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  Discussion on Chest Abscess
Author Message
Member:
Huntjump

Posted on Tuesday, Jan 17, 2006 - 8:00 pm:

You may remember, or not, but back in November I had scheduled to have my gelding put down. He had been diagnosed with cancer after running a fever of unknown origin for a month and a half. He was having a hard time moving around from swelling between his front legs that everyone just assumed was from the cancer. The day before he was scheduled to be put down, a HUGE abscess opened on his chest. I have never seen an abscess this large. That was Nov. 9th. The abscess blew, fever stopped (and has not reoccured) and he was once again running around the field and being his energetic self. Even with the fever for so long he never lost his appetite. Well, 2 months later he still has swelling in his chest and still has drainage which now seeps from a wound the size of my finger tip. The original abscess was larger than my fist and deeper than my fist, I would say the hole was even larger than a grapefruit once all the dead skin came off. I had the vet out about 3 weeks ago to check up on it, and he suggested that I just keep doing what I am doing, hot hose it, give him bute or small dosage of steriods (dex) periodically to help the inflammation. He did suggest chest surgery under general anesthesia, which after $2500 for a diagnosis for the unknown fever I financially can't afford it(I am also going through a divorce right now). Last week I had to go out of town on business all week and before I left, the hole opened up more, swelling was really down and if I pushed on it, I could squeeze more pus from it. I had friends hot hosing it and caring for it everyday. Now that I am back, his chest seems really puffed out on his right side way above the wound, and it is hard around the wound again. He seems fine as usual, and there was just a small amount of drainage when he came in from the field tonight. The swelling is not hot to the touch and he is not painful to touch when I push on it or massage it.
I am just so frustrated with this. Should I be doing something different in caring for this? I realized because the abscess was so large that it may take time and my vet said if it closes up and the swelling gets tight, he can ultrasound for a soft spot and open it up. I just want to be sure that I am doing what I can for it. I just wish it would heal.
Sorry this is so long. We still do not know what caused the abscess and may never know. I have pics of a week after it opened, and then again about a month. If I can figure out how to make the size smaller, I will attach later.
Thanks.
Member:
Huntjump

Posted on Tuesday, Jan 17, 2006 - 8:02 pm:

Member:
Huntjump

Posted on Tuesday, Jan 17, 2006 - 8:06 pm:

I will try to get an updated photo in the next day or two. The lighting is too dark at night.
Member:
Christel

Posted on Tuesday, Jan 17, 2006 - 10:29 pm:

My first thought is pigeon fever. I had a filly that had it several years ago. It seems now it took a while to heal, as it drained too. My vet lanced it and she was on antibiotics and was fine after.
I missed the november post, sorry if repeating what was already mentioned.
Hope he gets well soon.
Chris
Member:
Mrose

Posted on Tuesday, Jan 17, 2006 - 11:34 pm:

Pigeon fever was my first thought, also. Why was he diagnosed with cancer? ? You probably went into all of this last fall, but I don't remember. Did the vet comment at all on the abscess's cause? Why did he suggest surgery? To clean out the abscess?

Years ago we had a horse come in that got Pigeon Fever and it did take several months to totally recover. She had a large abscess, also on the chest, which drained for a long time. We flushed it out with Betadine mixture several times a day if I remember right.

If by chance it is Pigeon Fever, there's an article on it here and discussion if you do a search under equine diseases.
Member:
Huntjump

Posted on Wednesday, Jan 18, 2006 - 5:27 am:

Just to clarify, this is not Pigeon Fever.
Moderator:
DrO

Posted on Wednesday, Jan 18, 2006 - 7:35 am:

I do have several comments Kristen. First the dexamethasone makes no sense as this impairs the immune system's ability to fight infection. If you need antiinflammatory therapy why not use bute?

Second the manual squeezing of the wound can drive infection into deeper tissues this needs to stop immediately. If there are areas not draining well they need to be surgically opened.

Lastly I would not be using hot or even warm water for hosing. I would be using cold water to help cool out the inflammation that seems to be a problem. For more on this procedure see the article on long term wound care.
DrO
Member:
Huntjump

Posted on Wednesday, Jan 18, 2006 - 8:15 am:

Thank you. I rely on vets to tell me what I should be doing so I will stop what I have been doing and follow your advice and see what happens. He is not on the dex continuously. When he balloons I give him a small dose. I have him on bute daily (1g at night feeding) except for whenever I give him the dex. I will start with the cold hosing.
Thanks for your help.
Moderator:
DrO

Posted on Thursday, Jan 19, 2006 - 7:40 am:

You should not stop following your vets advice Kristen, after all they have the advantage of seeing the problem, while we just get to hear about it. Instead you should take the points you get here and discuss them with your vet. 1 gram bute once daily would be a suboptimal dose for a full size healthy horse, 1 gram twice daily would be better.
DrO
Member:
Huntjump

Posted on Thursday, Jan 19, 2006 - 9:19 am:

Thanks DrO. I have been trying to find a happy medium. I have gone for a week without the hot therapy from time to time, and I have had him on 2gr of bute daily for a few days periodically. The swelling is frustrating. Sometimes it seems to go down and is soft, sometimes he has more swelling and it is soft, sometimes less and hard, sometimes more and hard. It is never consistent. So, I have just been trying to find what helps the most.
Thanks for your advice. Good thing is he has not spiked a fever since the abscess first came to a head, and he has been moving normally also. So I will continue to plug away at hopefully getting this resolved.
Member:
Paul303

Posted on Thursday, Jan 19, 2006 - 7:39 pm:

Kristen: I can't find any antibiotic treatment. Did I miss it? If I did, I'm sorry. From my perspective ( 37 yrs. in the dental field ), antibiotics first, rinsing and cleansing gently a few times a day, and cover with a sterile dressing.
There was a discussion a while back, on some pretty ingenious methods to cover the chest area. I'd make a rectangular "bib" with ties at the top and bottom.
Tie one end around the neck, bring the bib down over the chest, through the front legs, and tie the other end strings together by the first tie. It helps to thread one back tie through the first tie. Pin a large baby diaper ( using very sturdy blanket pins ) to the inside of the bib in the appropriate area. This should still allow the air to circulate and offer some protection from barnyard contaminants. You certainly don't need any secondary infection. You could also try a and attach a disposable diaper to that.

An abscess that continues to change shape is still active. As long as it is draining, it is soft and not too painful. When it begins to swell, it's usually because the avenue of drainage ( the fistula ), becomes blocked. Then, the products of infection and immune response back up behind the blockage. This is why keeping it draining is so important.
I don't quite understand what the diagnosis is right at the moment. If you had an abscess blow and, thank God you did ( or he'd have been euthanized for cancer ), the last thing I'd give my horse is a steroid. A steroid is used to suppress a screwed up immune system that is out of control due to an allergic reaction. In these cases, the immune system needs to be slowed way down. Your horse has a real, active infection going on. He needs his immune system to be in high gear - along with the additional aid of antibiotics.
Has there been any attempt to irrigate the area gently with a mild, saline solution or very dilute betadine or dilute novalsan solution and a large syringe? This would be after the hosing. By the way, Kristen, you might want to get your own hose to use. The barn hose sometimes lays on the ground, or in the dust of the barn.
I think I would be inclined to finish each treatment with an antibiotic ointment around the edges of the wound to keep the tissues soft so they don't dry up and shrink causing the premature closure of the wound.
I missed the beginning of this because of an extremely complex computer problem( OK, OK, Dr.O, my own incompetence ). Could you please go over the antibiotic treatment for me?
Good luck, Kristen. Looks like it's about time some came your way!
Member:
Dres

Posted on Thursday, Jan 19, 2006 - 7:57 pm:

attached is picture of my geldings abscess years ago.. i used a pair of EXTRA LARGE UNDIES to make the cover...


On the first day God created horses, on the second day he painted them with spots...

Member:
Hwood

Posted on Friday, Jan 20, 2006 - 12:15 am:

Oh, gosh, Ann . . . and Kristin . . . I usually read the posts as I get them, and sometimes don't go to the site to see the photos . . . Those abscesses are really frightening, yet must be quite a relief to have them burst and drain. I had a mare who burst a sterile abscess on her chest, once . . . it was grapefruit-sized, but it never opened up like the ones your horses display.
Ann, your youngster is adorable. Is he the same one that is in your profile?
Member:
Huntjump

Posted on Friday, Jan 20, 2006 - 7:22 am:

Lee- He was on antibiotic therapy when the abscess blew for 4 days. I was told that doing antibiotics now would slow the drainage process. When the abscess was big as in my first picture, I used a syringe with betadine solution to flush it. He had many pockets in the big abscess. I will try to post an updated pic this weekend. The wound is now very, very small compared to what you see above. It is about the size of the tip of an index finger and has a small hole (can't see the hole with your eye) that it drains from. The swelling is never painful to him by your touch (or he has a very high pain threshold and he never lets me know it's painful). It does get very itchy periodically. If I go into his entire story since Sept this post will be so long, but he is still with me and he seems happy and content. The fact that this abscess came to a head the day before he was scheduled to be put down is a blessing. It has made my vet and another vet that is my secondary in the area question the diagnosis given to me by Leesburg Medical Center. I think because he is gray and has a long history of external melanoma, had a fever of unknown origin for so long, that they immediately were looking for internal cancer. But I have been told that it is possible that an internal tumor caused this abscess. We just don't know at this point what the cause was. So, like I said, I continue to plug along and treat this the best that I can. Right now I am just glad that he has had no fever in 2 months and is happy, eating and enjoying life.
Member:
Mrose

Posted on Friday, Jan 20, 2006 - 10:16 am:

I so glad he is doing so good. I hope he fully recovers. I know you are enjoying each day. Please continue to update us, and if you ever learn what the cause of the abscess was, do let us know. Actually, this is a pretty amazing story.
Member:
Dres

Posted on Friday, Jan 20, 2006 - 10:34 am:

Holly, yes that is him in the profile.. He now is coming 7 and a lovely boy... bad luck boy, but my herd clown...he is just serviceable sound these days .. nothing to do with the injury at 7 weeks old.. just plain bad luck on his part...These type injuries are UGLY but do heal well .. usually...

On the first day God created horses, on the second day he painted them with spots..
Moderator:
DrO

Posted on Friday, Jan 20, 2006 - 8:42 pm:

Swelling in this area can be problematic because once it gets to the bottom of the chest it has no where to go, so it accumulates. All in all though it looks like it is doing pretty well. Are you giving the bute dose divided twice daily, this is important with its pharmacokinetics.
DrO
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