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  Discussion on Recovery timeframe for late-gelded horses
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Member:
ekaufman

Posted on Wednesday, Nov 19, 2008 - 1:41 pm:

My 6 year-old stallion was castrated on November 5th. He is a very large and unusually active and elastic guy. He spends more time than he should leaping through the air and running /twisting on his hind legs. As a precaution, the surgeon "sutured the heck" out of the cords, but left everything else open to drain. The procedure was uncomplicated, and he looked good afterwards.

He came home with instructions to stay sane but active (I read this part to him twice, slowly), on no meds. The incision is large and seemed to drain appropriately.

A week post-surgery, he developed quite a large amount of swelling- slightly larger than a softball on either side of his sheath (so, 2 softballs), with additional swelling further back. He was very stiff and mopey, but did not have a fever. All vitals were normal. The vet recommended he go on SMZs and banamine.

2 weeks post-surgery, the inflammation is greatly reduced-- think 2 tiny cuervo-sized limes on either side of his sheath, and there's is only the occasional drip of dark yellow serum from the still-open incision. Vitals still normal. But the horse is still very painful and fairly mopey. He's unwilling to move and generally wretched.

My vets (now there are several involved) are concerned about sclerotic cords, even though we have no pussy discharge and the inflammation is greatly reduced. I am concerned, but trying not to spend money on diagnostics if patience is the proper investment. Speaking just for today, the remarkable symptom seems to be pain.

So my question is: what is a typical timeframe for pain reduction post-castration in a mature horse? Are there any simple ways to differentiate between a slow recovery and a recovery gone wrong?
Member:
paardex

Posted on Wednesday, Nov 19, 2008 - 3:30 pm:

I am used to horses gelded after 3 years old and often in 'showcondition' and thus not totally calm.
They all were totally recovered after about 5 days of a little dripping etc. So I would be frightened by this situation.
But perhaps I was just very lucky. Usually they were gelded like yours -open wound
I am talking of about 25 horses 'in my care' gelded like that to give you an idea of how often I've been around this.
Jos
Member:
rtrotter

Posted on Wednesday, Nov 19, 2008 - 4:02 pm:

I've had a number of horses gelded both open wound and sutured. I have had less problems with the sutured ones. They were sutured both inside and outside. I had very little swelling and no problems.

However, they all got antibiotics and bute for the first 2 or 3 days and then were put on oral Sulphur/Trimeth. pills for another 5 days.

Instructions were to make sure they moved, either jogged, lunged or turnout (if not nuts). Hose the incision and call the vet if any problems.

You must make the horse move, so the swelling stays down and the incision can drain properly.

After two weeks, I'd say you might have a problem, but the vet is the only one that will know for sure.
Member:
ekaufman

Posted on Wednesday, Nov 19, 2008 - 10:18 pm:

Hi guys, thanks. My aftercare instructions included exercise, though they are now suggesting that I allow him to be quiet if he chooses, since the site seems to have drained well, and he's so uncomfortable.

My vet came out to look at the horse today. It was kind of interesting watching her try to consult with the veterinary surgeon on her cell phone while she had her hand up in that incision.

She concurred with me that everything looks ok except for the horse, who is clearly miserably painful. The inflammation is now minor, and she finds no evidence suggesting sclerotic cords, or a blockage, or anything else. His vitals were normal for her as they have been all along for me. She drew blood for a CBC and looked at him for a while.

I have proposed a working theory of of "phantom testicle pain" which is similar to phantom limb pain for amputees. The vets aren't taking this idea seriously, of course. But really we're waiting to see what the bloodwork suggests. It is an unusually large incision, so one theory is that it is simply taking him a long time to recover.
Member:
scooter

Posted on Thursday, Nov 20, 2008 - 6:20 am:

Hi Elizabeth, at the barn I used to work at they had a 6 yo stallion castrated. He had softball swelling at first also. The swelling went down, but not completely as you describe and he seemed to "hurt". The lady had the vet down several times.

No infection seemed to be present, but he was put on some kind of antibiotic for just in case, but I don't remember what it was for sure...but I'm thinking smz's, but am not terribly sure on that.

The vet recommended stalling, with hand walking as often as possible. He had been turned out...was not "rowdy" before this recommendation. The odd thing was he seemed sorer and a little more swollen AFTER turn out, Even though he was quiet and kept in a smaller pen.

He recovered, but it took about 6 weeks before he was "back to normal"
Moderator:
DrO

Posted on Thursday, Nov 20, 2008 - 8:18 am:

Elizabeth,
We discuss routine recovery and signs of possible complications in the article on castrations. I still do open castrations with no routine postop medication and I expect all horses to continue to move and eat fairly normally from the time they recover from the anesthesia onward.

A horse that is "unwilling to move" at anytime post anesthetic recovery needs further investigation into what is going on. If the problem was infection I would have expected fever and swelling.
DrO
Member:
ekaufman

Posted on Thursday, Nov 20, 2008 - 2:12 pm:

Thanks DrO. I did read the article when I was trying to figure out whether we were still on a relatively normal path, and it helped me to draw the conclusion that we seem not to be.

We certainly had swelling (now greatly reduced), but never a fever. His CBC was "unremarkable" whatever that means, so our only symptoms are painful behavior and a short stride on the right hind (he has no heat or swelling anywhere in that leg, and no sign of injury). The vets have met him healthy, and keep asking whether he "did something stupid." Is he breathing? Then probably so.

My alternatives seem to be expensive diagnostics (ultrasound etc.) inpatient at Littleton, or waiting to see whether he improves with pain management and time. I'm going to take the less expensive approach for now, with the assumption that a problem requiring intervention will make itself obvious soon enough.
Moderator:
DrO

Posted on Friday, Nov 21, 2008 - 7:24 am:

With no remarkable swelling and no fever your course may be OK. Check for fever daily. Take a good second look at your horse without focusing on the castration: could something else be going on?

If on antibiotics already I would be sure they are continued and given religiously: it will take a while to treat a infected cord as blood supply may be reduced to the newly cut cord. Also goodly doses of NSAID's to get the guy comfortable seem fine.
DrO
Member:
ekaufman

Posted on Thursday, Nov 27, 2008 - 12:19 am:

Here's an update, 3 weeks post-surgery. We got results on the culture taken 2 weeks ago, and it came back positive for methicillin-resistant staph and strep, with a recommendation to put the horse on a 5 day course of Naxcel.

I consulted with my vet and with the veterinary surgeon. We all agreed that the horse simply doesn't seem all that sick-- he's still stiff-gaited with a small amount of inflammation, but has normal vitals and seems on the whole to be mending, albeit slowly. We all would expect him to be hugely swollen and feverish with the infection described by the lab, especially as we have just spent 14 days with SMZs killing off the competition to these bacteria.

Then again, it's a holiday weekend, and all of us agreed that if we decided to do nothing, he would blow up and DrOp right in time for the turkey.

So my vet very kindly gave me Naxcel powder and several vials of sterile water, for use w/o an emergency vet call and associated costs, in the event that he does take a turn for the worse over the next few days. If I don't use it, I can return it.

In the meantime, I'll continue the firocoxib and ulcerguard, and hope to see him mend as he has been without the Naxcel.

The stiffness in gait continues to bother me, but the surgeon did say that the size of the incision (it was nearly 6") could be bothering him-- it is still wide open. In any case, he has no heat or swelling in any part of the stiff limb, so the current plan of paddock rest and firocoxib will probably not send us backwards if he has somehow injured himself during his recovery from surgery.
Moderator:
DrO

Posted on Thursday, Nov 27, 2008 - 8:11 am:

Thanks for the update and delighted to hear things are improving if only slowly. Elizabeth what breed is this horse? I have always found castration on adult Arabs seems to bother them a touch more than some other breeds.
DrO
Member:
ekaufman

Posted on Thursday, Nov 27, 2008 - 11:09 am:

Happy Thanksgiving DrO!

He's a Spanish Purebred from one of the very old bullfighting studs in Spain-- also a hot blood, but not from Arab lines. Here's an old photo:

Member:
dres

Posted on Thursday, Nov 27, 2008 - 2:27 pm:

oh i hope he gets better soon.. !~

On the first day God created horses, on the second day he painted them with spots..
Member:
ajudson1

Posted on Thursday, Nov 27, 2008 - 5:15 pm:

Elizabeth,

He's a very nice looking fella! I hope he continues to improve for you.
Member:
ekaufman

Posted on Friday, Dec 12, 2008 - 1:44 pm:

Hopefully closing out this thread-- at just over 5 weeks post-surgery, he looks and feels good. I never treated with Naxcel, since he never showed signs of SMZ-resistant infection (maybe a false positive at the lab, or maybe he took care of it himself?). At any rate, the incision is nearly closed, drainage done, attitude good, vitals normal. So I'm thinking we had minor complications, and an abnormally long recovery.
Member:
lilo

Posted on Friday, Dec 12, 2008 - 3:47 pm:

Great news, Elizabeth! Lilo
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