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Discussion on Opaque, shiny, fibrous tissue popped out of capped eblow
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Member:
chloemom
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Posted on Wednesday, Jul 3, 2019 - 2:43 pm:
Hi, our mare developed a capped elbow in Sept 2018 (the day of a horse show). It was the size of 3/4 of a big mango, and was treated with cold hosing, dmso, poultice, as well as using a shoe boil donut every night, and bedding her more deeply.
It settled down substantially, and became a lightly callused small lump, with some white hairs around it.
The barn switched bedding recently to a very fluffy, soft paper product, in top of rubber mats. A week and a half ago, the callus fell off, exposing some healthy pink skin, but also some tiny dots of open skin. I put ointment on it and all seemed well until we noticed that it had increased in size to a 1/2 kiwi on Saturday. After her ride, it had increased further - 1/2 a peach.
With this hot weather, our mare tends to enjoy a good roll after exercise, in the sand ring. But she continued to wear the donut at night.
By Sunday, her elbow was enormous. 1/2 a cantaloup. Hot to the touch. Our vet recommended frequent cold hosing, using dmso/predef once a day, poultice, as well as a few days of dex.
We took her temperature daily - never any fever. Each day showed improvement and as of today, it was firm, cool to the touch. We are now keeping the donut on for any turn out, plus bedding extremely deeply.
Yesterday (Tuesday), I noticed some blood in the callused area, and then some serous weeping this morning.
We walked our mare bareback for the first time since Sunday, and to our shock, noticed a long string of tissue that had burst out and was hanging like a thin worm. I thought it was pus, but when I tried to wipe it, it wouldn’t wipe off. In fact, it is quite firm, shiny, and stretchy - with the consistency of a gummy worm. Our vet wants us to start antibiotics, and to continue gently hosing it etc.
I’m still struggling with understanding the anatomy of what is involved and know that fibrous tissue can develop over time - and thought that it was changes to the bursa itself? What other things go on in such cases, and what could this be? Reminds me of fascia but is stickier and
I’m trying to make the photos smaller in order to attach them. Will add them to the post.
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Member:
chloemom
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Posted on Wednesday, Jul 3, 2019 - 3:47 pm:
Photos
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Member:
chloemom
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Posted on Wednesday, Jul 3, 2019 - 3:48 pm:
At its worse (Sunday)
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Member:
chloemom
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Posted on Wednesday, Jul 3, 2019 - 3:50 pm:
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Moderator:
DrO
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Posted on Wednesday, Jul 3, 2019 - 7:29 pm:
Hello Ros,
This looks like a fibrin clot with white blood cells mixed in. This is a product of inflammation derived from the serous swelling and not normal parts of the normal elbow. I guess it is possible that it is a piece of necrotic connective tissue but will take a biopsy to know.
DrO
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Moderator:
DrO
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Posted on Wednesday, Jul 3, 2019 - 7:31 pm:
this is a test
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Member:
chloemom
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Posted on Wednesday, Jul 3, 2019 - 11:31 pm:
Oh thank goodness - I almost fainted when I pulled on it and it pulled back ;). And assumed the worse.
After washing the area, the piece of fibrin clot turned from yellow to white - well, cream coloured.
I ended up having to trim the remaining tail, as tugging seemed unproductive.
Some serous continues to drain from the (small) hole, and the swelling is very firm, but cool to the touch.
Our vet has recommended starting an antibiotic and seems to think that healing is going well.
Do you think that any special care might be needed? I’m struggling to fully understand this type of bursitis and am hoping that in its current state, it is not like an abscess?
Many thanks, as always, for the information and advice on this site!
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Member:
chloemom
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Posted on Friday, Jul 5, 2019 - 7:00 am:
I’m worrying as the area has a hole that exposes a smooth pocket. Only serous is draining, the capped elbow continues to shrink, and antibiotics have been started, but I worry about the area healing.
I’ll call our vet again to see if anyone can come out, but wondered what to expect when it looks a bit like a crater. In person, it looks less horrible than in the photos. 
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Moderator:
DrO
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Posted on Sunday, Jul 7, 2019 - 7:52 am:
This wound will have to granulate in to heal Roz. See the article on long term wound healing for a description of this process, (HorseAdvice.com » Diseases of Horses » Skin Diseases, Wounds, and Swellings » Wounds / Burns » Long Term Deep Wound Care). However the problem here is one of chronic irritation when the horse lies down and will need care to keep that from happening. The article associated with this discussion has more on this.
DrO
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Member:
chloemom
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Posted on Monday, Jul 8, 2019 - 12:30 pm:
Thank you, Dr. O! Amazing articles and the info on wound care is excellent - I was received so many differing opinions from well meaning friends that I was feeling overwhelmed. The article provides clear, easy to follow advice specific to the challenges with an open, ‘ulcer’ type wound.
A couple of follow up questions for you:
1. In the wound care article, you mention nitrofuran sprays (for open wounds, pressure/ulcer situations) - is this something that is picked up at tack stores? Perhaps I was searching on the wrong terms , but didn’t find any sprays
2. Going forward, once healed, I want to avoid softening the callus, which I think happened this time (the callus fell off suddenly about two weeks ago, and I put a variety of ointments on it - probably petroleum based.... Should anything be used on the area, once healed, if the callus falls off? Or should simply spraying it with water be my ‘go to’ treatment?
Given that the area is open, our vet has asked that we keep our mare stalled, and she’s in very deep soft paper bedding. We are in high temps/fly season, so our mare is actually happy to be inside, with a fan.
We were also told to stop exercising her for now, to stop excess serous production as well as irritation to the area. She’s only out for hand grazing, wound care and lots of grooming, and is a bit bored but behaving quite well.
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Moderator:
DrO
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Posted on Tuesday, Jul 9, 2019 - 9:36 am:
The gov't has found furizone-related-drugs trace contaminates in meat (used as wound sprays on cows) and started with limiting its labelling on livestock intended for food, then it created an outright ban of it's use in the US though it had remained available for years afterward, it may now be impossible to find in the US. There are not any great alternatives but I am now using betadine (apply twice daily) or chlorhexidine solutions, half strength for outside the wound. Once healed hmmm.... continued use of betadine solution may help toughen the area...in dogs they use benzoin (ask the pharmacist) to toughen pads and it is sage enough to use on human skin where it was used to help bandages adhere to skin. If you are old enough you will remember the strong smell to be that of your doctors office in the 50's and 60's.
DrO
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Member:
chloemom
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Posted on Wednesday, Jul 10, 2019 - 8:04 am:
Thanks!
When you say betadine or chlorhexidine (half strength) solutions OUTSIDE the wound, do you mean that I should stick to water/saline flushes of the wound itself?
Will look up benzoin for post wound care! I’m not quite old enough to remember its use in doctors’ offices though I distinctly remember, in a foreign country, the use of ether instead of rubbing alcohol - both the technician and I began to feel light headed in the poorly ventilated treatment room after a few areas were cleaned ;)
Another question for you, which I didn’t find the articles - do you recommend restriction of activity/exercise for such wounds? Does activity create inflammation/increase serous production (if yes, why? Just curious!) . I can certainly see how protecting the area from further trauma is very important - which I define as pressure on the area, as well as knocks, rubs, etc
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