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  Discussion on Fistulous withers
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Member:
rosieint

Posted on Friday, Jan 4, 2013 - 3:36 pm:

I would be grateful for advice.

My horse has been diagnosed with fistulous withers. Here is the history

He came in from the field a month ago as he couldn't put his head down. A couple of years previously he damaged his left jugular and when he came in from the field a month ago the jugular was very swollen and the right side of his withers were very sore. We treated the jugular with anti biopics and when it developed into an absess it was flushed and has healed nicely. the withers that were also sore when he came in a month ago, showed immediate improvement on the anti biotics and in a week he started grazing in hand. A couple of days ago he was sore in the withers again (ie a month after the initial symptoms). We took him to an equine hospital and they drew fluid from the inflamed bursa and it is septic. I have the option of surgical flushing now or to try a 5 day course of iv antibiotics and a local injection of anti biotics and if there is no improvement after the 5 day course, to go in surgically to flush.

I understand this condition is quite rare and therefore I am reaching out to see if anyone has any experience or knows the prognosis or has any opinion on the treatment options.
Moderator:
DrO

Posted on Friday, Jan 4, 2013 - 8:53 pm:

Hello RosieP,
Without examining the horse specific advice is impossible however general observations can be made.
In the case of any pocket of infection, like a infected bursa, surgical drainage and debridement always has the better chance of being curative. Of course wide spectrum antibiotics, first empirically used, but based on culture and sensitivity once test results are back should be used in either case.
DrO
Member:
rosieint

Posted on Saturday, Jan 5, 2013 - 2:08 pm:

Thank you DrO. Do you think it will prejudice the recovery to try the 5 day course of anti biotics? Is the infection likely to become more deep rooted?

Are there any studies which may give an indication on prognosis? Do you think that I can take encouragement from the fact that the first set of anti biotics initialky helped? Do you think that i can take any comfort from the fact that the fluid drawn from the bursar did not seem highly septic and the bursar is quite fluid and not custardy and has not burst?

Some idea on prognosis would be incredibly useful as i am understanding that ultimately if the infection cant be cured, my horse wont be able put his head down and as he is retired it would be no life not being able to graze in a field...

Many thanks
Moderator:
DrO

Posted on Monday, Jan 7, 2013 - 7:59 am:

Rosie,
Without examining the horse I do not have an opinion on whether the infection will spread with or without antibiotic therapy alone. The prognosis in a specific sense for your horse is best determined by those who can examine the horse but there are several small studies on the general condition you can review by pushing the "National Library of Medicine" button located at the bottom of the article just before the posting section. It will automatically call up published information on fistulous withers.

As to whether the other factors you list may effect the prognosis is uncertain.
DrO
Member:
rosieint

Posted on Tuesday, Feb 26, 2013 - 4:09 pm:

Hello,

I wondered if you could give me your thoughts on how my horse is progressing. He had surgery a month ago and the bursa was dissected and the wound stapled.There were no signs of infection of the bone on X-ray.

There was a large incision which healed nicely in a week other than in one spot. This small area oozes fluid but has consistently improved over the last month in the decrease in its size and the amount of fluid that discharges from it.

His comfort levels have gone up and down a bit and he has had a couple of short blips when he didnt want to lower his head down to the ground.

We have swabbed the wound each week post surgery and not found any infection other than a minor external infection which slough I can't remember the name of the infection is common in wounds and usually cleared up by the immune system. The surgeon didn't want to give anti biotics for it so that if we need another surgery they can be kept for post operative treatment.

I am a bit concerned with how he is now. He has had a swelling come up over 24 hours. The swelling is hard and firm and near the wound site. The swelling would fit in your hand when you out your hand over it. The wound also seems to have slightly increased the amount in which it is discharging.

I have decided with the surgeon that if the wound does not stop oozing in a week which will be abiout 5 weeks post surgery then we should uktrasound again. The surgeon thinks there is a low risk the bone is infected as xrays taken a month apart did not show any changes. The surgeon thinks that possibly inserting a drain may help the wound.

I would be grateful for your thoughts.
Moderator:
DrO

Posted on Wednesday, Feb 27, 2013 - 5:10 pm:

The continued oozing suggests ongoing infection Rosie. If the surgeon thinks he can get ventral drainage with a drain that would be ideal, otherwise I would recommend consideration of treatment as recommended in the article.
DrO
Member:
rosieint

Posted on Wednesday, Feb 27, 2013 - 5:30 pm:

Thanks for your thoughts. If it is a sign of infection do you think that it is the original infection or the recent externally derived infection or does it actually not matter which it is and the treatment will be the same ie leave it for a period of time and see if it heals on its own and if not to then put a drain in? Should the drain have been inserted originally?? Was it worth trying to heal without one? I am worried about taking my horse back to hospital as he has been there 6 times in 3 years and notwithstanding the cost to me, it is very stressful for him! How long should I leave it post op before throwing in the towel and taking him back for an ultrasound and possible op for the drain?
Member:
natalya

Posted on Thursday, Feb 28, 2013 - 11:08 am:

Hi Rosie, I had a horse who had surgery 2 year ago removing a large melanoma under her tail, it was very deep and big, bigger then a man's fist. Our surgeon didn’t close the wound, I had to clean it up with syringe and butadiene and do the scrubbing twice a day for one week then once for the next 2. And after cleaning I had to stuff it up with gauze soaked in diluted butadiene. So it’s healed from inside out. The wound was so big my whole hand was fit in it. But it’s healed in 3 weeks with a small scar. What surgeon said at that time if you close the wound you have more chances of infection, because no way of cleaning. But it did work fine and she was an old mare 26 at that time. Good luck.
Moderator:
DrO

Posted on Thursday, Feb 28, 2013 - 6:28 pm:

Rosie, I have no way answering any of your last questions. They would require examination and lab work and even then often require conjecture. As to specific treatment questions again examination would be required.

If you feel the current veterinarian is not giving you reliable information you should consider a second opinion.
DrO
Member:
rosieint

Posted on Thursday, Feb 28, 2013 - 6:52 pm:

Thanks for your thoughts. I appreciate the answers are subjective to each case. It is such a tricky thing to heal. I guess I just wanted some comfort that he will heal, eventually! I suppose the various treatment options eg surgery, drain, anti biopics are all armoury in our closet and we have to pick and chose when to use each of them to have the quickest recovery?
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