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Discussion on Abcess for over 2 months
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Member:
Sswiley
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Posted on Monday, May 15, 2006 - 10:55 am:
Help !!!
Our pony has an abcess that won't go away.
It started the begining of march. Pared it out and got drainage from the sole. Kept it clean and wrapped for 5+ weeks. Betadine/sugar packs, plus flushing the hole. It flared up again and traveled up coming out the cornet. Flushed and wrapped it but it healed over in only two days. It was obviously too early. That was 9 days ago. Have been soaking it all day(soak boot with warm water/epsom/betadine poured in during the day. Numotizine pack at nite. Now it is just growing down with the hoof. You can actually see a discolored patch under the wall. She has a pulse and she is lame about 4 out of 10. Waiting till it grows out is out of the question. My vet does not believe there is any forign body involved or coffin bone involment. Is it out of the question going in thru the side of the hoof wall? She already has a big defect about 1 1/2 inch long growing down. I just cant imagine waiting for this to come out the bottom. Right now it is about 1/4 to 1/3 of the way down.
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Moderator:
DrO
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Posted on Tuesday, May 16, 2006 - 6:29 am:
A foreign body would explain the ongoing problem bit it is not the only possibility. Though you got drainage out the bottom, you may not have got all the areas effected drained or the hole you pared became closed up before the sole was finished draining.
I personally think keeping the hoof immersed in water all day will do more harm than good by weakening the healthy areas of the hoof. When you have such problems You need to pare out ALL the undermined horn where ever it may lead you and yes you may come across a foreign body. For more on this see, Equine Diseases » Lameness » Diseases of the Hoof » Hoof Abscesses, Bruises, and Gravels.
DrO
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Member:
Sswiley
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Posted on Thursday, May 25, 2006 - 3:54 pm:
OK
Here is the bad news.
After carving up a bunch more out of her hoof and finding nothing, I took her for x-rays.
There is a big missing or transparent patch out of the side of the coffin bone. They dont know if it is a keratoma or an infection. I am going to get a second opinion of course, but I was hoping I could get some more information about each condition and the treatments etc.
There is only one post about keratomas in the archives. I have heard that I might have to do a complete hoof resection to remove it. Are there complications with that?
and if there is an infection, is the surgery as extensive?
Thanks
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Moderator:
DrO
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Posted on Friday, May 26, 2006 - 12:02 pm:
Shelley, I have just finished an article on Keratomas and you will find it at, Equine Diseases » Lameness » Diseases of the Hoof » Hoof Keratoma.
DrO
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Member:
Sswiley
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Posted on Sunday, Jun 4, 2006 - 1:15 pm:
Still here, And thanks for the article on the Keratoma.
We had decided, after a second opinion that it was most likely a Ketatoma. We scheduled her for surgery yesterday the 3rd. I had a discussion with the surgeon that morning and we decided it was more likely an infection of the coffin bone. He based this by looking at her hoof and looking into the pared holes. He saw healthy tissue and no evidence of the sloughing or whirling characteristic of a Keratoma. The heat was gone and she was sound 2 out of 5. He seemed to think that it was trying to resolve itself. Can bone infections resolve themselves ?
My concern is that if it is an infection. Should we still go in and debride it or at least treat it with anitbiotics? What are the risks of doing that, with the exception of the anesthesia which I know the risks.
According to the X-rays she has already lost a good chunk of the coffin on one side. I would hate to lose more and I am worried that what is there will contiue to cause problems if it is not healthy bone.
I know she is "just a pony" but she is our second pony and I can not afford (emotionaly) to lose another one (and of course neither can my daughter).
The radiographs are very disturbing to me and it seems that people are being very casual about it.
Of course there is also the fact that this has been going on since the end af February.
I will try to get the radiographs emailed to me on monday.
I am getting very worried about this pony.
Thanks in advance.
shelley
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Member:
Sswiley
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Posted on Monday, Jun 5, 2006 - 10:41 am:
Hi Dr O,
Just wanted to keep this thread active as I was hoping for some feedback on the proper way to deal with a coffin bone infection.
Thanks Shelley
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Moderator:
DrO
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Posted on Monday, Jun 5, 2006 - 12:55 pm:
It that is what they think it is, a course of antibiotics could be attempted Shelley.
DrO
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Member:
Sswiley
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Posted on Monday, Jun 5, 2006 - 2:24 pm:
OK, I talked to the vet/surgeon and he still does not want to give antibiotics. He says a lamness of 2out of 5 and the fact that there is no protrusion, discharge, granulation or swelling indicates that the infection is almost resolved. He says that he does not like to prescribe antibiotics (for the same reason you state, increased resistance) and also because it is expensive 600+ dollars and it can cause digestive problems.
Next question: if you dont mind Dr O.
Should I get a second opinion ? (besides you  ) I am worried about losing more coffin bone and having further complications.
Shelley
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Member:
Sswiley
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Posted on Tuesday, Jun 6, 2006 - 12:13 am:
More opinions, . . .
talked to my vet, the one that has seen her this whole time. She does not think she has seen the extreme lamness associated with bone infections. She also has never seen and swelling associated with it. She is concerned that there is something in there like debri or the Keratoma that is causing ongoing lamness that varies from a 1 to short periods of 4 (out of 5). My question is what kind of symptoms do you typicaly see with coffin bone infection.
How severe is the lamness
Is there typically swelling above the hoof.
How common is this cyclic lamness that comes and goes.
She wants me to take her to another clinic that will do the x-rays with the hoof under water to eliminate the air pockets created by the carved holes.
I will try to attach pics of the hoof so you can see the holes. I dont have the radiographs yet. The holes are dark because of the betadine/formaline mixture.
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Member:
Sswiley
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Posted on Tuesday, Jun 6, 2006 - 12:19 am:
one more picture.
Just for fun . . . can you find the goat in this picture ?
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Moderator:
DrO
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Posted on Tuesday, Jun 6, 2006 - 6:54 am:
Let me see, your second opinion thinks the radiographs show infectious osteomyelitis but from the clinical picture he can determine this is resolving without help from antibiotics. Your first vet thinks some other disease process is more likely. Why not have the radiographs forwarded to a veterinary radiologist for his opinion? Let me ask was all this betadine on the foot when the radiographs were taken: it would create irregular radiodense artifacts and may effect interpretation.
To answer your direct question on bone infections, they are painful, but I would not think as painful as a foot abscess. How painful will depend on how "suppurative" the infection is. Active infections with lots of purulence will be more painful.
I have never seen a "primary bone infection" of the coffin bone. The ones I have seen were always secondary to trauma with penetrating or open wounds.
DrO
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Member:
Sswiley
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Posted on Tuesday, Jun 6, 2006 - 11:54 am:
This picture was taken a few days before the xrays were taken, and I had not put anymore betadine for fear it would make it too difficult to see the hoof tissue.
We never found a lot of discharge. There was definitely a path of old affected tissue that we followed when my vet did the carving, and evidence of a solar abscess that is no longer filled. And if the x-rays are accurate and there is significant loss of coffin bone I would think the lameness would have been more severe(?) unless of course I have a very stoic pony.
I sent the radiographs to another clinic a week ago for another opinion. They recommended doing the radiographs under water to eliminate the air(?). It was a surgeon who looked at them. My vet wants me to take her there for them to redo the radiographs and eliminate the effect of the holes.
Still trying to get these radiographs. I would like to see what a good radiologist has to say.
My main concern is losing more coffin bone since I am told that it does not grow back. The vet that took the radiographs is adamant about not giving antibiotics.
Shelley
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