Not Thrush

The weather in South FL has sucked as of late. It hasn't been as hot, though this might also be because I'm just staying indoors during the hottest times of the day...but at night it's been sliding into the low 80's to mid 70's. Kind of unusual for September, to tell you the truth-last summer it was so hot even at night that a couple of times when I checked on Lily in the middle of the night (thanks to a wonky schedule then, too), I'd find her panting in her stall.

Remember how I thought her sweating was slowing down? Thanks to the cooler nights, her sweating is back to her "normal"-only on the front half of her body. Still better than nothing!

But it's been sucky in the sense that it has been raining A LOT!! And when you have a horse whose foot is supposed to stay dry, it makes riding nearly impossible! Last week we only put in 3 rides-for the last 2 I duct-taped her foot to keep it dry and managed to stay out of the puddles in the arena. The wet weather also calls for lots of arena riding, as the driveway has been flooding every time it rains for more than an hour-I don't want that nasty manure water seeping up into Lily's frog. There isn't enough duct tape in the world to keep her foot dry through the driveway when it floods-it doesn't take much rain to make the water ankle-deep! So when it's like this, we can't ride off of the property.

Lily finished her antibiotic, but by the end of last week, I hadn't seen a significant improvement in her comfort levels with her left hind foot. She wasn't lame by any stretch of the imagination, but was still resting it a lot, and on Friday I put her on the cross ties to do her stall and realized her right hind was puffy again, whereas her left hind was not-she had been resting the left leg that much again. Frustrated, I left a message with Dr. Gillard, knowing I probably wouldn't hear from him until Monday because the office was already closed for the weekend. My big question for him was weather I should do epsom salt soaks on her foot.

I struggled with what to do, and my instinct to soak her foot was so strong I just couldn't ignore it. Thrush be damned, I was going to get that infection out one way or another. So I soaked it, mixing the epsom salts with warm water (mixing hot water with enough cold water to make it comfortable for her), and halfway through the 20 minute soak, she started putting weight on her left hind and resting the right hind instead. I still put an ice boot on her right hind, then applied Sore No More gelotion to the right hind fetlock and tendons, and wrapped both legs for support overnight. I squirted some iodine into the crack in her left frog again, and again stuffed the cotton with antibiotic cream into the hole. However, while doing that I noticed that the back of her heel seemed very red and a little puffy, and was definetely ouchy to the touch. Hmmm...

Dr. Gillard called me the next day, Saturday, to my surprise. He gave the okay for the Epsom salt soaks, but only every other day. He did seem a little concerned about the lack of significant improvement, and wanted to know if the hole seemed shallower. I told him it was hard to say, as Lily tried to kick anytime you attempted to introduce anything in that hole, and I didn't want to accidentally jab her and make her bleed again. He said to stop all treatments for 4 days, as she might just be getting irritated by them, and if she wasn't better by then, he'd come out and x-ray the foot.

That evening she was back to normal-no swelling under her wraps. BUT...overnight she had blown out an abscess through her left hind heel! She was more comfortable on the foot, though. Contrary to what Dr. Gillard had instructed, I did do another soak that night to help drain out the abscess. I'm pretty sure the first soak helped draw out that abscess-it blew out through the same spot that had looked inflamed the night before post-soak. I skipped the iodine in the crack of her frog, but I did stuff it with cotton and antibiotic cream again. I just didn't feel comfortable leaving that open. I didn't want poop and shavings getting up in there. I also increased her bute dose to 1gram twice daily.

Over the weekend, I didn't get to ride because I was starting a 4-day stint of shifts at the hospital where I've been working relief, but luckily it stopped raining for 2 days in a row, which meant Lily's turnout paddock dried out enough for her to be able to go outside at night with Willy. The movement helped keep any fetlock swelling at bay, and Lily sane. Sunday night, I did a Lysol soak to disinfect the foot, adding 3 tbsp Lysol per gallon of warm water. (Lysol doesn't harm healthy tissue like bleach does.) That night I just started really worrying-I just didn't think this was thrush at all, and the abscess out the back of her foot indicated this was an infection that had popped out the only way it could.

On Monday morning, I put a call in to Dr. Gillard's office again, and they were actually able to squeeze me in that same day-Linda, his assistant, gave me a 1:30pm appointment, which worked perfectly-even if he was late, I still had enough time to do my chores and get home in time to change for work.

I showed him Lily's abscess and he said that was a good thing, as it meant the infection was coming out. I explained that I'd never heard of thrush causing a hoof to abscess. He said that it would be a separate issue altogether. He had me walk and trot Lily down the concrete barn aisle, and declared her to be stepping sound, even when I made her pivot on that foot to change direction. He did make a comment on her total lack of heels, and recommended 4 shoes to elevate her feet. I guess my horror showed on my face *lol* because he tried to soften the blow by saying that maybe I could get my farrier to trim her so that her heels will eventually be a little higher. (Between you and me, I think her heels are just fine! They are underrun, but so are most wild horses'!) We discussed hoof supplements. He had not heard about the supplement I have Lily on, Kauffman's Integri-Hoof. He poo-pooed it when he read the ingredients, and recommended instead Hoof Secret. I was bummed out because the whole reason I had chosen Integri-Hoof was because it had been the #1 hoof supplement per The Horse Journal (I'm a HUUUUGE fan of Dr. Elleanor Kellon! What she says, goes, when it comes to equine nutrition-she is one of the few equine vets in the world that has done extensive research on their nutrition and which supplements live up to their claims) not only for it's hoof-growth-oriented ingredients, but also because the minerals in it are balanced to one another and it doesn't contain iron. It's not just a hoof supplement, it's also a complete mineral supplement. However, after researching Hoof Secret, I discovered that it actually does NOT have more methionine and zinc than Integri-Hoof (it does have more biotin, but at 20mg for Integri-Hoof, that's still not bad at all)...Dr. Gillard misread Integri-Hoof's label. The ingredients are not in milligrams, they are in GRAMS. So Integri-Hoof has a WHOLE lot more of these 2 essential ingredients for hoof growth. So Lily stays on Integri-Hoof. Phew!

I had Dr. Gillard check Lily's frog crack, and I showed him where it was deepest (at the end of the crack proximal to her frog's apex). I insisted that this did not look like thrush to me at all.

Classic thrush presentation-note the flaky frog that appears to be falling apart, and the deep central sulcus that has turned into a crevice that runs all the way back between the heels of the foot. The frog will be sore, but the horse will allow you to stick the tip of a hoofpick between those heels. A hoof like this will also smell pretty bad. I got to know that smell really well-my previous gelding had one of the worst cases of thrush I've ever seen so far, on all 4 feet!

 



Lily's frog. The whole frog looks healthy and solid, except for that freaking crack that extends only along the underside of the frog. Plus, it doesn't stink. And yes, her white line is AWFUL. We're working on fixing that!

Looking closely at her foot, he had to agree with me. Dr. Gillard was able to gently introduce the rounded tip of a hemostat about half an inch in, and he exclaimed that it definetely looked like a puncture wound. I was instructed to continue the epsom salt soaks, as they obviously seem to be working, to keep the wound clean and dry, use yucky ichthamol on the abscess, and to ride, ride, ride. Mostly at the walk, but to do a 10 minute stint of lengthened trot at the end of the workout to really get her blood pumping, and ride as much as possible. Awesome! It sucks that our wonderful aerobic condition is going to be in shambles, but at least we're not just limited to walking exclusively. Our now boring arena rides have been all about the lateral work in an attempt to maintain her current muscle mass and flexibility. I still plan on lunging her at least once a week-she's going to have energy to burn!

There is a lesson here for everyone, though: ALWAYS trust your gut when it comes to your animals (and your own health, too!) This was one of those instances where my instinct proved to be 100% correct. Of course I have a veterinary education and certification to prove it, extensive training in one of the most demanding branches of veterinary medicine, and I'm constantly educating myself on horse care, so I know how to recognize and treat *some* things better than some vets. This doesn't mean that just because you googled some random condition you should go treat your pet on your own for something they may not have, or try out some holistic recommendation by so-and-so because it worked on their dog. Now mind you, I love holistic medicine, but there are some wackadoos out there, and not all holistic medicine is good, especially if you don't know how/when to use it, or if you are fanatical about it to the point of avoiding proven treatments. Traditional medicine by itself can and does fail, too. But I met a client that killed her dog with holistic medicine-the dog had a pretty serious degloving injury on a paw that the owner chose to treat with honey instead of giving the dog the antibiotic her vet prescribed & performing the required bandage changes. She had read that honey has wonderful antimicrobial properties. This is actually true, but it should only be used on small wounds or minor burns-not a huge area of exposed tendons and bones! This kind of injury is hard enough to heal with traditional advanced wound management! The dog developed a horrific infection that resulted in gangrene of the limb. The owner couldn't afford amputation, and instead ended up euthanising the dog. Improperly used holistic medicine cost this dog her life.

My point here is: if you think something is wrong, say it. A good vet will know a lot, and will think outside the box. But no vet is God-they are very much human, and they do make mistakes. If you're not satisfied, get the vet to take another look and reconsider, or get a second opinion. I can't tell you how often I see this at work, and why I always ask clients a bazillion questions about their pets when taking histories: the owner knows their pet best, and sometimes the animal will appear healthy on presentation, with vague symptoms that could be considered normal in another pet, but the owner insists something is wrong. You run bloodwork and voila: fubared, and the animal needs to be hospitalized or referred to an internist, for example.

Always trust your instincts.