The more we can do holistically to manage the symptoms of CPL, the better the horse’s quality of life will be.
10 CPL-friendly tips to help manage the disease.
I need to be clear here that if there is only one thing you do to improve the set up for your CPL horse, it must be to increase the amount of movement they get. Ideally, that looks like 24/7 turnout on a grass-free track system with plenty of ridden/groundwork exercise too (in accordance with the horse’s fitness levels and abilities). Failing that, 24/7 turnout and failing that again, some stabling but with the support of multi-level lymphoedema bandaging (MLLB), which must be taught by a qualified equine lymphologist.
Please, when you start to apply any of the changes below, be very careful to monitor your horse regularly, consult your vet if necessary and always only introduce one change at a time. That way you will know if it makes a difference. If you make too many changes at once, you will never know which has benefitted the horse. Give it a few weeks to see a difference.
Remember, there is no cure for CPL yet. The holistic approach detailed below is designed to slow the progression of the disease and increase the horse’s comfort and quality of life.
You can find even more information on the things we can do to help with lymphatic disease (and what to avoid) here.
Once we understand the lymphology of the distal limbs, it’s easy to see that exercise is essential to CPL management. The more movement the better so 24/7 turnout is good, but 24/7 turnout on a well-planned track system is better.
If they are sound – ride that horse! Lunge them, longline them, play with them at liberty. It all helps.
2. Feather Mites (chorioptes bovis/equi)
Vigilance when it comes to feather mites is absolutely essential. Mites are prolific in CPL legs because of the excess skin in the epidermis (caused by hyperkeratosis), the thick feather that protects the mites and eggs from extreme temperatures and the skin folds that provide them a great breeding ground.
Damage from mites can create entry wounds for bacteria which causes infection and cause the thickening and scarring that is so familiar in CPL. That scarring further damages the superficial lymph vessels. Effective treament is essential, as well as understanding the inate ability of mites to survive in the environment for up to 70 days.
In the first instance clipping the legs allows us to see the extent of the damage and assess the stages of lymphoedema, infection and inflammation. Secondly, it actually helps to exfoliate the legs prior to treating for mites – scuffing away the dead skin to make topical treatments more effective. Furthermore, it allows us to wash and dry the legs well and apply emollient. Finally, clipping makes it easy for us to see the progression of the disease – and it will progress because that is the very nature of CPL.
The process for clipping for CPL is slightly different to normal and a bit more involved so please refer to ‘Clipping Protocol for CPL Horses’ opposite.
It is absolutely essential to begin the process of desensitisation to clippers as soon as possible and professional help should be sought to do this kindly and reduce the risk of injury or trauma for everyone involved.
4. Combined Decongestive Therapy and medically correct compression
A highly skilled combination therapy that must only be performed by qualified persons. Learn more at Equilymph Ltd
Medically correct compression (multi-level lymphoedema bandaging, using non-elastic bandages and proper padding) adapted to the individual horse is of great benefit and must be considered a treatment option, but only with the input of a specialist. It not only helps to support the lymphatics and reduce oedema but also over time improves the tissue quality which can reduce the folds and nodules.
Be aware that there are lots of products out there that are “compression” but are not medically correct or appropriate for use in CPL specifically due to the indurations of the leg.
Dr Deborah Carley takes an interest in CPL and recommends a diet free from chemically processed, potentially inflammatory ingredients and those which can damage the delicate gut microbiome and overload the lymphatic system. With a simple, nutritious, alfalfa-free, forage-based diet, we can hope to protect from environmental triggers that may cause flare ups (such as pesticides and phytochemicals that get into the food chain).
It is so important to keep the horse from becoming overweight because this puts further strain on the already overburdened lymphatics (likewise, so does putting a mare in foal). In addition, some studies have found that some horses with CPL also develop laminitis so it is also really important to keep a healthy weight and stick to the <10% combined NSC (non-soluble carbohydrates, eg sugar and starch) content as recommended by the Laminitis Trust.
From a lymphatic standpoint, ad-lib forage is a must. This helps with the full body lymphatics, the mid to hind end of which relies heavily on the peristaltic action of the gut when it is working digesting food and pushing it along the digestive system. Since we know many of these horses with heavy feather tend to be incredibly good doers, this need for ad-lib forage again lends itself to a track system set up for turnout – increasing movement to maintain weight and hay fed in trickle type nets if needs be.
It may be beneficial to have your forage analysed to check for deficiencies and high sugar/starch levels. ForagePlus offer that service in the UK, with complete analysis of water, hay, haylage and grazing available so you can see your horse’s individual nutrition needs.
We fully advocate taking your CPL horse barefoot (or barefoot with boots), but only with the support of a qualified and experienced hoofcare provider. However we understand not everyone has that option.
Whether barefoot or shod the principles to CPL hoofcare remain the same. Firstly we need to make sure the horse is trimmed and balanced regularly to prevent injury to the internal structures of the hoof and leg. Secondly, we need to trim the ergots and chestnuts short to stop them splitting and bleeding because that leaves the area open to infection. Thirdly, we would like the heels and frogs to be in the best condition possible because CPL horses are prone to treatment-resistant thrush. Finally, we need to be aware that CPL horses can develop laminitis.
7. Washing the legs
This is fine to do and helps combat infection and sores – providing the legs are carefully dried and rehydrated afterwards using a good quality, easily absorbed emollient. Plenty of clean microfibre towels or a hairdryer on the cool setting are recommended. Avoid washing the legs unnecessarily or using very drying shampoos as it dries the skin and that is contraindicated in lymphoedema care.
8. Topical treatments
Aside from feather mite treatments which we will discuss elsewhere, its a good idea to have the following products (or equivalents) in your CPL kit:-
A quickly absorbed emollient such as Diprobase. This can also be used as a wash to help with intertrigo (MASD/“skin fold rub”).
A healing, antibacterial cream with silver in such as Flamazine™/Silvadene™. Zinc oxide based creams are useful.
A medicated shampoo such as Sebolytic can help rebalance the skin’s pH and beneficial bacteria.
Selenium-sulphide based shampoo for gentle cleansing and feather mites prevention. Common brands are Clinical Head & Shoulders and Selsun.
A mud barrier product. There are many to choose from at your local horse supplies shop. Only use on clean legs to avoid trapping dirt against the skin. Alex Penrose (a UK pathology vet with an interest in CPL) recommends Aromesse.
9. Stabling and Track Systems
We need to be clear – stabling will not work for these horses long term. We know that it is detrimental and will cause a rapid progression in the disease, but many CPL owners are bound by limitations on livery yards and even their own land if it is prone to flooding or excessive mud over winter. So while everyone who can, should turn their CPL horses out 24/7, for those who aren’t able to it’s a good idea to opt for the biggest stable possible and provide enrichment so the horse moves around more indoors. If you have turnout, talk to your yard owner about putting up a temporary track system in your paddock to encourage more movement. With cases on the increase, livery yards need to adapt and accommodate CPL horses needs.
To combat the stable problem, Rebecka Blenntoft developed a DIY technique – the Approved Stable Bandage Method (ASBM) which you can enquire about by emailing email@example.com
10. Medically correct compression and the SBW method
Traditional stable bandaging techniques (especially using stretchy bandages or boots/socks) have proven to be detrimental, in effect crushing the circulatory and lymphatic vessels. Furthermore, many “compression garments” on the market are not suitable for use in CPL, in part because of the indurations in the legs which cause the fabric to “creep” into the folds where it can constrict the micro-circulation and superficial lymph vessels. As such they do not meet the requirements for medical compression. So the ASBM (Approved Stable Bandage Method, formerly known as the “SBW”) was developed in 2020 by Rebecka Blenntoft at Equi-lymph as an affordable, practical way for CPL owners to support their horses legs when stabled. It is very specific but simple enough to do after the initial learning and sewing of pads and bandages. The legs must be monitored closely using the Press & Stretch Test.
There is a course for learning the ASBM (with your vet’s consent). For more information you can contact firstname.lastname@example.org