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Discussion on Head wound
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Member:
nadia
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Posted on Monday, May 28, 2007 - 3:18 pm:
Hi, Dr O,
My 16 YO TB managed to gouge himself on something on the top of this head last Friday. He had come in from the pasture with it. There was dried blood down his face, so it looks to have been there a good portion of the day. I had the vet out to sedate him so we could get a good look at it. He mainly scraped the skin except for a perfect slice through the top. I was able to wash with warm water that night, and Neposprin ointment on it. On Saturday, I wasn't as successful - got some on, but he would not let me near it. I put a fly mask on so it would protect from the sun and flies. He freaked out with that on (I thought he might) and kept trying to rub it off. I went back a few hours later and it had been touching the wound, unfortunately. (I am not putting that back on.) He won't let me halter him and trying to get the ointment on it is next to impossible without him being sedated. His attitude is fine - he really wants to go out in the pasture with his buddies, but have been keeping him up until it heals a little better. I tried to get a picture of how it looks, but he thinks anything near his head is going to hurt. These are best that turned out.
1 - How bad does it look?
2 - Should I give up on trying to put ointment on?
3 - If I need to apply something, any suggestions on how to get him to cooperate? He has had head issues in the past, so this just brings that all back. I think he'd need to be sedated if I need to get at it.
I think he will be a more cooperative as time goes on (hurts less), but I don't want to make things worse by waiting.
I remember something you said - 80-10-10 rule (or something like this?)
80% of the time, something will get better no matter what you do
10% of the time, something will get better because of what you do
10% of the time, something will get worse no
matter what you do...
I hope his problem is in the 80% area?
Thank you
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Member:
nadia
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Posted on Monday, May 28, 2007 - 3:20 pm:
Having problems with the picture size..
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Member:
nadia
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Posted on Monday, May 28, 2007 - 5:13 pm:
 
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Moderator:
DrO
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Posted on Tuesday, May 29, 2007 - 6:32 am:
Hello Nadia,
Nice gash.
1) Though a full skin thickness wound, with no complications from deeper injuries wounds or infection and proper treatment the skin in such injuries will heal fine with a barely noticeable scar. But we cannot assess these deeper structures so your best assessment was made by the veterinarian who could examine the wound: what did (s)he say?
2) This wound should receive daily cleaning and treatment for the best outcome.
3) Daily sedation is one fix but I would also suggest you apply the principles in Training & Conditioning Horses » Behavior and Training » Modifying a Horses Behavior: Conditioned Responses. Horses can be easily trained to withstand mildly aversive procedures using these techniques.
You misapply the 80/10/10 rule by assuming we always know which wounds are going to heal without complications: it is the nature of medicine that we are often not pre-aware of which wounds are going to have complications. So the rule to apply here is the "do the best you can rule".
DrO
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Member:
nadia
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Posted on Tuesday, May 29, 2007 - 8:33 am:
Thanks, Dr O. I'll try to work on this.
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Member:
corinne
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Posted on Tuesday, May 29, 2007 - 10:33 am:
Oh I bet that horse hit his head and was thinking......%#&^@%$*&^$ that hurt!
Good luck with the wound cleaning. Mine had a bad one near his eye this fall and I understand your pain trying to care for it...and his of course.
Keep us informed and thanks for the pics. I love to see pictures of wounds so when my horse has one I have something in terms of severity to compare it to!
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Member:
nadia
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Posted on Tuesday, May 29, 2007 - 10:26 pm:
The vet will be out tomorrow to sedate him so I can clean it. Good news - is he was much more cooperative tonight with me touching him! I was able to swipe the ointment on it - and I got it fully covered. I was even able to get a halter on. The previous attempts were not as successful. Even yesterday, when I was trying to take the pictures, I had peppermints in one hand and raised the other to take the picture - no way! He knew that raised hand could be trying to get at his head. I think the pain has reduced some. I should be able to get a good cleaning done tomorrow!
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Member:
jd1947
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Posted on Wednesday, May 30, 2007 - 11:17 am:
Nadia,
Too late now, but I thought maybe your vet could have knocked him out and trimmed along the edges, then stitch it up with the type of stitching that disolves over time.
I had a mare gash her forehead several years ago, right above her eyes...talk about bleeding...they have such thin skin on their heads...anyway, we stitched it up and when the stitching disolved it was healed so well it never even left a scar.
Dr.O's suggestion about working with his head is important...I think you know now you need to be able to work on a horse's head in times of trouble...you might post to Denny T...he's wonderful with training stuff.
Hope your boy heals up fast!!
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Member:
nadia
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Posted on Thursday, May 31, 2007 - 11:44 pm:
Hi, Joanie,
The reason she didn't stitch it was because she said there was a 6 hour window at which you can stich. He had come in from the pasture at 5 pm (out at ~8 am). There was no way to know when it happened. There was dried blood down his face (very dry). I would have said it was more than 6 hours.
Good news, though, she was out Wed at noon to sedate him so I could give it a good cleaning. It looked better when I got there. The divet is closing in and nothing looked infected. Here's the picture now.
I think it is healing well!
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Moderator:
DrO
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Posted on Friday, Jun 1, 2007 - 7:30 am:
It looks great and the change from earlier to now suggests it was not quite as deep as it appeared earlier.
I would like to comment on some of the principles illustrated here. As I have often stated before head wounds heal quicker with fewer complications than wounds elsewhere on the body and particularly on wounds on the legs. I have often broke the 2, 6, and even 24 hour rule and sutured head wounds successfully. However wounds with contraindications for closure I will leave open: they heal with fewer complications than closing over a wound with complications. The grey edges and amount of apparent blunt trauma in the first image above may be such complications. For more on this see the article on First Aid for Wounds and Long Term Wound Care.
DrO
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Member:
jd1947
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Posted on Friday, Jun 1, 2007 - 3:37 pm:
Hi Nadia,
OH...of course there was no way for me to know how much time had passed...but, looking at the new photo...it does look awful good...thankgoodness, eh!!
Funny coincidence...I got my "America's Horse' magazine yesterday and there is an article in it about 'head shy' horses and how to get them to accept your messing with their heads/ears...using the "advance & retreat" method...I thought of you right away.
One thing this trainer does when desensitizing head shy horses is to lay her arm along the horses neck, so when he moves her arm stays there...as soon as the horse DrOps it's head just a tiny bit, she removes her arm. She starts by slowly working her hand up towards the poll, keeping her arm on the neck...as soon as she fells the horse begin to tense up,she stops moving her hand, but doesn't remove it...as soon as the horse DrOps it's head just a tiny bit, which means he is relaxing, she removes her hand and arm and turns her back and walks a few steps away...that is the 'retreat' part (she says turning your back on the horse is important...it releases the 'mental pressure' on the horse.
Repeating this process over & over, waiting several seconds between each 'session'...you also need to work from both sides...since we all know horses can think using one side of their brain at a time...and you will probably have to do this 50 - 100 times, and the timing for each retreat & advance is crucial...you don't want to remove your arm/hand as the horse even begins to tense up again.
That is basically what the article says...just common sense & lots of patience. Be nice for you if your fella decides to conk his noggin again to be able to doctor him up without a fuss 
Good luck and I am glad that owie ain't as bad as you thought it was...silly horses!!
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Member:
nadia
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Posted on Saturday, Jun 2, 2007 - 8:29 am:
I have used that before on him when something happened to his head/neck about 3 years ago. It took 6-9 months before he didn't freak out when I put a bridle on (he panicked at the thought of something near his ears?) This past weekend, when he wouldn't let me near the wound, I spent time just massaging his neck - slowly going up near the top of his head, retreating when he got nervous. I didn't push trying to get the ointment on every time. I wanted him to think that I wasn't alway going to try to go there. My impression is that he will recover (psychologically) quicker this time (maybe I shouldn't have said that?)
Thanks!
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Member:
jd1947
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Posted on Saturday, Jun 2, 2007 - 9:47 am:
Nadia,
I thought you probably knew all that stuff....but it never hurts to make suggestions...sounds to me you will get him to accept your messing with his head in time, seems he is getting better about it... he trusts you and you are doing the right things with him...
good luck and give him a hug from me!!
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Member:
nadia
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Posted on Saturday, Jun 9, 2007 - 4:58 pm:
His wound is more or less healed, he'll even let me touch it. It's probably starting to get itchy, so I bet he'll cooperate more! Last week, he some how managed to get a bloody nose and 3 large scrapes down his nose. He must have really smacked his nose (the blood did not continue to run.) Did it in his run in about 5 min. Couldn't find anything that he would have done it on - must have been a section of fence and brought his head up fast. He let me put nitrofurazone on the scrapes, but probably had a sore nose for a few days! I think we'll get over the head shyness sooner than last time (knock on wood!)
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