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Discussion on Septic arthritis from injection
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New Member:
Astrea
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Posted on Saturday, Apr 15, 2006 - 9:38 am:
My gelding developed septic arthritis following an injection of his coffin joint. He appeared severely lame about 20 days after the injection. Initial diagnosis was abcess and was treated as such. After nine days of treatment and no response, the vet checked his joint. A darkish fluid spurted out of the joint. He was taken to the clinic on an emergency basis. His protein count was 5%. What are his chances? He is getting daily flushing of the joint, intensive antibiotics to the area and systemic antibiotics. He is 11 1/2 years old and shows at the 3' level as a hunter/jumper.
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New Member:
Astrea
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Posted on Tuesday, Apr 18, 2006 - 7:29 pm:
(continuation) Does anyone have any experience with life after, or with septic arthritis? My horse is still in the clinic, still lame, and receiving regular joint lavages. The vet finally thinks that he has flushed the joint out well (he was not getting good flow from front to back and vice versa before today), but is going to do a culture to see what else is there. If there is still a problem, then we will do the orthoscopic stuff. The thing that is worrying me so, is that my horse's protein count is still at 6%. The vet says that this is bad news. I am trying to be positive, but am having a very difficult time trying to judge what my horse's quality of life is going to be IF he makes it through this. Does anyone have any experience with this? Any advice? I have given up on ever riding the horse again and am just praying for a yard ornament. Does anyone have any happy endings they can share?
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Moderator:
DrO
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Posted on Wednesday, Apr 19, 2006 - 7:52 am:
Welcome Astrea,
And I am so sorry to hear about your horse. I am sure you read the prognosis in the article. If there were no signs of a penetrating injury this is the usual history and outcome. Because of the rarity of joint infections without trauma in adults, you don't go poking into joints with no indication of an injury, at least not at first.
I think you are right, it is unlikely the horse will be ridable at this time. It is difficult to know how fast the arthritis is going to progress at this point, but I think pasture sound with occasional bute during acute worsening is likely. There will be a limp in the pasture however.
DrO
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New Member:
Astrea
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Posted on Wednesday, Apr 19, 2006 - 8:35 am:
Thanks, Dr. Oglesby for the reply. This has hit us all quite hard and we are struggling to stay optimistic, while we try to understand why this happened. In your experience, is it normal for an infection to pop up with that big a delay after an injection? From what I have read, it is more normal for the infection to show about 2-5 days after an injection. Do you have any ideas about what caused the delay? Also, will my horse be in a lot of pain after he gets over the initial trauma of the procedures, etc...? How will I know when to 'bute and when not to? I am concerned about stomach problems with long term 'bute usage... Meanwhile, thanks for all of the wonderful advice you offer. It is a godsend at the moment.
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Moderator:
DrO
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Posted on Thursday, Apr 20, 2006 - 7:58 am:
Astrea, 20 days is quite a time. Use of corticosteroids in the injection will delay symptoms but I have never heard of one being delayed 20 days.
How much pain there will be is tough to say and will certainly depend a lot on how you manage and treat the case. Besides bute there may be times where enforced rest will be needed. You will develop an eye for his lameness and in time you will find a level of lameness you will find acceptable and one where you will want to rest and treat.
DrO
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Member:
Astrea
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Posted on Thursday, Apr 20, 2006 - 10:11 am:
Dr. Oglesby, I have double checked the dates of the shots and when he showed up lame. At the earliest, he could have been lame on the 18th day after and it was just not caught until the 19th. Our vets are baffled about the length of time...
Meanwhile, do you have any idea on how long it will take to get him stabilized? I need to think of what his long term needs are going to be... Ideally, I would like for him to go out to pasture with a friend, but that may not be possible if he requires a serious level of observation. Are there any good articles that you could direct me to? Again, I appreciate the help and your advice. Thank you.
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Moderator:
DrO
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Posted on Friday, Apr 21, 2006 - 7:02 am:
How long before he is stable will depend on how sensitive the infection is to the treatment and how much damage was done, neither of which I know.
I know you want more information about the future but for the results of an acute septic arthritis in a major motion joint prognostication is very difficult. We know that DJD is likely to result but anything else we predict could be wrong so you are going to have to take this a day at a time to see what the horse can do to stay comfortable.
DrO
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New Member:
Lyne
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Posted on Saturday, Apr 22, 2006 - 9:26 am:
Hi Astrea,
I just wanted to share my experience with septic arthritis, which is also in the somewhat early stages.
My 12 yr old mare had septic arthritis in her hock following a trauma. She was in the clinic for almost a month and just returned home this week after a cytology indicated the infection had likely cleared.
While she was at the hospital it was a difficult time. Although she was receiving very aggressive treatments (arthroscopic surgery, regional perfusion, lavage, IV antibiotics, open drainage), the vets could still not say whether or not the infection would clear. It was a very serious injury that, like Dr Oglesby said, we had to take one day at a time.
The good news is that after all of that, the infection did clear and she is home and, from what I can tell, very happy about it.
We still have a long road from this point. The first concern is that the infection will flare up again, although the vets at the clinic have suggested that the chances of this happening are small (fingers crossed it doesn't happen). Second, is the damage to the cartilage in such a high motion joint. She is still lame (maybe 1-2 out of 5) with significant inflammation and is on stall rest until her sutures can be removed. We are hoping that with time and physiotherapy, she will be able to remain pasture sound.
What I have learned from this is that there are no definitive answers regarding the prognosis for septic arthritis. Dr. Oglesby is exactly right when he says you have to take it one day at a time. So far, my horse has beaten the odds given to her. I just hope that her progress continues and am thankful for every day that her attitude, and degree of soundness is at least maintained.
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Member:
Astrea
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Posted on Saturday, Apr 22, 2006 - 11:15 am:
Dear Lyne,
I am happy that your mare has made it through so far and appears to be taking this relatively well. Just out of curiosity, how long was it between your mare's injury and the diagnosis of infection?
Both you and Dr. O. are recommending patience, which is so difficult. You obviously know what we are going through. I am trying to take this one day at a time, but it is hard when the news is fairly neutral and then gets worse. But we all are trying to stay hopeful...  The not knowing is the hard part.
Thanks for sharing your mare's story. I hope that she stabilizes quickly without a recurrence of infection. Long live the pasture ornaments!
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New Member:
Lyne
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Posted on Saturday, Apr 22, 2006 - 11:11 pm:
Astrea,
The diagnosis came roughly two weeks after the initial injury. During those two weeks she was being treated with antibiotics, as the initial wound was a puncture wound. It is tough to say when the joint became infected. The infection likely travelled from the wound to the joint. Regardless, it had been infected for long enough that by the time she got to the clinic it was pretty severe.
I agree, it is very difficult not knowing. It wiped me out. It comforted me to know that I was at least providing her with the best care possible. The vets that treated my mare were great.
Good luck to your guy. I hope he had a good day and really hope he pulls through.
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Moderator:
DrO
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Posted on Sunday, Apr 23, 2006 - 10:16 am:
Hello Astrea,
My point was not patience but that at this point the future within the parameters we have already set is unknown. However hope, patience, and praying for the strength to handle whatever comes the best way to deal with such situations.
DrO
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Member:
Astrea
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Posted on Wednesday, Apr 26, 2006 - 11:31 pm:
Dr. Oglesby,
This is definitely one prayed over horse! He came home from the clinic today. The vet has done pretty much everything he can for him at the moment. The orthoscopy (sp?) revealed much damage to the joint, but the vet was able to get out all of the nasty gunk that was clogging up the joint and housing the infection. As of right now, his joint is showing clear of infection (knock on wood that this continues), but he is back to being three legged lame. We are wrapping his good leg to help protect it from injury. The vet is giving him one month to show some signs of improvement/recovery. He already would have recommended putting him down based on the damage to the joint and his lameness, but my horse's attitude is good--his appetite is still good and he loves his hay and cookies.
Meanwhile, in talking with anyone and everyone about ways to save my horse, a mention has been made of some stem-cell research being done in the College Station area of Texas (either at Texas A&M or nearby). Have you heard of anything like that? Also, are there any vitamins or supplements or anything that might help? He already gets regular glucosamine and conDrOitin...
Thank you, again, for being a friendly voice of experience.
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Moderator:
DrO
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Posted on Thursday, Apr 27, 2006 - 7:54 am:
I am sorry to hear about the appearance of the joint Astrea and the horses continued grade 5 lameness. There are discussions on some of the ways stem cells can be used in such situations but you should look upon any such therapy as purely experimental and they do not have any therapy available that will return a joint with severe damage to the articular cartilage to soundness. You should talk with them however so that you know you are pursuing all angles and perhaps even get a second opinion on the diagnostic images that have been done. In such situations with such a dire prognosis, your veterinarian should welcome a confirmation of his opinion.
DrO
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Member:
Astrea
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Posted on Tuesday, May 30, 2006 - 10:48 pm:
Update: My gelding is still very lame, still on daily 'bute, and still has a good attitude, although he is in pain. There is substantial scar tissue just above his coronet band. He has responded ever so slightly to an injection of Legend (two weeks post hospital), and slightly to physical therapy (to keep the joint from freezing), but struggles to go approximately 30' to and from his stall door to get grass. He hops around his stall and occassionally stands on all fours. Any activity leaves him very sore. We had to have the vet block the affected area so that the farrier could work on him [He hasn't had his feet picked out since mid-April!]. The barn vet and the surgeon are going to talk with a vet at A&M to see if there is anything else that we might do to make him more comfortable (i.e. fuse the joint), but I am worried that we will end up going to heroic efforts to get him just well enough to be miserable for the rest of his life. The barn vet said that it is a matter of how much pain he can stand and how much pain we can stand. She does not think that he will ever be comfortable. The surgeon allowed him to come home from the hospital because his attitude was so good when in all reality, it should have been terrible.
Dr. O, how much time do you think is reasonable to figure out what is best for him? If he is still three legged lame after four weeks of almost complete stall rest, is there hope that more rest will result in an improvement? And if so, how much more rest? Weeks? Months? His attitude is good and his spirit is definitely willing, but his body has betrayed him. On the other hand, if the vets say that there is a possiblity of fusing the joint, what level of outcome would make it worth the trauma of more surgery? Everyone at the barn has been wonderfully supportive, but this is my horse and he trusts me to take care of him. It is incredibly difficult to know what to do. I am looking for guidance.}
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Moderator:
DrO
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Posted on Wednesday, May 31, 2006 - 11:03 am:
I know this is tough Astrea and really a decision you have to make. As long as the horses attitude is good, I can support your decision to wait however the prognosis means I can support your decision to euthanize also. If at anytime the horses attitudes worsens, the other leg starts to break down, or if he lays to the point of developing decubital sores I think that is long enough.
The horse may continue to improve somewhat for 6 months but this will always be a up and down problem. Surgical fusion is a possibility to achieve pasture soundness but will require a great deal of resources with only a fair prognosis of achieving a comfortable pasture soundness. You are in my prayers.
DrO
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Member:
Astrea
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Posted on Thursday, Jun 1, 2006 - 7:59 am:
Thank you for being here, Dr. Oglesby. Having an educated opinion from a neutral source helps me to gauge the situation. I truly appreciate your kindness. My gelding and I both say thank you.
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Member:
Astrea
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Posted on Tuesday, Jan 9, 2007 - 6:06 am:
Nine month update: Miraculously enough, my gelding's joint has fused about half way and he is finally able to stand in his stall on all four feet. He is able to go out to the paddocks for grass and should be moving to a retirement barn at the end of the month [he was still too significantly lame to move before]. He is still in pain but less so, but may be able to be weaned off of the bute on a daily basis.
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Moderator:
DrO
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Posted on Tuesday, Jan 9, 2007 - 7:49 pm:
Thanks you for the update Astrea and it is comforting to know the horse is more comfortable.
DrO
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Member:
astrea
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Posted on Tuesday, Feb 20, 2007 - 10:31 am:
Of concern: I just got an email from the retirement farm. The farrier was out to work on the gelding's feet and said that there are signs of laminitis in his good foot (although he shows no sign of lameness yet). The vet is being called out to take x-rays. He already has a bar shoe on the good foot and his feed has not changed significantly. Why would he be developing this now after having survived so much?
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Moderator:
DrO
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Posted on Tuesday, Feb 20, 2007 - 7:13 pm:
Astrea we need more information to comment. What did the farrier see to lead him to such a statement? I have had cases of severe lameness that resulted in acute founder in the good foot, simply from bearing the majority or the weight normally supported by the opposite foot, but we will have to wait to see if this is what is happening. The cases I have seen were painful.
DrO
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Member:
astrea
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Posted on Thursday, Jan 24, 2008 - 9:34 am:
Whatever changes were going on in his good foot have halted. If you see him walk, he almost looks normal and the intense swelling above the coronet band has decreased. For a horse with the odds stacked heavily against him, he is doing great. The one drawback to his recovery is that his overall personality has changed. He has a tendency to get mean in the stall and will bite hard on occassion. He is alive, but not the same horse as before. It makes me wonder if I should have put him down after all. He has about 4-6 hours a day in a 1/2 acre paddock and a nice, roomy stall for the rest of the time with views on three sides. The people around are affectionate and caring, but he is still not the same. Could this be a sign of pain or depression?
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Member:
juliem
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Posted on Thursday, Jan 24, 2008 - 2:26 pm:
My paint gelding, who is the sweetest horse I've ever known, will get cranky if stalled for any length of time. I had another gelding who turned ugly when on bute. Can he be turned out yet and what about companions?
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New Member:
reneehay
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Posted on Thursday, Jul 10, 2008 - 1:48 pm:
Astrea, my mare has a similar problem that started in December 07. My mare was never treated for an infection of her fetlock joint and lost most of her cartilage in her joint by March. Her fetlock is now collapsed on the inside and she is in a great deal of pain. We've tried everything. We were hoping for fusion of the joint to relieve the pain and hopefully live in a pasture for the remainder of her life. I am having difficulty seeing her in so much pain. We are medicating her for the pain but the fetlock is still very painful. I've started a post with more detail. My horse is scheduled to have another procedure at the hospital and I don't know how much more I can put her through. How is your gelding doing? Renee
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Member:
astrea
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Posted on Thursday, Jul 10, 2008 - 3:19 pm:
Renee, At the walk, my horse looks almost normal. For the most part, he is pain free, but if he forgets, and tries to act like a normal horse, he gets very sore and goes severely lame. His life is as good as I can make it, but I wonder if we shouldn't have put him down. He has his good days and loves his baths, but there is always an element of pain and regret in his eyes. It is a heart break to really think about his life. He has a good stall and a good pasture and two miniature donkeys,, but I will always wonder if we did the right thing. Our vet calls him a miracle because he should not be doing this well. I will check for the details of what is going on with your horse. I feel for you in having to deal with this! But there may be more hope if more of the cartilage is left...
Astrea
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