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
The vet came out to give Chance and Lucky their fall shots and do some follow up acupuncture on Chance. The vet said that Chance has increased flexibility especially in his cervical spine and has gained weight and muscle mass!!!!!!
His feeding regiment is as follows:
He is out all day when it is cool and all night when it is hot during the day. So he has tons of green grass to eat. He walks constantly- up and down the hills- and runs around with Lucky. We also walk ground poles and do stretches and massage every time I come out to the barn.
We still need to continue upping his weight and muscle mass preferably before winter. Fingers crossed.
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?
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!
When I arrived at the farm I was greeted by those familiar big brown eyes and a whinny.
I brought him out of his stall and gave him a bath. He has always loved to be groomed and bathed, even if he is apprehensive to walk into the wash stall. After his bath, we went outside for him to graze and get some sunshine. When we walked inside the barn, I stopped him and looked into his eyes and asked him, “do you want to keep trying to get better or are you ready to give up?” He just looked at me. A lump immediately formed in my throat. He nuzzled me and rubbed against me. I said again, “Do you want to keep fighting?” He shook his head up and down! I swear to you! This actually happened!
The decision was made, we would keep on fighting as long as we were able to keep him comfortable. There was nothing I wanted more than to bring him home with me, let him live out the last days of his life pain-free, and with me by his side.
This was his turn. He had always done what I asked of him- lessons, moving stables and even cities, and he was patient while I was in school- and it was his turn for me to make it about him. For Chance to get every ounce of my time and for me to fight for him!
The first round of injections provided Chance with some relief, in his ability to move around and the swelling went down a bit, but that only lasted about a week. At about day 8, Chance was swollen again and 3 legged lame. Thankfully, a family friend of the farms owner called me. She explained that the farrier was out shoeing one of the horses and saw Chance’s leg, and when he arrived to shoe her horses, he expressed his concern. I immediately contacted Vet4 an he was out the following day.
Vet4 injected the masses again as a temporary fix, until we could make some decisions. The ultrasound showed that the masses were the exact same as they were in the first ultrasound- they hadn’t increased or decreased in size.
Later that evening, Vet4 and I had a lengthy conversation about where to go from here.
We discussed the options again, at length. We could do an MRI to gain more insight into what is happening with that leg, go in with an Arthroscope and clean it out, or look into Stem Cell Therapy.
Well, I wasn’t comfortable putting Chance under anesthesia…he was too old and too frail. Plus, he could break a leg or a hip going down. So, that ruled out the MRI (unless I could find a standing one) and the surgery. The Stem Cells would run about $3000.00, plus he would need to goto the hospital to have the procedure done.
I took the night to think it over, and stayed up until sunrise reading as much as I could on leg issues, the different options vet4 and I had discussed, and other potential causes.
That next morning, I received a call that Chance was worse. Vet4 was out of town due to an emergency, so I called Vet3. She got out to the farm immediately.
Vet3 gave Chance Surpass topical to put on the leg, Banamine, Ulcer Guard, and continued with the Prevacox to keep him comfortable.
I asked her what she thought about the options- she felt, as I did, the surgery wasn’t a good idea and that an MRI should only be done without sedation.
I called Vet4 and we spoke about the current situation. What else is going on? He suggested changing the course and trying different diagnostics. He explained that TSMs (Tendon Sheath Masses) can cause swelling and pain, but they are usually relieved by the injections. The ultrasounds showed that his suspensory tendon and ligaments looked good. Could this be an infection? Soft tissue damage? A bone issue?
I asked him if he felt moving forward with more tests was a bad thing…was I being cruel keeping Chance alive like this? Something that had been weighing on me from the start. And what Vet4 said, empowered me to continue down the path I initially felt in my gut to be the right decision. He said, “I am not the kind of person to ever give up on someone or something.” I asked if we were able to manage his pain adequately and make sure he was comfortable and he said, yes. He advised me to “make a decision based on the horse” and “not to listen to the opinions of everyone else”.
The next day, I cleared my schedule, and headed to the farm.
Vet3 came out to see Chance. She has worked with Chance for about 10 years, doing adjustments and acupuncture.
Chance has always had issues with his back and neck.
Vet3 typically follows the below regiment:
UPSIS- RSP- LAS- R. front shoulder- PL 6- RL 4 & 5- LT 9 & 13- RT 10, 11, & 15- BL 10, 11, 13, 17, 21, 26- SI 1, 3, 9, 11- TH 1, 14- LI 1, 14, 15- LU 11
Vet3 did some adjustments and acupuncture and Chance did well. She then referred me to the “God of anything leg related”, Vet4.
One day I received a call that I needed to come out and see Chance because he wasn’t doing well and, according to Vet1, he needed to be put down. I quickly canceled my appointments and got on the road. The 4 hour drive was excruciating…once we finally arrived, my heart broke.
My old guy was skin and bones. His back right leg was swollen and he wasn’t able to bare weight on it. His eyes were dull. He could barely walk, and when he did, he wouldn’t put any weight on the right hind. There were even times when he would do this “neurologic dance” (coined by the farm’s owner and C’s other mom) where he would lift up his back right leg and hop!
But when he saw me pull up, he whinnied. He was excited to see me. He ate the pureed carrots but refused the apple puree (only my mom would make this for him). He wasn’t ready to die.
I called the vet who said that Chance should be put down to see what his thoughts were.
Me: What do you think is going on with C?
Vet1: I think he is ready to be put down.
Me: Because of what?
Me: Okay, well, what is the cause of the Lymphangitis? Did you run any diagnostics?
Me: I would like to manage his pain and run a few tests before making that decision. (I reviewed the research that I had done and asked where to go from there.) Could it be EPM?
Vet1: “It’s not EPM”
Me: How about Cushings? Or Laminitis? Lymes?
Vet1: Nope. Just old age.
Me: The journals I read said that some of the symptoms…(I was cut off)
Vet1: “I don’t care what journals you read! It’s a bunch of…”
Me: One was from VA Tech actually…
Well, that was that! Vet1 did not completely lack compassion but he was more “old school” I guess one could say. He was well respected in the horse world and up until this point, he did the job I needed. But I will say I was disheartened by our conversation.
I decided to contact the other vets that I had worked with in the past, who also knew Chance, and get second, third, fourth opinions.