I have a 9 year old OTTB who I have owned for almost 4 years. He’s a sweet guy who is doing well in our current program. Last June and this February he had the same “freak accident” - and I think it might be recurring now. My head is spinning so part of what I’m asking for is a reality check. The other part is any advice on what to do from here. I have told parts of this story before so it might seem familiar to some.
Last June he came in from night turnout with his right hind swollen and lame. No visible wound so we didn’t think much of it, gave him rest, bute, and SMZs (I have learned a lot about indiscriminate SMZ use since, but that’s what I did under trainer advisement at the time). In the first 24-ish hours he improved but then nosedived again with swelling and lameness intensifying. Regular field vet came out and administered IV drugs for 3 days but he never improved. I brought him to a hospital where they did cultures and all sorts of things, identified it as an abscess within the leg/fetlock (not in the joint capsule, just in that geography), performed several days of targeted antibiotics and regional limb perfusion, and cleared him to go home after 10 days. There was a 3x3 inch open wound where the abscess had blown out and skin died, which needed serious wrapping to keep clean as the skin slowly grew back. He was phased into hand walking, limited turn out, full turn out, and finally riding again in September. It was pretty grueling for all involved and approached a five-figure bill. However, he recovered fully sound and went back to work. He moved to a different barn in October.
This February, same symptom presentation, this time on the left front, and I got vet (different in-barn vet at the new barn) attention on it sooner since we had the history. Brought him back to the same wonderful hospital with the same wonderful doctor he had last June, they confirmed same bacteria strain and targeted treatment. We tested for cushings and another auto immune disorder and everything came back normal. This time he came home after 5 days, the wound was smaller, and he got back to work sooner. This bill was only (?) in the mid-fours. He recovered completely sound again and has been back in work for almost 2 months. I had him tested for Lyme last week and the results were normal.
I glossed over many tiny details but that’s basically the highlight reel.
This morning he came in with the same symptoms again, leg is not huge but he looks essentially stocked up, he is walking okay but not 100% sound. I texted the vet this morning and we agreed to wrap him with poultice tonight and touch base in the morning.
I am sort of spiraling. It’s too soon to know whether we are up against the same thing again, but I mostly think something is really really wrong that we haven’t tested for yet or maybe can’t test for. While it’s absolutely true that I don’t want to (and can’t afford to) pay these very large vet bills every 6 months, I am also worried about his actual quality of life if this is a chronic issue. The first time was a fluke, the second time lightning struck twice, and now I can’t deny a pattern. I am nowhere near a euthanasia decision but honestly, it’s on the table on the grounds of the frequency of these idiopathic dramatic abscesses. Someone tell me that’s heartless and awful if all he needs is some antibiotics? Someone tell me I am devaluing life for not wanting to pay the next vet bill? Someone tell me I don’t love this horse and should never be let around another?
Everyone’s best theory is that he is interfering/knocking himself in turnout, creating a tiny scrape, and it’s blowing way up. Each time this happens in turnout so I don’t think retiring him will change anything. He does wear turnout boots on all 4 which I wash at least weekly so they shouldn’t be horrifically filthy in there (other than the obvious fact of it’s a horse outside doing who knows what in his free time). The intent was for the boots to prevent scrapes/very hard impacts but that doesn’t seem to be working.
So what stones haven’t I looked under, what does this remind you of, how would you navigate this situation, and is this just horses? Any help appreciated.
My chronic cellulitis horses have benefited hugely with copper and zinc supplementation. I’d take a very good hard look at his diet and consider adding cu, zn, and perhaps vit e depending on his grazing status/vit e test status.
Thank you!
Cellulitis was my first thought. Once my OTTB had is first bout of it he was forever more susceptible to it for the rest of his life (of many more years, I should say). It doesn’t take much of a skin break to enter.
Be vigalant and treat at the first signs. My vet basically made sure I had at least a starter supply of SMZs on hand, so I didn’t have to wait for her to make it out to the barn.
Cold hosing, chlorhexidine or betadine wash, movement (hand walking if he was very uncomfortable or light ridng otherwise) and red light therapy wrap twice daily were all part of the management protocol. Some years we went through more than one bout, other times it was a year or two before another flair up. It’s frustrating, but the more you learn about it, it is managable.
I would wonder if the boots are heating up his legs and causing micro injuries in overheated skin, thus allowing bacteria to enter. I know it’s a crazy idea…
I don’t have an answer on the medical stuff but I wanted to say that you are absolutely not heartless. It’s so clear how deeply you love and care for your horse. You sound like you’ve been through so much together already, and it takes incredible strength to keep advocating for him while balancing the very real emotional and financial strain these situations bring.
It’s also not heartless to worry about quality of life. And it’s not devaluing life to be honest about the weight of these recurring issues. It’s okay to feel overwhelmed by all this.
Whatever decisions you make down the road, whether that’s adjusting his turnout setup or making tough calls, they sound like they’ll come from a place of love and advocacy, and that’s what matters.
Sending you and your sweet boy lots of good thoughts and hoping this turns out to be a mild episode. Hugs. 
This 100%.
You are going above and beyond. With many owners, he’d already be over the rainbow bridge.
This is just me – sometimes it comes down to what the owner can do, and what they can’t do.
You haven’t even mentioned just trying to get him sold and pass the problem on to some unknowning new owner, and I applaud you for that. It is very hard to cast their lives out into the wind, knowing a particular horse has a higher that usual chance of ending in a bad situation. In this case due to chronic vet issues that most owners can’t afford.
If you are thinking of putting him down, personally I am ok with that. He doesn’t know. Horses don’t know or think about how long their lives might be. I hate to put it this way but it is true that they are safe forever if they aren’t exposed to humans. That’s their biggest risk factor to your horse – exposure to other humans who aren’t going to do the right thing for them.
Possibly – You can hang in there with all the treating and the bills for one, two, or a few years, and eventually he comes right. But, no way to know.
A long time ago when there was so much pasture land for random horses, so many options to just turn a horse out and let him be, for months or years, that is what an owner would have done for a case like this. With very little expense. Turn him out in a generous field with a herd of ornaments. Keep an eye on his health, keep handling him once a week or so to keep him tame and civil. Bring him back in a year - or more - and see how things are then. If not ok then, he can become an permanent ornament himself.
Those low-cost good-pasture options just seem to have vanished over the last few decades. I don’t know if something like that is available for your situation.
All that said – I do not know enough to know what underlying condition is happening here, but something NQR is allowing one abcess / infection after another. Maybe his immune system isn’t right - maybe some condition is undermining it. Maybe the biologics in his entire body, his organic system, aren’t right. Maybe something tiny and foreign is embedded somewhere and his body keeps reacting. Something is off. And it may be something hard to diagnose. Much less treat.
Especially if the vets haven’t already mentioned a systemic problem of some kind that is opening the door to recurring issues.
My heart goes out to you. It must be incredibly stressful and I’m sorry you are dealing with this.
I’m wondering if you may now be dealing with osteomyelitis (a bone infection) beyond cellulitis of the soft tissue. If the infection has gotten into the bone, a sinus tract can open up to the outside periodically. That’s when the pus finally drains out through an opening until it eventually seals up, only to happen again.
I’ve dealt with osteomyelitis myself and it’s a very difficult infection to cure. My only suggestion would be to consider extensive imaging to rule out a bone infection.
Sending you both hugs and jingles. 
Systemic lack of something was my first thought. I’d look at vitamin E and selenium testing, if you haven’t already. I’d try supplementing copper and zinc as well.
My senior got mud fever pretty badly four autumns ago. Three autumn’s ago he got cellulitis from bacteria getting in through the mud fever, and it happened again two autumns ago. Each time he abscessed in his hind feet for months after the cellulitis. Last winter/spring was a nightmare of abscesses, and he had one in the summer that left part of his corium incapable of growing sole. I tried copper and zinc supplementation and the mud fever healed up within a few months and didn’t return last fall, and he didn’t get cellulitis. He does have PPID, but his numbers were well within normal range. Last spring I was honestly wondering if I was going to have to euthanize because of never ending abscessing.
Jingles that this time it’s not an infection and that diet resolves the issues!
Thank you. There is another horse in the barn that has recurring cellulitis but it is always in the same limb. Is it normal to present in different limbs each time?
It is possible. The first two injuries he had not been wrapped, and that lead to the interfering/knocking himself theory. Although we never saw obvious wounds, the swelling/abscess point is always inside the leg.
I did do some reading of the research into the concerns regarding overheated limbs but because of his history it was a case of trading risks. So, after the second injury is when he started getting diligently booted on all 4 during turnout.
Not saying it couldn’t have been a factor this time but it was not the same factor the first two times.
Thank you. I don’t feel like I have a lot of options regarding changing turnout. He is not a good candidate to live in a stall or with limited turnout, even with trazadone onboard. It was hard during his last two recoveries and he was very unhappy.
Thank you. My plan has always been to have this horse for his whole life. This plan included buying a farmette to keep him during his retirement. If the case arose I would consider leasing him out but never selling. Maybe that’s all easy to say now but that’s been the dream.
I can look into a pasture situation like you mention but I would still be wary of that since this recurring issue keeps happening during turnout. I am just not sure that is the solution to this particular problem. If it was some work-based injury he would have already moved onto a different career or retirement.
Now that is an interesting thought.
Thank you. I guess it is possible. The imaging we have done in the past suggested it was all soft tissue and nothing else (he presented SO lame in February that my regular vet was certain something was broken, but pictures looked clean outside of the inflammation we knew of). The hospital he was at both times did fancier imaging and agreed nothing beyond soft tissue involvement. Would it make sense for infection in a bone in leg 1 to manifest as an abscess in leg 2? Curious since it has not been the same leg each time.
Thank you. I’m sorry about your horse with mud fever, I have never seen this but hear it is really grueling for everyone involved. I’m glad he’s doing better now.
For this horse, the abscesses have been in the leg and not the hoof. I wonder if that makes a difference in what you have mentioned.
I’m going to write down his rations today so I can look into the levels a few people have mentioned.
Fwiw, I don’t keep my cellulitis horses inside once they’re out of that initial “omg my leg is broken” period, and just turnout in standing wraps. Movement helps reduce the edema and they don’t go bonkers.
I have my horses at home, am confident in my wrapping skills, and have a wee little herd that I can trust to not help remove wraps. Totally understand the cards may not align for everyone to turn out in standings, but it might be something for you to consider/talk about with your barn, esp if he’s so miserable inside during these recovery periods.
I’d never had even a single cellulitis before moving to CT, and then they started popping up with fair frequency, which was really quite the surprise. Adding copper/zinc helped a ton, but ditching commercial feed entirely and going to alfalfa pellets + Vermont blend pro (plus still more cu/zn on top of that) has (madly knocking wood) meant I haven’t seen anything in about a year.
It may also be interesting to really look at his feet and how they’re balanced, if you think he’s dinging himself in turnout. Perhaps his trim can be tweaked to prevent that.
One more thing to explore would be EPM. Not like EPM causes cellulitis/abscesses like you describe, but it could cause him to be less aware of where his parts are. And–this is a reach–but if his immune system is busy trying to deal with EPM, he’d be less able to handle a simple skin infection?
To your question of cellulitis typically recurring in the same leg rather than varying locations. My gelding had his first bout in his chest. We thought he possibly had Pigeon Fever even though we are not in an area where it was typical.
He had a small cut on the front of his chest and we wondered if he had some forreign body that had become imbedded there to cause the swelling and oozing that recurred several times that season. I had him at the university vet hospital several times. First for IV antibitoics to try to bring donw the swollen chest.
A few months later when the site broke open again and oozed, we went back to the univesity clinic and had him x-rayed. The specialty surgical vet had the x-rays majorly enlarged and saw a very small artifact of something. He said it could actually be from the betatine we were cleaning the area with or it cold be something as freak as a metal sliver or stiff little piece of plant/grass stem. He recomended against surgery, which would be major, since it was dificult to ID the visible image with certaintly. He recommend taking him home and “letting him be a horse” with his normal routine and turnout. Just keep treating the oozing site and maybe if there was something in there, the body would work it out. Over the next year and half or so, he had several bouts of the ooze, each a bit less the the previous. At one point, the swelling and cellulitsi did travel down one front leg. That leg was susciptible to future bouts.
Over time, he also had cellulits on a hind leg.
So my expereince is it is not limited to a single leg or site and my vet said the was not unusual.
We just lived with it and managed it as needed. He lived for another 9 or 10 years with off and on flair ups.
The year the whole issue started we had a VERY strange summer. Hot and droughty - typical weather for the soil borne bacteria that cause cellulitsi to thrive. We also lots of wasp nests and activity. Who knows if a wasp sting even precipitated it. To this day it’s a mystery and I never had any other horse on the property ever get a case of cellulitis.
We lost our 17 year old stallion to a reoccurring infection on his ankle 50+ years ago.
Some months previous he had pawed at a porcupine, vet thought he had all spines out, obviously one was still there.
Didn’t show on the old type x-rays, vet could not find it and finally the infection we could not clear permanently settled in the joint and bones and we had to let him go.
There could be something, somewhere, but that should not involve more than one leg, as in some stories presented.
