in such great pain and so depressed, I began to feel nothing but euthanasia would stop her suffering.

In the last 30 days Touché has not been given any medications or supplements other than the NitrOxide. She is now bucking in her stall eager to get on with her life.

Dana Meir
San Diego Equine Therapy Center