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  Discussion on Possible blunt trauma to tissue above knee...
Author Message
Member:
Corinne

Posted on Saturday, Nov 5, 2005 - 11:14 pm:

Sir,
Well this is my first bonafide injury since owning my horse and have read all the articles posted on wounds, blunt force trauma and swellings...I still have a few questions that I was hoping to get some advice on.

During my pre ride grooming on Friday I noticed a small 1 inch superficial laceration on the medial aspect of my gelding's leg approximately 3-4 inches above the knee. And a small 1 cm superficial wound 1 inch below the knee. The wounds were already scabbed over and were not more than 24-36 hours old as he must have sustained it some time between my evening ride on Wed and my afternoon ride on Friday. There were no outward signs of infection, no drainage and no lameness at any gate upon inspection on Friday. I only rode for 15 minutes mostly at the walk as I wanted to take it easy on him. There was some minimal swelling near the wound and some warmth which I attributed to the inflammatory process (I thought perhaps a small hematoma from playing with rowdy pasture mates) I opted not to cold hose because it was only 20 degrees so I thought it might be too cold. I decided instead (bad choice?) to turn him back out so he would exercise at will and came home with instructions for the manager to call me for increased swelling, drainage, signs of lameness etc, fever.

I spoke to her this morning and she did not notice any new swelling near the knee. After a day of rough housing with the boys in really muddy footing she called me to tell me he was favoring that knee and it had swelled up quite a bit.

I immediately DrOve out to the barn and noticed that he was swollen about five inches above the knee extending to the distal aspect of the patella. The swelling was warm and pitting slightly. There was no drainage and I had to look hard for the wounds as they are completely scabbed.

While he was blanketed, to keep him warm, I cold hosed his leg, above and at the knee for 20 minutes. It was tender to touch...and he kept giving me his leg when I tried to palpate it...like a dog gives his injured paw. I guess my sweetness is a bit of a drama queen...but I am a sucker for providing attention to sick and injured animals.

Anyway, he now has grade three lameness (?) on the lunge (which I think is consistent lameness at the trot from what I could tell from reading your lameness article) He is fine at the walk. I did not canter him after discovering he was having a hard time at the trot.
He is up to date on all vaccines. Is eating, drinking and hydrated and is afebrile.

Question 1

1. Is cold hosing 72 hours after a wound still beneficial? I plan on doing this for 20 minutes BID until the swelling subsides.

2. Without any other signs of infection should I be more concerned that it's anything other than soft tissue trauma at this point. He was not lame until today, 72 hours after initial injury, so I don’t think there is bone involvement. I suspect he may have gotten kicked initially and perhaps a bit of overuse today? Some dependant edema?

3. I know Bute is an NSAID but is it better to allow some pain and natural inflammation to aid in tissue healing and so he will know his limitations?

4. The vets here in town wrap everything and owners often give prophylactic antibiotics for wounds that I have seen no evidence of infection in. I would like to keep it unwrapped but not sure when antibiotics would be appropriate as I worry about dosing, adverse reactions, choosing the appropriate spectrum antibiotic etc.

Any information you could provide is greatly appreciated...Not having a great two days with the animals. Last night the Lab X (Rocky from the Black and White posts)...ate one of those dissicent packs found in shoe boxes and we had to induce vomiting with hyDrOgen peroxide and today my beloved Demetrius is lame. I think I need a drink! My goodness…if I worry this much about my animals I can’t wait to see how I am going to be as a mom. LOL

v/r
Corinne
Member:
Corinne

Posted on Saturday, Nov 5, 2005 - 11:26 pm:

P.S. ooopppsss In number 4 question, I shouldn't have said they give prophylactic antibiotics for wounds without infection because that is what prophylaxis is for. I should have been clearer in stating there is a lot of antibiotic use for wounds that don't appear to need them.
Moderator:
DrO

Posted on Sunday, Nov 6, 2005 - 7:35 am:

Hello Corinne,
The most important point in your post is you may misunderstand the importance of hosing these wounds: it is to keep them clean and open so that infection can drain and you can treat the wound to the bottom. Be sure to read the wound care articles again with this is mind.

Taking your questions in order:
1) Keeping wounds clean and well flushed out is always beneficial.
2) Pain, heat, and swelling several days after the wound suggests they have already become infected underneath the scabs that formed.
3) No.
4) Without an exam I cannot recommend specific treatment. If wounds drain well, are kept clean, and treated bandages or antibiotics may not be indicated. If uncertainty about the nature or severity of these wounds remain you should seek veterinary help.
DrO
Member:
Corinne

Posted on Sunday, Nov 6, 2005 - 10:40 am:

Dr O,

Thanks for writing back so soon.

Yes, as nurse I realize the importance of keeping the wound clean (I sometimes find this medium hard to communicate on and don't make myself as clear as I think I am) I was wondering more so if using cold therapy would help control pain, limit further swelling, and help protect the tissues, like we use in the athlete model, as the wound is already closed and practically gone. Reading back I know now to be more specific.....sorry...I am a bit nervous dealing with my first wound!

2. I guess that's what I expected...I was just wondering if reinjury or overexertion on an already injured leg could precipitate further swelling.

3. Will Bute for pain and inflammation

4. I have called the only two vets with in 3 hours of here but no one has called back. I will try to reach someone today for a more specific treatment. I guess not having a vet in close proximity makes it hard to deal with emergencies out here in cow country!

Thanks for the response...I will keep you updated on his knee.

v/r
Corinne
Member:
Corinne

Posted on Sunday, Nov 6, 2005 - 3:50 pm:

Well just back in...still haven't heard from any of the vets so I might just have to wait until Monday.
No one had any Bute at the barn and they only sell it in one place in town and that was closed too....I used a vet wrap as an insulation layer and then frozen corn secured with another vet wrap for 20 minutes to relieve some of the discomfort...still swollen but the temp of the swollen tissue is down today (before cold application)...not sure of the therapeutic value of cold therapy in horses but he seemed to like the cold and the swelling did go down somewhat after application.
My DO friend was at the barn and he said it looked more like soft tissue swelling (like from a Hematoma) as opposed to an infectious process but none of us can be certain (obviously) as we are used to dealing with Human injury. I will have to wait until Monday so I can actually speak or take him to a vet...Hopefully it's nothing serious by then!

Wish me luck...

Take care,
Corinne
Member:
Corinne

Posted on Sunday, Nov 6, 2005 - 3:53 pm:

I forgot to mention there is no change in the status of the actual small laceration...still scabbed, no drainage. No evidence of puncture elsewhere...
Member:
Sswiley

Posted on Sunday, Nov 6, 2005 - 5:18 pm:

HI Corrine.
Just a word of caution. I don't know how many times I have looked at a small wound on a horse that looked superficial only to find it had some depth to it. Horses (at least mine) are notorious for finding small pointy objects and running into them. The fact that he was sound at first and is now showing signs of pain leads me to suspect a growing infection. I would as a minimum keep those scabs moist and covered with some type of salve, that way if there is any infection it will find its way out the wound and alert you to the need for more rigorous treatment. They can have infections quite easily and they will heal over and stay inside with no drainage until they really get bad. If it were me I might even pop off a scab just to make sure. Also, if there is a small puncture and you can catch it early, you can flush it daily and usually avoid having to do the antibiotic routine.
My gelding ran into something last spring and poked a very small hole in his forearm. Turns out it went all the way to the bone. He, of course, was put an antibiotics along with daily flushing. The wound healed quickly with no complications. I guess my point is . .. always make sure there is no puncture. Sometimes this takes a bit of digging around and a tolerant horse. I always keep on of those wound irrigators handy. I buy them off my vet when I need a new one. You probably know what they are if you are in medicine.
Good luck and I hope it is just a simple bump.
Shelley
Member:
Corinne

Posted on Sunday, Nov 6, 2005 - 7:17 pm:

Shelley,

Thanks for writing back. I appreciate all your advice!

Yes....I would gather that debriding a wound to allow for infectious drainage to drain, would facilitate the healing process....we are keeping it moist with neosporin so it's not a hard scab. Hopefully if something needs to drain it will.

Anyway, Luckily, the vet, who just returned from hunting finally called and recommended Banamine and to keep an eye on the knee. He did not think Demetrius was a candidate for antibiotics at this juncture.

I explained the treatment we have provided and continue to provide and he seemed happy with what we were doing.

He said if the swelling doesn't go down in a day or two I should trailer him down to his clinic.

I do love living in the country...but it's rather frustrating to find a vet when you need one in an emergency. There are only two large animal vets within 3-4 hours radius. I guess it's the price we pay for living in the peace and quiet!

I will keep everyone posted. If anyone would like to add anything feel free as I am so interested in learning about everyone's experiences so that I can add to my information arsenal.

take care and have a good night.

v/r
Corinne
Member:
Lilly

Posted on Sunday, Nov 6, 2005 - 8:59 pm:

Hi Corinne,
You have made me realize how lucky I am to have my vet's office about a quarter of a mile from my barn! Good luck with your first injury.

Ann
Member:
Corinne

Posted on Sunday, Nov 6, 2005 - 11:02 pm:

Ann,
Thanks! There are obviously more remote points in ND and we are lucky to have a vet that close!
I know some people who board five hours away from their home so they can be close enough to a vet....We have one large animal vet office here in town that works on livestock primarily, but they do have a DVM there who has equine experience. Unfortunately he was not around this weekend. The one we use when we can get him to town (at $160 a visit for a barn call) lives 3 hours away and he was hunting this weekend but called back tonight.
So you are right to be thankful.I wouldn’t know what to do with vets that close.
Luckily, both are good DVM's but as you can see, not always reachable so thank goodness they are amenable to phone consults....a lot of phone consults.....other than that we read...and read....and read...and read to get health care information for our horses.

That's why I appreciate you all. Thanks for wishing me luck. Horses are very hardy and he will get through.

v/r
Corinne
Member:
Canter

Posted on Monday, Nov 7, 2005 - 8:38 am:

Hi Corine,
If you find a need to keep cold on the injury, rather than using the frozen veggies, try this: If you have some pillow wraps, wet them and then stick them in the freezer. If you live far from the barn, stick them in a cooler on your way out, but if you're close, this isn't necessary. The wraps will be rock hard, but give them a few minutes to soften up so that they are pliable enough to wrap around the injury. Then, using a polo wrap, secure the pillow wraps.

When my mare sprained her ankle this summer, I cold hosed for 20-30 minutes and by that time, the frozen wraps had softened up enough to put on her leg, keeping cold on there longer. After removing one, I just soaked it again and re-froze for the next time.

Good luck,
Fran
Moderator:
DrO

Posted on Monday, Nov 7, 2005 - 8:57 am:

Concerning your number 2 reply above Corinne, a puncture wound is unlikely to worsen from exercise alone as opposed to other types of soft tissue injury like a tendon sprain. The hose should be used to try and keep the wound open and flushed, is successful then the pallative therapy of cold hosing would not be necessary. If not successful the pallative therapy will not help.
DrO
Member:
Corinne

Posted on Monday, Nov 7, 2005 - 7:12 pm:

Shelley and Dr. O,

I debrided the wound because I couldn't get what Shelly said about something appearing superficial being deeper out of my head. Sure enough it appears to be deeper than upon initial inspection, although it's still hard to determine if it was a puncture with an object, perhaps triangle shaped to give the appearance of an laceration on the surface but allowing it to protrude deeper into the tissue, or a laceration.

He wouldn't let me do any more than that...

Either way there was some purulent drainage after debriding. And the swelling still persists proximal to the wound. I cold hosed for 20 minutes to flush it out and then called the vet I spoke to last night to tell him it's most likely infection. He was not answering his cell and the answering machine at the office was off.

I then headed to the Vets office in town for that banamine he suggested and advice about antibiotics or to make an appointment to bring my horse in.

Of course there was no vet there and the one who typically works on equines won't be back until wed. I left a message for the cow vet to call me back when he got back in this afternoon. I purchased the banamine and Pen G, just in case I was going to need it.

I then called an equine vet in Montana my last barn used and the one who did his pre purchase but she too was out on call. I left a message for her too.

After that...and a headache later...I DrOve to a small vets office 15 minutes in the other direction...just to inquire if anyone there had any experience with large animals...one DVM did and suggested PCN if I thought it was infected and to give 3cc of the 300,000 IU concentration IM QD, anywhere from 5-7 days but having not seen the horse could not be any more specific and I don't blame him so I waited for the call from any of the other three.

Four hours later, the cow vet called back and told me to give PCN, 3cc's per 100 lbs, in divided doses for 7-10 days. I asked him if I should have epi on hand in case of anaphylaxis and he said if there was a reaction he would likely die so I need not worry....in fact the epi in their office was expired that's how infrequently they see adverse reactions...MY, MY, MY that's comforting....he said just be sure not to give it in a vein or an artery...I said of course (I always, always landmark and aspirate back on anything I am injecting)

Anyway, not feeling comfortable with everything he was telling me, I called back the original vets office I spoke to last night and this time I got a tech. The tech there said to give the PCN, after I described the wound, but to give 5cc's per 100lbs for 3-5 days. I told her I don't want to chance resistance...should I give it for 3 or five? She said it didn't matter.

I have never been so frustrated in my life....

I wound up giving 24 ccs (3cc's of the 300,000IU concentration provided to me per 100 lbs) because at least two vets recommended that dose. I gave it in two divided doses on the left neck in the center of the triangle after I landmarked like I was instructed...(only after asking about landmarking)

I then stayed in the stall for 2 hours to monitor his reaction. He seemed fine...although pissed about receiving three injections today.

So....at the end of my rope....I just read the PCN article on this site again...

I am confident he needs it, confident on the dose, but not so sure on the duration. I have received three different answers on that one.

Duration has got to be important to prevent resistance...and to get all the infection...how can it be 3 or 5 or 7 or 14 and not matter?

I will follow wound care to a T for the rest of it.

Thanks!

v/r
Corinne
Member:
Corinne

Posted on Monday, Nov 7, 2005 - 7:18 pm:

P.S. Because everyone is recommending home care and he has gotten a dose of antibiotics a culture is moot at this point.
Member:
Bucky

Posted on Monday, Nov 7, 2005 - 10:59 pm:

Hi Corinne,

My heart breaks for you. Last spring I had a trailer accident with my horse and she ripped the skin straight off her tendon about 8 inches up and around the front below her knee. Anyhow LUCKILY (it was the Saturday before Easter) I was able to get her to a vet and stapled up within 45 minutes, and no muscle was torn. (The population in our nice little Montana valley has exploded by 40% in the past 10 years, the only benefit being vet competition!)That evening she swelled up from her knee all the way up into her shoulder. My vet had me give her a LARGE dose of Bute and Pennicillin. In my case it was imparitive to get the swelling out to prevent infection getting into her muscle. She was in enough pain that bute wasn't going to take it all away anyway and it was important to get the inflamation out. A very difficult 3 horse weeks later the staples were removed and she is fine.

Anyhow I don't know the difference between Bute and Banamine, but in my experience Bute is an excellent anti-inflamatory and if the Banamine isn't working shortly I would definately try Bute or something else. *Of Course I AM NO VET.

I am sure you and your horse will pull through, horses are so good at teaching us patience aren't they? Ugh. I hope Demetrius & Rocky are feeling better also. Loving animals can be so agonizing!

Best luck and wishes,
MM
Member:
Corinne

Posted on Monday, Nov 7, 2005 - 11:27 pm:

Mandy,
Those Montana horses are tough..Demetrius is from Bozeman...I think he is looking better already...just frustrated over not being able to get in touch with the vets...makes me wonder what would happen in a true emergency.
Anyway, long day...back to the barn for flushing and meds at 0730 then a full day of teaching Yoga and school work then back to do the evening wound care. Bute works really well...I have used it...I think he might have suggested Banamine which is also a non steroidal anti inflammatory because we thought it might be muscular?...Haven't actually spoken to the equine vets today....they have all been busy.
Demetrius might not be in pain by Tuesday...will see how the PCN and flushing, now that the wound is draining is paying off. I am sure it will relieve some of the pressure....
Well..hubby has to use the computer.
Thanks for the well wishes...Rocky is outside looking for snow to eat...got to go get him before he freezes.
Take care and have a great night!

v/r
Corinne
Moderator:
DrO

Posted on Tuesday, Nov 8, 2005 - 9:32 am:

I am glad we were able to help with the article last night and you might also find helpful Equine Diseases » First Aid » Giving Injections and Anatomy Orientation.

There is no predetermined treatment time and cessation should be based on resolution of signs of infection how well the wound is draining. It is typical to continue the penicillin for 3 treatments past resolution of the signs of infection and discontinue only after you are sure the wound drains well.
DrO
Member:
Corinne

Posted on Tuesday, Nov 8, 2005 - 11:00 am:

Dr O,

Thanks for the information....he looks well today...the swelling is slowly going down, after flushing the wound today it bled a tiny bit bit it's clean. Drainage is down. Thanks for information on the duration of the antibiotics.

I lunged him for 15 minutes and but allowed him to chose the gait...he walked a bit...trotted a bit then ended with a nice walk. I am keeping him in his stall one more day as the mud is horrible in his turnout and there would be no way to keep the wound clean.

Will go back after teaching this afternoon to reflush etc.

Still at a loss for what he could have injured himself on as there is absolutely nothing unsafe in their large paddock....but I guess if there is one sharp edge....anywhere...they will find it. Kinda like clean socks that fall on the floor in between the washer and dryer...they always find that one piece of lint. LOL

Well late for class.

Thanks everyone!

v/r
Corinne
Member:
Lilly

Posted on Wednesday, Nov 9, 2005 - 1:25 pm:

Hi Corinne,
Just a thought...is your horse turned out with horses that wear back shoes? There is a horse at my barn that sustained a deep "v" shaped wound on his hip a few months ago. When the vet came out to stitch him up, he said that Dakota's wound may have been caused by a horse with shoes kicking Dakota. The vet felt that the wound was most likely caused by a horse shoe nail on the kicker's foot.

Ann
Member:
Corinne

Posted on Wednesday, Nov 9, 2005 - 4:22 pm:

Ann,
None of his paddock mates or the neighboring mates have shoes except one very dominant mare in a paddock on the adjacent corner. She has electric fence that they have rigged so it's one foot before the wood panel fence starts....she she can't even nose over and hates the electric fence....But it's possible that she might have been able to get a leg through the fence. She is a draft and has the potential to do some damage because she is twice his size. So I guess It could have been a shoe nail injury...interesting thought. Too bad you can't be there to protect them all the time huh?
Demetrius looks great today! The swelling is almost completely gone, and the drainage has stopped, its no longer painful to touch and he is not lame that I can see, although I have only seen him at the walk and trot today as he was enjoying his freedom back in the turnout after wound care.
I walked the fence line again, found a piece of scrap metal that had worked itself up in the mud and picked that up. The paddock gets walked daily as it wasn't always a turnout and the previous owners were not very neat. Odd things turn up after a good rain and a thick mud.
All in all it's very very safe....and we have very attentive barn owners.
Anyway, didn't give the pain meds today as the pain is gone. Two more days of the PCN and boy is he mad about the needles....turning his hind quarters to me when he sees me coming with the PCN.....especially since he gets two in one dose (12ccs in each syringe.)
Wish I could explain to him in horse language the need for his medical care. When he gets tense about it....He does like music however and singing....so I sing to him...(albeit badly) and he lowers his head and smacks his lips and relaxes...unfortunately I have to sing the songs I know and I only know the words to Christmas carols...so it's a shot and some wound care during Rudolph the Red Nosed Reigndeer....and Frosty the Snow Man. Either he closes his eyes because it's relaxing to him or he is thinking...Man will she ever stop?
Too funny!
Anyway, thanks for everyone's support. Hopefully we will remain on the the right track and he will continue to heal. I had to keep it covered during turnout because there is to much mud and manure but it will be flushed and OTA at night.

Have a great night!

v/r
Corinne
Member:
Zane

Posted on Friday, Nov 11, 2005 - 4:37 pm:

Good luck Corinne, It seems you are doing your horse right. One suggestion for the future is to keep a supply of Banamine , Bute, and Aceprozine in your med bag so you don't have to search for it in an emergency. It seems these are the three basic things a vet always suggests as first aid for most injuries. the ace is especially important for an emergency like choke and makes treatment or handling of a horse much easier. Be sure to administer the ace before the horse is agitated or it may have little effect.
Member:
Corinne

Posted on Friday, Nov 11, 2005 - 5:39 pm:

Zane,
Great point! In fact we are on the same page because I stocked up today at the vets. I now have Bute Paste, Banamine, PCN, and various would dressing items and supplies that we can only get at the vets. I also made sure none of them expire until 2007. The only thing I don't have is the Acepromazine...but great suggestion.
He looked great today......even rode him for the first time since last Friday. He is pain free and happy that his PCN course is finally over!
Thanks everyone!

Take care for now!

v/r
Corinne
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