Cellulitis, need experiences, thoughts?

[Obsidian_Fire]

Cliff notes version: mare developed cellulitis in the LH 2 weeks ago today. Has been on SMZ’s for 11 days now. Friday (yesterday) RH has developed swelling and warmth. Vet appt scheduled for this afternoon. Apparently SMZ’s are not enough. What other antibiotics are used, that are not IV? What questions should I be asking my vet? What else can I do?

The longer version: Saturday evening March 4 I brought mare in and thought she was walking funny. Put her in wash stall, hosed down mud, etc., looking for anything. Stood the whole time with the LH in the air. Walked her to stall, she was markedly unhappy about putting weight on that leg. Towel dried legs, reached for fetlock to pick hoof, she kicked at me. It was warm - compared to the other leg - but not hot. Hmm. Closed her in her stall just in case of injury, since I didn’t know what I was dealing with. She was also very ‘down’ - not interested in her food, and not wanting to move. I left, came back about 3 hours later to check on her and she was eating, drinking and seemed “okay”.
Sunday morning BO told me the horses had been running very hard (playing, and she’s a TB) so my initial assumption was “what did you break/tear/strain”? Continued to cold hose and keep her quiet in her stall. Also noticed marked swelling around the fetlock area.
Monday 3/6 turned her out in arena to see how much of the swelling was injury vs. stocking up. She was very quiet, moseyed around gently. I left her out under supervision for ~hour and noticed the more she moved the more lame she got. Called vet immediately. Got appt for Weds 3/8.
Weds 3/8, first thing vet did was pull blood. The blood “count” was 174 and normal is 0-20, so definitely an infection. Also noticed a strong pulse. Looked for abscess, no reaction to hoof testers. Did xray, ultrasound of leg, no injury noted, just lots of fluid. Poulticed the hoof just in case, wrapped the leg up to the hock. Told me stall rest, abx, bute, could take the wrap off in 3 days.
Within a couple days of abx she was moving fine.
Sunday 3/12 took wrap off. Swelling down, nothing on hoof poultice. Turned her out in arena since she’s not injured and threatening to tear the stall down, lol. She was moving just fine and feeling very good.
Wednesday 3/15 talked to vet again just to be clear on what next and when can I/should I turn her out. Vet was pleased with progress so far and encouraged me to ride her and get her moving. Opened her stall up into her run.
Thursday 3/16 first day back outside in pasture. Ran and played and looked fine. Rode her that afternoon, she was pretty darn quiet. A little too quiet for a horse that had been locked up for over a week, not ridden and well fed. But, weather was lovely warm day, so?
Friday 3/17, now the RH is swelling. WTH? She seems okay so what gives? It’s a bit warm too. Turn her out, she trots off and I’m immediately suspicious she looks off to my eye. Call vet, ask for a call, make preemptive appt for this upcoming week, just in case. Come back out yesterday afternoon to find the RH (and the left) more swollen, warm, somewhat tender to the touch. Cold hose legs, clean off mud. Walk her to stall. Called vet again, have appt for this afternoon (Sat 3/18).
She’s not lame at the walk, but her demeanor is not right. She looks sick, to me, her eyes just don’t look right. Left her to eat. Came back about 3 hours later to give abx and dinner. Took temp, was 100.5. Warm day (mid 60’s), so it’s WNL.

If you’ve made it this far, thank you. What do I need to be asking? What should I know? I’ve googled and read every single thing I can find on cellulitis, but it’s all more about ‘what’ it is rather than how it’s treated.
Thoughts? Experiences?

[Angela_Freda]

Are you hand walking or turning out?
Cold hosing twice daily, 20 min at least?
With pressure, like a jetted tub?
Compression wrap and washing with an antibacterial if it’s oozing?

Mine needed several abs all at once, it was all the way up to his stifle the first time.
Diligence from them on about nipping any issues in the bud.

Read threads here, lots of experience with it on COTH

Adding pics for you of my horses LH cellulitis
Before…

During…

After

Note, he also had DSLD/ESPA

[Equibrit]

Those symptoms can be caused by migrating encysted small strongyles.

Larval Cyathostominosis in Horses - Digestive System - Merck Veterinary Manual

[Posting_Trot]

My previous horse had a couple of episodes of cellulitis. In her case, it was always related to either a re-infection or a relapse with Lyme disease. (I’ve posted about this before on other threads on COTH).

It would be worth having the horse tested for Lyme.

Good luck.

[Obsidian_Fire]

Wow. Poor guy.

[lenapesadie]

@Obsidian_Fire

What other antibiotics are used, that are not IV?

My horse was treated for cellulitis with Excede; given IM. Cellulitis was presumed to be connected to his chronic scratches. He had another case of cellulitis, also presumed to be scratches related, that popped as we were about to start an IV course of gentamicin (for the scratches). Both abx controlled the cellulitis quickly. YMMV. In both cases, I did cold hosing and solo turnout. No wrapping or stall rest. Both cases were mild to moderate.

Jingles for your horse!

[Bonnie2]

As you have discovered, cellulitis is seldom once and done. It can easily be a few weeks to get through an episode and she will be susceptible to recurrence. You will get very good at spotting the early signs and starting treatment before she is too uncomfortable. As she improves, don’t think it’s licked. Keep hosing and wrapping (+/- whatever medication is prescribed) for several days after she looks good. She may always need to be wrapped when she stands in. Best of luck with her!

[EmilyM]

For cellulitis i use IV gentamicin for three days (34 cc, 33 cc,33cc= 100ml bottle), smz, naquasone (if not Insulin resistant or founder risk) and banamine (10cc a couple days then 5cc a couple more depending on progress). Alternate ice, sweat wrap and continue to turnout or tack walk as tolerated. Movement helps. Sweat w dmso/furizone

[Simkie]

Ugh, cellulitis. Are you hosing/wrapping/sweating?

We’ve used equisul, naxcel or excede, or enro. None of those must be given IV, equisul & enro are oral, naxcel can be given IM, excede is IM.

Naquasone can be useful if the filling is stubborn.

I agree with @Posting_Trot that this may be an indication of Lyme.

[Obsidian_Fire]

Update: she ended up staying at the vets. Her SAA was 780 when at the first visit it was 174. They are doing IV Gentamicin and will recheck her bloodwork in 3 days to see where she is.
I am so glad I took her in. When I picked her up, it appeared to me that now the hock on the left was showing swelling.
I will go visit her in the morning.

[Fiesta01]

Haven’t done cellulitis but have experience with lymphangitis. I’m glad she’s hospitalized.

Once this episode is beat, as others have said, be very vigilant, and you’ll be able to catch the signs of another episode very early. Always take a temp if anything seems off. Always have antibiotics, banamine and bute on-hand so that you can start them immediately as directed by your vet. Cold hose, wrap, etc, as mentioned above by others.

Jumping on it immediately should help you keep future episodes less severe and shorter than this first episode. My horse’s first lymphangitis attack was a 106 temp and a week in the hospital. Subsequent attacks, I caught at the first sign with102 as the highest temp and no need for hospitalization due to immediate start of treatment.

Hang in there and jingles and prayers for your girl. Please keep us posted.

[Obsidian_Fire]

@Fiesta01

Once this episode is beat, as others have said, be very vigilant, and you’ll be able to catch the signs of another episode very early. Always take a temp if anything seems off.

You know what’s strange? She’s not had a fever this entire time.

Now, what on earth would be “early signs”? Because seriously, she was fine on a Saturday morning, and lame by afternoon. It was that fast.
What did I miss??? How will I catch this ‘ahead of time’, the next time?

[Simkie]

It just pops up that fast. Sometimes you notice they’re a little off–a little dull, or a little painful to touch, or a little lame.

I had one horse where if she tripped over the 2x4 threshold to the run off her stall, I knew one was coming. It can be so subtle, something that’s really easy to miss or just write off as nothing.

[spacehorse]

My TB has had it in alternating hinds now 3 times in the past 18 months? Onset is very fast, comes in fine and 3 legged lame in a few hours, and no swelling yet to indicate an issue. I can usually find a hot spot somewhere on the leg that is the telltale sign. We treat his with Baytril IV for 2-3 days, banamine as needed and then 7 more days oral Baytril. We used a steroid for a few days orally if the filling is stubborn.

I don’t wrap it as it tends to blow up on either end of the bandage anyway. He is usually not wanting to move the first 24 hours, and then I make him hobble outside for turnout. He is out alone and can do as he pleases without being harrassed to move if he doesn’t want to.

[Obsidian_Fire]

I’ve been checking in on my mare daily. Yesterday, the swelling was MUCH improved! Yay! Her demeanor is more normal also - she’s pissed about being stuck in a stall and left there, LOL. I am not allowed to hand walk her, only the staff is allowed to take her out of her stall (safety precautions, this is a very busy breeding/foaling/vet practice). So I groom her and spoil her with a few carrots.
Wednesday (tomorrow) we rerun the bloodwork and fingers crossed maybe I can bring her home.

On another note, it is completely bizarre to not have barn chores right now. Taking a little advantage of it to catch up on some ‘people stuff’, but boy it’s strange!

[endlessclimb]

I’m an anecdote n=1, but my young mare would get cellulitis at the drop of a hat when I first got her. It typically resolved without much fuss, but nervewracking to say the least.

For other reasons, I put her on copper, zinc, and VitE supplements.

I have never had a round of cellulitis since, knock on wood.

[Posting_Trot]

I used the Back on Track Quick Wraps (seen here: https://www.smartpakequine.com/pt/back-on-track-quick-wraps-7782?utm_source=google&utm_medium=cpc&utm_content=NB_Shopping_Health_3P&utm_campaign=NB|3P+Health+>+Therapy&gclid=CjwKCAjwq-WgBhBMEiwAzKSH6GT3VjsLIUTcyJdSZDS85oR3FN6KYC1YS5JOg8UtondYWgnbVtR6PRoC9NgQAvD_BwE&gclsrc=aw.ds) on my mare when she had cellulitis.

I think they helped. I didn’t use standard bandages or wraps because I didn’t want the combination of swelling and pressure from the wraps to cut off the circulation. The BonT wraps don’t apply much pressure. I’d usually put them on after cold-hosing the legs and letting them dry.

[Obsidian_Fire]

Update from the vet this morning, upon removing wraps and cold hosing her legs are completely normal. They are going to leave them off today and see how she does. Running SAA in the morning to check, will go from there whether she gets to come home or not.

@endlessclimb the whole zinc/cu thing… I have to wonder. For a long time I had her on a best quality hoof supplement. I ran out several months back and just didn’t see the need to continue. This winter I’ve battled scratches on the front feet - she does wear bell boots for turnout… I just wonder, if it would be worth it to just supplement cu/z “just in case”… I have heard it can help to prevent skin conditions such as scratches.

I dunno. I don’t want to go thru this again.

[Simkie]

I also battled cellulitis (and scratches, and abscessing) before I dialed in the cu/zn. Yes, it’s probably worth supplementing.

Lyme was also contributing for one horse.

[PNWjumper]

Ugh, sorry to hear you’re going through this. From my very distant perspective, I would guess abscess(es) over cellulitis. Abscesses often lead to swollen legs and that kind of lingering on/off again heat/swelling/soreness. IME, cellulitis is usually an “OMG MY LEG IS BROKEN!!” level of pain from the horse. And usually the swelling is extremely dramatic…and doesn’t change until you address it somehow. And I have never seen cellulitis without a fairly dramatic fever. But with horses I guess YMMV??

My TB has gotten an annual bout of cellulitis in his RH for something like 12 or 13 years now? (I’ve posted about it extensively, so I’m sure there are many many posts from me here talking about it). Leg blows up, seems like he’s broken something serious, we give him antibiotics (for many years penicillin + gentamicin + Uniprim, and more recently just Excede) and within 24 hours he’s sound but has a giant leg for a while. Now he’s at the point (at age 22) where his leg stays somewhat swollen all the time, though as long as I keep him in his BOT wrap, he seems to do ok. He can’t have bute or banamine, so we’re a bit limited on pain management and usually stick to Gabapentin or tylenol.

But with all of that being said, I just went through the most godawful experience with an abscess. Horse had to be dragged in from his pasture with a massive swollen LH (it was the “wrong” leg) and a fever. Had the vet out, she didn’t seem too concerned that it was the wrong leg, and we gave him Naxcel and Excede. Rather than getting better as usual he went downhill. His whole leg blew up and was massive through his hip and into his sheath with additional edema pooling in front of his sheath. Abscesses were evident as he had slits all around his hoof (both heel bulbs and on the lateral side) where they had been seeping out. He was barely moving and all of the skin was sloughing off of his LH, which was leaking serum from fetlock to groin.

Had the farrier out to see what he could find (answer was “nothing”). Had the vet back out, shot some x-rays (my farrier was predicting tendon sheath infection, another vet was predicting some other horrid infection), and we saw a subsolar abscess and the tiniest little gravel working it’s way into his heel. The vet dug it out and he has VERY SLOWLY been improving since. We’re at 2 weeks and he’s just now starting to put any weight on that heel again.

The post-episode analysis is that he developed an abscess from that tiny little bit of gravel working it’s way in and then got hit with cellulitis from the abscess. That hit boiling point and then we gave him antibiotics and it all chilled it out a bit which allowed things to just keep festering. So we’ve been in this waiting period while the antibiotics work their way out of his system and hoping that the abscess fully ruptures once that’s done.

All of that to say that abscesses can do any and everything. And if it’s wet where you are it certainly wouldn’t be unusual for there to be multiple abscesses. I’ve always suspected that was the “real” start to every one of my horse’s cellulitis episodes over the years…an abscess inside that just goes buck wild with his immune system. I’m interested in the Cu/Zn supplements people here have mentioned and have ordered both to supplement his feed with. Would love to find a way to cut down on all of this! But also…horses. And the switching hind legs could mean some systemic infection that will be dealt with via antibiotics.

But either way, in your position, I’m not sure I would be assuming this is anything more than a one-off episode. And it certainly doesn’t sound like cellulitis…or at least like any cellulitis I’ve experienced. So I wouldn’t drive yourself crazy watching for every little sign from now on. I think that just comes with the experience of more episodes (which hopefully won’t be the case). And at least in my guy’s case, the first sign is always that he quits eating. Then he stops moving. Then the leg goes BAM into double size. And all of that happens in the matter of hours. Either way, hope you don’t have to deal with it again!