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  Discussion on Large mass on neck after vaccination
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Member:
Vrich

Posted on Saturday, Jun 4, 2005 - 11:03 pm:

Dr. O - I have a 20-something mare of unknown heritage (probably part appaloosa by the look of her eyes) who developed a lump on her neck after vaccinations about 6 weeks ago. She had EWT, West Nile, and Rabies. The lump has spread out and is very pronounced. The horse has been eating, drinking, urinating, defecating normally, but has been very depressed. My vet came and took cell samples with a needle. The mass is very hard and it was difficult to get any kind of sample. Cytology exam showed no cells that appeared cancerous. The only remarkable thing he mentioned was a high eosinophil count, consistent with either parasites or allegic reaction. She is wormed regularly and rotationally every 8 weeks. We now have her on a course of tucaprim plus 1 gram bute 2X daily. Her attitude has improved markedly. The mass is changing. It has condensed but is thicker and more obvious. It is actually alarmingly large. I am wondering if dexamethasone or another corticosteroid might help in a case like this. There has never been heat associated with the site or an elevated temp. Could this be an allergic reaction? Perhaps an asceptic absess? Thanks in advance for your wisdom!}
Moderator:
DrO

Posted on Sunday, Jun 5, 2005 - 8:29 am:

If the problem is an abscess where the injection site became infected dexamethasone would not be a good choice and may make treating it harder. Did she have a fever before treatment started? An ultrasound may help define the nature of the sweling and a location of a abscess if present.
DrO
Member:
Vrich

Posted on Sunday, Jun 5, 2005 - 8:36 am:

DrO - There has been no fever before, during, or after the vaccination, no local heat. Could you tell me more about asceptic abscess? Is there a possibility of necrotic tissue in the mass? Ultrasound is the direction we're headed in, but I would like to avoid expensive diagnostic and therapeutic work for my boarder, if possible. She is owned and much loved by 2 little girls and their mom.
Moderator:
DrO

Posted on Sunday, Jun 5, 2005 - 12:09 pm:

How about pain on deep palpation of the swelling? Without heat and pain it certainly does not sound like a abscess, more like a large but mild subcutaneous allergic reaction but this can change so I would monitor it carefully for increasing signs of inflammation. For more on abscesses see, Equine Diseases » Skin Diseases » Swellings / Localized Infection / Abscesses » Abscesses and Localized Infection.
DrO
Member:
Frankdun

Posted on Monday, Jun 6, 2005 - 5:31 am:

Went through the nightmare of injection site abscess recemtly. Probably caused by too many injections in same site. Lower left neck. Vet injected 3-way E/W/T + West NIle. Potomac horse fever and Rabies, Srangle. Yes strangles. Apparently did not have IN on board vehicle. Noticed that several days later horse was acting lathargic. But no other symptoms. Four days later had fever of 103, plus area around injections had a defuse liquid feeling swelling or mushiness. Called Vets office immediatly ask for owner and senior partner who I have known for 30 years. He was not available (foaling season) so the vet that gave the injections showed up. Said it was injectiion site reaction;
never eplained it, was in wifes car so no equipment not even a thermometer. Told me to soak three times a day, put on Ichthomal ointment, that's right the black stuff that looks like tar, and give four bute a day. Fortunatly was able to get hold of senior vet. Told me soak o.k. four bute too much start with one per feeding and see if it works T.O. responds well to tratment and is pretty tuff. Senior came out after a week of soaking. Swelling began to consolidate and harden and was triangular in shape about the size of a football. Amazingly the horse was able to move his neck after the initail period no trouble in feeding. The swelling continued to coalese and harden. An ultrasound was taken revealing an abscess about two centimeters deep and 5.5 Cm long, unsure as to width. The abscess was lanced on the 24 of April and then the Vet used a scalpel to make a one inch incession after he placed a needle into the center of the abscess resulting in considerable drainage of puss, serum, and blood. After another four weeks of gauze, blasting with hose, keeping wound open so it would heal from within and antibiotics the horse is now down to a scabe. Good to go knock on wood. Dr.O maybe I am being to harsh on original Vet/Junior partner, but it seems to me, and I know a bacteria transport is always possible, that the whole inoculation procedure, the lack of communication or willingness to explain things caused or at least contributed to this mess. Still believe there is no reason to give rabies or tetanus toxoid twice a year. Maybe West Nile.

Frank
Moderator:
DrO

Posted on Monday, Jun 6, 2005 - 7:31 am:

Thanks Frank,
No I have not seen evidence that WN needs twice yearly either, though I often see the recommendation for places with year round mosquitos. The strangles vacc is certainly the most likely culprit but with all that going into the same spot it may well have been just too much.
DrO
Member:
Frankdun

Posted on Monday, Jun 6, 2005 - 12:55 pm:

DrO
Thanks for your response. There is no way of sorting out what caused what. The senior vet/owner of the practice did do a culture and it was clear it was not clostridia, but not clear as to what the actual culprit was. One good think from now on only the owner will work on the horse. After I got through with all the Vet visits, two different Vet services, ultra sound, two surgical procedures etc. the bill came to well over $1800. I am more satisfied that the horse is o.k. but that is a lot of money for what darn well may have been an error.

I was told by some well "it happens" not often but it happens. Not so said the Senior Vet, and more experienced horsemen. The Vet said it is relatively uncommon, particularly an abscess of that size and persistence. Although it turns out humans some times get them, either as a reaction to the serum (rare) or to a bacteria introduced via the syringe. Several horsemen that have worked with, or owned horses their entire life, (some giving injections when they did not even know what they were doing)said they had never seen an ISA. Your article on subject was classic. Had I gone to it when symptoms started I would have been ahead of game.

Don't know if your recall, but some time ago you were a big help with a different problem. We were having trouble with another quarter horse who was head tossing and running blindly like he was being swarmed by bees. You pointed me to an article on Photic Sensativity. Nobody around here could diagnose, the most common diagnosis was bad behavior, possible brain tumor, or teeth - When in doubt blame the teeth. Turned out you were right on target. Showed the article to a young Vet who was excellant with large animals. She owned a horse herself. Unfortunatly the practice where she worked did most of its business on small animals, and they got out of the Horse business. Now all she does is small animal surgery all day long. She was great but no longer does large animals. Anyway we tried the Cypro as well as the other more expensive medicine that is recommended in the article on Photic sensativity. Neither worked. The only relieve the horse would get was in a dark stall in the corner. When in the light not even the darkest face masks helped. Finally, just on a hunch, after some research, this vet recommended melatonin. Don't know why. At first we gave 12 MG in conjuntion with cypro then withdrew the later. Guess what it worked. Cheap old across the counter people melatonin stopped the head shaking. So we simply started Copper on a regiment of 12 Mg. of Melatonin in May and bingo no problem. We discontinued in early October, and then resumed in May. Copper has been sold since but is doing fine and medication continues to work. So in the future you might keep melatonin in mind as an alternative to the expensive stuff which did not work in coppers case anyway. Wanted to get back to you for some time on the Photic Sensativity thing and give you feed back so this gives me the oppertunity to say thanks and pass on the bit of info on malatonin as treatment.

With regard to the injection site problem, the horse T.O. has never exhibited this type of reaction to the same injections before. Will simply making sure that injections are spread out on body, Strangles given Inter-Nasal, etc minimize the chance of recurrence? Also, why would you give Rabies and tetanus twice in same year? what is the efficacy? I mentioned this to Senior Vet and he looked at me kind of funny and seemed surprised that it was done. Said no need for that althought West Nile if the first shot is given in April. Have you ever heard of the need for two rabies or tetanus in same year?? This one has me beat.

What about preparing the injection site? Does that help at all as far as bacteria?? Your article touched on it briefly but not in-dept.

Anyway for those that are following this issue this is what I encountered in summary:
T.O. first became subdued, for him, several days after the shots. His ears told a story. Could not lower neck to graze.

Then fever of 103 with squishy swelling in neck all around site of injections. Dosed with one bute per day no antibiotics yet. Fever minimized neck movement became less painfull. Hot packed horse for three weeks, swelling solidified into large hard lump about size of football and was triangular in shape. Abscess was then lanced with large barrelled needle, and then incision was made with scalpel. Horse was then placed on five days antibiotics, medicated gauze packed in abscess, and water under pressure constantly applied into incision for about a month. After all of this T.O. only has scabe about the size of a small grape. Lot of work but worth it, would not want to go through this again thou.

Oh, Dr.O what was the Ichthamol ointment supposed to do for an abscess an inch or more into the muscle tissue? That one made as much sense as two rabies shots a year.

Thamks again for your time, and again your articles have been right on.

Frank
Member:
Vrich

Posted on Monday, Jun 6, 2005 - 9:44 pm:

Today, Mocha's neck lump is very condensed and very pronounced. It has started very slowly exuding pus that is thick and creamy white. Am I right in assuming that the tucaprim has helped to cause a deep abscess to begin to surface? It also has some heat associated with it now. It seems to me that it may need to be lanced at some point. What are your thoughts, DrO? Thanks!
Moderator:
DrO

Posted on Tuesday, Jun 7, 2005 - 6:49 am:

Hello Val,
No, antibiotics actually slow the progress of the abscess. But now that it is draining it should be opened completely so that it drains well and can be thoroughly flushed and treated daily.

Thanks for the heads up Frank. If you would post the information about your experiences with photic head shaking in that topic I am sure this would help others who have run into a difficult case.

I do not know any reason to justify regular twice yearly tetanus or rabies vaccinations. The rabies vaccine is not considered as reliable in horses as it is dogs and cats but do not know any work that shows more frequent vaccination increases efficacy. I have seen Animal Control recommend rabies boosters when a rabid animal was found on a nearby property. The icthammol is considered a drawing agent to help abscesses surface by counter-irritation, you are right an abscess that deep would not be very responsive to it.

Simple alcohol swabs are of little value. Other than making sure an injection site is clean and dry it is time consuming to prep a site adequately to significantly lower the background bacterial count. Such preparation would double the cost of the injection and since I have not ever had an injection abscess without such preparation would find it hard to justify.
DrO
Member:
Vrich

Posted on Wednesday, Jun 8, 2005 - 10:40 pm:

DrO - The mass has now gone from comparatively large, lumpy and slightly rounded to a huge deep hard lump with a smaller one next to it like a baseball under the skin with a ping pong ball next to it. It started to ooze pus, I assume at the site of the needle aspiration. Now it has multiple openings that are weeping blood and serous fluid, There is some heat associated with it. I have spoken with my vet, planned a time to lance and drain it, and initiated warm compresses. Honestly, it's a scary looking thing...like a boil only worse. I am actually glad that it is starting to surface and hoping that it softens so it can be excised relatively easily. Poor little mare has really been through the mill with this and we really have no idea why it started, except that it began shortly after the vaccines were injected. Thanks for all.
Member:
Frankdun

Posted on Thursday, Jun 9, 2005 - 3:00 am:

Dr. O will do as you requested and post my experience with Phoetic Sensitive horse in that topic area.

As for injection site abscess. I learned time and patience is the key once it was determined that is what I was dealing with. This may be usefull to Val and others! Even though I caught the entire process early on, within days, it took a good 3 weeks plus of hot soaks two to three times a day to get the mass to consolidate and harden to the point were it was ready for lancing. I used a combination of those micro-waveable heat pads, and just plain hot water towels for soaking. One bute a day was enough to keep the horse's temperature at or below 101.5 at night. (Carefull with the microwave heat pads they do get hotter than they seem at first touch, and they can rupture.) Key is to follow instructions on microwave pack so as not to get too hot to burn horse. As I noted T.O.'s abscess was far too deep (1 Cm+ to outboard wall) to open by itself. After consolidation Vet lanced first using large barrelled neadel, then followed its path with scalpel. Stuff flew everywhere. My understanding from senior Vet, and followed the regiment to a T. is: get the abscess to consolidate, anti-biotics during this phase is counter-productive, as is large doses of bute since they both interfere with the inflammation process which is key to healing. Once the abscess was lanced vet Rx'ed 5 days of uniprim, continue conservative minimum use of bute, as needed. Also, as noted he stuffed about 5 ft of medicated gauze into incession. I removed a ft a day after. Also, twice a day I would literally blast water into the incissed area to flush it and keep it clean. I used a garden hose full blast within inches of the wound (I got wett'er than the horse). Again Vet explained, blasting the wound would flush it, keeping it clean, help continue the irritation/inflamation process, and most importantly keep the incession open and draining so the abscess would heal from the INSIDE TO THE OUTSIDE. The abscess can't be excised like a cyst, it needs to heal inside out. While this soaking process was a long haul "4 weeks plus" the progress in the reduced area of swelling was evident to the eye. Also, the drainage was obvious. In that regard, each time I cleaned the wound (twice a day) the vet had me prepare a vaseline "Table" under it. That is, I smeared a layer of vaseline in a wide swath below, not on the incession. The vaseline prevented "scalding" (blistering or burning of the skin) from the material draining from the abscess. Today about 5 weeks after lancing, all of the swelling is gone, there are no lumps, or dimples, at the abscess/incession site, and all that remains is a small scabe about the size of a pea.
Member:
Marroon

Posted on Sunday, Jul 24, 2005 - 9:17 am:

Frank, Val & Dr. O,
Have any of you heard of this abscess situation reocurring--like on a monthly basis in the same site area? The 19 year old we have now has this happen about monthly now. Been dealing with it for three years. At first we used hot pak/epsom salt water. Now we have turned to Betadine solution and hard hose cleanings. Have had about 4 of them lanced, the rest busted open themselves and just treated it from there. Just got done with iodine (?) I.V. once every four days for three rounds and followed up with sodium iodide every day for 14 days (1 oz/day). This is a tough one due to the abscesses coming out between the poll & whithers by the mane--in fact we are loosing clumps of mane now. Its about 3/4 of the way up. I posted once before on this subject but at that time February this year. I was chasing anything I could to find an answer. Daily Strongid C2 now given and was using ChonDrOitin, MSM & Gluclosamine--but quit that as I have learned the combination doesnt work. I heard there is a purple colored powder that one boarder used a long while back and this helped her horse completely. Any info is appreciated. Thanks!
Moderator:
DrO

Posted on Monday, Jul 25, 2005 - 7:36 am:

This is not a vaccine situation CJ and is more like fistulous withers, see Equine Diseases » Skin Diseases » Swellings / Localized Infection / Abscesses » Fistulous Withers & Poll Evil. If after reading repost in a new discussion in that topic and be sure to include all the information in this post.
DrO
Member:
Vrich

Posted on Wednesday, Jul 27, 2005 - 3:17 pm:

I'm happy to report that we have had no recurrence of the abscess. It is hard to believe, looking at her now, that it ever happened. The site is virtually gone, hair re-grown, just one tiny scab remains. I would never have thought it possible given the depth and breadth of the wound. Good luck with your situation. Abscesses are a challenge for sure.
Member:
Marroon

Posted on Wednesday, Jul 27, 2005 - 6:47 pm:

Thanks Val, I sure am happy to hear of your horses recovery! This has been a long battle and the two times the doc got samples they came back with nothing. Even the biopsy held no information to go on. He had surgery at KSC before we got him and really no info from there either. The ultra sounds hold little to no info as this is deeper and the only suggestion from the doc is to haul him miles a way for an ultra sound that is much higher in quality and observation. Can't really remember what he called it as I can't afford that. So we deal with what we have and will continue to luv him. He's sound otherwise and works well. I appreciate knowing that you have not had to deal with this over a long period of time.
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