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Lymphangitis/leg fungus...compromised immune system? UPDATE

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  • Original Poster

    #21
    Originally posted by NorCalDressage View Post
    Just wanted to say - I've had really good luck with the BOT quick wraps for cellulitis. The quick wraps will do the job, but not have to be so firm or tight (like a standing wrap) so he may find them more comfortable as well.
    Thank you, I'll look into the quick wraps. I thin right now he finds the wrapping uncomfortable because there is still an active flare up going on. Once it goes down he is fine with handling that leg. The quick wraps might be good though because then I can trust other people to put wraps on/off, as I'm not always able to make it to the barn with a full time college schedule.
    come what may

    Rest in peace great mare, 1987-2013

    Comment


    • #22
      Id becareful with the quick wraps. With the big guy, we had to make sure there was firm, even pressure throughout the whole pressure wrap. Wherever there was less pressure, he would swell.

      There is certainly a tradeoff for skin vs. thin leg. We had to thoroughly wash and dry the leg once weekly, or spray it with moisturizer in the winter.

      He was still sound, so riding and keeping him moving was important. He enjoyed to work and jump.

      The pressure wrap bothered his people more than it bothered him. He could still gallop around the field in it no problem. We had to wash the wraps daily, so had enough sets to last a week. Muddy season sucked. But, for 10 years he was a very very happy sound horse, it was so worth it.

      Comment


      • #23
        sporadic lymphangitis, lymphoedema

        I work with horses with lymphoedema, the chronic swelling which can result from lymphangitis, and am aware of how much confusion there is about this condition, not just with owners but vets too. Lymphoedema results when the lymphatic system is no longer able to adequately remove tissue fluid from the skin and adjacent areas, this can occur elsewhere in the body but is usually given a different name.

        I’m based in the UK, touch wood we don’t get pigeon fever or epizootic lymphangitis here, ulcerative is uncommon, but sporadic/idiopathic quite frequent.

        The lymphatic system in the horse’s legs is quite vulnerable as there is no fat or muscle between the deep vessels and the skin. Lymphangitis is an acute inflammation of the vessels, usually caused by an infection, but also by allergens, so it is quite feasible that if an allergy-causing fungus gained access to the lymphatic vessels, it could result in lymphangitis.

        A horse with poor health/compromised immunity is also likely to suffer infections because the body cannot defend itself so well from them. Lymphangitis starts as a localised issue, but if caused by bacteria these can spread systemically. Incorrect use of antibiotics can also encourage this – use of antibiotics is much more controlled here than in some other countries including the US, nevertheless I have come across people here who have ‘saved’ antibiotics from one course in case they need some again. This is so wrong! A full course should always be given to try to destroy all of the bacteria, not doing so encourages the growth of resistant ones, such as MRSA. Perhaps in other countries vets prescribe additional courses ‘just in case’ but there is no guarantee either that the next time a horse has an infection it will respond to the same antibiotics.

        I understand people’s concerns about giving steroid to horses, but along with emergency antibiotics these are often required to damp down the inflammation in the vessels, remembering that it’s this which does harm. This is permanent, depending on the degree of damage, the percentage of vessels effected, and how many the horse had to start with (it varies) the horse may make what appears to be a complete recovery and never have another attack, but it is generally acknowledged that once a horse has experienced lymphangitis, it will do so again at some point.

        Age does make some difference, simply because the lymphatic system, like everything else unfortunately, doesn’t work as effectively as it gets older.

        The blood circulation brings fluid to the tissues, so there may be some value in bandaging the legs if swelling is suspected, as this cuts down the circulation – even stable bandages/standing wraps - but not once the swelling is there. It’s a myth that the fluid is reabsorbed back into the local blood circulation, all fluid is removed by the lymphatic system, and this is prevented when there is infection present by the vessels to the lymph nodes closing, to protect the body from invasion. So any attempt to reduce the swelling through exercise, massage etc until the cause has been treated is both unkind to the horse as it will hurt, and potentially dangerous. Again, any treatment which increases blood circulation is going to increase the lymphatic load, not a problem when the system is healthy, but to be avoided when it’s not.

        Once recovered, a horse which has had lymphangitis shouldn’t be kept in unnecessarily, the equine lymphatic system has evolved to utilise movement and relies on it much more than the human one does. ‘Stocking up’ or filled legs as we call them here are often dismissed as harmless, but equine lymphologists believe they are indicative of ‘latent lymphoedema’ i.e. a stage of the condition where harmful changes haven’t yet occurred, and where the system copes under normal circumstances. However immobility for lengthy periods, such as being confined to a box, is not normal for a horse, without the stimulus of the almost continual movement with which it has evolved, the lymphatic system cannot manage to remove adequate fluid from the limbs of these horses.

        If people then apply bandages to ‘help’ this, the circulation to the lower leg is sufficiently compromised to limit the amount of fluid entering, and instead this is dispersed higher up, but at the same time, the lymphatic system is prevented from removing the metabolic wastes and other unwanted substances from the tissues, which react to this with a low grade inflammation. This can itself damage the lymphatic vessels so that the condition gradually worsens, and is thought to be why some horses develop filled legs for the first time if kept on box rest and bandaged. There is also a suggestion, now being researched, that horses that stock up are more likely to develop lymphangitis in later years.

        The only kind of bandage I would recommend for a horse with lymphoedema is a very specialised compression bandage of the kind used to treat people with this condition, it requires skilled application by a competent therapist and again is never used, or any other form of compression, during a lymphangitis attack.

        Because of the damaged tissue immunity, difficulty getting nutrients and removal of waste products, pastern dermatitis often results. It must be understood as a consequence of lymphatic damage, and treated very gently as the skin is easily injured and can get very dry. Necrosis causing the skin to die, can leave large scars which must be moisturised to keep them supple, but taking good care of the skin can help diminish the risk of further attacks of lymphangitis, as it is more difficult for bacteria to enter.

        Exercise, within the horse’s capabilities, can help a horse with lymphoedema, lymph isn’t moved by the heart, but is in effect ‘sucked’ forward by movement within the lymphatic vessels, which exercise stimulates. However there is a limit on how much a compromised system can handle, or more swelling will result, and over time vessels can tire out. Establishing this is trial and error but probably pretty high with horses.

        Also, this only effects the transport of fluid. Nutrients to the tissues are carried by large protein molecules in the fluid leaving the blood, and can only be removed by the lymphatic system. As they ‘sit’ in the tissues they cause changes resulting in fibrosis which makes the swelling firmer, encourages it to get larger, and affects the transport of nutrients including oxygen and waste materials. This damages local tissue immunity, making it more vulnerable to infection, and is one reason why lymphangitis may occur more and more frequently. Fibrosis also creates ‘hiding places’ for bacteria which the immune system and drugs cannot reach, again causing flare ups.

        Recently when treating a horse who’d have several attacks of lymphangitis, an abscess in her fetlock came to a head, encouraged no doubt by the warmth of the compression bandaging. My vet treated it aggressivly with antibiotics and a steroid injection and noted that it had been there for quite a while. I had previously noticed that the way she held her fetlock almost continually flexed did not seem right but her groom and vet assured me there was nothing to worry about here! And perhaps more interestingly, her groom had said that she was very picky about food. With treatment she perked up considerably, and developed a very healthy appetite, suggesting that the abscess had been causing her significant problems. So it’s worth taking subtle changes in horses who’ve had lymphangitis flare ups seriously, they may have a hidden infection left from a previous bout. I also suspect that if we hadn’t treated this abscess, it could have developed into another, this time final, attack of lymphangitis.

        I have noticed boots, bandages, electrical massage systems etc, whose manufacturers make all kinds of claims on websites for their use with horses’ legs, some of which is simply not true, much of which is not supported despite claims about ‘research’. When I’ve come across something which is dubious I have questioned it, and although I’ve never had a direct response, I have seen these claims subsequently removed or modified from websites. Unfortunately when there is little factual information available, all kinds of strange ideas rush to fill the gap! But bottom line is, they’re about making profits. My website www.equinemld.com is due for an overhaul, but attempts to supply accurate, research based information about the horse’s lymphatic system, the conditions involving it, and how they may be treated, and I’m always interested to hear people’s accounts about their horses.

        Comment


        • #24
          Lots of great info here!

          My 24 year old has had a few bouts of lymphangitis and the first time it was concurrent with dermatitis.

          Now that leg always looks thicker than the others, but with exercise it's not that noticeable. As the above poster noted, I almost never confine her in her stall or wrap the leg. Occasional standing wraps only give temporary relief of the fluid, although she does not appear sore or lame even when it's thick.

          Comment


          • #25
            Hi, nice to hear of an older horse with this condition doing well and being cared for appropriately.

            A lot of horses with lymphoedema don't show signs of pain or lameness, despite the appearance of the limb, and seem to enjoy life.

            Changes in movement are often caused by pressure, usually after fibrosis has started, on the joints, and because this can develop quite slowly and be subtle, it's often overlooked until quite established, so it's always worth keeping an objective eye on the way these horses move.

            It can be especially hard to notice when both hind or fore limbs are involved, I treated a horse with chronic progressive lymphoedema and not being familiar with her had not been aware of how much her movement had been inhibited until the first thing the owner commented on after treatment was how much this had improved, a lovely bonus on top of everything else.

            Comment


            • #26
              I've also noticed that weather/temperature seems to play a role in the amount of swelling.

              It seemed as though the lymphangitis really effected her hock as opposed to lower in the leg, is that common? During the acute infection, the swelling was the worst in the hock, and she lost hair there. Serum also oozed near the hock not in the lower leg.

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