Managing lymphangitis episodes in older horse

[firefoot]

Hi all, this is long, sorry in advance.

I am looking for input on managing what seems to be recurring lymphangitis episodes in my horse. He is an 18 year old TB gelding with a lot of miles on him. I’ve known him for 5-6 years and owned him for 3.5. For as long as I’ve known him, he’s been a slow healer with chronic scabbies on his hind pasterns (4 white socks), though they have improved a lot since I’ve owned him and his stress level has decreased. Years ago, he got some kind of insect bite on his LH and had a significant reaction – stovepipe leg and filling into the groin for about a week, lame, low grade fever. He came out of it fine but since then, that leg especially has seem compromised and had a few bouts of lymphangitis. A year or so after the spider bite, he had a case of true cellulitis with weeping skin, etc., but the past few years it has not gotten that bad.

Last August, he had an episode where he had a big leg for over a week, though he seemed comfortable enough. Treated with SMZs, gen, bute, naquasone, though he was not in an environment conducive to wrapping and this is probably why the leg stayed big so long. This past winter, he stocked up a lot more than usual, eventually in all 4 legs, despite being out 23/7 (came in to eat) with friends. I started riding him and the legs came down with exercise, but he had been on field board for a few years at that point so I would be surprised if the frozen mud, snow, etc, was bothering him. No round bale – I throw hay out for them, individual flakes scattered around the field so they have to keep moving.

Then last Monday (6/3) he came in NWB with a hot LH and working on edema. He was super uncomfortable and looking belly-achey so gave banamine with his SMZs and gen, started icing, and left him wrapped. His schedule is now in during the day (6-7 hours), no more field board, so he was iced 2x/day and kept in a standing bandage otherwise even for turnout. He responded really well and though the second day he had a huge stovepipe leg and was uncomfortable, by day 4 the leg looked 80% and he was sound. Did 5 days gen, 5 days bute (2g for 2 days, 1g for 3 days), 10 days SMZs (ended yesterday). For a few days, he came in in the morning looking nearly normal and has stayed in work as exercise helps bring the leg down, but the past two days a not-insignificant amount of filling has been present both in the morning when he comes in and then throughout the day when it fills into the front of the hock. I am still icing it 2x/day, which definitely helps, but it’s not a perfect system as I have crappy ice boots and a tiny barn fridge that doesn’t quite freeze the ice packs 100%. He remains sound and seems unbothered. He has some scabbies on both hind pasterns that I’m hesitant to mess with at the moment, I don’t want to irritate him and cause another flare.

I feel like the leg should be much better by now as we’ve had really nice weather and I’ve been super on top of his care (we changed barns last year and the new environment has really helped a lot of things). But I also recognize that he’s older and very inflammatory in general. I’m concerned that he’s had two significant lymphangitis episodes in less than a year with significant stocking up over the winter. He came up negative for Cushing’s, somewhat surprising to me but I tested twice and am ultimately happy that that’s not it. I am not sure how else to manage him but am happy to do whatever he needs. Will he need icing 2x/day from now on, or after working? Should I wrap him for turn out now? He is wrapped in the stall and it does help. My vet mentioned pentoxyfiline but that is expensive – is aspirin an alternative? I don’t know that it necessarily helps with vessel tone like pentoxy but just thinking it might help keep the inflammation down and protect the circulation. Has anyone tried those compression socks for horses? How much of a pain are they, or did they help a lot? I like icing and then using the Back on Track but am thinking if it’s still a little big tomorrow I might sweat it?

FWIW, he eats well – not quite a full ration of TCS so he gets 1lb of the TC RB plus 2 cups flax, 2 oz flax oil, lysine, quiessence, and MSM, 16 hours a day of grass pasture and orchard/alfalfa hay in the stall. And probiotics right now with all the antibiotics. I don’t typically believe in feed-through supplements and I tend to think the immune system is best supported by healthy diet and environment, but is there anything else I can do to help support his immune system? It’s not a desperate situation or anything, but I do not want a chronic situation and will do anything I can to keep him comfortable.

Edited to add: A dear friend recommends magnet therapy – she has a magnetic pastern strap she uses on her horses and said I could borrow it. But I have never seen any science to support magnetic therapy, at least not in people. Is there really enough iron in the blood to respond to a magnet? Any other therapies you’d recommend? I do understand that with the compromised tone in the blood vessels and lymph system and pro-inflammatory response, everything is essentially a band-aid and not a cure, but enough band-aids might hold him together!

[Peggy]

I kept my horse with recurring bouts wrapped with standing wraps on his hind legs. He was in a paddock that was about 12’x40’ so he could move around. His seemed to happen at the same time each year, which was June. They could worse each time and he eventually succumbed during one. This was in 2006, so management may be different. I’d had the horse since he was five and I would say that he did have a reactive immune system.

Good luck with your horse.

[firefoot]

@Peggy

I kept my horse with recurring bouts wrapped with standing wraps on his hind legs. He was in a paddock that was about 12’x40’ so he could move around. His seemed to happen at the same time each year, which was June. They could worse each time and he eventually succumbed during one. This was in 2006, so management may be different. I’d had the horse since he was five and I would say that he did have a reactive immune system.

Good luck with your horse.

So sorry to hear about your horse. What age did he start having these episodes and you started wrapping 24/7? Mine is senior but I wouldn’t call him “old” yet so I’m mentally not prepared to have him live in standing wraps, but maybe it’s appropriate. Or maybe I’m just rushing recovery from this recent episode.

[tipzythegreat]

There’s a horse at my barn that has a similar story. A couple years ago his front leg was massive and not weight bearing. They thought he broke it. It ended up being cellulitis and he’s since had trouble with the lymphangitis.

He too has the scabbies in his back hind feet that never heal. Scratches, I think.
He too stocks up all the time, and responds to exercise. He is a similarly aged OTTB.

Sometimes he can’t really pick up his RH. I’m always blown away at his large his legs can be after a day without turnout. He gets walked often, and gets turn out (weather permitting) but otherwise lives in a stall. The RH is always the biggest, but they both can get monstrously large.

He has had the the lymphangitis affect his belly. They thought someone had girthed him too tightly, but it turns out it was the beginning of his flare up. He will go down sometimes as soon as they put the girth on. Even if it’s loose!

He went down in cross ties the second the girth touched his belly a couple months ago. I asked, “Didn’t he have trouble with his belly last time he had a big flare up?” The owner agreed and worked with the vet. They gave him antibiotics for a week or two, and he didn’t have a huge flare up like the first time.

They never wrap. They never cold hose. They never ice. This horse is accident prone and in light work, so I think they don’t think all the extra work is worthwhile. If it’s really bad, two days of walking and some turnout usually get it back to it’s normal shape. It’s certainly never a tight leg anymore, but it isn’t bad. And I’ve never seen a leg get as big as the cellulitus flare up.

I think the trouble with wrapping is the body can become dependent on wrapping. Not to mention all the laundry you have to do, all the supplies you have to buy, and how many backaches you get from it! Eventually the body gets less effective at doing its job when it doesn’t have to do it.

I’d be hesitant to try the compression sleeve because it looks hard to get off if his leg gets huge. I see you’re using the BOT. I also have asked them about sweating the leg. I wouldn’t sweat with DMSO but I probably would do a furazone sweat, if it were my horse. Maybe consult with your vet though

[theresak]

I’ve wrapped for 4+ weeks and slowly weaned off for severe cellulitis. BOT wraps made the swelling worse, so I just use a DMSO+furacin sweat for 1-2 weeks and stack wrap or do a wrap and a hock wrap for a hind leg to get all of the swelling covered.

Icing/cold hosing is good as well as movement (forced movement if he’s just standing in the pasture).

The tissues will slowly retract, but probably not all of the way back to normal. If you can prevent the continual cycle of the leg filling back up each day, it should help train the tissues to stay a bit tighter. If it’s hot outside, my horse tends to fill up more in the legs that have had cellulitis.

For somewhat recurrent cellulitis in my horse, we tested for Cushings (negative) and updated his diet to include:
-More Vitamin E
-Added poly copper and poly zinc to help with general skin issues (scratches sometimes causes the cellulitis)
-Added a probiotic to help his gut and skin flora recover from all of the antibiotics

[Angela_Freda]

For my oldster with recurring lymphangitis/Cellulitis we did cold hosing with pressure, like a cold aqua massage. 20-30 min twice daily.
I also did compression wraps when in, all the way up above the hock, until well after the filling had subsided.

I did get a pair of the EquiFlexx sleeves compression socks and I like them. They did not work for my horse as he had DSLD/ESPA and his dropped fetlock would articulate so low and pull them down, but for a horse with ‘normal’ conformation I think they are nice, not as hard to get on as some suggest and did a decent job.

[Peggy]

@firefoot

So sorry to hear about your horse. What age did he start having these episodes and you started wrapping 24/7? Mine is senior but I wouldn’t call him “old” yet so I’m mentally not prepared to have him live in standing wraps, but maybe it’s appropriate. Or maybe I’m just rushing recovery from this recent episode.

Wrapping hinds didn’t start until after the first lymphangitis episode, so he was probably 19. He died two years later.

Several years before that that he had a weird response to a puncture wound where all four legs swelled up somewhat and took forever to go down. There was cellulitis in response to scratches a year or two within that.

He reacted badly to vaccines throughout his life.

Looking back on the above and other stuff, he probably had allergies, but I didn’t test for them.

[Groom_amp_Taxi]

I have a 17yo gelding with chronic pastern dermatitis on the hinds. He is presently retired and living out 24x7 in a decent sized private paddock with a run-in and equine neighbors on two sides. Reading the above posts, I am thankful that he has (knock wood) only had one incident of lymphangitis/cellulitis in over a dozen years of owning him. That was on the RH about three years ago, and it did take forever for the leg to return to normal size.

I have tried the Silver Whinny Sox (you can find the web site for them by googling ). I do think they help the dermatitis, and the horse seems to enjoy wearing them (and he is not shy about letting you know when things bug him). Unfortunately this horse has always had trouble lifting his hind legs (mild shivers like symptoms), and the regular sox were too hard for me to get on and off as often as that needed to happen. I worked with the company to have a couple pair custom made with Velcro, and I use them when it is especially hot. They are too expensive to use all the time, but I find when I use them that his “scratches” affected areas seem a lot calmer. They are not designed for compression, and I think some of their value is just in keeping the scabbed/irritated areas separated from something in the environment that is part of what causes them to wax and wane.

[PNWjumper]

I have an 18yo OTTB who has annual bouts of cellulitis. He also has the scabbies other people have mentioned (there’s a thread on here somewhere where a whole bunch of us with TBs commiserate about the weird scabbies that seem to be a “TB problem”).

But when my guy has a bout it’s pretty classic cellulitis presentation…hot, swollen leg and extremely painful/dead lame. If I get it right away (as in, before the swelling starts) and get him on penicillin and gentamycin immediately, the swelling doesn’t get as bad and only lasts a week (ish). If I don’t catch it until the leg is swollen it lasts a few weeks (ish - on the “more” side). This is what it sounds like you dealt with the last time? If so, I don’t find that I need to do any “preventative” or long term wrapping. Once the swelling is gone it stays away until the next [annual] bout of cellulitis (always the same leg).

[firefoot]

@Groom&Taxi

I have a 17yo gelding with chronic pastern dermatitis on the hinds. He is presently retired and living out 24x7 in a decent sized private paddock with a run-in and equine neighbors on two sides. Reading the above posts, I am thankful that he has (knock wood) only had one incident of lymphangitis/cellulitis in over a dozen years of owning him. That was on the RH about three years ago, and it did take forever for the leg to return to normal size.

I have tried the Silver Whinny Sox (you can find the web site for them by googling ). I do think they help the dermatitis, and the horse seems to enjoy wearing them (and he is not shy about letting you know when things bug him). Unfortunately this horse has always had trouble lifting his hind legs (mild shivers like symptoms), and the regular sox were too hard for me to get on and off as often as that needed to happen. I worked with the company to have a couple pair custom made with Velcro, and I use them when it is especially hot. They are too expensive to use all the time, but I find when I use them that his “scratches” affected areas seem a lot calmer. They are not designed for compression, and I think some of their value is just in keeping the scabbed/irritated areas separated from something in the environment that is part of what causes them to wax and wane.

Yes, these were the socks I was looking at. I was thinking the silver would help the skin and in turn help reduce the episodes, as I do think the two are related, though maybe not all the time. Are they snug/do they slip down? I guess they’re not compression socks but are they snug enough to have a somewhat similar effect or it’s really just a lose bit of fabric with silver in it?

[firefoot]

@PNWjumper

I have an 18yo OTTB who has annual bouts of cellulitis. He also has the scabbies other people have mentioned (there’s a thread on here somewhere where a whole bunch of us with TBs commiserate about the weird scabbies that seem to be a “TB problem”).

But when my guy has a bout it’s pretty classic cellulitis presentation…hot, swollen leg and extremely painful/dead lame. If I get it right away (as in, before the swelling starts) and get him on penicillin and gentamycin immediately, the swelling doesn’t get as bad and only lasts a week (ish). If I don’t catch it until the leg is swollen it lasts a few weeks (ish - on the “more” side). This is what it sounds like you dealt with the last time? If so, I don’t find that I need to do any “preventative” or long term wrapping. Once the swelling is gone it stays away until the next [annual] bout of cellulitis (always the same leg).

Yeah, last year I was a day behind it. I noticed the leg was a little stocked up but I didn’t ride him that day, just groomed and figured he had a little reaction from the MTG on his legs. Then the next day, bam, tree trunk leg. At that point, he was out 24/7 at a place that super sucked, had no facilities and he was not in a great group of horses for me to feel comfortable leaving him wrapped. So being that far behind it really cost me and he took a while for it to go down. Of course, he retains filling in both hind legs typically – they are not tight young horse legs, ever. So I know he has some inflammation/lymph issues/blood vessel tone issues as standard. I feel like the wrapping helps break the inflammation cycle and keeps things “tighter,” if not tight. I am also concerned as I do hear about everyone’s annual lymphangitis/cellulitis, but this has been less than a year with some significant episodes of stocking up in between (winter). So I’m worried that he will have more frequent episodes.

The TB scabbies are brutal. It’s been a mix of benign neglect and controlling my obsession to address them. Neither works great, lol, but less seems to be more. Does your guys leg go back completely to normal? And then you just wait for the next episode? Does he stock up throughout the year or is it normal leg to big leg overnight then good for a year?

[firefoot]

@theresak

I’ve wrapped for 4+ weeks and slowly weaned off for severe cellulitis. BOT wraps made the swelling worse, so I just use a DMSO+furacin sweat for 1-2 weeks and stack wrap or do a wrap and a hock wrap for a hind leg to get all of the swelling covered.

Icing/cold hosing is good as well as movement (forced movement if he’s just standing in the pasture).

The tissues will slowly retract, but probably not all of the way back to normal. If you can prevent the continual cycle of the leg filling back up each day, it should help train the tissues to stay a bit tighter. If it’s hot outside, my horse tends to fill up more in the legs that have had cellulitis.

For somewhat recurrent cellulitis in my horse, we tested for Cushings (negative) and updated his diet to include:
-More Vitamin E
-Added poly copper and poly zinc to help with general skin issues (scratches sometimes causes the cellulitis)
-Added a probiotic to help his gut and skin flora recover from all of the antibiotics

I was hesitant to put anything on the skin and make it worse, but maybe I will consider a sweat for next time (or now, if he stays big). Yes, the icing and moving helps a lot! The BOT wraps have helped a ton provided it is not 90+ degrees. I do think breaking the inflammation cycle and trying to encourage proper circulation/drainage is important. I know people say they get dependent on wrapping but I don’t think I really believe that. Once you stopped wrapping, did the legs stay pretty good? And do you supplement vit. e? I feel like between the flax meal, oil, and grass, he gets a ton of vit. e, but maybe more would be good.

[PNWjumper]

@firefoot

The TB scabbies are brutal. It’s been a mix of benign neglect and controlling my obsession to address them. Neither works great, lol, but less seems to be more. Does your guys leg go back completely to normal? And then you just wait for the next episode? Does he stock up throughout the year or is it normal leg to big leg overnight then good for a year?

I’ve had my guy for 12 or 13 years, and he is in pretty hard work (he’s been jumping around FEI level Grand Prixes for the last 9 years, and though I think we’re done with FEI, he’ll probably still show in the 1.40m this year and maybe next if he’s feeling up to it?). I’ve tried EVERYTHING with the scabbies and nothing has made a difference. My vet lasered them, we tried a million different topicals, we did scrapings at one point. One time his cellulitis hit at a show and the vet there peeled off one of the scabs, sniffed it, and said, “yep! That’s where your infection came from!” But I can say that there’s been no rhyme nor reason behind when the episode hits. It was in the first week of July for the first several years, and then it hit in January one year, and then back to July, and then an 18 month break before the next one in Dec/Jan. Doesn’t matter if it’s muddy or rainy or dry. Doesn’t matter if he’s in a stall 24/7 (like he is at shows) or out 24/7 like he is at home. So I’m not convinced that the cellulitis has anything to do with the scabs, but I would imagine that when he’s in the midst of a cellulitis infection, any port into the leg (through any of the scabs) I would assume would not smell great. Or maybe they really are the “ports” for infection into the leg? But then I’ve never had a cellulitis episode after/due to peeling the scabs.

Anyhow, to answer your questions. Yes, it only happens to his RH, and it goes down pretty close to normal (the leg is a tiny bit “chunkier” than the other hind leg, but it’s not very noticeable visually). And then yes, I just wait for the next episode. He will stock up if he cuts himself, but he does not stock up randomly. It’s normal to big leg during the cellulitis, I always DMSO + furacin sweat wrap overnight it for 3-10 days (just depends on the severity of swelling), and then transition to just wrapping it overnight for another 2-10 days. Then we’re back to normal and just waiting for the next episode.

[theresak]

@firefoot

I was hesitant to put anything on the skin and make it worse, but maybe I will consider a sweat for next time (or now, if he stays big). Yes, the icing and moving helps a lot! The BOT wraps have helped a ton provided it is not 90+ degrees. I do think breaking the inflammation cycle and trying to encourage proper circulation/drainage is important. I know people say they get dependent on wrapping but I don’t think I really believe that. Once you stopped wrapping, did the legs stay pretty good? And do you supplement vit. e? I feel like between the flax meal, oil, and grass, he gets a ton of vit. e, but maybe more would be good.

See also PNWJumper’s post above as her experiences are fairly similar to mine with both the scratches and cellulitis, although I dread April-June because that is when he’s most likely to flare with cellulitis.

I finally cleared up his scratches (crossed fingers) a few weeks ago. Making the homemade from this forum really helped us turn the corner - I think the addition of the anti-fungal is what helped; none of the vet clinics in this area have anti-fungals in their ointments. The recipe is 40% zinc oxide, anti-fungal, triple antibiotic, cortisone - 1 part of each mixed well.

Because he flared with resistance scratches and then cellulitis in January/February where our temperatures were below freezing (-35F one morning when I went out to administer antibiotics and wrap), we tested for Cushings and reviewed his diet. I think you might want to check for Cushings if you haven’t already. Feeding extra zinc and copper are supposed to help with scratches and I had good luck upping his Vitamin E a few years ago. Then the probiotics was suggested because he’s had high doses of antibiotics at least once a year for the last several years and the vet wondered if we’d affected his microbiome and all of the good bacteria had been killed in his GI tract and skin.

[Groom_amp_Taxi]

@firefoot

Yes, these were the socks I was looking at. I was thinking the silver would help the skin and in turn help reduce the episodes, as I do think the two are related, though maybe not all the time. Are they snug/do they slip down? I guess they’re not compression socks but are they snug enough to have a somewhat similar effect or it’s really just a lose bit of fabric with silver in it?

If you get the right size, the socks start pretty snug and gradually stretch out. My experience was that they stay up pretty well for about a day. The makers recommend changing them once a day, and washing and machine drying them after you do that seems to tighten them up enough so they are good to go again. The makers also suggest adding a couple wraps of electrical tape if the sox need a little help. I never had much trouble getting the standard sox on, but getting them off was another story - the last time I used the ones without Velcro, I ended up cutting them off.

I too literally spent years obsessing over the pastern dermatitis - and am pretty sure that in doing so, I made it worse by “encouraging” inflammatory responses in that area. Tried everything topical ever mentioned including some really weird stuff. Brought in a veterinary dermatologist for a consult. Since the horse has been living the pasture life (now going on three years), his living situation has not lent itself to obsessive leg care so benign neglect has been the default. Knock wood again, the overall situation has not gotten any worse and may even be a bit better (somewhat weather dependent). This particular horse’s “scabbies” have never cleared up completely in almost 13 years.

[GutsNGlory]

My 26 yo OTTB mare had a bad cellulitis/lymphangitis episode a few years back - hind leg stove pipe swollen from coronary band to utter, extremely high temp and heart rate, etc. We were sure I was going to have to make the hard decision to put her down. But antibiotics, banamine, and wrapping did the trick. She still “flares” every winter and lives 24/7 in hind standing wraps for a few months (usually Dec thru Feb). This is during the time our horses have to be taken off pasture and she lives in the paddock (cannot tolerate being stalled - bad stall walker/weaver). The laundry and wrapping every few days sucks… but except for this my mare is still very happy, healthy, and content living the retired life so until she shows me otherwise, we make due. And it completely clears up as soon as the spring grass comes in and she is back out on pasture and moving around more regularly!

She too has the awful TB scratches and cannon crud that I have never been able to cure with her (I’ve owned her 21 years) and has always been very sensitive to vaccines, etc. My vet did give me one of the Silver Whinny Sox and I like it lot! It does provide a bit of compression and only sags when/if it gets heavy from mud/rain/snow. I actually need to order several more before next winter so that I can have clean ones on hand to change her into while the others are in the wash. Also the one I have, after heavy use for one winter and mild use for another, is starting to unravel and tear on the bottom just from general use by a horse out 24/7.

[firefoot]

@PNWjumper Yes, I have tried EVERYTHING for his scabs and while I want them to heal, I am also not convinced that they directly contribute to the big leg episodes, at least not this last one. For a few years when I first met him, his hind pasterns were more scab than skin and nothing helped. Still, nothing really helps, but maybe I should revisit some of the concoctions now that I have his stress levels under control. Thank you for your story! Interesting that yours doesn’t stock up randomly, mine certainly does and it makes me so paranoid.

@theresak I am thinking I should revisit some of the topical remedies. For the first few years, I tried everything from lady cream and other anti-fungals to panalog and neosporin, even dissolved SMZs into a paste with nolvasan, silver sulfadiazine, vetericyn, the WellHorse paint-on stuff, biozide, equiderma paste, azium powder mixed into creams… exhausting! The past few years, I’ve had better luck with dousing in MTG for a couple days, then picking off scabs in the shower, and dressing with the Blue Stuff or equiderma, but for the most part leaving them alone. I have to twitch him to pick them off and we both HATE it.

Good call about the Cushing’s. For a few other reasons, I did pull blood for Cushing’s this spring, which came back negative. But when this lymphangitis happened, I pulled blood again for the more accurate test – something-or-other challenge test. Still negative. He’s been on probiotics since he started the antibiotics and I will finish out the jar but maybe a probiotic year-round would help him.

@Groom&Taxi, good to hear about the Sox! I think I will get some! And I totally know what you mean about encouraging the skin to react. When my horse was working in his career and going hard all the time, I would pick the scabs and treat the skin frequently, at least once a week. Now, I do it maybe once a month, though I do try to dress them with something greasy to keep them soft. If they are soft, them sometimes I’m able to “sneak” picking one off during grooming.

@GutsNGlory, thanks for the Sox info! And glad to hear your horse is still in good spirits despite these lymphangitis episodes. I honestly don’t mind washing wraps – I have enough sets between regular fleece no-bows and BOT no-bows that I don’t have to wash super often. I just don’t want to incur the time cost of wrapping if he doesn’t need it, but I think he does need it right now. Interesting to hear your horse does the big leg in the winter … I am hoping to avoid a twice yearly cycle, but was worried with how much he got stocked up the past winter.

Thanks for all the info, guys!! Sounds like I am doing the right things so far. If anyone has any other suggestions for supporting the immune system, circulation, or thoughts about the efficacy of magnets, I want to hear about it!