Spotting Lameness: The Game Plan
— Read on horsenetwork.com/2018/10/spotting-lameness-game-plan/
Spotting Lameness: The Game Plan
Spotting Lameness: The Game Plan
— Read on horsenetwork.com/2018/10/spotting-lameness-game-plan/
For the past 6 weeks, my horse has been receiving Ozonetherapy to aid in his chronic back leg related issues- dermatitis (“scratches”), previous DDFT tendon laceration, a history of Lymphingitis, and the residual scar tissue from his DDFT injury. Due to his age (27), he lacks proper circulation in his hind end which does not help him fight his pastern dermatitis.
According to the American Academy of Ozonetherapy, Ozonetherapy is described as;
“Ozonotherapy is the use of medical grade ozone, a highly reactive form of pure oxygen, to create a curative response in the body. The body has the potential to renew and regenerate itself. When it becomes sick it is because this potential has been blocked. The reactive properties of ozone stimulate the body to remove many of these impediments thus allowing the body to do what it does best – heal itself.”
“Ozonotherapy has been and continues to be used in European clinics and hospitals for over fifty years. It was even used here in the United States in a limited capacity in the early part of the 20th century. There are professional medical ozonotherapy societies in over ten countries worldwide. Recently, the International Scientific Committee on Ozonotherapy (ISCO3) was formed to help establish standardized scientific principles for ozonotherapy. The president of the AAO, Frank Shallenberger, MD is a founding member of the ISCO3.”
“Ozonotherapy was introduced into the United States in the early 80’s, and has been increasingly used in recent decades. It has been found useful in various diseases;
After doing research and speaking to one of my good friends, we determined that Chance’s flare up of Lymphingitis, after almost 3 years of not a single issue, could possibly be caused by his immune system’s response to Ozonetherapy. Let me explain.
Chance suffers from persistent Pastern dermatitis (“scratches”) since I purchased him in 2000. I have tried everything- antibiotics, every cream and ointment and spray for scratches, diaper rash ointment, iodine and vaseline mix, Swat, laser treatments, scrubs and shampoos, shaving the area, wrapping the area, light therapy…you name it, I have tried it. So, when we began Ozonetherapy to help break down the left over scar tissue from his old DDFT injury, I noticed that his scratches were drying up and falling off. We continued administering the Ozonetherapy once a week for about 6 weeks. The improvement was dramatic!
However, one day Chance woke up with severe swelling in his left hind leg and obviously, he had difficulty walking. He received Prevacox and was stall bound for 24 hours. The vet was called and she arranged to come out the following day. The next morning, Chance’s left leg was still huge and he was having trouble putting weight on it. I did the typical leg treatments- icing, wrapping. The swelling remained. I tried to get him out of his stall to cold hose his leg and give him a bath but he would not budge. He was sweaty and breathing heavily and intermittently shivering. So, I gave him an alcohol and water sponge bath and continued to ice his back legs. I sat with him for 4 hours waiting for the vet to arrive. He had a fever and wasn’t interested in eating and his gut sounds were not as audible. He was drinking, going to the bathroom, and engaging with me. I debated giving him Banamine but did not want it to mask anything when the vet did arrive.
The vet arrived, gave him a shot of Banamine and an antihistamine and confirmed that Chance had a fever of 102 degrees and had Lymphingitis. There was no visible abrasion, puncture, or lump… I asked the vet to do x-rays to ensure that he did not have a break in his leg. The x-rays confirmed that there was no break. The vet suggested a regiment of antibiotics, steroids (I really am against using steroids due to the short-term and long-term side effects but in this case, I would try anything to make sure he was comfortable) , prevacox, and a antacid to protect Chance from stomach related issues from the medications. It was also advised to continue to cold hose or ice and keep his legs wrapped and Chance stall bound.
The following day, Chance’s legs were still swollen but his fever had broken. The vet called to say that the CBC had come back and that his WBC was about 14,00o. She suggested that we stop the steroids and do the antibiotic 2x a day and add in Banamine. I asked her if she could order Baytril (a strong antibiotic that Chance has responded well to in the past) just in case. And that is what we did.
Being as Chance had such a strong reaction to whatever it was, I did some thinking, discussing, and researching…first and foremost, why did Chance have such an extreme flare up of Lymphingitis when he was the healthiest he has ever been? And especially since he had not had a flare up in 3+ years…plus, his scratches were getting better not worse. The Ozonetherapy boosted his immune system and should provide him with a stronger defense against bacteria, virus’, etc. So why exactly was he having a flare up? And that is when it hit me!
In the past when Chance began his regiment of Transfer Factor (an all natural immune booster), he broke out in hives. The vet had come out and she felt it was due to the Transfer Factor causing his immune system to become “too strong” and so it began fighting without there being anything to fight, thus the hives. My theory- Chance started the Ozonetherapy and his body began to fight off the scratches by boosting his immune system. As the treatments continued, his immune system began to attack the scratches tenfold. This resulted in his Lymphatic system to respond, his WBC to increase, and his body temperature to spike. Makes sense…but what can I do to ensure this is not going to happen again?
My friend suggested attacking the antibiotic resistant bacteria by out smarting them…okay, that seems simple enough…we researched the optimal enviroments for the 3 types of bacteria present where Chance’s scratches are (shown in the results of a past skin scape test). The bacteria – E. Coli, pseudomonas aeruginosa and providencia Rettgeri. The literature stated that PA was commonly found in individuals with diabetes…diabetes…SUGAR! How much sugar was in Chance’s feed? I looked and Nutrina Safe Choice Senior feed is low in sugar…so that is not it. What else can we find out? The optimal temperature for all three bacteria is around 37 degrees celsius (or 98.6 degrees fahrenheit), with a pH of 7.0, and a wet environment. Okay, so, a pH of 7.0 is a neutral. Which means if the external enviroment (the hind legs)pH is thrown off, either to an acidic or alkaline pH, the bacteria will not have the optimal enviroment to continue growing and multiplying. How can I change the pH?
Vinegar! An antimicrobial and a 5% acetic acid! And…vinegar is shown to help kill mycobacteria such as drug-resistant tuberculosis and an effective way to clean produce; it is considered the fastest, safest, and more effective than the use of antibacterial soap. Legend even says that in France during the Black Plague, four thieves were able to rob the homes of those sick with the plague and not become infected. They were said to have purchased a potion made of garlic soaked in vinegar which protected them. Variants of the recipe, now called “Four Thieves Vinegar” has continued to be passed down and used for hundreds of years (Hunter, R., 1894).
I went to the store, purchased distilled vinegar and a spray bottle and headed to the farm. I cleaned his scratches and sprayed the infected areas with vinegar. I am excited to see whether our hypothesis is correct or not…I will keep you posted!
References & Information
Resources on how to diagnose, treat, prevent, and handle lameness in horses
Common Causes of Lameness in the Fetlock
My old guy has always had issues with his cervical spine/neck. Throughout the years he has developed arthritis which has caused symptoms which mirror EPM such as; ataxia, difficulty bending, hind end weakness, difficulty going up hills, lethargy, difficulty balancing when foot is lifted, muscle atrophy, sore back…you get the picture.
When his symptoms first came on I had the vet test for EPM. The test was positive. I did my research and found out that about 50% of horses will test positive for EPM but only 1% show actual impairment from the virus. I went ahead and completed two rounds of EPM medication therapy and still his symptoms continued. So, I sought out another vet who practiced eastern and western medicine.
After some chiropractic adjustments and acupuncture she felt that his issues were actually due to the cervical spine and not EPM. The vet also showed me how, when looking at Chance straight on, one of his eyes was lower then the other- a classic sign of cervical and jaw issues. We continued with the chiropractic and acupuncture therapy and have continued for over a year and the change has been remarkable. Along with these therapies, we upped his feed, added supplements, began stretches and different exercises, and had him walking and running up and down hills whenever he was outside. The dentist has also been of great help by floating Chance’s teeth every few months instead of once a year. This helps with the alignment of his teeth because he tends to ware one side of his teeth down more then the other; ultimately straining his jaw and neck.
He has rebuilt the muscle on his hind end, put on around 100 lbs, and is able to do stretches while someone is holding his foot up. He runs when he is outside and is no longer on pain medications (except on the rare occasion).
Here is some useful information on a horse’s back and cervical spine.
A little over a year ago Chance was diagnosed and treated for a lesion on the Deep Digital Flexor Tendon (DDFT) of his hind fetlock. At the time, I decided to go with Stem Cell injections due to it being the least invasive treatment option. The Stem Cells worked wonders and Chance went from barely being able to walk to running up hills, from daily pain medications to a supplement (DuraLactin) to help with pain and inflammation) for arthritis.
A few months ago I wanted to see how Chance’s fetlock was holding up. He did not have any symptoms- no swelling, lameness, etc- but I wanted to make sure. The ultrasound revealed that he did still have a small lesion on his DDFT that the vet felt was “congenital” and not problematic. But due to his history I wanted to ensure that it stayed non-problematic. I invested in some protective and supportive hind boots for hi to wear when he is outside or stall bound due to weather and decided to do a round (about 5 sessions) of laser treatments on his hind leg. The laser treatments are relatively inexpensive (about $65.00), non-invasive, and pretty much risk free.
We are coming up on our 3rd treatment and due to Chance being asymptomatic it is hard to tell if they are beneficial until we do another ultrasound. Once an ultrasound is completed I will post more.
Article on Stem Cell Treatments: http://www.rossdales.com/news/new-stem-cell-trial-to-treat-deep-digital-flexor-tendon-injury.htm
Articles on Laser Treatments: Research Laser Therapy
I brought Chance in from his turn out this evening and immediately noticed this flap of skin hanging off of his forehead. Another emergency vet visit…yay! Unfortunately, due to the skin flap being to the side and not hanging downward from the top, Chance needed staples…I believe it was 14 staples in the end and two cuts.
Needless to say, the vet did a phenomenal job stapling his poor forehead.
What type of shoe should I use on Chance’s back feet?
I am looking for something that is glue-on, provides support and comfort, that has good grip, while providing protection for his hoof from the rocky terrain.
After some research, I found GluShus- a company out of England. Their shoes sound fantastic. They have an aluminum shoe set in rubber that glues onto the hoof. Read more about these shoes by clicking the link below.
I’ll let you know how it goes!
Today was not the greatest of days….but I will say that we had the luckiest unlucky day ever! And, of course, it was a full moon tonight which means I should just stay inside.
Today we met with a new farrier. I have been doing some research on shoes that provide comfort, support, and do not mess up Chance’s hooves like nails tend to especially when a horse is on rockier terrain. I spoke with my vet who suggested to, “put shoes on all 4 hooves with a 1 degree wedge pad on both hind shoes. Set all 4 shoes back from the toe of the foot by at least a 1/4th an inch.”
I went to the farm a bit early and gave Chance a bath, some Equinox for pain, and got ready for the farrier. The farrier arrived and Chance was great! He stood on the cross ties and ate hay like a champ. For some reason I decided to lengthen the cross ties. I am not sure why exactly but thank God I did.
My dad and the farrier were with Chance while I went to feed Lucky his dinner. Well, after I fed Luck, I turned the corner and saw that Chance was on the ground! Yes, you read correctly, he was on the freaking ground…all 17.1 hands of him! The moment I saw him our eyes met- I know it sounds like the beginning of a love story- and he immediately took a deep breath and calmed down. I walked up to him and he slowly got up and stood there right in front of me with his head resting under my arm- breathing heavily and he had the beginnings of sweat covering his body.
I stood there and just spoke to him- calmly- telling him he was okay. Once a few minutes had passed, and he was calm, I walked him forward to make sure he was okay. Sure enough, he was fine…aside from some surface scrapes. I cleaned his scrapes up and walked him outside to eat some grass. After about ten minutes, I walked him back into the aisle for the farrier to finish up.
According to both my dad and the farrier, Chance was having his back left shoe nailed in when the nail hit a nerve and he flinched. I guess the farrier didn’t realize this because he hit the nail once more. That was when Chance reacted and went down. Thankfully, the farrier got out of the way & removed the nail midair (so that Chance wouldn’t go down on the foot with the nail and drive it deeper). Think of a splinter going under your nail…and then hitting it again, deeper under your nail….ouch!
However, he landed somewhat gracefully, but due to the cross ties not being break away and the concrete not allowing Chance to gain any “grip” with his newly shod feet, he began to panic. Upon seeing me, he calmed down, and he was able to get back up. I can’t help but thank my lucky stars that I had lengthened the cross ties so that he had some slack, and that I came back inside when I did…had I not, he would have kept flailing. Had I been in there when the nail hit the nerve it may not have happened because I would have said something to the farrier. However, had I been in there when it occurred, things may have also been far worse…since my dog, Sadie, is always right by Chance’s or my side at all times.
We ended up deciding to forgo putting hind shoes on until later (a few weeks) and the farrier removed the one evil hind shoe and trimmed up the other hoof. Chance stood quietly and allowed him to complete his job. I was so impressed with my old guy!
I have emailed my vet to see if she is able to come check on Chance tomorrow just in case…hopefully, Chance will just be a bit sore in the morning and nothing worse….:(
Chance is continuing to gain weight, although as I said in the previous post, he still needs to put on a good 50-75 lbs. As the days continue to get warmer, Chance’s arthritis seems to become more manageable for him; his stride is longer and he runs around (mostly after Lucky) more frequently.
Unfortunately, when the farrier came out about two weeks ago Chance was too stiff to get his back right shoe on. The farrier decided to come back out to try and re-shoe him and, during that time in between, Chance must have tweaked it…AGAIN!
While Chance did not have a shoe on his back right I kept it wrapped to provide some protection and also even out all of his hooves. However, when I arrived I noticed that Chance was significantly twisting his back right leg inward at the walk & it had some swelling. The swelling was not horrible but it was noticeable. I cold hosed his leg for about 45 minutes while I groomed him & gave him a dose of Equinox (pain medication) and Ulcer Guard. I put on his back leg wrap to help with reducing the swelling and provide some extra support. Chance did his neck stretches effortlessly and was baring weight on his back hind.
But as I was grooming him I noticed, on the left side his chest, he had patches of hair loss and dandruff. The area did not look red or inflamed, nor did it seem itchy or painful. So I continued grooming him and decided to put a call into the vet to come and check his leg and the hair loss.
Of course, I turned to Google to try and find out what exactly could be the cause of the patches of hair loss.
According to a handful of sources, there are a few possibilities for hair loss- mites or Lice, a vitamin deficiency, rain rot or crud, or even just his natural shedding tendency. A skin scrape would help to confirm what may be the cause.
As for the swelling of Chance’s back right leg, I decided to call our previous vet who collected and injected Chance’s DDFT with stem cells to heal the hole in his tendon. We have some stem cells left over and I wanted to see if injecting his leg again would be of any benefit. I also would like to get an ultrasound recheck to ensure that there is not another injury to his DDFT tendon sheath again.
The twisting of his back hind leg is worrisome as well.
Everything I have read about EPM states that horses can have a relapse in symptoms after treatment is complete. My concern is that the twisting are due to the neurological symptoms coming back since Chance’s EPM treatment has been finished for a little over two weeks….
Our current vet believes that Chance’s ataxia and twisting is not due to EPM but his cervical spine instead. Could the twisting be worse due to the swelling of his hind leg? Or is the swelling and the twisting two separate issues all together?
What a difference almost a year can make!
Text from Vet4 after ultra sound #3:
“I can see that he has a deep digital flexor tendon lesion and the medial side of the tendon sheath has improve but lateral side is about the same. The DDFT may the cause of all this in the first place and everything else is secondary. We will re ultrasound in 10 days or so just to confirm my findings. If they are correct, it would help to treat that area.”
Conversation with Vet4 :
So far, Chance has received; shock wave therapy, compression therapy and laser therapy.
Chance has a hole in his tendon. Vet4 believes that this is due to an infection/bowed tendon and severe lameness. The ultrasound, done yesterday, shows no change in size of the tendon hole after the previous two rounds of injections.
“Lymphangitis is a symptom rather than a cause and the cause was never treated.” Vet1 continued to treat it like a disorder rather than a symptom!
The swelling and infection have dissipated, as has the severity of the lameness. Though still lame, he is running around in the pasture.
Pain meds were started again due to increased discomfort and soreness.
Vet4 suggests doing one of the following:
1. Stem cell- which can take about two days if sample drawn has enough stem cells. If not, it could take about 4-6 wks to culture. Once injected he can move home. He is to be hand walked for a few days and then can go out as normal. Vet4 will come out in about a month to do another ultrasound and, depending on the size of the hole, may need to do further injections.
2. Surgery to clean out but NOT repair the tendon. This was not discussed in detail.
Payment plans may be an option. I emailed the office for payment options.
Time to make another decision!
Chance’s fever is still at bay, the swelling is almost gone, he is sound, eating, and the light has come back into his eyes!!!
I quickly tried to set up a trailer to haul Chance to the hospital where he would begin further diagnostics and treatments. I would have taken him soon if I felt that he was stable enough to withstand the haul. But he was too unsteady until now!
It took a few days, there was a trailer and someone to haul him (thanks to Vet3) and we had him on his way to the hospital! I was there waiting for him to arrive.
We began Baytril on 8/16. The next day Chance came in from pasture with NO fever, NO trouble walking, but also NO appetite- eating a little grain, hay stretcher, peppermints and the swelling worse.
Chance got Compounded Baytril- 2 scoops with feed previous pm. Vet3 advised us to give another dose of Baytril but Chance won’t eat (most likely due to the taste of the Baytril in feed previous night. But Vet3 believes it is due to his pain). So, we gave another dose of Banamine/10 cc (am and pm) and Tridex- 1 packet. Iced 2x/kept in/ wrapped both hind legs with boots. And the waiting game begins!
After I left the barn, I drove home and went straight to my computer.
What was happening? What are the masses? Scar tissue? Nothing was able to be extracted out of them…How can I get rid of them in order to see behind them?
Again, I stayed up until the sun came out the next morning. I already had two binders full of research and now I had a third.
Research made me believe that C has an infection in the Synovial Tendon Sheath that was being masked by the masses on the outer lining of the SS. The masses could be scar tissue from his MANY past Lymphangitis flare-ups. Perhaps, his immune system was not able to fight last attack and the infection settled in the SS and was walled off. Thus his CBC & WBC were normal and no fluid was extracted from SS masses due to the large size of the scar tissue.
C has a major hx with his RH and “flare-ups” and lameness. I never realized this until I took the time to study his past records from the first 5 years I owned him.
Symptoms are similar to an infection- what if we proceeded as if it were?
Lack of a positive culture does NOT mean that there is not an infection in the sheath!
1. Swelling decreases after being active
2. Fails to extend fetlock
3. Lame- exasperated by flexion
4. Positioning for fetlock flexion
Septic Synovitis: Cartilage degradation ischemia, Fibrin deposition lead to lameness to pannus form and adhesive form
Most common is Staph
Systematic Procaine Penicillin 22000 iU/kg or Sodium Benzyl Penicillin & Gentamicin 6.6 mg/kg for 2-9 days
Then change to oral potentiated sulfonamides 5mg.kg Trimethoprim and 25 mg/kg of Sulphadiazine
Other potassium penicillin w/ Amikacin Cectiofur or Enrofloxacin
IV antibiotics for 7-10 days switch to oral for 2 weeks
Regional limb profusion or placement of impregnated Polymethyylmethacralate or PMMA
I immediately called Vet4 and told him my theory. He said that it was possible and that we should begin treatment asap. He was still out of town so I called Vet3 to order Baytril. Vet3 felt my theory was legit and immediately ordered the antibiotic!