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Chronic cellulitis or...? -- update for anyone interested

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  • Chronic cellulitis or...? -- update for anyone interested

    My retired TB turned up lame in his stifle more than a month ago. He was very sore, almost 3 legged lame. I had the vet out. Of course, when the vet arrived, he ran around the field and looked sound. No swelling. Off for flexions. Vet diagosed stifle strain and gave him some Banamine, contined with bute over the next 3 days.

    Three days later he I went out and his leg swelled up four times its normal size. Horribly lame, would not bear weight, would not eat. Another emergency vet call. Vet came out, gave one of those "sure didn't expect this when I saw him 3 days ago!" apologies, gave him painkillers and antibiotics, I continued antibiotics and Banamine for 10 days. soaked leg, did wraps. On day 2, his leg seeped serum from a number of places, with previously no injuries. He never had any injuries to the leg other than an old scratch near his hoof. All the swelling was high, between stifle and hock. The pain seems to be up high.

    He did not eat grain, picked at hay during this time. Finally on day 10 started eating again. Continued Banamine and Bute. Never a temp, which is odd for cellulitis. On day 10, all the hair fell off his leg from the stifle to the hock.

    The swelling is mostly gone, a little residual but nothing like it was. No heat, no temp.

    But he came in yesterday more off than he has been for a while. Not horrible, but definitely in pain. I gave him extra bute and some Banamine and when I checked on him later he was walking around the field pretty comfortably.

    How long is this going to go on? I hate this. I am calling the vet this morning but wanted another sounding board since there is so much experience here too. Am I missing something? Is this normal for cellulitis? Is it normal for him to have such residual pain when there is no obvious swelling or heat left from the cellulitis? It is consistent with the fact he had pain for several days before I ever saw any swelling to start, but I can't help but worry it isn't cellulitis at all.

    This morning he looks pretty good, off a little but pretty good.
    Last edited by fordtraktor; Mar. 20, 2011, 02:49 PM.

  • #2
    The lack of fever and oozing and serum makes this sound similar to my horse, who has chronic lymphangitis. However, Tru does not seem to experience pain, rather just stiffness because the lymph fluid builds up and makes it hard to bend his stifle and fetlock. We used to treat it with Ace and bute, thinking for ages that it was chronic cellulitis. It isn't. At all. Which probably explains why those things didn't help much or for long. The serum could actually be lymph that is draining out. Tru's leg does that on it's own periodically. Not a bad thing in our book... it's getting it out of there.

    I'm not sure what difinitive vets can tell the difference between cellulitis and lymphangitis, mine knew it was the lymphatics as soon as he saw my horse's leg. Perhaps it's the persistance, lack of fever, and oozing. Maybe bring that up? It responds VERY well to acupuncture.

    Do you know how this started? Was there an open wound on the leg, of any size? Both conditions enter through wounds.
    Tru : April 14, 1996 - March 14, 2011
    Thank you for everything boy.


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    • Original Poster

      #3
      There was an old scratch near his hoof where he had stepped on himself playing in the field. It is very far from the inflammation, but that is the only injury we could locate so it is possible that it entered there. Otherwise it would have been something too small to see.

      It does look like lymphagitis would, from Dr. Google. What else did you do to treat your horse? Did the bacterial infection respond to acupuncture or did the lameness respond after you treated the infection with drugs? Thank you! Unfortunately Dr. Google is not making me feel much better, seeing too many cases of horses being euthanized b/c of chronic lameness after this.

      My guy has had some serious pain, but in short bursts -- both emergency vet calls were the "I think he might have broken his leg" types. One he was literally hanging it out to the side shaking it with it hanging loose, like you see a horse with a broken leg do. It was awful. Then the vet gets out here an hour later and he's totally different. I've taken to videoing it when he has an episode, so the vet can see, per a suggestion on a COTH thread (thanks COTH!). He couldn't believe the difference. It is so bizarre.

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      • #4
        He get acu as often as I can afford... 1 to 3 times a month. He seems to do better in the cold weather. I wrap it when it's doing well and small enough. Wrapping does not "cure" it. It's merely cosmetic. He tends to get a bulge on his fetlock fo fluid and wrapping smoothes it down and keeps his leg looking nice and smooth. We discovered that it was lymphangitis in April '10 when he had a terrible, terrible flare up. I'd say atleast 80% of his days since have been good or great. He is still rideable and runs around with his friends... doesn't seem to care at all.

        Lymphangitis, to my understanding, is not an infection. It's a disorder. The lymphatic system in the leg literally stops working properly and thus, the lymph does not move out and settles in the leg. The acu stimulate the lymphatics to work again. It's like the on-switch.

        The hanging thing is interesting. The only time Tru did that was after his bad flare and after the doctor gave him his very first acu treatment. He forgot to tell us that it would make his leg feel very funny and bit uncomfortable and that we should've started him on bute. The next day... poor Tru was pissed and wiggling his leg lightly all morning. Doctor said basically, since the acu was making the fluid flow it feels how a limb feels when it's "asleep" and coming back. Very strange. Tru was annoyed at the sensation and kicking his leg all morning. He was fine the next day.

        Perhaps he is feeling his lymph move around suddenly?
        Tru : April 14, 1996 - March 14, 2011
        Thank you for everything boy.


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        • #5
          Also, do not feel that this is some fatal issue. From what I've read lymphangitis results in euth only if it does not respond to any treatment, or if the horse is in long term pain. Tru has never appeared to be in pain. The leg bears weight, his hoof is unaffected (though it's gotten rings, like you would see with a horse that foundered), and he normally has a enough flexion in the joints to move the leg almost totally normally. He feels 100% normal when riding.
          Tru : April 14, 1996 - March 14, 2011
          Thank you for everything boy.


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          • #6
            Did you say you were giving bute and banamine together? They are both NSAIDS. They should not be used at the same time. Using them together, you are basically overdosing your horse on NSAIDS. Yes, they decrease pain and inflammation, but they also decrease good prostioglandins that are needed to protect the stomach, GI and kidneys.

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            • #7
              Banamine is shrot living, so depending on the spacing between them bute and banamine can be given together. My friend has a horse with lymphangitis, when he was younger and got flareups he was quickly given Banamine IV then about 3-4 hours later given Bute. Bute seemed to help better but Banamine relieved some of the pain and colick like symptoms at the beginning of the flareup.

              Does sound like lymphangitis. My friends TB has had it for 8 years, and is showing the meter jumpers this year (at 18). His leg is chronically enlarged but he is completely sound.

              Your horse sounds like an extreme case when it comes to the pain - usually pain lasts short term (less than 3 days), but I guess all horses are different.

              Its likely NOT a cut that caused the flareup, its a lymphatic disease...like "cancer" nothing causes it....it just happens. A lot of vets/horse owners believe its triggered by bacteria from a cut and the horse is placed on antibiotics. While antibiotics are generally warranted for severe cases the routine lymphangitis horse who has a flareup is generally treated with banamine, bute, diuretic, steriod and compression. Its similar as in people, they dont go around getting cuts and running in a muddy paddock - and the condition occurs.

              Best thing you can do short term is pain management, best thing long term to keep the swelling down is lots of turnout...and if the leg is enlarged pressure wraps. Once the leg gets big and stays big for a while, scare tissue builds up and it will never get back to complete normalness. The lymphtic drainage system also becomes scarred and thickened. If you can get the leg back to normal size sooner rather than later you will decrease the chances.


              My friends guy had 1 huge flareup when he was about 10. It was in his right hind. Huge, like all the way up to his stifle huge. The leg returned to normal size after a week and that leg has never been a problem again.

              The left hind leg however blew up a few times between 11- 14, and it became more freqent and more frequent as he got older. By 14 he was retired and in a lot of pain as these episodes happened weekly. Decision had to be made to either euthanize him or look for further treatment.

              Decided to move him to a boarding stable, and try compression wraps. Horse is now 18, showing the meter jumpers and is happy as can be. He maybe goes through 8 hours a year of moderate pain from a flareup....but thats it.

              His "treatment" that significantly brought the swelling down (before being able to start compression wraps) was a third generation antibiotic, followed by 4 days of diuretic and 10 days of tapering steroids. Once his leg was small enough to allow wraps, the compression wraps kept it coming down even further. Its not as small as the other leg, but its just "thick" looking now, but not massive. Everyone on the show circuit knows him....not because of his fat leg, but because hes always top 3

              Good luck with your horse, and keep us posted!

              Comment


              • #8
                Originally posted by SquishTheBunny View Post
                Banamine is shrot living, so depending on the spacing between them bute and banamine can be given together.
                The plural of anecdote is not data.
                Eventing Yahoo In Training

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                • Original Poster

                  #9
                  thanks all. I am not sure it is the same...it sound like these other horses are not in much pain. My horse is TOUGH and he is hurting. I need to get it under control.

                  He has been retired for 6 years from high ringbone, so not sound on the best of days, but this is much worse. I stacked the bute and banamine because one alone wasn't working. My priority is keeping him as painfree as possible. It did help. While I might not on a youngster with the old ones sometimes you might go a little farther than you otherwise would. He is now just on bute.

                  Maybe I will be more aggressive with the wraps, I was only using them 12 hours on, 12 off. Squish, was there anything special to the compression wraps beyond normal standing wraps? I am not sure I know what you mean by compression wrap but that sounds very promising!

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                  • #10
                    I just use normal quilts and polos and I LEAVE it on. Atleast 24 hours straight. They slide down once the leg shrinks... so you know you have progress.

                    If he's in a lot of pain it may not be lymphangitis. His other symptoms just seemed fitting. If it is you just have to keep trying until you find something that works. Seems like they all respond to something better than other. Like Squish said, it will never look normal again. I've had to face that reality. It will get close though. Close enough that people won't notice from a distance.

                    Just curious.... what diruetics and how do they work with this? I'd love to have an emergency drug to give to him at the time of bad flare as we wait for the vet to come.
                    Tru : April 14, 1996 - March 14, 2011
                    Thank you for everything boy.


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                    • #11
                      Furosemide (Lasix, Salix, etc.) and trichlorthiazide are two of the most commonly used diuretics. Naquasone, which is still made in Canada but I believe is not available in the U.S. unless compounded, is a combination of dexamethasone and trichlorthiazide. I'll let one of the vets explain the mechanism, but the basic idea is that increased excretion of water and electrolytes (via the kidneys) leads to decreased edema.
                      The plural of anecdote is not data.
                      Eventing Yahoo In Training

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                      • #12
                        A blood panel might help give some insight whether it is lymphangitis or cellulitis or vasculitis. I might also consider the possibility that a foreign body might be present. Good luck!
                        Every mighty oak was once a nut that stood its ground.

                        Proud Closet Canterer! Member Riders with Fibromyalgia clique.

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                        • #13
                          Sorry if i missed it but have you radiographed the stifle? Id be concerned that perhaps something is in there...
                          "Kindness is free" ~ Eurofoal
                          ---
                          The CoTH CYA - please consult w/your veterinarian under any and all circumstances.

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                          • #14
                            My horse had a similar course with cellulitus, although not nearly as bad. A few days after he finished the antibiotic it was back. We kept put him back on the antibiotic for a longer course and it resolved and didn't come back. The steroids really help get the swelling down quickly. Mine was on naquasone; it was available in the US as of last November (not compounded but in a packet). Good luck!

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                            • #15
                              What is acu?

                              My five-year-old has an old leg injury and lots of scar tissue low down on her right hind. We've had two episodes of exteme swelling - no idea what caused either, but her leg doesn't seem able to shed swelling once it occurs. Last August, we did a round of something that was a steroid/diurectic combo, and that worked well. That flare up scared me so much that we've only ridden her once since, although she has been sound on it other than a day or two of careful movement when it was really swollen.

                              I'd love to see pics of the other horses with similar issues. I worry so much about Jess having pain/discomfort, but she is getting bored being a pasture pet.



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                              • #16
                                Katy, it sounds like lymphangitis. I had a horse with this, including the "big leg". He only had two flare-ups in the 8 years that I owned him. Just keep a close eye on the leg and treat any small cuts with triple-x or something similar to keep the bacteria at bay. Riding shouldn't be an issue and even helps with the circulation.

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                                • #17
                                  Originally posted by kcmel View Post
                                  Katy, it sounds like lymphangitis. I had a horse with this, including the "big leg". He only had two flare-ups in the 8 years that I owned him. Just keep a close eye on the leg and treat any small cuts with triple-x or something similar to keep the bacteria at bay. Riding shouldn't be an issue and even helps with the circulation.
                                  Do you have photos of your gelding? I'd like to see a comparable. It probably worries me more than it should, because I feel so guilty for selling her to someone who let her get in that shape.

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                                  • #18
                                    I don't have a closeup. Here is a picuture where you can see it somewhat if you magnify it. It is the back left of the chestnut. The area around the fetlock is enlarged. This is his baseline of course, not during a flare-up.

                                    http://www.flickr.com/photos/40820162@N04/5483024973/
                                    Last edited by kcmel; Feb. 27, 2011, 05:59 PM. Reason: spelling

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                                    • #19
                                      I see it - thanks! I wish I had taken a picture of Jess's when it was so huge, but I was so discouraged at that point, I didn't want to document it. It was huge, but went down quickly. Her normal is still pretty bad, but she doesn't seem bothered at all, and she tracks normally at all gaits.

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                                      • #20
                                        Katyb, your horse's leg, actually the scar, look VERY similar to Tru's! He was cut in the same spot, but an unknown source while with his previous owner. He get's a lump over his fetlock too, which goes away if I wrap him overnight. I don't have any pictures either of him at his worst... never wanted to take pictures of something that looks so awful.

                                        Oh, and acu is just short for acupuncture. Tru gets laser acupucnture, which I find to be faster acting and longer lasting than regular acu with needles.

                                        I have another question for those that use diruetics. Do you have to use them continuously for them to work or can you use them sporadically? I'm thinking of asking the vet about them this week when he comes. I'd like to have something to use during flare ups or before/while at any shows we may go to. I'd like to get Tru back to some low level dressage.
                                        Tru : April 14, 1996 - March 14, 2011
                                        Thank you for everything boy.


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