Experience with pastern joint infection?

[AusEventer]

Yeah I reckon we could be dealing with multiple bacteria. There was an initial improvement with her almost sound in walk the past two days. This morning, she’s gone backwards. So, they are going to do a perfusion whilst lying to try to get a more thorough treatment in today.

She’s on gentamicin and penicillin, plus the limb perfusions of Amikacin.

I’m not sure what else can be done when we STILL don’t have lab results in yet for sample taken on weekend?

They are going by her level of soundness to gauge success of treatment. Vet didn’t seem to think bloods would give us any other useful info.

After all the stories I’ve read, I’m not sure if soundness level really tells us the whole story? Is there anything else we can do that is not being done?

Sigh.

[RAyers]

Ironically, I am teaching a course on spine infection in humans this week.

I am very sorry about this. Joint infections are brutal. The joint is a vascular and is very limited in its response to bacteria. Additionally, once bacteria get residence in the cartilage and bone it is impossible to get to them because there are no immune cells in those tissues that also don’t destroy the healthy tissue. Additionally, it is becoming more realized that all infections have multiple pathogens. Clinical cultures only ever capture 50% of any infectious agent. And now we know that microbes work across species as multicellular networks.

From the sounds of it, with doing washouts, local and systemic antibiotics, your team is doing everything at the gold standard level of care. So long as any erosion of the cartilage is minimized on x-rays or MRI, they are maintaining the upper hand.

One thing to realize is that all animals, including humans, are always fighting a local infection and cancer ever since we were born. We literally are bacteria in a mammalian cell matrix. Every tissue has its own local microbiome. Our immune system is generally robust enough that we never feel anything or know it’s happening as it keeps the local bacteria and fungi in control. But an infection can spring up simply by a tiny local immune imbalance.

[AusEventer]

It is all a very depressing thought…jeez. We are all just a bacterial soup, waiting for our demise…🫣🤣

Yes, I’m aware we may not find out what bacteria we are dealing with. It’s so frustrating to feel very powerless over the situation. I’m equally frustrated, that despite doing all the right things, we are not really getting anywhere.

It’s crazy that some horses make a good recovery with very basic treatment, yet others you can throw everything at it, but if it’s a bug requiring a specific drug, we could be all out of luck

[Jump314]

In 2021, my gelding had a puncture wound near his hock that gave him cellulitis. I took him to the vet and they started him on SMZs. A week later, his leg was back to normal size but his hock was huge and hot.

I took him back to the vet and after x-raying, they said his hock was now infected. He stayed there for a week, had his hock arthroscopically flushed the first day, had two regional limb perfusions with amikacin later on different days, and received potassium penicillin and gentacin every 6 hours for 5 days. I then took him home, gave him more SMZs for two weeks, and he was off for three months with a gradual return to work.

The total was about $7000. He is now sound and back to his original level of work, doing Modified level eventing and Intermediate I dressage. The vet gave me a choice between two different kinds of penicillin and I chose the more expensive, generally more effective one. Do you know which kind of penicillin your horse is getting?

[AusEventer]

She was on penicillin and gentamicin, plus the amakcin perfusions.

I’ll update fully below.

[AusEventer]

I only just got a vet update, because we had a mass power outage, my dumb phone was not working!!! Grrr.

Anyway. The filly is still sore. Lab culture did not grow anything.

We have done 5 IVRPs with amakicin (sp), multiple joint flushes (I’m not sure how frequently they’ve done them). Of note, the flush today was clear, there’s nothing “yuck” draining out. She had from saturday until yesterday (Tues) not on Bute, with some tenderness, put her on a low dose. She’s been on gentamicin and penicillin.

Because we have no idea what bug it is, we are changing ABs to gauge response - taking bloods to measure counts and then assessing over next 2 days for any change, then making a plan. I think the plan is doxycyline? It’s an oral rather than multiple jabs. Now I am questioning whether vet said doxycycline or amoxycillin?

Long term, it’s looking like long term ABs with xrays along way to assess any potential bone infection. Really flying blind!

Given she was almost sound in walk Sun/Mon and only went a bit sore yesterday, I can’t but wonder if all the treatments have made her tender. I really don’t know what to expect on this path of the unknown and if soundness level is the only metric we go on?

[trubandloki]

Still Jingling!

It sounds like things are going in the right direction if the fluid sample taken recently was clear.

[AusEventer]

This is the thing! Vet was concerned there wasn’t obvious “yuck” in the flush? She’s thinking the infection is still active because the filly has gone a bit more lame than after initial treatment?

Have to say I’m getting confused and not sure if we are winning?

[Texarkana]

Are the monitoring SAA or anything?

If you are winning, SAA should be decreasing.

[AusEventer]

No. I asked about various tests and this was never mentioned. I was told a few days ago that blood tests ‘won’t necessarily tell me much’, which I was a bit shocked about. I like numbers and concrete data to base decisions on!

Is SAA monitored in bloods? Or synovial fluid? I need to see if that’s typically run here in Oz.

I will ask, as she’s having bloods done tomorrow.

Initial joint fluid sample did not culture anything - very frustrating.

So I don’t know what bacteria are involved (or, even IF it is bacterial), if the infection is improving or not, if all the treatments into the one part of the distal limb have made made her sore…etc etc

All decisions being made about treating the infection (and if it is improving) seem to be about her comfort/soundness level, when she’s had very little in the way of NSAIDS.

I’m a bit worried something in the bigger picture is being missed.

[IPEsq]

SAA (serum amyloid A) is tested from blood. It is a protein marker for inflammation and infection. My vet has a machine that can run the numbers stall side. It’s a separate thing from CBC or chem panel.

[AusEventer]

So…after all the ‘she’s better, she’s worse, she’s worse’….today vet said well, today she randomly looks much better. Improvement happened 2 hrs after change to Doxycycline - we both agreed that the response was not likely due to change in drugs (bit quick!) but maybe because she’d had a rest from perfusions and was feeling more comfortable? Or maybe - it’s just taken a bit longer to get on top of? Who knows?

Had one more RLP done this afternoon and provided all is still tracking ok, she’ll come home tomorrow for lengthy systemic AB treatment and anti inflams.

My blood pressure is shot, I can feel grey hair emerging and have no fingernails left.

Yet, cannot wait to give my little girl a big, big cuddle xx

[trubandloki]

Glad she is doing so much better. I hope she continues on this track. Such happy news that she is allowed to come home.

[Texarkana]

So glad she’s improving! Yay!

[Bluey]

Great news, improving is a very good sign she may have turned the corner on fighting the infection.

[phantomhorse]

jingles for continued improvement!

[AusEventer]

She’s home!
Lameness is much better than initially, no temp. She’s on doxycycline by mouth twice a day and a small amount of bute. Given she’s had so much poking and prodding with the flushes and RLP, she’s bandaged up to support the veins and reduce swelling and stop anything getting in to those areas.

The plan is to monitor her for next 2 weeks on this regime (obviously if it turns to rubbish, revise!). I’m in 2 minds re the bute. Was told to take her off it cold turkey after a week, but I feel that’s a bit mean! Will see how she is still on it before I make that call. I know we need to assess lameness, but I don’t think less than 1g of bute per day is going to mask returning infection? I might reduce the dose more gradually. We will also X-ray at some point to see if there’s any damage to the bone.

So she’s home, she’s eating, drinking everything in normal territory so now it’s a matter of wait and see.

[trubandloki]

Great update.

Thank you for keeping us informed.

[IPEsq]

How much Bute is she on now? It has about 12 hours effect, and if she is only on 1g/day at the time you are instructed to pull her off of it, then I would see no reason to titrate down from there.

[AusEventer]

I think I have worked out she’s on 0.6g per day. Which is really, a pretty low amount. She would only be about 200-250kg, only a fine leggy filly, about 13.2hh-14hh max (I’m bad at height estimation after working with a few 17.2 hhers!)

So maybe you are right, This morning when I gave her meds, she didn’t look a whole lot more sore when the peak effect would have worn off. I wasn’t sure how much of a residual effect there would be after stopping.

She is bearing weight better and standing square in front now (when acutely lame, sore leg was always out in front of her). She’s no longer a 4.5/5 lame. I find it hard to define, as she bears weight but every now and then looks a bit tender. All other vitals are good and she’s bright and looking content in her small field.