Struggling with lymphangitis...

[beowulf]

I took care of a school horse who struggled off/on with lymphangitis. He was almost always sound except on the most swollen days, but his hind legs were thick from stifle to hoof. He was on steriods, anti-flam, and antibiotics almost round the clock because his lymphangitis was very hard to manage.

Couple things that I noticed:

1. His legs would always balloon after wrapping. Terribly. If he had any sort of wrap on him, the next day his legs would be ginormous and painful. Stable and bandage wraps especially. No matter how clean or perfect the wraps were, any sort of pressure seemed to trigger a flare-up.
2. Stall time: if he was kept in a stall for more than 12 hours, he wouldn’t just stock up, he would flare up and be very lame.
3. Water - the more OCD the owner was about drying/keeping his legs clean after contact with dirt/water/anything, the worse the flare-ups were. There was definitely a correlation between activity on the legs (rubbing, brushing, drying, toweling) and flares.
4. NEVER pick, scratch, curry or rub any scurf, keratosis, crud or scabs on the legs. If there is a cut, gently wipe clean with baby wipe and spray Alushield or WoundKOTE.

Cold hosing did not help him and IMHO it made the flares worse and more painful. My opinion of wrapping is that you better make damn sure the leg and wraps are sanitary and 100% clean otherwise you are just trapping bacteria, dirt and grime in between the wraps and the skin which is bound to have a very reactive reaction in a horse with lymphangitis.

The best thing for him was an absolute arsenal of steroids and ABX and 24/7 turnout. The owner really pushed against it, but after the 200th episode right before PC championships, the vet finally got her to concede and switch him to a 24/7 turnout reigme. He was much better with the forced movement, had fewer episodes and I think the benign neglect was good for him. The owner really was the type to pick and package and wrap and helicopter and IMHO I think it made it worse for him.

He had a whole host of problems and was definitely immunocompromised. He had his own medicine cabinet, that is how much ABX, steroids and joint supplements/anti-flam supplements he was on.

Unfortunately, for him, his other issues compounded the lymphangitis and he was PTS.

[Nestor]

@theresak

I assume he’s standing still while you are cold hosing, so perhaps the hosing is not cold enough and not enough pressure to prevent the fluid from returning. You could try some ice packs/boots and wrap those on snugly and go for a slow walk right after working him - see if the cold + compression helps.

To truly make an effect with just cold hosing, it has to be really cold water and you have to have water running over the whole affected area, which is hard to do with a hose (the Leg Soakers are really good for this). When I ice, I always wet the leg too so it gets colder.

I know he doesn’t necessarily do turnout well, but ideally you would work him, ice him, and wrap him or turn him back out for slow, constant movement.

That would certainly be ideal! He does turnout somewhat, he’ll go out for a few hours and he’s a wanderer, so he moves the entire time. On a day when the stars align, he’ll happily stay out all day. But if there are bugs, or the wind blows the wrong way, or a friend gets upset, he runs and screams to come in. :rolleyes:

But he also absolutely will not move with a wrap on. Normal standing wraps, somewhat. Anything more than that, and he will kill it or himself, whichever comes first. Or just not move, and paw until you take it off (which multiple times has been all night, trying to tell him to suck it up - doesn’t work). I went so far as to rent a Game Ready unit, and he tried to kill the sleeve, without me even turning it on. Luckily it wasn’t connected yet either, as I knew better than to go further than just putting the sleeve on.

I did invest in Back on Track standing wraps (tried the Quick Wraps and he wanted to kill those as well) and hock boots (which he will probably try to kill, but at least I can say I tried), but I’ve seen with him in the past that BoT stuff doesn’t help his legs in the summer - he always stocks up behind some anyway, and BoT stuff doesn’t help it go away, whereas working him in regular boots or wraps does. So I will try those in the cooler weather, when I’ve found them to be more helpful.

[Nestor]

I should clarify for all, at this point we are as good as we are going to get. Perhaps when it’s not as humid out, his leg will look better day to day. But he’s getting regular turnout, as much as he will handle, and is getting put back to work. His infection is gone, the leg isn’t hot, and he’s sound. He’s also 20, though he looks and acts more like 8, so I’m not looking for anything from him. Keeping him in work at this point is more for his well-being than for any kind of goals or ambitions of mine.

[Nestor]

@beowulf

I took care of a school horse who struggled off/on with lymphangitis. He was almost always sound except on the most swollen days, but his hind legs were thick from stifle to hoof. He was on steriods, anti-flam, and antibiotics almost round the clock because his lymphangitis was very hard to manage.

Couple things that I noticed:

1. His legs would always balloon after wrapping. Terribly. If he had any sort of wrap on him, the next day his legs would be ginormous and painful. Stable and bandage wraps especially. No matter how clean or perfect the wraps were, any sort of pressure seemed to trigger a flare-up.
2. Stall time: if he was kept in a stall for more than 12 hours, he wouldn’t just stock up, he would flare up and be very lame.
3. Water - the more OCD the owner was about drying/keeping his legs clean after contact with dirt/water/anything, the worse the flare-ups were. There was definitely a correlation between activity on the legs (rubbing, brushing, drying, toweling) and flares.
4. NEVER pick, scratch, curry or rub any scurf, keratosis, crud or scabs on the legs. If there is a cut, gently wipe clean with baby wipe and spray Alushield or WoundKOTE.

Cold hosing did not help him and IMHO it made the flares worse and more painful. My opinion of wrapping is that you better make damn sure the leg and wraps are sanitary and 100% clean otherwise you are just trapping bacteria, dirt and grime in between the wraps and the skin which is bound to have a very reactive reaction in a horse with lymphangitis.

The best thing for him was an absolute arsenal of steroids and ABX and 24/7 turnout. The owner really pushed against it, but after the 200th episode right before PC championships, the vet finally got her to concede and switch him to a 24/7 turnout reigme. He was much better with the forced movement, had fewer episodes and I think the benign neglect was good for him. The owner really was the type to pick and package and wrap and helicopter and IMHO I think it made it worse for him.

He had a whole host of problems and was definitely immunocompromised. He had his own medicine cabinet, that is how much ABX, steroids and joint supplements/anti-flam supplements he was on.

Unfortunately, for him, his other issues compounded the lymphangitis and he was PTS.

This sounds similar to what I noticed!

IF he has flare-ups in the future, and it becomes harder to handle, he can come to my house and have 24/7 turnout that should satisfy his stupidity - I have stalls with attached sand paddocks, ready and waiting for him, including friends. But that would mean retirement, because I have zero places to ride, so I’m trying to avoid that for him as well, since he is sound and happy with a job.

I think I mentioned that we did a thyroid stim test to check for Cushings, and he was completely normal. Him being immunocompromised in some way would explain not just this episode but some past nondescript fever episodes he’s had.

(I am continuing to discuss this for anyone who might be searching on lymphangitis in the future, as I did before posting this.)

[theresak]

Was this preceded by any injury, etc.?

My horse seems to get cellulitis around the same time of year and/or related to mud. So my vet has agreed he’ll go on SMZs for 5 days if it’s muddy + right time of year + gets anything that breaks the skin barrier on his lower legs (scrape, cut, heel grab, skin funk, etc.). So in the future, you could chat with the vet about doing that.

Also, chat with the vet about things to support his immune system. For my horse, adding Vitamin E up to 8,000 IU per day helped a lot with this and skin issues for a few years, but we had cellulitis 2x this winter/spring due to fetlock sores + mud. I asked about testing for Cushings since he seems prone to weird infections but he’s a bit young and doesn’t really have other symptoms.

[Nestor]

@theresak

Was this preceded by any injury, etc.?

He did get a tiny cut on that leg, right above the coronet band. So inconsequential that when I found it picking his feet (I’m very attentive so it was new), it had already scabbed over. Didn’t think anything of it, until a few days later when his leg blew up.

I’ll certainly be extra careful about future cuts or abrasions, and if he has future flare-ups, I can also consider having antibiotics on hand to be proactive. Good thought!

[SAcres]

OP, daily trot work greatly helped my old TB with his lymphangitis. He was out 24/7 but I still saw a huge difference after 20-30 minutes of trot work. I usually put a modified sweat wrap on him which was furazone, plastic wrap, and then a polo. He was not rideable so I would lunge or jog with him. I would start as soon as he could somewhat trot (he would work into soundness) and keep up daily sessions until his leg was back to normal. His first few lymphangitis flares completely shrunk down but as he got older the leg didn’t shrink down completely. We always got him down to where you could see some tendon definition though. I would keep working on wrapping him, it was soooo helpful for my guy.