March 11, 2025 • 23 mins
Cooling treatments for equine laminitis have long been standard practice, but groundbreaking research now reveals that not all cooling methods deliver equal results. Drs. Andrew Van Eps and Sarah Ciamillo join us to discuss their study which found that distal limb immersion in ice and water dramatically outperforms other cooling techniques for equine hoof lamellae under real-world conditions.
Their research addresses a critical clinical challenge: while ice water immersion has been the gold standard in experimental settings, its practical application in everyday equine practice presents significant hurdles. The weight of water columns makes movement difficult, leading many practitioners to seek alternatives like ice packs or sleeves. This study definitively demonstrates that these alternatives simply don't match the cooling effectiveness of traditional ice water immersion.
What sets this research apart is its methodological approach. By measuring temperatures directly within lamellar tissue while horses moved freely in stalls, the team created truly clinically relevant conditions. The results were striking – even to researchers who anticipated ice water's superiority. "I just didn't expect there to be such a drastic difference between all the different methods," notes Dr. Sarah Ciamillo.
Beyond cooling techniques, our conversation explores the frontier of laminitis research, including exciting applications of artificial intelligence for predicting which horses might develop supporting limb laminitis. The team discusses ongoing collaborations with equipment manufacturers to develop more practical cooling solutions that maintain therapeutic effectiveness.
For horse owners and practitioners alike, the message is clear: when dealing with horses at high risk of laminitis or showing early clinical signs, ice water immersion should be the treatment of choice – even if that means referring to a hospital facility equipped to provide this therapy properly. This episode delivers critical insights that could change how we approach one of the most devastating conditions in equine medicine.
Have you dealt with laminitis in your equine patients? Share your experiences with cooling techniques and join the conversation about this research that's transforming our approach to equine foot care.
Open access AJVR article: https://doi.org/10.2460/ajvr.24.10.0291
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Wellness Pet Foods (00:01):
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:31):
You're listening to Veterinary Vertex, a podcast
of the AVMA Journals.
In this episode we chat abouthow distal limb immersion in ice
and water is the most effectivemeans of cooling the equine
hoof lamellae under clinicallyrelevant conditions, with our
guests Sarah Ciamillo and AndrewVan Eps.
Lisa Fortier (00:48):
Welcome to Veterinary Vertex.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Andrew and Sarahjoining us to talk about a very
important clinical diseaselaminitis and cooling the hoof
lamellae.
Andrew and Sarah, thank you somuch for being here today and
bringing on an equine podcastfor us.
Andrew Van Eps (01:07):
Thank you.
Sarah Ciamillo (01:08):
Thanks for having us.
Sarah Wright (01:10):
All right, let's trot on over.
So, Andrew, your AJVR articlediscusses how distal limb
immersion in ice and water isthe most effective means of
cooling the equine hoof lamellaeunder clinically relevant
conditions.
Please share with our listenersthe background on this article.
Andrew Van Eps (01:25):
Well, I think a cooling feat for laminitis
prevention has become and earlytreatment has become something
that's fairly commonly done andour research group, going right
back to when I did my PhD withChris Pollitt, we have looked at
the efficacy of cooling toprevent laminitis in
(01:46):
experimental models and we'vealways used ice water immersion
in those situations, either inboots or in recirculating tubs.
And ice water immersion isdifficult to practically do in
the clinic.
But our suspicion has alwaysbeen and some of the data that
(02:08):
has been generated has backed upthe fact that ice water
immersion is probably the mosteffective way to cool the
lamellae themselves.
But there's been at least acouple of papers in the last
five years that have, um, uh,perhaps had results that are at
odds with that, one that showedthat an ice pack system could be
(02:31):
effective and one that showedthat an ice sleeve that didn't
include the foot, that didn'tinclude water, could also be
effective, and in fact thatmethod we'd used here at New
Bolton for quite some years in aclinic.
The difficulty with ice waterimmersion is that the horse has
to carry around the ice watercolumn, so the weight of the
(02:56):
water itself is very difficultand impractical to ambulate
around with.
So, I think in clinicalsituations we've always searched
for methods that might be morepractical.
This paper we wanted to see if,by actually measuring lamellar
(03:18):
temperature itself within thetissue and trying to perform
these studies in clinicallyrelevant conditions inside
stalls with horses free to roam,whether in fact these other
methods could be as effective asice water immersion.
That's the short answer.
Sarah Wright (03:38):
No, it's a very good answer, actually Very good
summary, thank you.
So now, what are some of themore important take-home
messages from this article?
Well, I think it shows prettyclearly that ice water immersion
is much more effective thanother means.
Um, and I think, um, that's nota big surprise to us, um, but
(04:00):
uh, I think the reason there'ssome disparate information in
the literature is because thelocation at which you measure
temperature and the conditionswith which the horses are kept
in these experimental studiesmake a big difference to how the
temperature data appears.
(04:20):
So, I think, um, we took a lotof care in this study to try to
make it a realistic, um, uh, arealistic study.
The question I guess now is um,uh, you know, how cold does the
tissue need to be?
Um, and for how long?
Uh, but I think this is atleast a step that shows that,
(04:43):
that these ice water immersionsare better.
What's the important take-homemessage?
I think the important take-homemessage is in horses that are
at high risk of laminitis, or inhorses that are experiencing
early signs of acute laminitis.
If you want to cool their feet,I think you need to try to do
(05:05):
ice water immersion, and if youcan't do it in the situation
you're in, it's a good reason torefer a horse to a hospital
where it can be achieved.
Lisa Fortier (05:14):
Andrew, it's a good point of like how cold is
cold enough.
Given your vast experience andobviously your key opinion
leader in this area, what's yourgut instinct?
Tell you what is cold enough.
Andrew Van Eps (05:26):
Yeah, I don't know, and we've always tried to
make it as cold as possiblebecause we've always been trying
to look at changes, look ateffects in experimental models.
And so, we are always trying togo for the maximum defense.
In those situations, theprophylactic effects are really
profound, they're not small,they're really profound.
But there is literature inmodels of acute lung injury and
(05:55):
other things, in rodent modelsshowing that small differences
in body temperature, even fivedegrees of hypothermia, five
degrees Celsius lower thannormal, can make differences to
the acute lung injury, forinstance.
So, you know, I think it'spossible that even small
differences can help.
Um, small cooling effects canhelp, but I think our
(06:18):
overwhelming experience is thatthe colder the tissue is, the
better.
Um, when you're talking aboutlaminitis prevention and
stopping it from progressing.
Lisa Fortier (06:28):
That shouldn't be a problem.
Here in New York it's prettychilly, so the hoof capsule is
plenty cold here.
Andrew Van Eps (06:34):
Yeah.
Lisa Fortier (06:35):
Sarah, I'm sure you know you're incredibly
fortunate to be amongst Andrewand just the vast amount of
experience around New BoltonCenter.
What sparked your interest inlaminitis?
Sarah Ciamillo (06:48):
Yeah, so I first came to New Bolton I guess in
2020, and I was a Marsequestrian research fellow and
during that time I got to likekind of work with the laminitis
lab and Andrew and really hispassion for the like looking
into laminitis and everythingreally made me interested in it,
(07:10):
even though I would partiallysay it wasn't, you know, my ever
my topic of choice previously.
But I really enjoyed my timethere and like he's so intrigued
by it that it then makes meexcited about it.
So then, like my second year inthe research as a research
(07:30):
fellow, I really got moreinvolved in it as well and
really started to enjoy it.
Lisa Fortier (07:36):
Yeah, it's nice to be around thinkers right, and
Andrew and his group have alwaysbeen.
Like you said, it rubs off.
It's the bane of my existenceas an equine orthopedic surgeon.
So, knowing that somebody'slooking and really thinking
about this horrible disease forour horses is really wonderful.
Sarah Ciamillo (07:54):
Yeah.
Lisa Fortier (07:55):
Andrew pointed out that you kind of predicted the
main finding of the article,given all your other research
experience.
But every time we do studies wefind something that surprises
us.
What surprised you from thefindings in this article?
Sarah Ciamillo (08:07):
Yeah, I think I was just surprised how much of a
difference there really wasbetween just using the plain,
like ice, in a sleeve around thehoof, compared to submerging
them in this ice water immersion, like I always knew.
It would probably be better,but I just didn't expect there
(08:29):
to be such a drastic differencebetween all the different
methods.
Lisa Fortier (08:33):
Yeah.
Now, do you, now that you knowthat, do you watch like football
players differently, where theyjump in their little ice bath,
or
Sarah Ciamillo (08:39):
Right, yeah.
Lisa Fortier (08:41):
Or you think of like the old cowboys right, they
knew when their horse's feethurt, they walked them into ice,
cold streams, you know, theywere onto something a long time
ago.
It just took the brains ofAndrew and Pollack and others to
prove it.
Sarah Ciamillo (08:53):
Yeah, and when you walk around the racetrack
they have them standing in likebuckets of water up to their
elbows and I was like, oh, okay,yeah.
Sarah Wright (09:04):
So, Andrew, you talked a little bit about some
next steps, like, for example,like how cold does it need to be
but what are some other nextsteps for research in laminitis?
Andrew Van Eps (09:19):
Well, um, in laminitis in general, um, you
know, I think we, us, we stillthere's still some missing
pieces in terms of exactly whatcauses laminitis at a, at the
cellular level, uh, in differentsituations, although we have
got a lot more information thanwe did, say, 10 or 20 years ago.
But there's still a little bitmore to go.
(09:39):
And I think there's a lot ofprogress on, particularly the
endocrine side, bettermanagement of endocrine disease
for prevention and eventreatment of laminitis.
And even though there's someholes there in terms of better
understanding and bettermanagement, I think overall
(10:02):
that's where most progress hasbeen made.
Back at this sort of supportinglimb laminitis side.
There's still, um, uh, there'sstill some, some levels of
understanding that we have to toget to, but I think we are
making a little bit of progressthere.
And then you know, funnilyenough, that most of the
research had always been done insepsis related laminitis, that
(10:25):
um, particularly with thecooling and the models that we
were using to test it in theearly days, and that's really
stagnated and I think partiallyit's because the cooling does
seem to be effective in theclinic and we here at New Bolton
Center.
Most of the laminitis we see inthese sick horses now is
(10:47):
botanicals fever, I'd say, andin those cases it just happens
so rapidly.
I think a lot of the timethey're laminated even before we
we see them.
But I think that's an area thatwe're actually kind of
interested in working out whythat is such a profound cause of
laminitis in our population.
(11:08):
But, um, but I think therethere's still work to be done on
understanding how we can betteruse cooling, how cool it has to
be, and there's stilldevelopment that needs to be
done and hopefully we're workingwith some of these companies to
come up with better solutions.
So some of the companies thatcontributed equipment for this
(11:30):
study have modified their bootsto try to make them better.
In the aftermath and there aresome more prototypes coming.
I'm hoping that we can come upwith more practical ways to cool
feet that are more effectiveand easier for people to use in
(11:51):
the clinic.
Lisa Fortier (11:53):
Yeah, I'm just going to take this opportunity,
Andrew, to shout out to anybodywho's listening don't let your
horses get fat.
You know, I think many, many ofus.
Now that there's a stall-sideinsulin test, it really should
be part of your spring and fallcheckup on your horse.
You might not think your horseis overweight, but most horses
in the show ring not racehorsesthe, but at least in the show
(12:15):
ring most of them areover-conditioned, as my mother
would say, well-covered.
Yeah, and Andrew, I don't knowwhat to think about those
Potomac horse fever horses.
You know, some of them are.
I think they're close tothey're in DIC before they even
get across the threshold there.
I don't know that any icing isgoing to help them
Andrew Van Eps (12:32):
yeah, I think the interesting, my suspicion is
that the near rickettsiaactually um, it's replicating
and causing havoc withinmacrophages that are resonant in
the lamellae, the tissue itselfin the foot, and so in most of
these other causes and sickhorses you've got this systemic
inflammation and maybe endotoxinor other products circulating
(12:55):
that are the tissue and thecells in the lamella reacting to
and that's what's setting themoff, whereas I think in Potomac
it may be happening locally andit happens very rapidly and I
think probably we we just don'tget the chance to inhibit it.
Sarah Wright (13:15):
Very cool.
Now, Andrew, since the last timewe talked to you, we've added a
fun new question.
It's about AI.
So, do you see a role for AI inlaminais research?
Andrew Van Eps (13:25):
oh, absolutely.
I mean I think in laminaisresearch, um, uh, there is,
particularly as we start to getaccess to more of these tools
for big data.
AI can help sift through andlook for patterns and look for
(13:46):
associations in genetic basis orin protein profiles.
But the other thing is we'reactually quite into looking at
in horses that are prone tosupporting limb laminitis,
horses with fractures, lookingat locomotory patterns in those
horses and how they mightpredict whether that horse is at
(14:09):
high risk of developingsupporting limb laminitis.
Until now we've mostly usedthese foot-mounted sensors and
in fact Sarah, during her timein my lab, did a whole bunch of
work with foot-mounted sensorson horses with fractures and
that's shown us that thosehorses have lower rates of
(14:31):
ambulation and don't move asmuch as normal horses and
perhaps gives us someinformation on how we can
predict risk.
But I think now we're trying totake it a step further.
We used a bit of machinelearning in those protocols but
now we have video cameras set upon these horses that have
(14:52):
fractures and breakdown injuriesand we are developing models
that are AI-based to quantifyambulatory behavior and laying
down and standing up, in thehope that we can use that to
better predict risk in thosehorses and warn us early.
I think it's an exciting timeto be alive, probably the most
(15:18):
exciting time, because maybe in10 years the AI will be doing
the thinking for us as well, andnow we can do the thinking and
apply it.
Lisa Fortier (15:28):
I think you're safe.
I remember, Andrew, probably 30years ago at a VOS meeting,
Jeff Watkins saying he preferredhorses that had stall vices
when he was doing fracturerepair, like the weavers and the
pacers, and that, and he said,because they don't, they're far
less prone to founders than thehorse that just stands there.
Andrew Van Eps (15:47):
Yeah, and I think it was Larry Bramlage who
was into walking, and still, Ithink down at Rue Real they do
they like to walk them.
I do think it's a.
It's a, it's a kind of leapleap in understanding and I
think we probably will haveanother podcast on this at some
point, at least for the future,when I send this paper into you.
(16:07):
But, um, you know, I think thatit is something that we can
potentially, um, uh, work on andand and uh and understand
better.
Similar to, you know, perhaps,some ileus in people
postoperatively when they kindof worked out that, hey, you're
just going to get people up thenext morning after their surgery
(16:27):
and get them walking up anddown the highways.
Lisa Fortier (16:29):
Yeah, because fortunately the walking the
horses is a bit cumbersome whenyou want them to be iced, pick
your poison.
Andrew Van Eps (16:37):
Yeah.
Sarah Wright (16:41):
For those of you just joining us, we're
discussing how distal limbimmersion in ice and water is
the most effective means ofcooling the equine hoof lamellae
under clinically relevantconditions, with our guests
Andrew and Sarah.
Hey, Sarah.
Uh, you've heard andrew talkingabout this this vast uh depth of
manuscripts and articles andresearch that are behind this
(17:02):
article and that came beforehere.
How did your training andprevious work prepare you to
write this article?
Sarah Ciamillo (17:08):
Yeah, I guess it was really all my time when I
was the Mars Equestrian Fellow,working with Andrew and getting
to do real-time Laminitis workand the different variety of
projects that we are working on.
To really help write this andput it all together to help
further my knowledge in thetopic would probably be key, as
(17:32):
well as, like other clinicalexperiences you know, like
firsthand treating clinicallaminitis cases.
Sarah Wright (17:43):
So Sarah's next set of questions is going to be
really important for ourlisteners.
The first one deals with theveterinarian's perspective.
So what is one piece ofinformation the veterinarian
should know about equine distallimb immersion in ice and water
in cases of laminitis?
Sarah Ciamillo (17:58):
So kind of as a two-parter to that answer.
So I think it's key for them toknow that ice-water immersion
is way more effective than justusing plain ice and you'll get a
should get a better response tothese horses.
But also that, since it is kindof cumbersome and these horses
(18:20):
probably need a little bit moremonitoring with the ice water
immersion, that it would bebetter for them to be managed in
a clinic or, you know, somesort of hospital setting as
opposed to just managing at homeunder the owner's care for full
effect.
Sarah Wright (18:40):
Now, on the other side of the relationship, what's
one thing clients should knowabout this topic?
Sarah Ciamillo (18:46):
I guess it's kind of the same for clients,
because you know, one thing theclients care about most is
probably cost and effect.
So it's probably going to be alittle more costly to come refer
them into hospital.
They may want to manage them athome.
I mean, if you have a reallydedicated client, I think they
could probably do it.
(19:07):
But I know like here we usuallyare checking ice boots every
two hours, making sure they'restill on properly, they're still
full, because some of them liketo play with them and take them
off themselves and all that.
So I think that's somethingthey need to be aware of as well
.
Lisa Fortier (19:28):
Yeah, it's hard to do that stuff on the farm.
It's just hard.
I remember my first horse thatgot a really bad foot abscess
and you know I tried to followmy own instructions.
I was like soak it in a bucket.
That's the dumbest thing ever.
I was wet.
The bucket was under my horse'sfoot.
It was flinging around.
It was like who came up withthese instructions?
Andrew Van Eps (19:50):
yeah, I mean, until you do it yourself, you
don't realize.
And we, um, you know, we one ofthe boots that we used for the
first experiment, one in thisstudy, one of the SoftRide boots
.
We just had a terrible timekeeping them on, and so we
invited Monty from SoftRide tocome and, yeah, he was kind of
swearing and throwing his hat onthe ground and stomping on it
(20:14):
and you know, he went away witha bit of fire in his belly to
make something better and he isactually still on it and, um, I
think it is happening.
So, um, but uh, yeah, I thinkyou don't.
You know, it's all well andgood for us to say, hey, I just
think continuously for, you know, several days, um, uh, and then
you'll all be, you'll be good,but I think, in, in reality it's
(20:36):
, it's difficult, particularlywith the tools we have available
to us right now.
But, you know, hopefully, goinginto the future, we might have
some slightly better ways to doit.
Lisa Fortier (20:47):
Yeah, I think you're right.
You know you showed theresearch in a clinical
application, like in thismanuscript, how important it is,
and then technology will follow.
Companies will follow alongbecause they know it's real.
Thanks again so much forfilling my heart full of equine.
Even if it is laminitis, it's agood way to end my day.
(21:09):
So as we wind down, we like toask a little bit more of a fun
question.
Sarah and I have a hypothesisabout this question and we're
going to do a follow-up study, aretrospective.
Andrew, when you do a puzzle,do you begin with the exterior
and border piece or do you do atheme?
Do you do a color?
Are you a hybrid person?
Andrew Van Eps (21:29):
Totally the border, yeah, border, and the
corners, no doubt.
I don't think there's any otherway, really true.
Lisa Fortier (21:38):
Amen Sarah how about you?
I'm the same.
I like the border.
It really like sets, theboundaries, I think.
I mean, like you know, if Ifind a piece that matches while
I'm doing the border, then I'lldo that, but otherwise I think
it's a little unhinged uh fromthe middle?
yeah, it's.
We do a lot of puzzles at myhouse, especially around the
(22:00):
holidays, so my one daughterstarts in the middle and she's
in medical school and not goingto be a surgeon.
So now you know mine andSarah's hypothesis.
It drives me crazy and I'm likestop take your insides over
there.
It drives me nuts.
Sarah Ciamillo (22:15):
I feel like they make a puzzle now that has no
borders.
I don't know.
Lisa Fortier (22:21):
That's not a puzzle,
Sarah Ciamillo (22:22):
Right would like.
It's like no end pieces orsomething like that.
I feel like I saw somethinglike that and I was like I would
never.
Lisa Fortier (22:30):
Nope.
Sarah Wright (22:32):
We had a weird one over the holidays where it was
like four puzzles in one, so itwas one picture, but you had to
put together like all four parts.
I was home with my family.
My brother's an engineer, so hestarted with the border.
I noticed because now I'm likepaying attention to this after
doing the podcast my sister doeschildhood development and she
started with the middle, so itwas really interesting.
I'm a border girl myself, butthe four in one was challenging.
(22:52):
So, thank you so much again,Andrew and Sarah, for being here
and for sharing your knowledgewith our listeners.
Sounds like we might have somemore from you in the future, so
hopefully we'll have you back onthe podcast.
Andrew Van Eps (23:03):
Thank you so much for having us.
Sarah Wright (23:05):
Yeah, thank you.
And to our listeners, you canread Andrew and Sarah's article
in AJVR.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:31):
You're listening to Veterinary Vertex, a podcast
of the AVMA Journals.
In this episode we chat abouthow distal limb immersion in ice
and water is the most effectivemeans of cooling the equine
hoof lamellae under clinicallyrelevant conditions, with our
guests Sarah Ciamillo and AndrewVan Eps.
Lisa Fortier (00:48):
Welcome to Veterinary Vertex.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Andrew and Sarahjoining us to talk about a very
important clinical diseaselaminitis and cooling the hoof
lamellae.
Andrew and Sarah, thank you somuch for being here today and
bringing on an equine podcastfor us.
Andrew Van Eps (01:07):
Thank you.
Sarah Ciamillo (01:08):
Thanks for having us.
Sarah Wright (01:10):
All right, let's trot on over.
So, Andrew, your AJVR articlediscusses how distal limb
immersion in ice and water isthe most effective means of
cooling the equine hoof lamellaeunder clinically relevant
conditions.
Please share with our listenersthe background on this article.
Andrew Van Eps (01:25):
Well, I think a cooling feat for laminitis
prevention has become and earlytreatment has become something
that's fairly commonly done andour research group, going right
back to when I did my PhD withChris Pollitt, we have looked at
the efficacy of cooling toprevent laminitis in
(01:46):
experimental models and we'vealways used ice water immersion
in those situations, either inboots or in recirculating tubs.
And ice water immersion isdifficult to practically do in
the clinic.
But our suspicion has alwaysbeen and some of the data that
(02:08):
has been generated has backed upthe fact that ice water
immersion is probably the mosteffective way to cool the
lamellae themselves.
But there's been at least acouple of papers in the last
five years that have, um, uh,perhaps had results that are at
odds with that, one that showedthat an ice pack system could be
(02:31):
effective and one that showedthat an ice sleeve that didn't
include the foot, that didn'tinclude water, could also be
effective, and in fact thatmethod we'd used here at New
Bolton for quite some years in aclinic.
The difficulty with ice waterimmersion is that the horse has
to carry around the ice watercolumn, so the weight of the
(02:56):
water itself is very difficultand impractical to ambulate
around with.
So, I think in clinicalsituations we've always searched
for methods that might be morepractical.
This paper we wanted to see if,by actually measuring lamellar
(03:18):
temperature itself within thetissue and trying to perform
these studies in clinicallyrelevant conditions inside
stalls with horses free to roam,whether in fact these other
methods could be as effective asice water immersion.
That's the short answer.
Sarah Wright (03:38):
No, it's a very good answer, actually Very good
summary, thank you.
So now, what are some of themore important take-home
messages from this article?
Well, I think it shows prettyclearly that ice water immersion
is much more effective thanother means.
Um, and I think, um, that's nota big surprise to us, um, but
(04:00):
uh, I think the reason there'ssome disparate information in
the literature is because thelocation at which you measure
temperature and the conditionswith which the horses are kept
in these experimental studiesmake a big difference to how the
temperature data appears.
(04:20):
So, I think, um, we took a lotof care in this study to try to
make it a realistic, um, uh, arealistic study.
The question I guess now is um,uh, you know, how cold does the
tissue need to be?
Um, and for how long?
Uh, but I think this is atleast a step that shows that,
(04:43):
that these ice water immersionsare better.
What's the important take-homemessage?
I think the important take-homemessage is in horses that are
at high risk of laminitis, or inhorses that are experiencing
early signs of acute laminitis.
If you want to cool their feet,I think you need to try to do
(05:05):
ice water immersion, and if youcan't do it in the situation
you're in, it's a good reason torefer a horse to a hospital
where it can be achieved.
Lisa Fortier (05:14):
Andrew, it's a good point of like how cold is
cold enough.
Given your vast experience andobviously your key opinion
leader in this area, what's yourgut instinct?
Tell you what is cold enough.
Andrew Van Eps (05:26):
Yeah, I don't know, and we've always tried to
make it as cold as possiblebecause we've always been trying
to look at changes, look ateffects in experimental models.
And so, we are always trying togo for the maximum defense.
In those situations, theprophylactic effects are really
profound, they're not small,they're really profound.
But there is literature inmodels of acute lung injury and
(05:55):
other things, in rodent modelsshowing that small differences
in body temperature, even fivedegrees of hypothermia, five
degrees Celsius lower thannormal, can make differences to
the acute lung injury, forinstance.
So, you know, I think it'spossible that even small
differences can help.
Um, small cooling effects canhelp, but I think our
(06:18):
overwhelming experience is thatthe colder the tissue is, the
better.
Um, when you're talking aboutlaminitis prevention and
stopping it from progressing.
Lisa Fortier (06:28):
That shouldn't be a problem.
Here in New York it's prettychilly, so the hoof capsule is
plenty cold here.
Andrew Van Eps (06:34):
Yeah.
Lisa Fortier (06:35):
Sarah, I'm sure you know you're incredibly
fortunate to be amongst Andrewand just the vast amount of
experience around New BoltonCenter.
What sparked your interest inlaminitis?
Sarah Ciamillo (06:48):
Yeah, so I first came to New Bolton I guess in
2020, and I was a Marsequestrian research fellow and
during that time I got to likekind of work with the laminitis
lab and Andrew and really hispassion for the like looking
into laminitis and everythingreally made me interested in it,
(07:10):
even though I would partiallysay it wasn't, you know, my ever
my topic of choice previously.
But I really enjoyed my timethere and like he's so intrigued
by it that it then makes meexcited about it.
So then, like my second year inthe research as a research
(07:30):
fellow, I really got moreinvolved in it as well and
really started to enjoy it.
Lisa Fortier (07:36):
Yeah, it's nice to be around thinkers right, and
Andrew and his group have alwaysbeen.
Like you said, it rubs off.
It's the bane of my existenceas an equine orthopedic surgeon.
So, knowing that somebody'slooking and really thinking
about this horrible disease forour horses is really wonderful.
Sarah Ciamillo (07:54):
Yeah.
Lisa Fortier (07:55):
Andrew pointed out that you kind of predicted the
main finding of the article,given all your other research
experience.
But every time we do studies wefind something that surprises
us.
What surprised you from thefindings in this article?
Sarah Ciamillo (08:07):
Yeah, I think I was just surprised how much of a
difference there really wasbetween just using the plain,
like ice, in a sleeve around thehoof, compared to submerging
them in this ice water immersion, like I always knew.
It would probably be better,but I just didn't expect there
(08:29):
to be such a drastic differencebetween all the different
methods.
Lisa Fortier (08:33):
Yeah.
Now, do you, now that you knowthat, do you watch like football
players differently, where theyjump in their little ice bath,
or
Sarah Ciamillo (08:39):
Right, yeah.
Lisa Fortier (08:41):
Or you think of like the old cowboys right, they
knew when their horse's feethurt, they walked them into ice,
cold streams, you know, theywere onto something a long time
ago.
It just took the brains ofAndrew and Pollack and others to
prove it.
Sarah Ciamillo (08:53):
Yeah, and when you walk around the racetrack
they have them standing in likebuckets of water up to their
elbows and I was like, oh, okay,yeah.
Sarah Wright (09:04):
So, Andrew, you talked a little bit about some
next steps, like, for example,like how cold does it need to be
but what are some other nextsteps for research in laminitis?
Andrew Van Eps (09:19):
Well, um, in laminitis in general, um, you
know, I think we, us, we stillthere's still some missing
pieces in terms of exactly whatcauses laminitis at a, at the
cellular level, uh, in differentsituations, although we have
got a lot more information thanwe did, say, 10 or 20 years ago.
But there's still a little bitmore to go.
(09:39):
And I think there's a lot ofprogress on, particularly the
endocrine side, bettermanagement of endocrine disease
for prevention and eventreatment of laminitis.
And even though there's someholes there in terms of better
understanding and bettermanagement, I think overall
(10:02):
that's where most progress hasbeen made.
Back at this sort of supportinglimb laminitis side.
There's still, um, uh, there'sstill some, some levels of
understanding that we have to toget to, but I think we are
making a little bit of progressthere.
And then you know, funnilyenough, that most of the
research had always been done insepsis related laminitis, that
(10:25):
um, particularly with thecooling and the models that we
were using to test it in theearly days, and that's really
stagnated and I think partiallyit's because the cooling does
seem to be effective in theclinic and we here at New Bolton
Center.
Most of the laminitis we see inthese sick horses now is
(10:47):
botanicals fever, I'd say, andin those cases it just happens
so rapidly.
I think a lot of the timethey're laminated even before we
we see them.
But I think that's an area thatwe're actually kind of
interested in working out whythat is such a profound cause of
laminitis in our population.
(11:08):
But, um, but I think therethere's still work to be done on
understanding how we can betteruse cooling, how cool it has to
be, and there's stilldevelopment that needs to be
done and hopefully we're workingwith some of these companies to
come up with better solutions.
So some of the companies thatcontributed equipment for this
(11:30):
study have modified their bootsto try to make them better.
In the aftermath and there aresome more prototypes coming.
I'm hoping that we can come upwith more practical ways to cool
feet that are more effectiveand easier for people to use in
(11:51):
the clinic.
Lisa Fortier (11:53):
Yeah, I'm just going to take this opportunity,
Andrew, to shout out to anybodywho's listening don't let your
horses get fat.
You know, I think many, many ofus.
Now that there's a stall-sideinsulin test, it really should
be part of your spring and fallcheckup on your horse.
You might not think your horseis overweight, but most horses
in the show ring not racehorsesthe, but at least in the show
(12:15):
ring most of them areover-conditioned, as my mother
would say, well-covered.
Yeah, and Andrew, I don't knowwhat to think about those
Potomac horse fever horses.
You know, some of them are.
I think they're close tothey're in DIC before they even
get across the threshold there.
I don't know that any icing isgoing to help them
Andrew Van Eps (12:32):
yeah, I think the interesting, my suspicion is
that the near rickettsiaactually um, it's replicating
and causing havoc withinmacrophages that are resonant in
the lamellae, the tissue itselfin the foot, and so in most of
these other causes and sickhorses you've got this systemic
inflammation and maybe endotoxinor other products circulating
(12:55):
that are the tissue and thecells in the lamella reacting to
and that's what's setting themoff, whereas I think in Potomac
it may be happening locally andit happens very rapidly and I
think probably we we just don'tget the chance to inhibit it.
Sarah Wright (13:15):
Very cool.
Now, Andrew, since the last timewe talked to you, we've added a
fun new question.
It's about AI.
So, do you see a role for AI inlaminais research?
Andrew Van Eps (13:25):
oh, absolutely.
I mean I think in laminaisresearch, um, uh, there is,
particularly as we start to getaccess to more of these tools
for big data.
AI can help sift through andlook for patterns and look for
(13:46):
associations in genetic basis orin protein profiles.
But the other thing is we'reactually quite into looking at
in horses that are prone tosupporting limb laminitis,
horses with fractures, lookingat locomotory patterns in those
horses and how they mightpredict whether that horse is at
(14:09):
high risk of developingsupporting limb laminitis.
Until now we've mostly usedthese foot-mounted sensors and
in fact Sarah, during her timein my lab, did a whole bunch of
work with foot-mounted sensorson horses with fractures and
that's shown us that thosehorses have lower rates of
(14:31):
ambulation and don't move asmuch as normal horses and
perhaps gives us someinformation on how we can
predict risk.
But I think now we're trying totake it a step further.
We used a bit of machinelearning in those protocols but
now we have video cameras set upon these horses that have
(14:52):
fractures and breakdown injuriesand we are developing models
that are AI-based to quantifyambulatory behavior and laying
down and standing up, in thehope that we can use that to
better predict risk in thosehorses and warn us early.
I think it's an exciting timeto be alive, probably the most
(15:18):
exciting time, because maybe in10 years the AI will be doing
the thinking for us as well, andnow we can do the thinking and
apply it.
Lisa Fortier (15:28):
I think you're safe.
I remember, Andrew, probably 30years ago at a VOS meeting,
Jeff Watkins saying he preferredhorses that had stall vices
when he was doing fracturerepair, like the weavers and the
pacers, and that, and he said,because they don't, they're far
less prone to founders than thehorse that just stands there.
Andrew Van Eps (15:47):
Yeah, and I think it was Larry Bramlage who
was into walking, and still, Ithink down at Rue Real they do
they like to walk them.
I do think it's a.
It's a, it's a kind of leapleap in understanding and I
think we probably will haveanother podcast on this at some
point, at least for the future,when I send this paper into you.
(16:07):
But, um, you know, I think thatit is something that we can
potentially, um, uh, work on andand and uh and understand
better.
Similar to, you know, perhaps,some ileus in people
postoperatively when they kindof worked out that, hey, you're
just going to get people up thenext morning after their surgery
(16:27):
and get them walking up anddown the highways.
Lisa Fortier (16:29):
Yeah, because fortunately the walking the
horses is a bit cumbersome whenyou want them to be iced, pick
your poison.
Andrew Van Eps (16:37):
Yeah.
Sarah Wright (16:41):
For those of you just joining us, we're
discussing how distal limbimmersion in ice and water is
the most effective means ofcooling the equine hoof lamellae
under clinically relevantconditions, with our guests
Andrew and Sarah.
Hey, Sarah.
Uh, you've heard andrew talkingabout this this vast uh depth of
manuscripts and articles andresearch that are behind this
(17:02):
article and that came beforehere.
How did your training andprevious work prepare you to
write this article?
Sarah Ciamillo (17:08):
Yeah, I guess it was really all my time when I
was the Mars Equestrian Fellow,working with Andrew and getting
to do real-time Laminitis workand the different variety of
projects that we are working on.
To really help write this andput it all together to help
further my knowledge in thetopic would probably be key, as
(17:32):
well as, like other clinicalexperiences you know, like
firsthand treating clinicallaminitis cases.
Sarah Wright (17:43):
So Sarah's next set of questions is going to be
really important for ourlisteners.
The first one deals with theveterinarian's perspective.
So what is one piece ofinformation the veterinarian
should know about equine distallimb immersion in ice and water
in cases of laminitis?
Sarah Ciamillo (17:58):
So kind of as a two-parter to that answer.
So I think it's key for them toknow that ice-water immersion
is way more effective than justusing plain ice and you'll get a
should get a better response tothese horses.
But also that, since it is kindof cumbersome and these horses
(18:20):
probably need a little bit moremonitoring with the ice water
immersion, that it would bebetter for them to be managed in
a clinic or, you know, somesort of hospital setting as
opposed to just managing at homeunder the owner's care for full
effect.
Sarah Wright (18:40):
Now, on the other side of the relationship, what's
one thing clients should knowabout this topic?
Sarah Ciamillo (18:46):
I guess it's kind of the same for clients,
because you know, one thing theclients care about most is
probably cost and effect.
So it's probably going to be alittle more costly to come refer
them into hospital.
They may want to manage them athome.
I mean, if you have a reallydedicated client, I think they
could probably do it.
(19:07):
But I know like here we usuallyare checking ice boots every
two hours, making sure they'restill on properly, they're still
full, because some of them liketo play with them and take them
off themselves and all that.
So I think that's somethingthey need to be aware of as well
.
Lisa Fortier (19:28):
Yeah, it's hard to do that stuff on the farm.
It's just hard.
I remember my first horse thatgot a really bad foot abscess
and you know I tried to followmy own instructions.
I was like soak it in a bucket.
That's the dumbest thing ever.
I was wet.
The bucket was under my horse'sfoot.
It was flinging around.
It was like who came up withthese instructions?
Andrew Van Eps (19:50):
yeah, I mean, until you do it yourself, you
don't realize.
And we, um, you know, we one ofthe boots that we used for the
first experiment, one in thisstudy, one of the SoftRide boots
.
We just had a terrible timekeeping them on, and so we
invited Monty from SoftRide tocome and, yeah, he was kind of
swearing and throwing his hat onthe ground and stomping on it
(20:14):
and you know, he went away witha bit of fire in his belly to
make something better and he isactually still on it and, um, I
think it is happening.
So, um, but uh, yeah, I thinkyou don't.
You know, it's all well andgood for us to say, hey, I just
think continuously for, you know, several days, um, uh, and then
you'll all be, you'll be good,but I think, in, in reality it's
(20:36):
, it's difficult, particularlywith the tools we have available
to us right now.
But, you know, hopefully, goinginto the future, we might have
some slightly better ways to doit.
Lisa Fortier (20:47):
Yeah, I think you're right.
You know you showed theresearch in a clinical
application, like in thismanuscript, how important it is,
and then technology will follow.
Companies will follow alongbecause they know it's real.
Thanks again so much forfilling my heart full of equine.
Even if it is laminitis, it's agood way to end my day.
(21:09):
So as we wind down, we like toask a little bit more of a fun
question.
Sarah and I have a hypothesisabout this question and we're
going to do a follow-up study, aretrospective.
Andrew, when you do a puzzle,do you begin with the exterior
and border piece or do you do atheme?
Do you do a color?
Are you a hybrid person?
Andrew Van Eps (21:29):
Totally the border, yeah, border, and the
corners, no doubt.
I don't think there's any otherway, really true.
Lisa Fortier (21:38):
Amen Sarah how about you?
I'm the same.
I like the border.
It really like sets, theboundaries, I think.
I mean, like you know, if Ifind a piece that matches while
I'm doing the border, then I'lldo that, but otherwise I think
it's a little unhinged uh fromthe middle?
yeah, it's.
We do a lot of puzzles at myhouse, especially around the
(22:00):
holidays, so my one daughterstarts in the middle and she's
in medical school and not goingto be a surgeon.
So now you know mine andSarah's hypothesis.
It drives me crazy and I'm likestop take your insides over
there.
It drives me nuts.
Sarah Ciamillo (22:15):
I feel like they make a puzzle now that has no
borders.
I don't know.
Lisa Fortier (22:21):
That's not a puzzle,
Sarah Ciamillo (22:22):
Right would like.
It's like no end pieces orsomething like that.
I feel like I saw somethinglike that and I was like I would
never.
Lisa Fortier (22:30):
Nope.
Sarah Wright (22:32):
We had a weird one over the holidays where it was
like four puzzles in one, so itwas one picture, but you had to
put together like all four parts.
I was home with my family.
My brother's an engineer, so hestarted with the border.
I noticed because now I'm likepaying attention to this after
doing the podcast my sister doeschildhood development and she
started with the middle, so itwas really interesting.
I'm a border girl myself, butthe four in one was challenging.
(22:52):
So, thank you so much again,Andrew and Sarah, for being here
and for sharing your knowledgewith our listeners.
Sounds like we might have somemore from you in the future, so
hopefully we'll have you back onthe podcast.
Andrew Van Eps (23:03):
Thank you so much for having us.
Sarah Wright (23:05):
Yeah, thank you.
And to our listeners, you canread Andrew and Sarah's article
in AJVR.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
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