Out of curiosity, what topics would you like to see covered at the next laminitis conference? what speakers would you like to hear from?
I would love to hear discussion, or even just acknowledgement! of the existence of the lymphatic system within the horse's hoof and its involvement in laminitis. I work as an equine manual lymph drainage therapist, (www.equinemld.com) and emld has been shown to relieve symptoms and support recovery in acute and sub acute laminitis. It cannot affect pedal bone displacement in chronic cases, so is not actively recommended for these, but may still play a part in relieving inflammation and pain and supporting soft tissue repair. I have searched extensively, and with the exception of work produced in Germany which has pioneered equine lymphology, have found only one or two very passing references to the lymphatic system in research on laminitis. I appreciate that historically the lymphatic system has been very difficult to visualise directly and that this is still so within the horse's hoof, and that today 'evidence based' research dominates, but there are conditions which would go untreated were this the only way of observing results - for people with lymphoedema, treatment based on manual lymph drainage is the international one of choice, and only after mld was developed did the scientific evidence that shows how it is effective really begin to mount up. So I don't feel that saying that we cannot directly see the lymphatic system during laminitis is a good enough reason to pretend it doesn't exist! And clearly it plays a role, as it does with every cell in the body, it would be ludicrous to pretend it doesn't. Lymphatic vessels are present in every lamilla within the hoof, and the system is crucially involved in inflammatory processes. In recent years, technology has developed to allow the lymphatic system to be 'seen' much more clearly, resulting in renewed interest amongst scientists. It has been established that links exist between obesity, associated inflammation, metabolic syndrome and the lymphatic system in people, and that the lymphatic system plays an important role in the transfer of gut derived inflammatory products to distant organs, and the development of SIRS and MODS, all of which have been proposed as important factors in laminitis. Yet when it comes to horses, there is a deafening silence where the lymphatic system is concerned. Perhaps the differences between horses and people are too great for there to be a relationship between these factors - though much of the experimentation for human research is conducted on animals - but surely some consideration is justified? So please, put the lymphatic system on the conference agenda!
Is there any evidence and/or research that is accessible that discusses the lymphatic system within the equine hoof? Why do you suppose that none of those individuals who are deeply involved in laminitis research or other hoof physiology research have not included the lymphatic system within the hoof as part of their ongoing research? To my knowledge, even those specifically involved in histopathology research of the hoof have not made mention of the lymphatic system within the hoof or its specific relevance to hoof pathology, including laminitis/founder. Regardless, you might want to consider submitting a paper to the International Hoof Care Summit for their consideration and adding you to the list of conference speakers.
I have sarcoidosis so unfortunately am highly aware of what your speaking about. However I find it very hard to see it having anything to do with laminitis, but im wrong about most things. How does one become an equine manual lymph drainage therapist? Do you specialise after vetinary degree? How do you manually drain from the lymph system in the foot?
Hallo, David, I’m sorry to hear about your sarcoidosis. To the best of my knowledge, research into the horse’s lymphatic system has been pioneered in Germany, which makes sense as this is also one of the countries where human lymphology was developed. Historically, the lymphatic system has been difficult to visualise, the vessels have thin walls and are frequently ‘collapsed’, and can be hard to differentiate from blood vessels. Manual lymph drainage was developed by Danish Dr Emil Vodder nearly a century ago, who realised there could be a link between swollen lymph nodes and chronic conditions such as sinusitis. At that time it was considered ‘taboo’ to work with the lymphatic system, and because manual lymph drainage is a very light, gentle technique it was difficult at times to be taken seriously. However, other interested researchers developed Dr Vodder’s work, leading to ‘combined decongestive therapy’, the current most effective treatment for lymphoedema, and initially in Germany and Austria, the formal establishment of lymphology. I am based in the UK, and although CDT is now available through the NHS, it has taken time for it to become established here, and I know that in the United States it’s still a relatively new treatment, and cases of severe lymphoedema (elephantiasis) are not uncommon. The equine situation reflects that of human lymphology, but is informally estimated to be 30 years behind. In the last couple of decades ‘molecular lymphology’ has produced big advances in visualisation techniques and knowledge of the system, and we know it’s much more active and complex than previously thought (though to be fair, MLD therapists have always been empirically aware of this!) My impression is that some of these developments will have relevance to laminitis. Nevertheless, there are still many references to the lymphatic system being passive, the ‘body’s drain’ etc, and important uncorrected assumptions. One example, it’s still widely claimed that the blood circulation brings fluid and nutrients to the tissues, and reabsorbs 90% of this fluid, the other 10% being removed by the lymphatic system, when in almost all circumstances it’s totally responsible for the removal of this fluid. So my impression is that the lack of research into the equine lymphatic system and laminitis is due to a combination of history, visualisation difficulties, and perhaps because what work has been done, has not been translated into the English language. I understand that many dissection/preservation techniques destroy the lymphatic vessels, but this isn’t my area of expertise. I don’t know how research is funded, but perhaps it follows certain lines, and if an element is ignored at the start, it may continue to be left out. I’d be interested to know others’ thoughts! I have been told be a very well known and respected laminitis expert that a lymphatic vessel in the hoof would not be recognised, but in her 1987 dissertation Elke Laue* includes a photograph of a vessel in a lamella. The use of manual lymph drainage and CDT for lymphoedema following lymphangitis is supported by scientific research, but because of the current impossibility of visualising the system in the hoof it hasn’t been possible to provide this for laminitis. However in Germany it is supported by many anecdotal reports, to the extent that it is recommended as an auxiliary treatment alongside veterinary care. My own experience is that it can produce results quickly, and although not specifically recommended for chronic laminitis because it can’t affect pedal bone rotation, it can make ‘footy’ laminitics more comfortable and prevent recurrences. It’s known that massage reduces cortisol levels, and recent preliminary research suggests that manual lymph drainage significantly increases uptake of blood glucose by the tissues, all of which indicates, to me at least, that it is a mistake to ignore the lymphatic system when investigating laminitis, not least perhaps in the ‘mountain and moorland’ breeds of the UK, which can get fat at the sight of a blade of grass. My interest in using MLD for laminitis began when I was training to use it with people, and learning about its effectiveness with aseptic inflammation and oedema reduction, and it occurred to me that anything which could reduce pressure and help remove damaged tissues from the hoof could possibly help to limit damage there. The ‘superficial lymphatic system’ collects and transports fluid from the skin and mucosa, and the deep lymphatic system drains the muscles, joints, tendon sheaths and nerves. Lymph is moved forward by co-ordinated self contraction of the vessel units, and external factors including manual lymph drainage. The chief influence on lymph pulsation is stretching from this internal filling or external factors. If there’s damage in the tissues, including laminitis, the lymph vessel system must transport the damaged cells, toxins and products of the inflammatory response away from the area. The quicker this can happen, the faster recovery will be, and the system is able to increase its transportation speed by at least ten times when required. The human and equine lymphatic systems are very similar, but the lymphatic vessels of the horse, while having far fewer smooth muscle cells responsible for their contraction, possess a high percentage of elastic fibres which stimulate the vessels to stretch and contract, possibly related to the horse’s evolution as a creature almost constantly in motion. Therefore the horse is more responsive to MLD. Draining initial lymphatic vessels are present in the dermal primary lamellae, tendons and sheaths, periosteum of the bones and the joint capsules. Because these vessels are interconnected and valveless, lymph can flow in any direction between them, an ability utilised during MLD treatment The whole of the hoof tissue fluid enters directly into the lymph deep collector system of the leg. MLD mostly influences lymph transport by working with the superficial system, but because of the thin subcutis in the horse’s lower leg it works there simultaneously with both systems. Proximal stimulation draws fluid from the hoof. MLD looks deceptively simple, resembling a very light, skin deep ‘massage’, but isn’t easy to learn, and Vodder practitioners (my qualification) have to be reviewed every two years to maintain our qualifications. To the best of my knowledge equine manual lymph drainage is only taught in Germany and Austria, I believe the Austrian course is in two parts and caters for people who have no previous experience with MLD but I don’t know if it offers a qualification. I trained in Germany and qualified through the Europäisches Seminar Für Equine Lymphdrainage, which runs courses for vets, so that they will have a better understanding about when to refer clients for MLD, and for practitioners qualified in human use. I believe it is essential to have done this previous training as the course presumes knowledge about the lymphatic system and experience in combined decongestive therapy, and without this would not be possible to complete, and successful use of MLD is partly dependent on experience, learning to ‘feel’ the tissues. Sorry this is rather long, but I hope it answers some of the points raised. *Makroskopische, licht- und elektronenmikroskopische Untersuchung über das LymphgafäВsystem des Pferdes vom Huf bis zum Larpalgelenk (Berlin 1987)
