|
|
Discussion on Deformed/Swollen Hind Leg - leaking pus,blood and serum
|
| Author |
Message |
New Member:
Nastazja
|
Posted on Tuesday, Jan 2, 2007 - 4:04 pm:
Greetings,
I have been looking for some advice or second opinions from vets and farriers regarding an unusual abscess.
During July, we have acquired a pair of emaciated Belgians - nursing mare and her two month old filly.
Around mid October, Rosemary, the mare, developed a festering abscess. It occurred overnight, she could not walk nor place any weight on that leg,and lost appetite. The edema traveled up her leg and slightly set in next to the "udder". The farrier came out, checked her hooves, and claimed that there were no sensitive areas in the hoof, instead there was a little awful smelling black thrush. We administered 15cc of penicillin g twice a day (which I don't think was enough) for five days until the swelling went down. For the trush, she is on zinc/copper supplementation.
The edema at that time went down, and since there was no way in draining the abscess, I had to find and antibiotic during the weekend to give her some relief.
After the treatment, until this day, the leg is larger than the other, and by looking at it, the purulent fluid had bursted through the knee joint area, and that resulted in a small hole that oxygen could get into. Thankfully.
It has been releasing that odor for quite some time now.
Rosemary will not, under any circumstances, let me touch that leg, nevermind try to push the fluid closer to the exit hole. Before we have brought here to the farm, she was shoed, and what we saw were the remaining nails piercing the hoof every which way.. she was not trimmed, and she was also not wormed for a year or more. We spent weeks removing the hookworms.
Since the availability of vets around here is very scarce, I have decided to purchase a basic culture tri-plate with BAB,CNA and MacConkey chambers in it in order to find out whether the organism/s attacking the leg is gram + or gram - or both. I will also acquire the antibiotic plate after the smear is done.
My questions are: Would it be at all possible to collect the sample from a more accessible area on the mare's body? I would think, that the bacteria is in the bloodstream/serum/saliva.. and it might unveil the amount of specific bacteria once cultured - OR is it better to just proceed with slightly poking the mare's leg within the draining hole with a cotton stick or ear swab (it needs to be soaked,though)? She cow kicks, when you touch that leg... otherwise she seems to have gained plenty of weight.. seems to trot and cantor by her own admission.
The next question is: Is it also possible to give oral metronidazole to anaerobic gram negatives (I know that it can cause anemia among many other problems, and it has not been proven in nursing mammals)or injectable Gentocin? - I also know that Gentocin is mostly used for respiratory problems/pneumonias.
Metronidazole is mainly used in small animals and humans, though it has been proven to be very successful in combating such anaerobic infections.
Next - Rifampin/Erythromycin or Rifampin Naxcel for anaerobic gram positives ? I have had a few vets consider giving her sulfas and trimeths - which I certainly do not approve of due to the fact that sulfatrimeth is the most loved combination antibiotic among the local vets.. and it is not very useful for reducing an infection - it rather does the complete opposite and it promotes the less susceptible bacteria to continue over growing.
Rosemary's appetite is tremendous, and she seems to be a happy gal that way even though her leg is not completely healthy.
I will be posting photos shortly.
I would love to have some insight into this condition - Thank you.
Nastia
|
New Member:
Nastazja
|
Posted on Tuesday, Jan 2, 2007 - 5:04 pm:
|
Member:
Nastazja
|
Posted on Tuesday, Jan 2, 2007 - 5:16 pm:
Some before after photos of the horses.
Ana at 2 months
Ana at 5 Months with Mom (and abscess seems to be ok) Sorry that the pics are so small.
|
Member:
Mrose
|
Posted on Tuesday, Jan 2, 2007 - 5:46 pm:
What a good job you've done getting these horses back into shape! Good for you! I'm sure Dr. O. will have advice regarding the mare's wound. You are out of my league with that. Sorry.
|
Member:
Nastazja
|
Posted on Tuesday, Jan 2, 2007 - 6:15 pm:
Thank you Sara ! It took tons of stress and love to make them just a tiny bit better. 
|
Moderator:
DrO
|
Posted on Wednesday, Jan 3, 2007 - 7:21 am:
Hello Nastia,
I think what needs to be done here is to lay this horse down with xylazine and ketamine, have this wound carefully cultured and thoroughly explored and debrided and left open, thereby converting it to a larger well draining wound that can be safely hosed daily and a good long term antibiotic administered that is adjusted in response to the culture results.
The culture will have to be taken from the area and even then care to get a good sample and not one full of the contaminates that are sure to be all around the outside of the wound will be necessary to be of use. I strongly suggest you get someone familiar with the handling of such specimens to help you: how about your local human hospital?
We have an article about metronidazole use in horses and a whole list of antibiotics to review and you will find it at, Treatments and Medications for Horses » Antibiotics and Antimicrobials » Metronidazole. Given your problem with resistance, the expense of treating such a large horse, and the difficulty you might experience with long term daily injections I would consider doxycycline or chloramphenicol both of which you can read about in the article.
DrO
|
Member:
Qh4me
|
Posted on Wednesday, Jan 3, 2007 - 1:50 pm:
Oh my heavens. What a wonderful thing you have done for these 2 horses Nastia! They are very lucky to have you to take care of them. That poor wee filly... She was a rack of bones.
|
Member:
Adriaa
|
Posted on Wednesday, Jan 3, 2007 - 4:15 pm:
Those lucky babies to have found you! the poor filly. Good luck with the abscess.
|
Member:
Adriaa
|
Posted on Wednesday, Jan 3, 2007 - 4:17 pm:
Nastia, I notice you are a vet tech student and are near Cornell. Have you approached them about the problem?
|
Member:
Nastazja
|
Posted on Wednesday, Jan 3, 2007 - 11:26 pm:
Andria,
I have not contacted Cornell about this problem yet, then again I felt that it was not a very serious abscess in the first place.. or at least it is an explainable abscess.. I will do as Dr. O had suggested, although, I will rather try sedation with a tranq first because like I mentioned before, using a general anesthetic would be a little more difficult and I would end up doing it myself anyway - and te use the antibiotics necessary to treat the abscess - we live in the middle of no where, and the vets here are just awful ot willing o travel more than '5 miles'.. My question to DrO - Is it possible to try using a tranq first, and if that will fail, proceed to the next step...(?)
Nastia
|
Member:
Nastazja
|
Posted on Wednesday, Jan 3, 2007 - 11:26 pm:
Thank you all for such nice support !
|
Moderator:
DrO
|
Posted on Thursday, Jan 4, 2007 - 6:57 am:
Hmmm......normally I would say yes, attempt with detomidine and butorphanol and if that failed a little extra xylazine followed with ketamine. But with a large cold blood and the increase risks of anesthesia, just getting the horse up and down can be a bit of a challenge, and the above regimen might cause increased unsteadiness on standing. I think for such a case under most conditions if I could not get it done with sedation, I would back out and reattempt fresh another day.
DrO
|
Member:
Nastazja
|
Posted on Saturday, Jan 6, 2007 - 12:53 am:
DrO...
Chloramphenicol.. dosage 50mg per kg..
for a 908 kg horse.. 500mg pills equals to 90 pills per dose.. how many doses ?! 4 per day ?!
I get 500mg/500 count for $100.
How many days does the treatment usually last for both antibiotics? (used separately, one or the other, of course)
I also get metronidazole for 500mg/500 counts $50.00.
I have examined the leg.. flushed it down, cultured it.. I used dormosedan and it seemed sufficient, it kept her unusually dead to the world..
The leg seems to be as hard as a rock, not filled with purulent fluid.. The opening had already healed, so I had to pry it open a little to culture it, and then flushed it again with water, applied some antibiotic ointment.. and covered her with some blankets...
Now, I am just waiting for the culture..
|
Moderator:
DrO
|
Posted on Saturday, Jan 6, 2007 - 9:09 pm:
The problem with metronidazole is its narrow spectrum of activity against the large groups of likely pathogens in a chronic wound. Nastia did you see if you can do any better with the doxycycline?
Unfortunately it is not going to be cheap treating a horse this large and treatment might be prolonged. If cost is a big factor maybe you should consider the TMP/SMZ course.
DrO
|
Member:
Nastazja
|
Posted on Saturday, Jan 6, 2007 - 10:57 pm:
Oh, no the cost is not so much the problem..(although I am facing a $400,000 lawsuit from my monster-in-law (long story) the problem is that I am not sure how long I would continue the treatment and whether it will not cause other gastrointestinal problems if taken orally - I will be giving her a good daily dose
of probiotics.
Also.. you are absolutely correct about mentronidazole, it usually deals well with conditions like septic/purulent pneumonia which can be both gram - gram +...
Doxycycline only prevents the bacteria to continue growing.. or 'reproducing' in size.. and that means, that the horse needs to have a good immune stability. How approx. long should I continue treatment with either doxy or chlor ?
NO sulfas !!!
Thank you DrO !!
N.
|
Moderator:
DrO
|
Posted on Sunday, Jan 7, 2007 - 9:29 am:
Many very effective antibiotics are bacteriostatic and not bactericidal and this alone should not be used to reject such a drug. This class of antibiotic could be rejected if the immune system of the horse is impaired however. Many serious infections are very responsive to the tetracyclines particularly if bone is involved. The length of therapy will depend entirely on getting the wound closed up, you quit when the wound is healed or so far along that infection no longer a problem.
DrO
|
Member:
Nastazja
|
Posted on Sunday, Jan 7, 2007 - 1:21 pm:
The wound is already close up, but the swelling is still there.. I will give you an update about the gram smear.
|
Member:
Nastazja
|
Posted on Monday, Jan 8, 2007 - 6:50 pm:
Ok ! DoC !!!
Doxy - can I use it an additional to another drug ? If, yes - which ?
|
Moderator:
DrO
|
Posted on Tuesday, Jan 9, 2007 - 6:44 am:
I would use this very wide spectrum antibiotic by itself. How did the cost work out Nastia? Be sure the wound has not prematurely close with a scab that can easily be removed with hosing under pressure. If it has the infection will just incubate under that scab (see long term wound care for more on this).
DrO
|
Member:
Nastazja
|
Posted on Tuesday, Jan 9, 2007 - 4:37 pm:
DrO.. the cost worked out fine 250$ or so and that gives me quite a few doses 10mg per kg - horse is 908kg - 90 pills per dose - 2 doses - 180 pills a day each 100mg - I hope my calculations are correct... if not I would love a correction.. I've been calculating different doses for too long and too late at night.
The scab opened up again today, I have done the hosing, and it seems that blood is just leaking out.. no purulent fluid of any kind.
Before I can give her the doxy I need some probios to go with it..
Thank you, you, wonderful DrO, you
|
Moderator:
DrO
|
Posted on Tuesday, Jan 9, 2007 - 7:43 pm:
If your dosage above is correct, yes 90 pills is right. Now if there was only good support for the notion that Probios would help....but of course that is another article, in the nutrition section I think.
DrO
|
Member:
Nastazja
|
Posted on Tuesday, Jan 9, 2007 - 11:33 pm:
Well.. I just am paranoid about the antibiotic to ruin the bacterial flora of the digestive system.. then again, do bacteriostatic drugs destroy valuable bacteria that assist digestion?
My vet had suggested it...
|
Member:
Nastazja
|
Posted on Wednesday, Jan 10, 2007 - 12:23 am:
One more question DrO..
Should I tranq her again and perhaps open the wound a little more.. ? OR just keep on hosing it.. and cleaning it.. and hope that there will be enough oxygen getting in...
The other thing is that there is no pus leaking (just blood).. my guess is that it is unable to break through.. like I said, her leg is rock hard..
OR is it overgrown tissue, overlapping inside of the leg? If I'll administer doxy.. and not drain the leg.. will it get better at all.. (?) Maybe it will have permanent damage to tissue and just remain a little 'ovesized' in comparison to the healthy leg.
I can't believe I listened to a farrier with that louse 15 cc 2X a day.. I thought he knew better than me, considering he has been a farrier for 25 years. 
Thank you for your lovely help, DrO
|
|
|
