Struggling with lymphangitis...

[Nestor]

Looking for thoughts or experiences.

Two weeks ago today, my horse came down with lymphangitis. BM found him at breakfast shaking in pain, leg huge and painful. We’ve seen lymphangitis before, so knew what we were dealing with, knew what was in store for us and the need to address it aggressively ASAP. Vet came out quickly, and we started on a course of antibiotics, banamine, and naquasone, plus as much movement and cold hosing as we could. To be blunt, I’ve lived at the barn for much of the last two weeks. Wrapping ended up being a no-go (horse WILL NOT move with a wrap on, so his leg would get worse any time he was wrapped), and it’s so debated in its help that we decided not to bother.

His leg came down somewhat within 24-48 hours. He was initially swollen up to his sheath, and that receded to basically his hock/lower gaskin. It essentially hasn’t changed since, though it fluctuates a tiny bit. We’re currently on our fourth antibiotic to try to get the infection under control (he got a dose of gent on day 1, did Naxcel/ceftiflex for the first 5 days, started Baytril on day 5 and is still on it, tried a course of gent with no change, and are currently trying Excede). Did an SAA test this weekend to get a picture of the strength of the infection, and to give us something to track. Tonight we do another SAA test (got first dose of Excede on Sunday). He’s been on banamine the entire time, and is currently on his second course of naquasone.

I’m about at my wits end with this. The most perplexing part is he’s SOUND. He wasn’t the first few days, but by end of day 4, when vet said to start lunging him, he was sound. He’s been sound ever since. Maybe a few stiff steps to start, but honestly he’s always stiff to start on that leg anyway, just his M.O. I’ve even ridden him a few times, mostly walking and a little trotting, no problems. He even canters on the lunge and looks fine - not quite his normal stride, but not even enough to be considered off. BUT he still has an infection, the leg is still pretty big, and it’s hot and painful to the touch.

He literally has a team of vets overseeing him. Our general practice, which is two vets, and they work with another vet who happens to be our lameness vet. So all 3 are talking and discussing how to proceed and have seen him. We’ve even double-checked him for Cushings (TRH stim test was normal) to check his immune system isn’t compromised. CBC/Chem are basically normal, or at least what you’d expect with an infection going on.

Are we missing something? (I hope I didn’t forget anything in all of this…) In all honesty, my next step if the SAA numbers aren’t good enough tonight is to send him to the local very good hospital to do a deep dive and take over the constant walking and hosing. I don’t know if it’s just because I’m exhausted and want a break, or I should actually be pushing this harder to get rid of it (really I think it’s both). I’m OK if he has a bigger leg than normal for the rest of his life, because again he’s already sound on it, but I’m concerned about the toll this is taking on his body currently, and the potential for flare-ups in the future (which may already be a guarantee regardless). :no:

[Groom_amp_Taxi]

What an ordeal - wish I had some solid advice to offer. Sounds to me like you are on the right track in trying to figure out what the infection is doing with the SAA testing.

I had one scary go round with something like this, and it was not fun. In my horse’s case, the swelling took a long time - like a couple of months - to resolve even after the infection seemed to be cleared, and the course of antibiotics had been completed. In his case, the swelling at onset was from hoof to groin, but after about a week, it was primarily below the hock - affected leg was right hind. He also immediately moved on to supporting leg abscesses in RF and LH.

Is your horse stalled when not being exercised? I am wondering if turn-out in a small paddock rather than the hand-walking/lunging/light riding might be better - just to let him do things more on his terms and rest when he feels like it.

Good luck - keep us posted!

[Nestor]

@Groom&Taxi

Is your horse stalled when not being exercised? I am wondering if turn-out in a small paddock rather than the hand-walking/lunging/light riding might be better - just to let him do things more on his terms and rest when he feels like it.

He is stalled, which at this point is essentially just overnight, he’s out of his stall most of the day from 7am to 9pm being walked and hosed and lunged and turned out. He’s a bit less than trustworthy in turnout (as in panic attack style freak outs). He does get turnout during the day because there are people around to bring him in when he gets upset (not out during this heat wave though), and when he’s out he generally walks constantly, and that has helped.

We discussed possibly bringing him to my house, as I have a stall with an attached run-out (specifically because the only horses I would have at my house are all sissies with turnout). But then we have no where to really do anything else with him, as it’s just meant for retirees, and I think he’d be really stressed by the move itself. He’s already quite stressed by all of this (we’re doing a course of GastroGard to be safe), and shows it by screaming when we’re walking or lunging or riding, beyond his usual issues with separation anxiety.

[Sansena]

I’m sure you know that frequently horses live with this type of swelling… the type that comes from lymphangitis. Don’t want to be the bearer of bad news, but the reduction you’ve seen in swelling may be all you’re going to get at this point. I’m actually optimistic, though, that it’s still hot and painful. That makes me think the root cause has not been addressed so therefore-- once it has been, you’ll have even better results.

Would a regional profusion of abx make sense in this case? My memory is foggy.

I’d also address his immune system overall simultaneously. Platinum Performance Immune system support is an EXCELLENT product, though spend-y. A few friends have had phenomenal success addressing chronic conditions and seen huge improvements after a few weeks on this, after treating repeatedly with just prescription drugs/ vet rx therapies prior.

Has his skin cracked and begun to slough?

[Nestor]

@Sansena

I’m sure you know that frequently horses live with this type of swelling… the type that comes from lymphangitis. Don’t want to be the bearer of bad news, but the reduction you’ve seen in swelling may be all you’re going to get at this point. I’m actually optimistic, though, that it’s still hot and painful. That makes me think the root cause has not been addressed so therefore-- once it has been, you’ll have even better results.

This is my thinking as well. I would be OK if his leg stayed this size, because as I said he’s sound (though he is on banamine so perhaps that helps). My major concern is the infection, definitely, and like you said, I would hope that once that is treated, it will actually go down a little more.

@Sansena

Would a regional profusion of abx make sense in this case? My memory is foggy.

I hadn’t heard of this, so I’m not sure, though I guess it would make sense? At least according to Dr. Google.

@Sansena

I’d also address his immune system overall simultaneously. Platinum Performance Immune system support is an EXCELLENT product, though spend-y. A few friends have had phenomenal success addressing chronic conditions and seen huge improvements after a few weeks on this, after treating repeatedly with just prescription drugs/ vet rx therapies prior.

Also hadn’t heard about this! Interesting thought.

@Sansena

Has his skin cracked and begun to slough?

It did initially, he oozed a bit the first week, and the outer later of skin flaked off a bit, but other than some hairless patches now and one scab, it looks fine.

[CindyCRNA]

We went thru this 3 weeks ago and with a week of intensive treatment, he competed the past weekend and took 4th place as an eventer. Here is what our vet did:

Sweat wrapped leg day one and two
Bute 2 grams a day
IV DMSO on day one and two
Gentamycin 3500mg IV once a day (he had an indwelling catheter) for 7 days
A long acting oil base cephalosporin (don’t know the name) IM on days one and 3

Hand walking starting on day 3, return to flat on day 7, full work on day 14.

And a check for $1700. :)SaveSave

[Nestor]

@CindyCRNA

He is under vet care , correct? We went thru this 3 weeks ago and with a week of intensive treatment, he competed the past weekend and took 4th place as an eventer. Here is what our vet did:

Sweat wrapped leg day one and two
Bute 2 grams a day
IV DMSO on day one and two
Gentamycin 3500mg IV once a day (he had an indwelling catheter) for 7 days
A long acting oil base cephalosporin (don’t know the name) IM on days one and 3

Hand walking starting on day 3, return to flat on day 7, full work on day 14.

And a check for $1700. :)Save

Yup, he actually has 3 vets overseeing his care. Two in our regular practice (they do our shots and emergencies), and they consult with the vet who happens to do our lameness work, so he has also seen him. All 3 make decisions together on him, so really we have 3 brains.

We did two days of sweat wrapping in the very very beginning, tried wrapping with poultice, tried a full leg bandage with poultice, tried regular standing wraps, it all made his leg worse because he wouldn’t move. I assume because his leg is painful to touch.

We tried putting a catheter in this past weekend, for gentamicin. He got a dose when the vet put it in Saturday afternoon, promptly rubbed it and kinked the catheter by the time I tried to use it for IV banamine that night; vet came out and replaced it immediately, gave him his banamine IV. Tried to give him his banamine IV the next morning, and it was kinked again. Told her to just come out in the afternoon for his next gent dose; she removed the catheter, and we decided to change treatment because the gent wasn’t cutting it anyway.

I have already spent at least triple that unfortunately…

[CindyCRNA]

@Nestor

Yup, he actually has 3 vets overseeing his care. Two in our regular practice (they do our shots and emergencies), and they consult with the vet who happens to do our lameness work, so he has also seen him. All 3 make decisions together on him, so really we have 3 brains.

We did two days of sweat wrapping in the very very beginning, tried wrapping with poultice, tried a full leg bandage with poultice, tried regular standing wraps, it all made his leg worse because he wouldn’t move. I assume because his leg is painful to touch.

We tried putting a catheter in this past weekend, for gentamicin. He got a dose when the vet put it in Saturday afternoon, promptly rubbed it and kinked the catheter by the time I tried to use it for IV banamine that night; vet came out and replaced it immediately, gave him his banamine IV. Tried to give him his banamine IV the next morning, and it was kinked again. Told her to just come out in the afternoon for his next gent dose; she removed the catheter, and we decided to change treatment because the gent wasn’t cutting it anyway.

I have already spent at least triple that unfortunately…

:eek: Have they tried IV DMSO? It may be a bit far out from the original injury though. We had to stall Vic at night but he was a good boy and left the catheter alone. My vet, a big name area equine practice, said it was the worst case he had ever seen. I feel I got off cheap!

[Nestor]

@CindyCRNA

:eek: Have they tried IV DMSO? It may be a bit far out from the original injury though. We had to stall Vic at night but he was a good boy and left the catheter alone. My vet, a big name area equine practice, said it was the worst case he had ever seen. I feel I got off cheap!

:eek: is right… ugh!

We talked about IV DMSO, forgive me for not remembering why we decided against it… I think we decided it’s one of those things that people do out of habit but there’s no actual proof it helps?

Really hoping we have some improvement on the SAA tonight…

[CindyCRNA]

@Nestor

:eek: is right… ugh!

We talked about IV DMSO, forgive me for not remembering why we decided against it… I think we decided it’s one of those things that people do out of habit but there’s no actual proof it helps?

Really hoping we have some improvement on the SAA tonight…

My understanding is it can’t hurt. It is eliminated via respiration and possible other routes also but it can be doubled up on top of other NSAIDS which is what makes it popular. Was anything cultured for bacteria to see what you were fighting? Vic’s lymph fluid was negative for bacteria so the source of infection was upstream more in the chest/shoulder.

[IPEsq]

What about poultice without a wrap? It may at the least have a little cooling effect. Slather on some clay after one of the cold hose sessions. When it’s fully dry, it’s probably time for another cold hose anyway.

[PNWjumper]

Is there a reason they’re so concerned about the swelling? I would think that the abatement of pain and his willingness to bear full weight would be the positive progression you’re looking for. Swelling can take a long time to go away.

I have a TB who gets an annual case of lymphangitis/cellulitis. Sometimes the swelling goes down in a matter of days, but there have been a few times where it took 3-4 weeks for it to go down all the way. This last time it was closer to 8 weeks.

We just got done with a case of it that started in the end of March. The whole-leg swelling remained between hock and fetlock for maybe 7-10 days (I kept him wrapped and/or sweat-wrapped through that time). Then some weird swelling remained on the medial side of the leg midway between hock and fetlock for another 6-7 weeks. He was back to showing at 1.40m in mid-April. But there was still swelling present in the leg (no tenderness, obviously no lameness, and had the “all clear” from the vet). Complicating this run with it, though, was the fact that his kidneys failed (thanks to a round of Osphos) in in January, and so we didn’t want to do bute. I suspect that the anti-inflammatory properties of bute would have helped the swelling a bit more.

The treatment we’ve done in the last several years has been: Immediate Gentamycin, Excede (or Naxcel), and bute or banamine, and then ongoing Uniprim and bute (or banamine). Usually sweat-wrapped for the first few days and then standing wraps at night for the next couple of weeks. My guy lives out 24/7 and we’ve never restricted his movement at all. But my vet changed it up this time and said that she didn’t want to hit him with Naxcel and wanted to go back to Penecillin instead. So we did the treatment above with Penecillin swapped in for the Excede/Naxcel.

Are you wrapping his leg now that you’re past the pain part? My guys leg would swell considerably more when I didn’t keep it wrapped. Obviously they can’t tolerate it initially, but as soon as they can I get a wrap on there and keep it on for a while (comes off daily for handwalk/lunge/ride, but then back on again). Also, I got a microcurrent patch to put on his leg this time and that seemed to help a bit with the swelling (comparison was the days that I put it on under the wrap versus the days I forgot to put it back on).

[Angela_Freda]

Yes Yos worst case was up to the stifle, he walked like a drunk sailor with a peg leg… and when he was in he was in a compression wrap, when oozing it had gauze and cotton underneath, but once oozing was over it was just no bows and vet wrap, all the way up to the stifle.
When oozing it got washed with antibacterial/antifungal soap, then cold hosed 2 times daily for 30 minutes with pressure.
Out as much as he could be out too.

The time he was swollen up to the stifle, the first bout his leg went back to normal.
About the 2nd or third time though it was less severe it also never went back to normal.

[Nestor]

To answer some questions… he’s sound when going, but it’s very painful to put any pressure via wraps or even applying poultice. Again, we did wrap, but then he didn’t move, so his leg got HUGE. According to the SAA, he has an active infection (result was 1019), so we’re really just trying to get that under control, as well as his discomfort with contact. The leg is hot and painful to touch. Perhaps it hurts when he goes and he’s just a trooper? It really doesn’t make sense but I do have videos to prove it! :lol:

We haven’t cultured anything, the vet mentioned a possible biopsy but she wasn’t keen on it. I’ll definitely ask about it tonight if the Excede isn’t doing the trick. She did pull blood to run a titer for something rare, but that takes time to come back.

I hadn’t thought about poultice without a wrap…

[theresak]

So you know for sure the infection is still active? Have you started tapering any of the banamine - to see if the fever comes back and how sound he is?

If the infection is still raging, you need a culture to tell you what kind of bacteria and then I’d consider a regional limb perfusion if possible.

Once the infection is under control, the leg may stay slightly to greatly enlarged forever. The tissues are all stretched out and they sometimes don’t ever go back. My horse’s right front is slightly larger than his left from the knee down due to the last case of cellulitis.

You can do a DMSO/Furacin sweat or a poultice without a wrap. I’ve done both, and put a layer of paper towels over the top. The Furacin will turn bright red if exposed to the sun and look like blood, so FYI.

[Angela_Freda]

We used 3 ABs when Yos was the worst… can’t remember which ones, but we used a gram negative, a gram positive and then metronidazole rectally [cause he was being a pill for the IV injections and the oral dosing.
This was all at the same time.
I have done a poultice only w/o wraps on a weanie with a fat leg… worth a shot.

You say he didn’t move with wrap on… is he used to having standing wraps on? Is he not moving cause you’re wrapping above hock or are you not wrapping that high?

[Nestor]

@theresak

So you know for sure the infection is still active? Have you started tapering any of the banamine - to see if the fever comes back and how sound he is?

If the infection is still raging, you need a culture to tell you what kind of bacteria and then I’d consider a regional limb perfusion if possible.

Once the infection is under control, the leg may stay slightly to greatly enlarged forever. The tissues are all stretched out and they sometimes don’t ever go back. My horse’s right front is slightly larger than his left from the knee down due to the last case of cellulitis.

You can do a DMSO/Furacin sweat or a poultice without a wrap. I’ve done both, and put a layer of paper towels over the top. The Furacin will turn bright red if exposed to the sun and look like blood, so FYI.

Yup, that’s what the SAA tells us. We’ve dropped the banamine with no change in soundness or body temp, but don’t want to take him off of it as we want the antio-inflammatory properties still.

I’ll definitely ask about a culture tonight if the Excede isn’t helping, we’re running another SAA.

[Nestor]

UPDATE! Just finished the recheck, and his SAA dropped to 195! So the Excede (possibly the Baytril he’s been on) is doing the job.

He’s also definitely more comfortable to palpate, so more good signs.

The vets also recommended trying either a GameReady system or IceVibe, since he can’t be out as much as we’d like, so I’m renting a GameReady system after hearing good things about it and and that it’s good at helping with lymphangitis.

[IPEsq]

I think that’s a good call. IceVibe is probably going to be as uncomfortable as a regular wrap, and the gel packs don’t stay cold very long compared to a lot of other products. You can use the vibration on its own, but where he’s at now, GameReady or maybe those whirlpool boots might be more comfortable. Glad he’s showing improvement!

[mlb722]

Sorry, lymphangitis is really tough. Sounds like things are improving though.

IME each episode left my mares leg more permanently swollen although her soundness remained the same. 24/7 turnout was essential for her. It could take awhile (at least a week) for heat to go away. Smz’s worked for her. The key was to get the antibiotics started asap. I found poultices to be helpful. Also Vaseline on any split skin. Her hair would fall out.
i really thought one episode would kill her, but it ended up being colic. The leg was really swollen permanently in the hock area.