PDA

View Full Version : Leg edema following respiratory symptoms. Final update post 39



RegentLion
Jun. 3, 2009, 09:58 PM
Two horses in the barn went to a horse show at Michigan State the first weekend in May. One horse came home and shortly thereafter had respiratory symptoms (coughing, runny nose) that cleared up with SMZs. Horse was also off his feed. I would like to mention that the horse went about 2 1/2 weeks before starting the SMZs. Not my horse, because I would have treated it much sooner. This horse and my horse share a pasture but live on opposite sides of the barn.

My horse went off his feed on Sunday (for sure-maybe earlier, BO didn't notice or didn't say anything....:mad:). I suspect he was feeling poorly on Friday as well because his stall was abnormally clean. No cough, slight nasal discharge. Monday started a course of SMZs. (10 pills two times a day). Today I went out to the barn and he was turned out on pasture as usual and has swelling in all four legs--not above the knees or hocks however. Hind legs stocked up from hoof to hock but still definition around the fetlock. Front legs swollen between knee and fetlock joint, and one leg down to the hoof. No other swelling or edema anywhere else, I specifically checked his belly and sheath area.

Temp is 102. Horse is going to the vet tomorrow (Hubby is taking him down as I have to work. It is a 2 1/2 hour drive).

Horse is also slightly lethargic and looks like he's lost some weight or isn't drinking well.

I cold hosed his legs, and hand walked him. Hand walking for 15 minutes took all but the swelling in the front tendons away.

What could this be? One "old timer" vet my husband talked to (the vet is now "retired" from large animal work and only does small animals) said it sounds like "purpura hemorrhagica." I googled it since I have never heard of it before, and it is frankly TERRIFYING.

Is this something I could be facing? Horse did NOT GET the strangles vaccine this year, don't recall if he did last year or not. I know that the live vaccine can cause bastard strangles/purpura hemorrhagica.

FREAKING OUT here... obviously I will know in the morning after the vet sees him, but I'm incredibly upset/worried/nervous/angry for not being told sooner that this was going on. :cry:

Jingle for Tuff please....

deltawave
Jun. 3, 2009, 10:03 PM
It's smart of you to be vigilant and I would also be taking the horse to MSU or getting him checked out.

Bonnie got purpura hemorrhagica after a course of TMP/SMZ as a weanling. It was truly awful, but she recovered very well. No more sulfa for her, though! :eek: She had not gotten the strangles vaccine before this happened, just a case of the "snots" and subsequent antibiotics and EqStim.

Jingling that it isn't the case with your horse. :)

RegentLion
Jun. 3, 2009, 10:24 PM
Deltawave...

What was treatment like? And why no more sulfa drugs? I do not have a solid understanding of what this "purpura" thing is...

twofatponies
Jun. 3, 2009, 10:26 PM
Jingles! :(

shawneeAcres
Jun. 3, 2009, 10:29 PM
I suspect your hrose has a virus, and it is not uncommon for leg swelling to accompany this type oif thing, have seen it many times. I would have vet look into it but likely they will tell you just to keep him moving some. If he is feeling bad he is not miving much contributing to it, plus a fever is probably having him retain some fluid. We had a horse get a similar virus, but was the ONLY horse in the barn to get sick, and he had not been anywhere. He ran a fever (somedays pretty high) for about a week, was controlled with banamine, and he also had some edema, even a couple weeks after he recovered. My vet felt that anitbiotics were not indicated and his bloodwork showed no bacterial infetion and antibiotics are not effective against viruses. Time and good supportive care kept this old man going (he is 20 yrs old)

greysandbays
Jun. 3, 2009, 11:03 PM
A horse I used to take care of was diagnosed by the local cow vet as having that "purpura hemorrhagica" (only I think that vet called it hemmoragic purpura).

Only symptom was MASSIVE edema -- the horse's legs, whole body, neck, and head were puffy. This was long before strangles vaccines were available, and the vet said this sometimes happens after a horse has strangles (which as far as anyone knew, this horse had not -- closed herd for many months, no symptoms at all).

I think the vet said the survival rate was something like 50%, but this horse recovered uneventfully. I think the treatment was antihistamine shots, but my memory could be fuzzy on that; I know that horse did at one time get antihistimines for something.

Horse went on to live another twenty years or so.

happyhorsegirl
Jun. 3, 2009, 11:26 PM
Don't rule out colic. Colic can present in different ways as I found out heartbreakingly this past winter. Lethargy, off feed, nasal discharge, fever....within 24 hours horse was dead from stomach rupture/sepsis. Horse was passing manure the whole time.. Vet was called but decided a visit was unnecessary...prescribed SMZs over the phone ("there's a flu virus going around") had the vet actually come and seen him, do a thorough eval/rectal/?NG tube, who knows if the story would have had a different ending. Up to the dire end (in the vet clinic) the vets didn't even suspect colic..maybe its congestive heart failure?...then they ultrasounded his swollen abdomen, drained huge amount of bloody fluid...oh maybe its a ruptured tumor/abscess? we just don't know, well have to get a specialist in tomorrow morning. It wasn't until he was on the table later that night and opened up they figured it out. And it was much too late. I can only imagine the suffering.

the nasal discharge in question turned out to be foamy stomach contents.

Horse was not in my care at the time, I wonder if things would have been different had he been home with me. Sorry if I sound bitter and angry. It's just the grief talking I guess.

Just to spread the word, sometimes colic presents in strange ways. Never underestimate it, it is the deadliest of horse ailments.

ohear001
Jun. 4, 2009, 12:12 AM
This sounds very similar to what happened to my horse that was eventually diagnosed with purpura hemorrhagica. Risky had a cold, which the BO decided to treat with an extremely short course of antibiotics (one shot), without telling me until after the fact. He got better for a little while, then all the respiratory symptoms got worse, he became lethargic and had swelling in all four legs. Have you checked for petechia? (sp?) If I remember correctly, the petechiation plus all his other clinical signs is why they (at the vet school) diagnosed purpura. He was in isolation at the vet school for about 5 days and came home on antibiotics (penicillin, I think) and we had to keep his legs wrapped to keep the swelling down. He made a full recovery, by the way, and was practically breathing fire by the time he was out of isolation.

Jingles for your boy!

Androcles
Jun. 4, 2009, 12:13 AM
Two horses in the barn went to a horse show at Michigan State the first weekend in May. One horse came home and shortly thereafter had respiratory symptoms (coughing, runny nose) that cleared up with SMZs.

My horse went off his feed on Sunday ( Monday started a course of SMZs. (10 pills two times a day).

What could this be? One "old timer" vet my husband talked to (the vet is now "retired" from large animal work and only does small animals) said it sounds like "purpura hemorrhagica." I googled it since I have never heard of it before, and it is frankly TERRIFYING.

Is this something I could be facing? Horse did NOT GET the strangles vaccine this year, don't recall if he did last year or not. I know that the live vaccine can cause bastard strangles/purpura hemorrhagica.


Really, the live vaccine causes purpura hemorrhagica? I've not heard that. What I have heard is that once a horse gets strangles you should not treat it with antibiotics but rather let it run its course, because doing so can cause purpura hemorraghica, bastard strangles.

atr
Jun. 4, 2009, 12:56 AM
Don't panic.

Shawnee Acres is probably right. The assorted edema is a pretty standard reaction to a viral infection/fever.

He'll be feeling like crap with a fever of 102--I'd try to get that down with bute or banamine if I were you.

It's sensible to get him checked out, but don't work yourself into a lather over it until you know what it is.

BuddyRoo
Jun. 4, 2009, 01:22 AM
More than likely, it's a simple virus.

"Bastard strangles" can occur when a horse has been exposed in the past to the strangles virus. Giving the vaccine after a recent exposure is thought to increase the risk of bastard strangles.

Will jingle anyway. I work right across the street from MSU...so my jingles should carry just fine.

Good luck.

AnotherRound
Jun. 4, 2009, 01:29 AM
Good luck. A virus has to run its course, and I would be concerned if the vet tried to give him antibiotics, if he thinks its virus, try to get him not to do that, I don't know if it would hurt him or not, but I wouldn't want them myself. I'm sure he'll recover. good to get the vet out to make sure he is treated correctly. I'll be thinking of you (I don't jingle. I send out love and healing thoughts. Much more productive, psychic-ly, :winkgrin:). Poor thing. You I mean. Be well. Try to sleep.

Ghazzu
Jun. 4, 2009, 11:12 AM
"Bastard strangles" can occur when a horse has been exposed in the past to the strangles virus.


Bastard strangles can occur when the horse is exposed to S. equi period. No prior exposure is necessary.
And strangles is a bacterial infection, not a viral one

Ghazzu
Jun. 4, 2009, 11:33 AM
Purpura hemorrhagica is an immune-mediated vasculitis.
IOW, the immune system causes damage to the animal's own blood vessels--particularly the small ones in the skin, causing them to become leaky. This is due to the deposition of antibody-antigen complexes.
Fluids and proteins leave the vascular system and accumulate in the tissues--edema.

This is the reason one wants to be cautious in vaccinating a horse for strangles if it already has a high level of antibody to the organism.

There are numerous triggers for purpura hemorrhagica --Strep equi being one, and probably the major one, in terms of those which can be determined to be from a particular etiology.
Others include various viral or bacterial infections, reactions to drugs of one sort or another, vaccines, and even wounds.

deltawave
Jun. 4, 2009, 02:11 PM
Deltawave...

What was treatment like? And why no more sulfa drugs? I do not have a solid understanding of what this "purpura" thing is...

Treatment was supportive--about half of her skin and hair came off, she lost so much weight she was skeletal, and her joints were swollen and achy and she didn't eat well for about 10 days. She just got skin care, daily walks and lots of food. :) Oh, I should mention I was 9+ months pregnant when this happened and had my son right when poor Bonnie was at her worst! Thank GOD she was at a great TB layup/breeding barn (I'd taken her there after weaning so she could be with other youngsters) and they took great care of her. She had to be clipped and it was January so they kept her in the office all day so she could be warm. :D It's no wonder she's a big lap dog, nine years later. :lol:

Since in Bonnie's case the presumed "trigger" was a sulfa reaction/allergy, I just won't chance it again.

BuddyRoo
Jun. 4, 2009, 02:16 PM
Sweet jesus...I need to not post at the end of a long day. Goodness. Thank you for correcting. I know this...I apparently go brain dead in the evening.

RegentLion
Jun. 4, 2009, 02:19 PM
Thank you Ghazzu for the explanation! It makes more sense to me now that I know what it "is".

The vet that initailly said "purpura hemorraghica" didn't actually treat the horse. He's an old time livestock vet who is retired to doing small animals, but will do phone consultations with us as he's a friend of my husband's family. He suggested getting the horse to a vet hospital ASAP, as this could be something we were facing. He didn't say definitively but let us know it could be serious. I appreciate his candor!

Anyway, an update.

This morning I called the vet first thing to make an appointment for Tuff to go down there. I spoke with the vet directly and she felt it was not in his best interest to travel as he is weak/lethargic. The trip is 2 1/2- 3 hours each way, and it is the closest vet.

She discussed his symptoms at length and felt that it was probably strangles or something like it. She prescribed penicillin, genomyacin (sp?), and some bute for the fever. She did say that not too much bute as it can cause something--anemia maybe? My father in law was in the area of the vet's office this morning and picked up the antibiotics. I was told to watch to see if he continues to decline, or has diarrhea, in which case he needs to go to the vet. She did not seem overly concerned outwardly, but she did say "good luck" in tone that has me concerned.

She said that if we had caught this sooner, it would go away sooner. I'm even more upset that the BO didn't notice the leg swelling or mention it to me. She claims she noticed it on Tuesday but didn't let me know--IDK if she noticed and didn't call or else didn't notice and was trying to cover it up. Furious either way.

The vet said that he will need to stay at the barn for 21 days after he is better. She also said that she doesn't think the barn needs to be quarantined, which confuses me. I'd think that if my horse has it, and two others have it (at least) and the index case had it and is better.... might be going to go thru the whole barn? Or if it isn't "strangles" but another strep infection maybe she feels it isn't contagious as it took almost a month of my horse sharing the same pasture to contract the disease?

Anyone have any light to shed on this?

Ghazzu
Jun. 4, 2009, 02:30 PM
Not to cause you further alarm and stress, but IMHO, it wouldn't hurt to do some icing and tape some styrofoam on his feet, just in case.

RegentLion
Jun. 4, 2009, 02:38 PM
Ghazzu

Yes I can do that. What kind of styrofoam? Should he be on stall rest or out in his pasture (there is grass but not a lot, very cold spring/summer for us)?

RegentLion
Jun. 5, 2009, 02:23 AM
Also what would cause the laminitis? The condition (purpura hemorrhagica) or the drugs?

Ghazzu
Jun. 5, 2009, 11:13 AM
Styrofoam--insulation type stuff found at Home Depot, Loew's, etc.

Inciting cause of the purpura, if that's what it is--hard to be certain, but playing the odds, the most common cause is S. equi.

Has the other horse (or your, for that matter) been definitively diagnosed with S. equi?

lovemyoldguy
Jun. 5, 2009, 11:24 AM
RegentLion, if it helps, we did something like this for my horse. My farrier went to Home Depot and got a sheet of styrofoam for my old man to stand on while we did his feet, to try and help his old legs comfortable. (I loff my farrier!) What you're looking for should be over in building supplies - just tell the salesperson that you're looking for sheets of styrofoam and they'll point you in the right direction. We used a product that was almost two inches thick for my horse to stand on...not sure if you should use something that thick for taping to the hooves.

While you're there, pick up several rolls of good-quality duct tape...the stuff you get at Home Depot is much better quality than what you can buy at CVS in an emergency. :) Good luck, and I hope Tuff feels much better soon!

ChocoMare
Jun. 5, 2009, 11:30 AM
If you can't get styrofoam, go to the garden section of Wal-Mart etc and get a couple of those cheapie neoprene kneeling pads. Trace out the hoof and cut 'em to fit. I prefer Gorilla Tape to any generic duct tape. It holds those pads on great.

Jingles!!!

RegentLion
Jun. 8, 2009, 12:03 AM
ANother update:

Hubby and I had to go out of town so his dad (a farmer) gave the shots and bute for the weekend.

Temp is now normal, lethargy is gone, appetite is back.

Edema has INCREASED and he even has it on his face below his eyes and down to his nose. :eek: Hubby's dad thought he got kicked in the face, which I suppose is possible but?

Have to call the vet first thing again tomorrow.

Not sure what the increasing edema means? He's been turned out 24/7 since Saturday morning.

His feet have remained cool and he's sound on his swollen legs. I noticed this because when I got to the pasture gate he RAN to me. I guess he was hungry!

deltawave
Jun. 8, 2009, 12:06 AM
Is he peeing normally? Urine look OK? Skin turgor good?

RegentLion
Jun. 8, 2009, 12:14 AM
Is he peeing normally? Urine look OK? Skin turgor good?

AS far as I know yes. I will know more in the morning. Skin turgor was great this PM as I watched hubby give the shots and he pinches the skin to numb it(?) before injecting.

EqTrainer
Jun. 8, 2009, 12:26 AM
Please let us know what the vet said. This is disturbing.. hang in there!

atr
Jun. 8, 2009, 01:08 AM
Any EVA in the area? We had quite the exciting outbreak here a couple of years ago--respiratory stuff, edema as you are describing, high temps, miserable horses for several days. I had one horse out of three on my property get it via human transmission. He was quite sick for about a week, but the other two never succumbed. I had to keep him at home for a while and practice careful quarantine hygeine because I have quite a lot of contact with breeding stallions.

In geldings and open mares, it's miserable, but not a big long term deal. For breeding stallions and pregnant mares it's a very big deal indeed--it causes abortion and stallions can turn into shedders, so you may want to discuss it with your vet and see whether it is a possibility.

EqTrainer
Jun. 8, 2009, 08:53 AM
We've had EVA run thru our area, too, with the same symptoms... but it sounds like the swelling on the OP's horse is quite out of hand compared to what I remember. Still... EVA would be a nice answer :yes:

RegentLion
Jun. 8, 2009, 09:00 PM
Vet update.

This morning, Tuff had a temp of 101. So it is going up after he was off the bute. I "grew a set" and did his IM injections in the hamstring, and then hand walked him.

Edema was unchanged in the head, and slightly increased in the legs. Now a "pouch" in his right "armpit" about the size of a fist or orange.

I called the vet and they had my husband take him down there. Hubby got to the barn and found all the horses running like crazy because BO put 3 new horses in with the herd. :eek:

Vet said that when she first saw him she thought it was an allergic reaction because his legs were so blown up. She did blood work and his neutrophils were high, and he had low protein (4.6) and was anemic (27). Apparently normal for protein is about 5.5 and red cell count is between 33 and 45. She feels that the edema is in part to his low protein levels.

She changed him to Naxel (sp) 10cc twice a day, IM. He's off the Gentomyacin and Penicillin.

She heard some fluid or swelling in his lungs and said he's got a "Pus lucrogram" but not sure what that means. She said that since there is no discharge she can't run a culture but could culture the lungs--however didn't want to put him thru that stress.

The plan of action is the Naxel, no bute or banamine orally, and give him red-cell (for the anemia), yogurt (so his guts stay healthy), and soy bean meal for the protein. Also we are keeping him warm and quiet with no forced exercise.

She said he definitely has a bacteria of some sort, and gave me a shot of dex incase his tongue swells.....

This whole thing is so so scary. :(

DVM2003
Jun. 8, 2009, 09:11 PM
said he's got a "Pus lucrogram" but not sure what that means.

I wonder if she said "stress leukogram"...just means specific types of white cell numbers are a little out of whack due to stress of illness, but not specific for any one disease.

Hope your boy gets better soon.

hitchinmygetalong
Jun. 8, 2009, 09:22 PM
Oh, you must be so scared. Jingles for a big turnaround soon!

EqTrainer
Jun. 9, 2009, 09:53 AM
Crap. We will be thinking of you today.

Re: the anemia, is your horse getting enough copper and zinc? They work together to make iron accesible to the horse. If you don't have enough of them some horses will become anemic.

How did his heart sound?

deltawave
Jun. 9, 2009, 01:23 PM
Boy, I don't know if I'd leap to the conclusion that "low protein" and "anemia" are related to the current illness OR needing immediate dietary correction right away. Probably no harm in adding some nutrients to the diet, but I'd focus on treating the illness first. :)

Hope today brings better news.

flyracing
Jun. 9, 2009, 05:57 PM
When my horse had cellulitis followed by vasculitis and his blood work showed low protien/low RBC count, my vet specifically said not add any supplements except a probiotic until his illness cleared. We address the anemia later. Not saying what your doing is wrong, just sharing my experience.

Good luck!!

EqTrainer
Jun. 9, 2009, 09:56 PM
Boy, I don't know if I'd leap to the conclusion that "low protein" and "anemia" are related to the current illness OR needing immediate dietary correction right away. Probably no harm in adding some nutrients to the diet, but I'd focus on treating the illness first. :)

Hope today brings better news.

I was thinking the same thing. Also, I think I'd want to know why the horse was anemic, or at least think I had an idea. Having been severely anemic myself, I know that throwing some iron supplement at it is not always the answer.. wish it were that simple. And maybe in this case it will be, for the OP certainly I hope it is.

FWIW, Redcell is some of the *nastiest* stuff I have ever encountered. It has animal byproducts in it, too.

RegentLion
Jun. 12, 2009, 07:42 AM
How would I check out his copper/zinc levels? I have no idea.

Well an update is that we brought him home from the boarding facility. His fever spiked a bit (to 103, highest it has ever been) on Tuesday night. Wednesday morning it was down to 102, and has remained there. It tends to be 1 degree lower in the morning than in the evening.

His appetite is good, however his penicilin shots in the neck caused his neck to be sore so he doesn't like to eat grass off the ground. So we built him a pasture and the grass is very tall, he doesn't have to bend much. The vet thinks the temp may be from the fact that his neck is so sore (?).

The edema is sloooowly decreasing ( i think) but my husband doesn't see much change. His last dose of Naxel is this morning and then we may do another round of it after giving him a few days off.

Could someone talk me through the other reasons for low protein/anemaia and how else you would treat those issues?

And what is so gross about Red Cell? I think it LOOKS and SMELLS gross but....

deltawave
Jun. 12, 2009, 05:17 PM
Low serum protein and anemia are often RELATIVE, or transient, when an animal is sick. In other words, it's probably worth checking them again when he's well rather than necessarily adding these two findings to the disease that's present. The infection may not be causing either--these things (especially if they're mild) could very well be spurious or incidental.

RegentLion
Oct. 24, 2009, 06:40 PM
Thought I'd (belatedly) update this thread.

After my last post we waited a few days and did another round of Naxel which seemed to do the trick. Once his neck had stopped hurting from the penicillian shots, we turned him out in a large pasture with an old Jersey bull for company. :lol: We kept him out as much as flies/ weather allowed. He put on a lot of weight but we kept him on the soybean meal, Red Cell, and SmartGut probiotics.

By mid-July the vet came back out and said he was the picture of health! He'd been looking good for a couple of weeks by that point but I was still treating him like glass, even though he was looking kind of fat (he put back on all the weight he lost, seemed like over night!).

By the end of July/early August he was getting fitter and fitter and I had a lesson with my trainer who said he was looking STRONGER and better on the flat than he had in May. I was really surprised to hear this... but grateful! At that time we did decide that jumping was PROBABLY not his forte, but that had nothing to do with his health! ;) Here is a pic of him trying to figure out how to trot forward while on contact... He's a WP horse at heart (http://photos-a.ak.fbcdn.net/hphotos-ak-snc1/hs166.snc1/6212_583575014237_40600898_34362036_7823868_n.jpg) .

August he ran out of his second bottle of RedCell and I have kept him off of it since... He was eating grain and soybean meal until the end of August, but now he's still fat and maintaining on pasture.

This fall he showed "tag team" at the county fair--a friend's daughter showed him in a few classes, I showed in a few, and my western trainer rode him in a few. He won everything but halter (got 2nd) and really looked AMAZING. He still stocks up a bit while in a stall but nothing like he used to.

So the entire scary situation seems to have been resolved. Neither the vet nor I anticipate any lasting complications.... which is great. I was really scared for a while there, especially when the vet gave me a syringe of Dex with written instructions on when and how to use it (should I need to). The instructions ended with the phrase "Good luck." :eek:

Thanks for all of the info and support you guys gave me earlier this spring!

sdlbredfan
Oct. 24, 2009, 07:41 PM
Good Lord, on top of all this, you have an idiot BO!? (" Hubby got to the barn and found all the horses running like crazy because BO put 3 new horses in with the herd").

Please, do not give him any more Red Cell, and if your Vet actually thinks that a pro-inflammatory substance (high iron) was appropriate in this case, you need a new Vet immediately! (do a search engine look up on equine overload when you get a spare minute) IMO, although I am not a Vet, just an extremely well-read and scientific-minded person, adding anything that feeds inflammation, in the existence of this edema could have been deadly. You are very lucky it was not. Horses are herbivores, therefore if they are anemic it is not likely due to iron lack.
http://www.fivepineranch.com/images/Iron%20Overload%20-%20A%20Growing%20Nutritional%20Disorder%20from%20D ietary%20Excess.pdf

RegentLion
Oct. 24, 2009, 09:34 PM
Good Lord, on top of all this, you have an idiot BO!? (" Hubby got to the barn and found all the horses running like crazy because BO put 3 new horses in with the herd").

Please, do not give him any more Red Cell, and if your Vet actually thinks that a pro-inflammatory substance (high iron) was appropriate in this case, you need a new Vet immediately! (do a search engine look up on equine overload when you get a spare minute) IMO, although I am not a Vet, just an extremely well-read and scientific-minded person, adding anything that feeds inflammation, in the existence of this edema could have been deadly. You are very lucky it was not. Horses are herbivores, therefore if they are anemic it is not likely due to iron lack.
http://www.fivepineranch.com/images/Iron%20Overload%20-%20A%20Growing%20Nutritional%20Disorder%20from%20D ietary%20Excess.pdf

Well, this whole thing was the final straw on keeping the horses boarded out. They're all at home now, and will stay here even though I don't have an indoor. I'm very happy having him at home, and actually feel much closer to him emotionally.

Also, as far as the red cell goes, he's off it now and is doing GREAT so not sure what to think. I will be looking into the link you provided. Overall, however, I'm very happy w/my vet, and TBH don't have much choice in terms of equine vets in this area. But won't hurt for me to get more informed and ask some questions.