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  Discussion on Blood in joint fluid-lame-hock swelling
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Member:
rdrj

Posted on Tuesday, Nov 4, 2008 - 3:07 pm:

Can anyone help suggest the next step in this mystery?
May 25, 2008 -14 yr old appendix mare was treated for a 8lb granulosa tumor on her right ovary. It was successfully removed - the incision was on her right flank. Recovery was unusually rough and she ended up getting a hernia. Had surgery 10 days later to repair the hernia and a small intestine resection was performed. She was released from the clinic on June 24, 2008 and was put on strict stall rest. She had 4 metal stitches in her.
It was noted that she had some swelling on the left hock, however the attending surgeon attributed it to her "stocking" up from being in her stall for a month.
July 5 - my home vet came out to evaluate the incision in the flank. It was healing but the stitches had to be tightened and were to remain in for another month. The mare could not lie down this whole time. He noted the swelling, but thought it was due to stocking up.
July 25th- I was able to hand walk her and she seemed sound at the walk. Still had the stitches in. Periodic swelling in the hock continued, but she was starting to not be able to lift the left hind leg when I wanted to pick it up.
August 15th- stitches come out-the wound is still opened and he still keeps her on the hand walking schedule. Thinks she's hock sore due to lack of activity. Still wanted her inside her stall due to incision healing.
September 6th-comes out to evaluate the hock. Takes radiographs which appear clean and taps the joint. He is surprised when blood and fluid come out. He tests for infection and it comes back negative. He thinks she experienced some trauma to the joint and possibly tore some ligaments within the joint. Recommends 30 days stall rest and then the following 30, hand walking. Says he'll re-xray then.
October 27- Vet comes and repeats what he did 7 weeks ago. Taps the joint which still has blood and fluid and tests for infection (comes back negative). He also tested for lyme (which I don't understand because she's been stall bound for months) and did not xray. He said more stall rest for another 30 days.
November 4th-His office called and they want to come out and re-xray in 10 days and then talk about some options.

I am confused because I don't know what exactly is wrong and I don't understand the logic of repeating the same tests he did 7 wks prior.

I have researched a little and it seem to point to a bog spavin. I can't afford arthroscopic surgery for her as her other surgery was supposed to cost 3500.00 and ended up costing me 14K. He is eluding that she may only be a pasture pet but as of right now she is obviously very uncomfortable.
Moderator:
DrO

Posted on Wednesday, Nov 5, 2008 - 7:38 am:

Hello Rita,
The joint should have fluid in it and it is unclear if the blood is incidental to the procedure of sampling that fluid or if the joint had bleeding into it. Can you provide us with the complete evaluation of the joint fluid including color, clarity, cellularity, and chemistry?

The history suggests an injury occurred around the time of the surgery but the nature of the injury remains unknown. As to why the veterinarian would like to take more radiographs I can only guess at but one possibility is that he wants different views to see if something shows up that cannot be seen in the first views. You should discuss this with the vet along with your goals and resources.
DrO
Member:
rdrj

Posted on Friday, Nov 14, 2008 - 11:18 am:

Hi Dr. O-
Sorry for the delay. Here is the cytology report:
Direct and cytospin preparations of synovial fluid from the left tibiotarsal joint were examined. The slides are of adequate staining and preservation of cellular detail with mild to moderate hemodilution against a stippled eosinophilic background.-automated cell count is verified with the direct preparation. Cells are present in the following proportions: 66% mildly vacuolated mononuclear phagocytes; 28% nondegenerate neutrophils; 6% small lymphocytes. Occasional erthrophagia is noted. No infection.

Microscpoic findings: Mixed inflammatioon with evidence of recent hemorrage, cause undetermined.

Comment: These findings are nonspecific and could be consistant with degenerative joint disease if supported by clinical findings.

Another vet exam has been scheduled for Tuesday of next week with another veterinarian. I will update again at that time. Thanks for helping out with this!
Moderator:
DrO

Posted on Saturday, Nov 15, 2008 - 8:05 am:

Well the report does say it all though the conclusion not consistent with the clinical findings and history. More consistent would be recent trauma followed by inflammation. Rita what are you doing to control the inflammation with the hopes of not having it turn into chronic arthritis?
DrO
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