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  Discussion on Lilly got Cast and the Resulting Injury
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Member:
aannk

Posted on Wednesday, Sep 12, 2007 - 10:47 am:

This happened the 1st of September, the day someone was coming to sign lease papers, of course. I wasn't there, but she was rolling in the field and got her left hind stuck under the fence, and in getting out, struck her left hind around the stifle / udder area. She came in in shock, and was treated for that, and cold hosed and left to rest. I didn't see her till the next day, when she was pressing up against her stall walls to even stay upright, and had a hematoma the size of a watermelon where her leg joined her abdomen. She was also in a lot of pain, though the vet had administered 12 ccs banamine IV, 2 ccs ace IV, 10 cc bioba#### (can't read his writing), 10 cc ketofen IV, and 10 cc solu delt#####. The barn manager told me the vet had said these drugs would keep her sedated, so we weren't worried that she had trouble standing up. The thing I didn't know is that the hematoma was new, and that they hadn't told the vet about it. I was supposed to call to set up an appointment for Tuesday or Wednesday, but he couldn't make it out till Thursday. When he got there, he was pissed because her hind legs hadn't been wrapped (I couldn't read his writing, so didn't know that was part of the instructions for her care) and because no one had told him about the swelling.
So, he came back the next morning to drain it with a needle and got about a liter out. The next day he came back again and cut a drain in and stuffed the wound with Kerlix AMD. The instructions this time were to coat her leg with vaseline to minimize scurf and to keep her in her stall and keep her on antibiotics and 2 grams bute twice a day (which she had been on since the 1st). Yesterday, he came back again, and took out the first Kerlix and put another in after squirting a mix of saline and betadyne into the wound. The care is now 1 gram twice a day of bute, continue antibiotic, and flush the wound twice a day with the fluid, then squirt up three tubes of an antibiotic cream and stall rest. I guess he is going to come out again in a few more days and make recommendations on changes to her care.
First off, I wanted to know if this course of action was good.
Second, I didn't mention this yet, but he said he felt a bounding pulse in her right hind that first day he came back and he blamed it on the no standing bandages. He recommended taking her off her alfalfa pellets because they have "too much protein which causes founder". I thought that was an old myth and that carbs, not protein are the culprit. She has EPSM, so can't have grain, so basically she is on hay only with enough pellets to get her meds down.
Am I wrong in this?
By the way, this is not my regular vet, they called the vet who most folks at the barn use.
Alicia
Member:
hwood

Posted on Wednesday, Sep 12, 2007 - 11:40 am:

Gee-whiz, Alicia. Another member was just commenting to me this morning that it seems that we're having more than our usual glut of horse injuries and horse deaths this year. Not sure if that is true or if we are just sharing on a more intimate level so we are more aware of the angst of one another . . . but I hope that your Lilly will be fine with the good care you and the vet can give her. (and I hope you told the vet that the handwriting was impossible to read. Some doctors and vets have impossible to decipher writing, and it's terribly frustrating for us as patients . . . and for the pharmacists, too.)
Member:
aannk

Posted on Wednesday, Sep 12, 2007 - 11:57 am:

Holly,
You know, I haven't really been paying attention that much, as I have a house full of puppies to deal with and had surgery on my arm, so I really haven't been too involved with my horses or horses on line. However, let's hope this slows down or stops so no one else has to go through this kind of thing.
Yes, I did tell him. He then proceeded to read to me each word to show me what each one was. In a pretty annoying fashion. I actually don't like this guy too much, but I am kinda forced into keeping with him for this injury. I hope it doesn't hurt Lil in the process!
Alicia
Member:
lilo

Posted on Wednesday, Sep 12, 2007 - 12:15 pm:

Best wishes for you and for Lilly, Alicia. Holly - it does seem we have had more than our share of bad luck lately ...
Healing thoughts,
Lilo
Member:
mrose

Posted on Wednesday, Sep 12, 2007 - 3:37 pm:

Alicia, it certainly sounds like you've got your hands full. Puppies along are more than enough to keep you busy. Has your mare's swelling gone down any yet? I've been cold hosing my mare and using Cool Gel and her leg is looking a lot better. I hope your mare progresses equally well.

Have you had time to read the articles on founder and laminitis on this site? I found them very informative; you might also. There's a lot more involved than just high protein levels.

How much longer is your arm going to be in a cast (I'm assuming it is now.) I know how much more difficult it is trying to do things with one limb not working. Best of luck.
Moderator:
DrO

Posted on Wednesday, Sep 12, 2007 - 6:14 pm:

Hello Alicia,
You do sound like you have your hands full. Other than the veterinarians demeanor, the treatments all sound appropriate, though I too cannot figure out the biobab... The other you could not read was Solu-Delta-Cortef often used to stabilize horses in shock, though usually when of a allergic nature.

I do not know of any research that attributes laminitis to too much protein and of at least one research study that looked into the effects of high protein diets and did not find an ill effect at levels higher than your diet would provide.

My concern from your post is the horses instability and if that is due just to the injuries you can see or possibly deeper injury. Does the degree of lameness seem appropriate to the soft tissue injuries? What did the vet say?
DrO
Member:
aannk

Posted on Thursday, Sep 13, 2007 - 3:09 pm:

Sara,
No, I took off 6 weeks to heal, and didn't return to handling horses until I had an x ray confirming I was OK, so there is no cast.
Dr. O.,
Thanks for the info on the protein, you have added to my opinion that this guy is a little on the "I know what I am doing so don't question me" side.
Yes, that was very concerning, but he said it was from the shock, and she only did it the first day after the injury, and hasn't done it since.
She is sound now, actually, and has been for the last few days.
I asked if there was a possibility that she could have more than a soft tissue. Apparently, the day it happened, there was only a small swelling, and he palpated and flexed and found nothing alarming. So, his current program is to take her entirely off bute (starting yesterday evening, after he came out again, though I wasn't there), start turning her out more and more, and continue with the cleansing and creaming the wound and with the oral antibiotics. I will see her again in a few hours. He also said after the wound is healed, if she is not lame, he will not do any more diagnostics, but if she is, he will look for something more serious.
Alicia
Moderator:
DrO

Posted on Friday, Sep 14, 2007 - 6:35 am:

Sounds like a reasonable plan Alicia.
DrO
Member:
aannk

Posted on Friday, Sep 14, 2007 - 9:45 am:

Thanks, I feel better about the treatment, but i still am not happy he is so old fashioned in his ideas of founder. Oh well, we didn't listen to him anyway :-)
Alicia
Member:
aannk

Posted on Monday, Oct 29, 2007 - 11:23 am:

Dr O.,
So, she still isn't healed up. The wound created from him cutting her seroma open is still closing up. It makes it difficult for her to bring her leg as far forward as the other leg.
He had her on 30ccs of injected penicillin twice a day for three weeks. She is currently on nothing and still being flushed twice daily with a saline betadyne solution and a topical cream is then applied.
Your article says to use water pressure. He was totally adamant not to do that. Any comments on this?
I am trying to give her away and have three good candidates. I want to tell them the best way to continue to care for the leg. I will also recommend they have their current vet look at it.
Alicia
Moderator:
DrO

Posted on Tuesday, Oct 30, 2007 - 6:23 am:

What is the consistency of the drainage and what cream are you using Alicia? While if the defect to be healed is large enough it might take this long it is hard to figure why your horse would still be lame? Would it be possible to post images of what is going on?
DrO
Member:
aannk

Posted on Tuesday, Oct 30, 2007 - 10:51 am:

Dr O,
I have not been out for a long time so I can't tell you what the stuff comeing out looks like now. The last time I actually cleaned the wound, nothing came out except the stuff we squirted in. The cream is cefalak. I saw her yesterday, and the hole is very small, probably the size of a pea. The area is hard to the touch. It appears the "sqeezing" of the tissue you talk about in your article has happened.
As for the lameness, it really isn't a lameness per se. I actually got on her last night for the first time since it happened, and she walked off sound. She felt really good. She would take a short step on that side from time to time, but not as consistantly as when she is being led. I was very pleased with the way she felt.
So, it appears to me it is the physical blocking of the motion by the lump of skin that is the problem. I would intuitively think more motion of the area would help break apart that hard tissue. Is that a reasonable assumption?
Alicia
Member:
aannk

Posted on Tuesday, Oct 30, 2007 - 10:53 am:

Oh, sorry, I am not able to take a photo today, I don't have my camera. I also am not going out again till next Monday. If I still have her then, I will take a photo and post it. It basically is the size of a tennis ball and is situated directly over the stifle joint.
Alicia
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