Cellulitis, Stocking Up, And The Accident Prone Horse

[LockeMeadows]

I have a young horse that has been trying to kill himself for about the last 3 weeks. He is under saddle about 3 times a week for about 20 min each. 3 weeks ago, another boarder chased him through the fence. He was scratched up, but everything was superficial and he was completely sound.

A week later, he goes quite lame left hind. Farrier comes out and can’t find anything. No heat or swelling present. No new injuries. The next day, leg is swollen from hoof to stifle. Horse can’t even set hoof on ground he’s so sore. Vet comes out immediately. It is all pitting edema. Tendons feel great. No sign of fracture. Horse is put on stall rest, PO Bute in the morning, PO Banamine at night, 30ml of IV Gent a day, Furasone sweat on leg. Nothing helps for a full week.

A different Vet comes out and blocks the hoof. Horse goes sound. Leg still quite swollen. Diagnosed abscess but horse non-reactive to hoof testers before being blocked. Horse gets turned out and swelling improves, but does not resolve completely. Horse is now on 14 SMZ’s, 2x a day.

Horse is almost sound and and is put back into light work per Vet (long walks, light trot, no canter). Leg is still a bit swollen from hoof to above hock. Horse is now stocking up in 3 out of 4 legs if in stall more than 3 hours. We are at almost 3 weeks for this pitting edema to be present. Vet doesn’t seem too concerned, but I sure am.

Thoughts? Ideas?

BTW - mean horse was evicted immediately, so that is no longer a problem.

Current treatment - 14 SMZ’s 2x a day, Poultice on left hind hoof, intermittent soaking off hoof in Epson salt, light trail riding to get blood flowing in legs.

[Simkie]

SMZs are just not enough for stubborn cellulitis, ime. We use naxcel. My vet also prescribes a lot of baytril.

Naquasone powder and pentoxy are also useful, along with banamine.

Hitting this hard and fast is important, otherwise you wind up compromising the lymphatic system.

[mlb722]

I treated multiple cellulitis events with SMZs (once it happens, it can happen again, unfortunately), but sometimes it took time for swelling resolve (atleast a week). Poultice and movement helped a lot. Worse case it oozed serum. Leg never looked “normal” though it did not cause lameness once the infection cleared.

[Simkie]

@mlb722

I treated multiple cellulitis events with SMZs (once it happens, it can happen again, unfortunately), but sometimes it took time for swelling resolve (atleast a week). Poultice and movement helped a lot. Worse case it oozed serum. Leg never looked “normal” though it did not cause lameness once the infection cleared.

Well, sure, I’ve treated multiple cellulitis cases with SMZs, too…but without some real notable improvement in three days, we switch to bigger antibiotics. Or if the presentation is extreme, like this horse, we start with the heavy hitters. (My vet mentioned gent once, but I think in combo with something else? IIRC, it wasn’t broad spectrum enough by itself?)

This guy has been on SMZs for three weeks, and still has pitting edema? Yikes. Time for more help. Maybe he just needs a course of naquasone to get him over the hump, but this does not sound like a “keep doin what you’re doin” scenario, IME.

@LockeMeadows I had one pop with cellulitis Friday evening (of course, always Friday evening, right? :sigh:) This horse had a terrible cellulitis earlier in the summer and we were juuuuuust about back to normal. I sweat wrapped Friday, gave banamine, gave SMZs, texted vet. Saturday am cold hosed, rewrapped, gave SMZs, gave banamine, gave pentoxy, and turned out (she wasn’t uncomfortable, just lame from the filling.) I picked up naquasone and naxcel from the vet. Saturday night gave naxcel, naquasone, pentoxy, banamine. Continued this through the weekend. She’s looking markedly improved tonight and we’ll see which antibiotic we’ll continue with when I contact the vet in the morning.

[firefoot]

I agree you might need bigger antibiotics. I usually use two at once for cellulitis/lymphangitis. Any fever ever? Is it oozing? Has bute helped? Breaking the inflammation cycle is crucial. Like mentioned above, naquasone might also help knock out the edema. Long walks will also help if he’s sound enough the be ridden. And with lymph issues like this, it’s really easy to compromise the system and has chronic issues going forward. This leg might now always have more stocking up.

In my horse who has lymph issues and lymphangitis episodes, I keep him wrapped 24/7 during active episodes and then wrapped in the stall when he’s in. He had a severe insect bite reaction some years ago that compromised the lymph vessels in the LH especially and there is always more filling in that leg. Movement is the best maintenance. During an active episode, icing helps a lot too but I would be hesitant to get the leg wet at all if there is oozing or much pitting edema.

While lymph issues take a while to resolve (my horses leg took over a month to start to look completely normal after the last episode), I would be concerned that there’s so little improvement in this timeframe. I would definitely express your concern to the vet or get a second opinion.

[LockeMeadows]

The leg never got terribly big the way some can. There was no oozing or skin breakdown at all. Just “swollen” with pitting edema. I didn’t mean to make it sound terrible. I’m frustrated that it still isn’t better. He was on 8 full days of IV Gent, but no other abx at that time. He’s now on SMZ’s. I will call again in the morning and see if we can switch him to something else.

Thank you so much for the suggestions!!

[LockeMeadows]

OK, I just googled Cellultis in horses and his swelling is not nearly as bad as any of those picture. It is definitely swollen, but not grotesque. My main concern at first was that he was completely non-weight bearing. Now, he’s 100% sound at the walk and canter and 50%-75% at the trot depending if he’s been in a stall vs his paddock. I’m leaving him out right now 24/7 and he seems better today, although I did not get a chance to ride him.

[firefoot]

@LockeMeadows

OK, I just googled Cellultis in horses and his swelling is not nearly as bad as any of those picture. It is definitely swollen, but not grotesque. My main concern at first was that he was completely non-weight bearing. Now, he’s 100% sound at the walk and canter and 50%-75% at the trot depending if he’s been in a stall vs his paddock. I’m leaving him out right now 24/7 and he seems better today, although I did not get a chance to ride him.

I totally understand the frustration. It can be very slow to get back to normal. I have to say, mine’s most recent episode was early June and even now he is stocked up in the bad leg about half the time a little more than usual (or this is his new usual). If your horse is sound, moving will help the most. And since the leg is not oozing, I would try icing. And depending on his turnout, I would also try wrapping. I have gotten pretty comfortable turning mine out with standing bandages. But if there are pasture mates who will try to undress him, it might not work.

For mine, I tried to do lots of long walks. I saw no difference in the leg in rides less than 30 minutes, but 45 m-1 hour and the leg would look nearly normal. I’d come back and ice for at least 20 minutes. I was also icing first thing in the morning, so 2x/day. Then wrapped again for turnout. They can be ridden every day at a marching walk if they are willing and I think that is the best medicine, after antibiotics of course it was hard for me to find that much time to ride but I got it done and the horse stayed fit.

[theresak]

My vet hits cellulitis with gent + penicillin to cover both anerobic and aerobic bacteria then switch to SMZs once significant progress is made. Since my horse is now allergic to penicillin, we use Equisul, which has worked pretty well.

Once the infection and fever are mostly gone, we focus on turnout, handwalking, icing, and slowly wean off the wraps.

[Simkie]

@theresak

Since my horse is now allergic to penicillin, we use Equisul, which has worked pretty well.

Huh, I’ve never heard of that. Is it different than SMZs? Google says it’s just an oral suspension of sulfadiazine and trimethoprim?

@LockeMeadows my horse popped with pitting edema maybe four weeks in with the last cellulitis. I started trotting her on the longe for 10 minutes every day, and it quickly (1-2 days) resolved. The leg still had edema, but it didn’t pit. Vet said if we didn’t see quick improvement, we’d do another short course of naquasone.

Today we switched to excede from naxcel. Same drug, but long acting so I don’t have to poke the horse twice a day.

I also use this breg ice machine…it has compression + icing. Pretty slick. You can pick them up on eBay for not much money.

https://www.breg.com/products/cold-therapy/devices/vpulse/

[theresak]

@Simkie

Huh, I’ve never heard of that. Is it different than SMZs? Google says it’s just an oral suspension of sulfadiazine and trimethoprim?

My vet says it’s a bit broader-spectrum and they are finding it more effective than SMZs. It’s liquid and some horses will eat it right in their grain. Still has to be dosed 2x daily, like all oral antibiotics. We usually switch to SMZs after the acute phase (7-10 days in).

[Simkie]

@theresak

My vet says it’s a bit broader-spectrum and they are finding it more effective than SMZs. It’s liquid and some horses will eat it right in their grain. Still has to be dosed 2x daily, like all oral antibiotics. We usually switch to SMZs after the acute phase (7-10 days in).

Interesting, thanks for the info!! Shelf stable? How’s it compare in price (if you don’t mind sharing)?

Always looking for options, seems there are just so few for this sort of thing.

(If you’re looking for an oral antibiotic with once daily dosing, baytril does fit that bill. I avoid the fluoroquinolones because the FDA black boxing is worrisome, but they do work very well for most. It’s the heavy hitter my vet generally uses, and comes in a compounded paste.)

[tipzythegreat]

We had a horse blow up with cellulitis seemingly overnight.

SMzs, cold hosing and hand walking have reduced the leg size by over half. They have him on turnout now and continue to handwalk and he is doing better every day. It was a tree trunk when they found it. Front leg up to his shoulder.

He didn’t want to walk at all when it happened. Could barely lift his leg. We had another gelding have this happen… they thought he broke his leg. He was also non weight bearing.

[theresak]

@Simkie

Interesting, thanks for the info!! Shelf stable? How’s it compare in price (if you don’t mind sharing)?

Always looking for options, seems there are just so few for this sort of thing.

(If you’re looking for an oral antibiotic with once daily dosing, baytril does fit that bill. I avoid the fluoroquinolones because the FDA black boxing is worrisome, but they do work very well for most. It’s the heavy hitter my vet generally uses, and comes in a compounded paste.)

Equisul is shelf-stable - I keep a bottle in the tack room, which is not kept very warm during the winter but above freezing. It is more expensive than SMZs but cheaper than a round of Exceed injections.

Baytril has limited coverage for gram-positive bacteria. I think SMZs and Equisul have broader coverage for gram-negative and gram-positive, and unless we culture, my vet likes to cover both types.

[BravAddict]

@LockeMeadows

OK, I just googled Cellultis in horses and his swelling is not nearly as bad as any of those picture. It is definitely swollen, but not grotesque. My main concern at first was that he was completely non-weight bearing. Now, he’s 100% sound at the walk and canter and 50%-75% at the trot depending if he’s been in a stall vs his paddock. I’m leaving him out right now 24/7 and he seems better today, although I did not get a chance to ride him.

Yeah, it is freaky to watch them go from completely crippled to perfectly fine with the magic of antibiotics.

Cellulitis is super painful because the skin is really inflamed and any movement hurts like hell.
Stall rest is recommended at first so the horse doesn’t have to move to get food or water. Once the acute infection starts to subside and they can walk, they need to move to have their circulatory system remove the remaining built up fluid. Gravity is working against us here.

[DMK]

It does sound like you are dealing with the residual effects, and like many said, more movement is better, especially if the horse is sound (and the vet isn’t worried). And if you are where it is hot and humid (raises) hand, that doesn’t help*. But think of walking/hoof hitting the ground as the engine that gets the lymphatic and circulatory system moving at optimum capacity, and it needs to move at optimum capacity to stay ahead of the remaining inflammatory response (which is a good response because that is what is cleaning up the remaining infection).

• the other day when I went to feed the beasts and turn them out for the night, the notsoold retiree presented with two stove pipes for hind legs.I checked him out while he was eating. Not a scratch on him and no where near cellulitis levels of discomfort. Conclusion? It was hot as hades and he basically did not move all day as he tried to become one with the stall fan. Turned him out and the problem disappeared.

[RainWeasley]

No advice, but commiseration. They are all nuts right now. My 4 year old came in friday evening with a gash on his knee that was blown up, but was still sound. Then another one on the other knee, also blown up. Still not lame, but we had an AWFUL case of cellulitis that somehow got in the tendon sheath a little less than a year ago so I just had the vet out and asked them to skip the SMZs and go for the big stuff, SMZs just made it worse last time. Vet said he is good though, to keep him out and ride him as normal as long as he is sound. They gave him Excede and penicillin. Fingers crossed for all of our nutcases.

[Peggy]

The OP’s comment about stocking up on three of four legs caught my eye. I had a horse do that (actually four of four legs) after getting a wooden surveyor’s stake stuck in his foot at the coronary band. It closed up, I was out of town, and by the time I got back it was infected and all all the legs were swollen to some extent. The infection subsided, but there was residual swelling. The vet, an old track guy, suggested buca leaves. Couldn’t find those, but did locate uva ursa leaves that were also supposed to be a diuretic. Fed him one a day and swelling went down, but not all the way. Then, one epic day, he unloaded me on the trail and galloped all the way back to the barn. All swelling was resolved by the next day.

Where this might be relevant to the OP is that this horse subsequently developed cellulitis from a scratches episode and then had a series of lymphangitis bouts that weren’t triggered by anything obvious. I attributed much of this to a whacky immune system (unsubstantiated), but now wonder if his lymph system was compromised.

[Simkie]

@Peggy along those same lines of something else being the root cause–my cellulitis horse had A WHOPPING chronic Lyme titer. We checked because someone here mentioned a Lyme/cellulitis connection.

[theresak]

So I shared my vet’s antibiotic protocol yesterday, and unfortunately I had to implement last night for cellulitis.

My horse seems to be getting it 2-3x per year, and usually you can tell where it entered the system but this time it’s a mystery. He’s been at the same property for all cellulitis cases - has anyone ever had luck moving the horse to a new area (like 45 minutes away) and no longer having cellulitis issues?

We started him on extra copper and zinc in March to help with his scratches, which is sometimes the cause of the cellulitis. We also started probiotics - the vet thought perhaps all of the systemic and topical antibiotics killed off his good bacteria. He wasn’t eating his supplements well for about a month and I took him off the probiotics a few weeks ago. Anyone have a a low-volume, palatable probiotic recommendation? My vet says avoid anything pelleted as it has usually been heat-treated and will kill the live cultures. I am out there every day right now and could do a paste if it’s cost effective.

I might also ask if we can go ahead and start treating him for Cushings even though his TRH test was within normal limits. He’s had a few odd symptoms, including scratches and cellulitis in January in WI and his first ever hoof abscesses (3 this year).