I am looking for advice from those who have experienced tendon sheath infections and your experiences and outcomes.
On June 1, my horse was in a horrible accident involving barbed wire and ended up with a severe laceration across his pastern. He was brought to the emergency vet and they did a standing lavage, regional limb profusion, and oral antibiotics. A tendon sheath laceration was confirmed with a tendon tap.
At that time, they recommended surgical lavage. That was not an option for us as it would cost over $10,000 and they were still only giving him a 50/50 chance.
So we were sent home with oral and topical antibiotics. We did another RLP a week later. The would is closing up nicely, however there is still a lot of swelling and inflammation in that leg. He still does not want to put weight on it (he was weight bearing without lameness the first week while it was still open and draining).
I talked to the vet yesterday and she said “he is not going to get better” and recommended putting him down.
I am not ready to do that yet. He still very much has his will to live and I don’t feel like I can take that from him this early in good conscience. I just read an article about a horse who had similar injuries and after 5 months of stall rest is back to competition in eventing again.
He is at my house so I can give him as much attention as he needs, I am also a physical therapist so I can do the rehab. Am I just delaying the inevitable? Do we have a fighting chance?
I would be worried about supporting-limb laminitis.
I’d say you’ve come a good long way in just under a month in.
looks like the healing is coming along.
Not a vet here but I’ve seen and taken care of some pretty bad
Injuries and diagnoses where
A vet has mentioned euthanasia
But the horse and I disagreed.
Inflammation can take a while
To completely go away.
What I do to help them…
Keep nutrition top quality. I like
To put them on good Vit/min
Like Amino Trace plus or Vermont Blend. Tissue is re-building and needs help.
Also good anti-inflammatories like Omega 3, I use Omega Horseshine - ground flax and vitamins. Also natural Vit. E.
I use Elevate.
For comfort/pain/healing help, I really like
Smartflex Rehab pellets. Loaded with good anti- inflammatories
Plus horse is much more comfortable within a few days.
I also like to offer an in/out setup where horse can decide if they want to hobble in/out.
Movement helps healing and circulation which you need now.
It can seem like a slow process
But keep fighting for and with your horse.
You’ve come a long way in a relatively short time.
Hoping for a good outcome for you.
That would really worry me as it’s a huge quality of life concern and high risk of comprising the other leg. I’d get a second opinion but I’ve found that vets are very hesitant to bring up euthanasia without good reason.
My late DH was a veterinarian, trainer, and very creative. His favorite thing was to buy horses at the track and restart and sell them. We bought (yes, paid money) one that had his front leg sliced open by another horse’s toe grab. The race horse trainer spent thousands trying to clean/heal that wound. We packed it with icthomol (sp) and kept it wrapped. It healed up and he came sound. It was winter and we had snow. To clean it up, we’d turn him out unwrapped and let the snow clean the wound up. This was 30 years ago, but he healed up without a scar. The laceration was from just below the knee to above the fetlock. I don’t remember if there was tendon or ligament involvement but it was an ugly injury. I hope this is helpful somehow. Best of luck to you…this sounds heartbreaking.
It looks so much better…I agree you’ve come a long way. Can you get a second opinion??
Why are you not injecting antibiotics? There are some pretty powerful antibiotics available. As to when to give up… your horse will tell you if you listen. As my favourate vet once told me… “Sometimes they surprise you, and live”.
Good luck!
Good idea! What about something like Exceed???
Was the wound cultured and are you sure the antibiotic is an appropriate one? I’d get a second opinion before you make any decisions. Sending Jingles.
The problem with this injury isn’t the wound, it’s the tendon sheath. Once there’s infection in there it can be nearly impossible to get it under control and cleared. The tendon sheath is lined with 1970s shag carpeting and you know that stuff is impossible to clean. If you would like comfort in your decision, I would recommend tapping the tendon sheath and looking at what types of cells are in there and trying to culture the fluid. If it’s full of neutrophils, that means infection, and I’m afraid there’s no good answer.
Very concerning that he is non weight bearing. Something is clearly infected. I would get a second opinion before I euthanized. It is quite possible your choices will be surgery or euth. I am so very sorry this happened to you and you horse!
I was not given that as an option, the emergency vet put us on SMZ and my vet just continued the same. I will ask about this! My regular vet has been hesitant to say much or change anything
It’s my understanding SMZs aren’t a particularly powerful antibiotic.
I do understand that and I think that’s part of what is making this hard to accept. The wound looks better but I know there is still an infection inside. I have read numerous studies and cases where horses with infected tendon sheaths, even if treated without surgery, recover 50-60% of the time, I feel like it’s too early to give up
One thing to consider is what are your benchmarks for it being time. Not weight bearing is a pretty large red flag. Is it consecutive days, a fever, not being able to get up, refusing to lie down, not eating, etc? It can be very hard to be objective with our own horses. We had a perforated tendon sheath back in 2014 that was aggressively flushed and then heavy duty antibiotics. She recovered well but she was at a teaching hospital within 2 hours of the injury. It isn’t something I would feel confident treating at home, especially if there’s an active infection. I hope you have a good outcome and encourage you to think through your indicators of when it’s time so that you can navigate the days ahead.
My horse had a tendon sheath inflection many years ago. The wound wasn’t as severe as this, and he was never super lame/non weight bearing, but it was still a very serious situation.
The vet started him on penicillin 2x/day and gentamicin 1x/day. I can’t remember how many days because it was a long time ago, but it was a while. Stall rest with daily wrap changes/wound cleaning, eventually moved up to a little bit of hand walking. I think he ended up being on stall rest for six weeks. He recovered fully sound and I’ve been riding and competing him ever since. We got very lucky.
If it were me, I’d be talking to the vet about going a lot more aggressive with antibiotics instead of using SMZs, and I’d be calling them today ASAP.
Are you near a university veterinary medical center? If not, perhaps your vet could arrange for an emergent telephone consult. Some are just more creative, have more/different experience, and have better ideas than others.
I am definitely monitoring him closely, and knowing the severity of the injury I am watching for him to tell me when he’s done and I don’t see that yet. He is eating/drinking/pooping normally, laying down/getting up several times throughout the day, whinnys when he sees me, and no signs of laminitis and the other limb.
At this point, I’d be rethinking the antibiotic choice at the very least.
The recommendation abouve for tapping the tendon sheath for culture/sensitivity and histology is a good one.
I’d definitely take him to a university if that’s at all possible (understanding that a trailer ride might not be an option right now). At the very least, get in touch with a university hospital and explain the situation and see if they’ll do a paid consult. IMHO SMZs probably aren’t going to do much, and clearly they haven’t so far. It’s great to hear that he’s doing well mentally - hopefully you can find the right antibiotic to take care of the infection.
