Recovery from severe lymphangitis - tips?

[ChasseurSauteur]

My gelding had a terrible lymphangitis episode in the RH at the end of July – extreme pain and swelling up to the stifle, high fever, skin sloughing off, the whole lot. As the vet has mentioned a few too many times for my liking – “He was really circling the drain.”

We are now four months on and his recovery seems to have stalled. He has finally been weaned off dex and is down to a minimal dose of antibiotics along with bute for pain management. He has been back on 8 hour/day turnout for the last month and we have started bringing him slowly back to work under saddle and on the longe. He is gaining strength and muscle back well – some days, he feels super sound and works out of any stiffness in the first few minutes of riding. Other days, he is not doing so hot. The hock is still consistently quite swollen and doesn’t appear to be materially improving. Randomly, he will present with a pocket of swelling right above the heel as well (which seems to the indicator for whether he will be sound enough to ride) for a couple of days, which will then resolve itself a couple of days later.

I’m starting to wonder whether a more-or-less full recovery will be possible. He is supposed to be my dressage horse but I’m coming to terms with the fact that that career is probably over – I’m just hoping he will be serviceably sound. For those who have dealt with severe lymphangitis in the past – any words of advice about helping support his continued recovery, increase his immune function, etc?

[flyingchange]

The more you can keep him moving, the better. So if possible, full-time turnout. Keep the area dry and clean. If he must be stalled, put a standing wrap on the back hind. Continue to sweat it - if you haven’t already been doing that.

[firefoot]

I have a gelding who has recurring bouts of lymphangitis. He gets it primarily in a leg where he had a very traumatic reaction to spider or tick bite years ago. Has your horse experienced trauma in the leg that was particularly affected? How old is he? It seems that once something like that happens, the lymph vessels stretch and lose tone and the leg becomes more prone to lymph episodes thereafter. He has had a significant lymph episode annually for the past 4-5 years and is prone to stocking up rather quickly.

For mine, he is on year-round night turnout and wrapped behind in the stall. Once recovered, the key is to keep inflammation/edema out of the leg so it doesn’t start the cycle over. As much turnout as possible and keeping them in at least light work will help. Even if he’s not sound enough for much actual work, long walks of at least 45 minutes help with any lingering edema. I’ve found 30 minutes to not be enough time.

I have talked to my vet in the past about using daily doses of aspirin or pentoxyfiline to help blood flow. A friend uses aspirin on her horse with similar issues and it seems to help. I haven’t actually done that for my horse yet as he seems to respond to the current level of management. Full recovery takes a very long time, especially from such a significant case. My horse’s last episode was the beginning of June, and I think it was August or September before I was seeing consistently less filling in the leg. From the first day, I’d say he was wrapped behind 24/7 for a month or a little more, also (turned out in standing wraps and wrapped in the stall). I used Back on Track wraps in the stall when it wasn’t super hot out, I think they helped.

I had some luck with sweating the leg and would recommend it, but had the most luck with just keeping him in standing wraps when he was in the stall and turning him out as much as possible. Some people say they get “dependent” on wrapping, but I’m not sure I buy it. Plus, oh well if it’s true if it breaks the inflammation cycle.

Based on your timeline, I’m not too surprised it’s taking this long to recover, but I would talk to vet if it really drags out. How often are you riding/working him and for how long? Is there any way to turn him out more?

[2tempe]

I had a gelding who had two incidents. The first was at maybe 18, front leg, huge to elbow. after about a week fo cold hose/sweat/hand walk and some turnout, I went back to riding him. We were lucky - some oozing but not much skin impact and he was quite sound when back at work. Swelling went away. by 3-4 weeks. All was well.
Fast forward about 7 years, second incident, same leg, huge, painful. Several weeks of drugs, hosing, and so on, swelling very slow to go down, skin was a mess from the knee down and in spite of much effort and vet help, it wasn’t improving. Sweating is a no-go when there is that much compromising of the skin. Concern about potential joint capsule infection at ankle. Now this horse had (for years) Atrial fib and a murmur. No obvious impact to his well being. BUT one day, maybe 4 weeks in to the above, he had ventral edema - girthline to sheath. Vet put a stethescope on him and said his heart sounded “like a sneaker in a dryer”. All over the map. And the cause of the ventral edema. We agreed that this was probably a big contributing factor to the lack of healing and that his heart issues had finally caught up to him. Sadly we euthanized him a few days later, at 25+.

OP - I would have a serious talk with the vet and what your expectations should be. If the horse is on the younger side, you may end up ok. If older, it is more of a challenge and more likely to recur at some point. Hard to say. No thoughts on how to boost the immune system, other than to say that if blood work hasn’t been done, do it. May tell you something.
Secondly, you might consider specific looks at the hock and above the heel - ie xray or ultrasound to see if something is going on that you cant see.

[Peggy]

Movement as others have said. Mine lived on a large-by-California-standards paddock. I kept the leg wrapped. He did have recurring bouts, at the same time of year, with each one being progressively worse. His leg never went down totally but looked decent and I kept riding him. He died at 21 during a bad bout. The vet was walking up to euthanize him when he took matters into his own hooves and died. He never did like the vet.

[ChasseurSauteur]

Thank you so much for the war stories and advice, all. Will be taking into consideration for next chat with the vet.

@flyingchange – thanks for this – 24-hour turnout is not an option where he is boarded unfortunately, and I’m reluctant to move him right now as they have been taking superlative care of him. I have been leery of sweating the leg, because he still has barely-healed wounds where the skin split and I’m afraid of them splitting open.

@firefoot – he is 12, no significant trauma to that leg though he did have a minor cellulitis episode last summer that resolved easily. Will definitely take your advice re the 45 minute walks, as I’ve been reluctant to fully work him on days that he is more painful. He is in standing wraps behind when stalled (have just got some Back on Tracks).

@2tempe – very interesting – my guy also had ventral edema which is now totally resolved – vet said it was shedding protein due to how sick he was. Now I will lie awake at night thinking about heart murmurs lol.

@Peggy – so sorry for the loss of your guy. Thanks for sharing your experience.

[firefoot]

The cellulitis might have been enough to weaken the structures in the leg. Did he have a lymph response anywhere else? Any other trauma anywhere else on the body in the weeks before this recent event? I think with this recent leg, my horse had a large lymph node in his jaw a few days before. I didn’t really think anything of it, then went on a really long (2 hr) walk one day. He also didn’t have hind shoes (not abnormal, only put hinds on him this fall) so I wonder if that was part of it. He was stocked up the next day a little bit, then 3-legged acute lymphangitis the day after that.

Definitely do the walks, great way to keep him fit and strengthen the structures in the leg to support better lymph drainage. As long as he’s not hobbling and 3-legged, he will benefit.

I’m not sure if you cold-hosed, but going forward, I highly recommend icing instead. Basically keep the skin as dry as you can. In the acute stages, just dry wrap and ice, save the sweating for residual filling or in cases where he’s not so acute. Big D’s sells those big nine-pocket ice boots that are awesome, just get some ice from the gas station and fill the pockets with ice, leave on for 20-30 minutes, go for a walk, come back and ice again, then wrap up. I have used the Ice Horse boots and while they were convenient because I couldn’t fit a whole bag of ice in my barn fridge, they did not stay cold enough and did not stay on well. Even after healing, I would keep him wrapped in the stall or get something like the BoT quickwraps and put them on snugly.

You might also look at his nutrition. He might do with some extra protein and vitamins to support healing.

Also now that he has had this issue twice, he will probably get have episodes again and be more prone to lymph/immune issues. Keep your drugs stocked and watch for filling in the legs. Good luck! It is so frustrating.

[theresak]

I wonder if he’s still got a bit of infection if there are pockets of swelling that appear - you could ask the vet about kicking up the antibiotics again or trying something else. Or the pockets could just be because he’s not moving around as much some days.

My horse has had cellulitis in all 4 legs over the past 10 years, with some legs affected multiple times. I do find that when it’s humid or hot or when the footing outside is bad (icy) and he’s not moving around much, his legs fill more.

I did as another poster suggested and started going for a marching walk for >45 minutes - that finally moved the swelling out significantly. I had been doing 20-30 minutes and getting some improvement but the extra time moving around really helped. Then I would cold hose or ice and re-wrap. If the hock does not have open sores, you could try just sweating that with a dry standing wrap around the lower leg. I sweat with Furacin + DMSO.

After his last bout, we changed his diet to support his skin and immune system - the vet thought all the antibiotics he’s been on could have killed off his good skin and gut bacteria and made it easier for bad bacteria to invade. I added copper, zinc, and a probiotic (in addition to the extra Vitamin E he was already getting).

[Lusoluv]

My 10 year old had a severe case of lymph/cellulitis 3 years ago (very lame for 4 days, skin weeping but no open wounds). Recovered enough to start bringing back into work riding at 3-4 weeks. The meds helped a lot, but hosing/wrapping/sweating/worrying…nothing made a significant or consistent difference. Time, meds and walking were the only obvious remedies that worked. I had 2 vets attending this first incident. Wrapping made me feel useful, but results are temporary as swelling in fetlock and pastern remain to this day.

Horse has had a “mild” episodes annually, tho I haven’t found a pattern as it’s been early June - late Sept. Same hind leg gets swollen up to gaskin, but fever, lameness and pain leave within 12-24 hours. I march at walk only (in hand and undersaddle) for at least 5 days before we’ll start any trot work, etc. just to make sure recovery is complete. This year’s episode happened at the height of horse’s fitness. Since we only lost a week of work, I went to a show 3 weeks later with my trainer and vet approval. For the past 18 mos. I have fed Elevate E, Poly Zinc and Copper to support the skin, immune, etc. via anecdotes. It didn’t do anything that I can tell.

This is a very frustrating disease that no one seems to know any more about since the last half century or more. So, as long as my horse recovers and is comfortable to work after past (and no doubt future) bouts, we will keep kickin’!

I’m at a big boarding barn. There are a few horses who’ve had this and all have different outcomes. One got it when elderly and never came fully sound. One had a case as a youngster and now has it again after a 15 year hiatus. One gelding is on his 2nd bout this last 6 mos, etc. Only one horse got it after an acute injury. And then my horse’s case… Seems to have no rhyme or reason amongst the lot which is what makes it so frustrating! You can’t help/prevent what you don’t understand, so you wait…