Saturday, March 9, 2013

Insulin Resistance in Horses...from The Anvil Archives

Mr. Rob Edwards, Publisher Extraordinaire
IR Finally Gaining Traction In Horse Industry 


Matt & Susan Frederick
Dr. Ric Redden
[Note: The following editorial first appeared in Anvil Magazine, in January of 2002, following the presentation of a paper introduced by Matt and Susan Frederick at the previous year's  Laminitis Symposium, Galt House, Louisville, Kentucky.  And no, Matt and Susan offered no scientific or academic credentials to the attendees -- Matt, a Napa, California Farrier and his wife Susan, among other talents, an academic background in biochemistry.  How this meeting of minds occurred is the direct result of Dr. Ric Redden's firm belief that all folks, scientific AND lay...have something to bring to the table when combating a serious and devastating disease.  But we needed to first heal some real divisions that existed in the relationship between our own allied professions, before we had the slightest chance to unravel the many manifestations
of laminitis.  Ric and Nancy Redden opened that often pad-locked door.

Denise Dodero -- Think she just wanted my dog...
Enter Denise E. Dodero.  I spent a good portion of my life with this highly dedicated, somewhat rambunctious Italian woman.  Her background was academic medicine, while her personal history included Type I Diabetes (juvenile onset), the ravages of which ended her life at 50 years of age.  At the time of her death, she was a lobbyist in Washington DC, not only fighting for the future needs of Academic Medicine in this country, but as a spokesperson for the American Diabetes Association, of which she was both volunteer and an unpaid administrator for most of her adult life.  Quite sadly, her dream...the eradication of juvenile diabetes in her lifetime, has so far eluded science.  So next time you might feel tempted to condemn or compartmentalize all the lobbyists who skulk nefariously in the unseen corridors and back rooms of Congress, please remember people like Denise.  It is not always about money, some obscure cause or localized agenda.  Sometimes it is about the substance of life and death.
So why mention her?  An honest question here.  Well, when you live with a person, the disease travels with you.  And if you love that person, you fight the same fight.  And as one mobster noted, "You keep your friends close and your enemies closer."  I knew this damn disease personally.  When it showed up in the middle of the night, when she suddenly went blind in one eye.  So, sitting in that audience in Louisville, somewhat bored -- Matt and Susan's words lit a fire between my ears.  So I told Rob Edwards, publisher of Anvil Magazine, that we needed to bring these folks to Georgetown for a serious conversation, because they had just taken chronic laminitis and Cushing's Syndrome out of their tidy little box.  The rest as we say, is history.  Far too slow it seems, at least for me, but it represents the most substantial leap in thinking for decades.

The Editorial:    
Napa, California, farrier Matt Frederick did not plan to "research laminitis."  As he stated in his opening remarks at the 2001 Laminitis Symposium in Louisville, Kentucky, in spite of proper shoeing, many horses would re-founder.  "Why did the acute episode last for only days is some horses and months in others?"
A meticulous note-taker, Matt began seeing connections in these so-called 'refractory' cases.  With the help of his wife Susan, whose background is in biochemistry, the pair created a field study involving 43 laminitic horses, of which 22 were declared refractory, or in effect, hopeless.  They were searching for connections or, in endocrinological terms, "the wiring diagram" that instigates the body to turn on itself with such devastating results.  Veterinarians and farriers are all too familiar with the tertiary aspects of this disease -- Styrofoam pads, pain-killers, anti-inflammatories, and ultimately that painful confrontation with the truth:  euthanasia.  The horse isn't terminal, but the situation is.  Their research produced definite connections -- some suspected, others rather startling, or largely ignored in the literature.  Vascular anomalies have always been a major culprit in laminitis, but as Matt asked, "Why?"
The key to the puzzle may lie in both genetics, the so-called "thrifty gene" inherent is specific breeds, and the insulin resistance, associated with Both Cushing's Syndrome and Diabetes Mellitus, Type II, or adult-onset Diabetes.  In simplest terms, insulin is a hormone that facillitates glucose transference to every cell in the body.  It's a bit like a car with a full tank of gas and a bad carburetor:  lots of fuel, but the engine is starving to death.  In the case of the laminae in the hoof, blood flow, as many authors have suggested, may not be nearly as critical as glucose absorption.  Flood the carburetor and these fragile tissues simply die because the endocrine system (the on-board computer), is receiving mixed messages.  Keep flooding it, and the case becomes refractory.
The genetic connection is the least complicated.  Frederick's study showed that a high percentage of cases were breed-specific, particularly ponies, Morgans, Arabs and gaited breeds, some sharing a common genetic pool, but most associated with that "thrifty gene" which allowed, over (evolutionary) history, for those animals to cope with a "feast or famine" environment.  Their endocrine system was highly adapted as a defense against starvation, and subsequently, the preservation of the species.  Two-hundred thousand years of evolution is not easily overturned by a few hundred years of rapid domestication and a new and rather refined diet.  The body is defending against the coming storm, but the lean times fail to materialize.  The "land of plenty" is little more than a fat farm with no hope of escape.
The American Diabetes Association recently released the results of a fifteen-year study focusing on the elevated incidence of Type II Diabetes among minority populations in the United States. [Author's note: it is now at epidemic proportions across the demographic/ethnic/racial spectrum.]  Highest on the list were African-Americans, Native Americans and Hispanics -- populations that fit, for the most part, a model that indicated an evolutionary tolerance to periods of famine.  These populations also had a predisposition to excess weight gain and a number of health problems associated with obesity, notably cardiac incidents.  The culprit:  High protein, high fat, and most importantly, high carbohydrates.
While it may seem impossible in this culture to overlook racial overtones, none exist.  European diets, as a rule, have a long history of plenty.  These populations have adjusted over the centuries to assimilating a high-carbohydrate diet -- carbohydrates being little more than simple or complex sugars.  A Shetland Pony scrounging out a living on a rock in the North Atlantic has never really had the chance to adjust to a free meal.  Fat storage and a reduced metabolic need guaranteed survival in a vicious environment.  An African in the Kalahari or a Hopi Indian in the desert Southwest faced the same of seasonal crisis.  Centuries of coping with marginal conditions made these populations highly versatile at assimilating anything or nothing.  Over time, three square meals virtually guaranteed a visit to the emergency room.
Why should horses be different?  Statistical information is sketchy at best, but a safe assumption is that North American feral horses, horses in the developing world -- i.e., Africa, Asia and South America -- even zebras, have an extremely low incidence of laminitis, other than captive or cultivated populations.  These equidae (as a rule), work hard, scrounge what they can directly from the environment and their metabolism works out the details.  The Serengeti is a great photo shoot in the African spring, but the dry season starves to death a fourth to a third of the grazing population.  As Frederick points, good intentions and aesthetic considerations are enough to "kill with kindness."  We tend to worship a thin, athletic human body, but when it comes to horses, counting a few ribs is grounds for calling out the Humane Society.  As almost all veterinarians know, and most farriers appreciate, the majority of 'companion animals' (dogs, cats, horse -- yes, even Bob the hamster) are chronically overfed, over-supplemented and overly protected.  Two much care can be as destructive as too little, particularly in a susceptible population.
Matt and Susan Frederick's search for the wiring diagram led them to both Cushing's Syndrome and Diabetes Mellitus, Type II, the former associated more commonly with canine populations;  the latter responsible for a sizable portion of human health care. (Recent studies suggest that one of every seven dollars spent on health care is spent on diabetic patients -- 1995 figures), as well as untold trips to the country's overburdened emergency rooms for potentially life-threatening complications, most notably vascular difficulties involving the eyes, kidneys, heart and not surprisingly, the lower extremities, particularly the digits.  A human can afford to lose a few toes, even a foot, as tragic as it is, but a horse is a digital animal, literally transporting itself on the equivalent of one rather complicated big toe.  The big question then is whether laminitis is really a circulatory response (either vasodilation or vasospasm, or constriction), or, as Frederick believes, insulin resistance, cutting off the laminae in certain susceptible populations from glucose absorption.  Add another element -- the body's response to shock, which normally sacrifices the extremities in order to save the major organs and the puzzle deepens.  We know that horses develop laminitis from a number of systemic insults -- everything from carbohydrate overload to endotoxicity, or basically an overwhelming systemic infection of some sort, to the use of artificial glucocorticords such as dexamethasone, betamethasone and trianmcinolone, the most common synthetic versions of cortisol used in the equine.  Cortisol, a regulatory secretion of the adrenal gland responsible for counter-regulating the body's inflammatory response (it is the body's 'natural' anti-inflammatory) and is also important in helping the body metabolize fats, proteins and MOST importantly, carbohydrates -- sugars.  It is so important in the regulation of sugar usage that it is classified as a GLUCOcorticoid.
Also of note, women experience "gestational" Type II Diabetes, possibly connected in some ways to the type of equine laminitis associated with a retained or tainted placenta -- so-called, foal founder.  In either case, pregnancy is both stressful to the endocrine system and in some case actually toxic to the host.  In Frederick's theory, foal founder and/or laminitis attributed to a retained placenta could also be explained by insulin resistance caused by increased hormone levels during pregnancy (e.g. growth hormone, cortisol, prolactin and other hormones), produced by the fetus and placenta.  In this hypothesis, laminitis would be comparable to the development of gestational Diabetes in humans.  This gestational Diabetes is usually manifested in the 3rd trimester.
As the Fredericks note in their research paper, studies suggest that in some mammals, the fetus produces a large spike of cortisol prior to parturition. [Roger Smith MD, Scientific American, March 1999] .  The Fredericks suspect that this additional "cortisol load" in a horse with a mild to severe unrecognized or undiagnosed Cushing's-like syndrome could worsen the inherent insulin resistance, leaving them at risk for the development of laminitis.
In humans, women who suffer from gestational Diabetes are suspected to be "pre-diabetics."  Although their Diabetes often resolves after birthing, many will progress to overt Diabetes Mellitus, Type II in the future.  In a like fashion, the Fredericks suspect that horses who suffer from laminitis during pregnancy are possibly "early or pre-Cushingoid" horses; being "pushed over the edge" due to the influence of high hormone levels which cause a certain degree of insulin resistance inherent in all pregnancies.
Please do note that this material was from studies/observations made in the mid to late 1990's and presented initially in 2001.  During the interview, a great deal of discussion also took place on the matters of USDA labeling practices (vis a vis -- carbohydrate values), protein sources, supplemental additives and especially the marketing of so-called Senior Feeds, which were often very high in carbohydrate levels.  Most of the above editorial was composed of both conversations with the Fredericks and my personal research.  The Fredericks probably never received the recognition, nor thanks they deserved for not only taking on such a tough topic, but presenting it to capacity crowd -- 2/3 of which were highly skeptical of the connection.  Well,  some 13 years later, nobody is dismissing the connection. 

Tuesday, March 5, 2013

Some things never change...they just keep running over you.

Rob Edwards - Publisher Extraordiaire


[Blog Note: This editorial was first published in the January 1, 2001 edition of Anvil Magazine.  The words...and the experiences are mine.  Yet recently, it was pointed out to me that like many things in farriery that have changed, evolved, improved perhaps...there is still no shortage of lunacy among the troops.  Why this goes on is obvious:  Money, a foot in the odd form of self-deception?  And of course, in a bad economy, a touch of desperation.  All for nought, as in this crippled economy of ours, it is only the bottom that slips below the waves.  Major equestrian areas in this country...most clustered around metropolitan areas or those locales with a long tradition of horses and money are not particularly bothered by hard times elsewhere.  Farriers who work these areas (more importantly, hold an address in those areas), have established business practices and pricing structures based that address -- that in turn, establishes the cost of living.  So if you wander in from the hinterland in search of better living (an honorable pursuit), then compete on your skills, not your ability to cut your own salary.]   





    Real estate agents have a catch-phrase:  “Location, location, location.”  In the most rudimentary of terms, it places a dollar value on where you live, what your neighborhood is like and quite frankly, if four or five other folks happen to agree with that assessment.  It places a dollar value on geography, which roughly means that an acre south of San Francisco goes for $2.5 million, while the same acre in northern Afghanistan might bring in fifty cents and a goat. 

     In case nobody has noticed, real-estate prices dictate horseshoeing prices.  You don’t think so?  I used to practice (euphemistically speaking), in Washington State.  I happened to live on the western side of the Cascade Mountains within shouting distance of Seattle.  Back in the rich old days, us big-city guys got $12.00 to shoe a horse, $4.00 to trim.  In Eastern Washington, farriers only got $8 to $10 for the same job.  Our arrogance was only matched by our lifestyles.  Most of our rigs were less than ten-years old.

     A decade or so later, Bill Gates showed up as the new sheriff in town, and well, we all got a raise.  Reagan’s “trickle-down theory” actually had some validity.  Corporations like Microsoft do spin-off economic incentives in what might seem like obtuse directions.  The popularity of the Windows operating system, hence, the success of Gate’s corporation, brought in hard cash to the area and bumped up the real-estate prices.  Rent went up – shoeing prices went up.  Even so, Eastern Washington lagged behind.  After some sloppy research, I discovered that the per capita number of Cadillac’s in Yakima roughly mirrored the figures for Seattle, even though a wide gap existed in the bottom line – roughly, what you earned for virtually the same hour of sweat.  Head scratching hardly helped.  Some mysterious gestalt existed that connected your zip code to your potential lifestyle and by default, somehow pre-determined your income.  And the sad part was that farriers accepted the notion.  What was generating this obvious disparity?     

      Real-estate prices.  Money made in the west was re-invested in the east because you could get more bang for the buck even though nobody cared to spread it around.  That would’ve ruined the principle.  Concurrently, west-siders, who actually had to work for a living (like, horseshoers), started shaking their heads because the ‘new’ economic standard meant that a latte cost five bucks and the rent increased 150%.  Meanwhile, supply costs continued to escalate.  In response, horseshoeing prices went through the roof.  Guys on the east side got wind of these shoeing prices and were pretty impressed.  So much so, that they would drive four or five hours to work in somebody else’s backyard.  They competed by undercutting the standards that had already been set by the folks sucking down that $5 latte.  Then, they crawled back to Yakima and paid the mortgage – 200-300% less than a three-bedroom rambler in Bellevue.  Carpetbagging is the kindest description I can think of for this kind of aberrant behavior.

     What triggered this particular tirade is an article that appeared in The San Francisco Chronicle last September.  The usual stuff – a feature story about a horseshoer and the ‘hot’ economy in the Bay Area.  The guy at the core of the article really doesn’t matter.  What he revealed though does, which was his interpretation of what Bay Area farriers make for a living, which of course, is nobody’s damn business until it gets splashed in a newspaper, which just brings more termites out of the woodwork looking for a cheap meal;  in turn, causing existing clients to assume that they’re getting their pockets picked.  Brilliant piece of p.r. work folks.  

      The crux of the matter is that the guy lives in Chico, which according to his own account, constitutes “a 380-mile” commute down to the promised land.  From a business standpoint (which demands a degree of ruthlessness on a good day), it’s a smart move.  Live cheap and work uptown.  But far too many of these valley migrants use their cost of living allowance to compete in a marketplace that is not of their making and of which they have invested nothing.  Repeat: NOTHING!  And to ‘get in the door,’ so to speak, they cut prices.  There is no nice way to say it and to be perfectly honest, I don't care to.

     “Business is business,” as the old cliché goes, is an age-old excuse for preserving ethics for that Sunday get-together with the Padre.  The rest of the time these niceties are ignored in favor of getting the check.  Folks that have lived in these economically blessed areas for twenty years or more set the financial standards because they have to live there.  That means they’ve got that 300% rent increase whether they like it or not.  What they don’t like is an interloper in the sandbox who won’t play fair.  The message is simple:  Compete with your skills.  The only person that bleeds when you cut prices is yourself.  These folks have already negotiated your ‘raise.’  Take it.  Don’t undermine a status quo that took three decades and lot of sweat and effort to create.  We are after all, a mutually dependent trade.  Push the envelope a bit instead of burning it in the forge.  There might be a check inside.  

Old adage from the poorhouse in New York:  "Well ya know, I buy my pickles for $1.00 a pound and sell 'em for 80 cents.  But by God, I did sell a lot of pickles!"                 

Monday, March 4, 2013

Items that Never Quite Made The Anvil Deadline

Mr. Rob Edwards, Publisher Extraordinaire


Book Reviews:
{That Never Quite Made the Cut}

The Gentleman's Pocket-Farrier, Shewing
How to ufe Your Horse on a Journey,
What REMEDIES are Proper for Common Misfortunes
 that may befall Him on the Road
Captain William Burdon
London: John Grage, 1732
"Queis gratoir ufus Equorum, Nocturna verfate manu, verfate diurnal."
Okay, second version of this difficult book review.  A rough translation from the Latin goes something like:  "Tonight's special at Denny's is the chicken-fried steak with mashed potatoes and garvy."  The 'manu' part has something to do with either a foul tasting tropical root or Don Ho's ukulele.  We're not sure, but this seems like either a Hawaiian religious icon or a pasta dish from southern Italy.  The 'diurnal' is defintely one of those things you find in the men's room that looks like a Rice Crispy's treat, but tastes like the lid on a Clorox bottle.  The 'ufus Equorum' is one of those big, dumb European horses.  Probably Dutch.  'Nocturna' is what most book critics do half-way through Chapter 1 -- fall asleep.  Our staff is busily trying to sort this out.  Coffee isn't helping.
First Chapter deals with...REMEDIES:
"Whenever you intend to travel, hunt, or only ride out for AIR, let your Horfe's Feet be examin'd, two or three DAYS, or fome convenient Time before you fet out, to fee that his Shoes are all faft, and fit eafy on his Feet, for on that depends the Pleafure and Safety of your Journey."
"If he cuts either before or behind, loo at his Shoes ftand not out with Edge beyond the Hoof, and feel that the Clinches lye clofe, but if his Cutting proceeds from Interfering (that is, croffing his Legs in his Trot) then 'tis natural infirmirmity, and can only be a little helped by Care."
[Editor's note: So, no need to bother with Veterinarian!]
"Before you mount, look round your Horfe. to fee if his Bridle, Curb, Saddle, and Girts are all fitted in their proper Places.  Always accuftom your horse to ftland firm, and without Motion, till your Clothes adjufted."
[Editor's note: Very important, especially that last part!]
This first section seems to address things like fastening your seatbelt, turning up the CD real loud and checking if the turn signals work, just in case you actually bother to use them.  The rest has to do with checking your make-up in the rearview mirror -- very important if you happen to be a woman that might accidently run into another woman.  Also, in 1732, leprosy was still a very unsightly distraction for other riders.  Adjusting your 'Clothes' falls under the category of wool underwear, which tended to 'ride up' as they say.  Skipping underwear altogether would probably alleviate this problem.
"Moft Men whip and fpur their Horfe to make him go fafter before they bid him; but that is cruel Treatment, to beat a generous Creature before you have fignified your Mind to him (by fome Token which he may be taught to underfland) who wou'd obey you, if he knew your Pleasure."
Well, this critic has come to believe that most horse's (horfe's if you prefer), don't speak English.  Apparently, neither does the author.  Perhaps Captain Burdon has confused a Lexus 300 with a large, four-legged hairy thing that wouldn't know a brake pedal from a head of cabbage.  However, the 'whip and fpur' part does have to do with an after-hours club I know in San Francisco.  Obviously, I haven't been there, but most good journalists know where disgusting things take place.  Hey, it is a tough job, but we have to ferret out the truth, no matter how risky.  I mean, I once had to interview Bambi...Bambi?  She had this thing about salad oil, a snake and....
"...there is a wrong judg'd Cuftom amongft our Profeffors concerning Rowels.  If a Horfe is fick, they bleed him right or wrong, give him a Drench, and put a Rowel under his Belly; without enquiring of his Mafter or Keeper, what Ufage he huth lately had, which did occafion that Illnefs.  Rowels are abfolutely neceffary in fome Cafes, but are abfolutely unneceffary in others, and ferve only to disfigure and torment a Horfe.  As for Example:  The Rowel in the Navel for the Greafe (which you may fee in almoft all the coach and Cart-Horfes about Town) is very wrong; becaufe Rowels, in a Horfe that's greas'd, promote too great a Difcharge from the Blood and animal Spirits, which weaken him to a Degree of irreecoverable Poverty."
It is quite possible that Captain Burdon is referring to the IRS in this vague passage.  Being "weaken [ed] to the degree of povery" almost always has to do with either taxes or alimony.  "Rowels" are a bit more problematic, especially if one is stuck in your ear, navel or arse. I could see it happening though in one of those western-style bars during a line dance, especially if you were a bit "greas'd" on some of those "animal Spirits."  I do agree though, that "Rowels are neceffary in certain Cafes."  I know a couple of spots outside Moscow where a good set of Rowels will get you anything in the place.
Lastly, Captain Burdon comments on common eye ailments:  "After you have taken a pint of Blood, get a Quarterri Loaf (something like a sourdough baguette), hot out of Oven, cut away the Cruft, and put the foft Infide into a Linnen Bag large enough to cover his Forehead and Temples; prefs it flat, and bind it on by way of Poultice, as hot as may be without fealding.  Keep his throat warm.  Let the Poultice flay on 'till 'tis almoft cold, and repeat it once or twice.  Into a half a Pint of Kofe or Spring Water, put one Dram of Tuffy. finely prepared.  One Dram of white Sugar-Candy powder'd; and half a Dram of Sugar of Lead.  With a Feather put a drop into each Eye Mornings and Evenings."

So readers, there you have it...whatever it is.  As a side-note, Captain Burdon's tome (some edition of it) is available -- along with mine:  (Mares, Foals & Ferraris) in a special Amazon section called:  Best Bathroom Material of 2013   Half kidding.  Actually, both ARE there! 
Insert Smiley Face here:


Sunday, March 3, 2013

My kind of race....

Fifth Race, $3200 Claiming, Maiden 3 YR. OLDS

Purse: $5000

1 1/8 Mile



1.        Rider: Dick Nixon                                                                                                           122lbs


2.        Rider: Willie Nelson                                                                                                   *116lbs


3.        Rider: Lloyd Bridges                                                                                                       126lb


4.        Rider: Ollie Stone                                                                                                           122lb


5.        Rider: Earl Baaach                                                                                                       **162lb


6.        Rider: D. Trump                                                                                                           *110lb


7.        Rider: Cap Kirk                                                                                                               122lb


8.        Rider: H. Thompson                                                                                                       126lb


9.        Rider: D. Quixote                                                                                                          *116lb


10.    Rider: Art Drano                                                                                                 Late Scratch


                                                                                                               *Denotes Apprentice
                                                                                                                                                                     **Denotes optimism