"And, when you want something, the entire Universe conspires in helping you to achieve it." -The Alchemist, by Paulo Coehlo



Wednesday, May 1, 2013

Up...and way down

Yesterday morning, I received a text from my vet early in the morning: she had heard back from the specialist, and he confirmed that Lily's issue is all soft tissue-no bone involvement. The specialist thinks the little fleck in the fetlock rads is a piece of calcified tendon or ligament from a previous old injury. We have to check it with ultrasound at some point, but we're hoping to wait until we do Lily's recheck in a month.

Relieved, I went to the barn to hand walk her. I had originally considered walking Jez first, but at the last minute changed my mind and decided to take Lily out first.

I peeked into her her layup stall, which is very dark. All I could see was her star and stripe when she turned her head to look at me, and her cocked left hind. Something didn't look right. She took a step towards me, and that's when the light hit her left hind sock. The fetlock was huge.

One hot, red, swollen fetlock.

I pulled her out of her stall immediately. The swelling started at her fetlock, ran up her cannon bone, then wound around the inside of her hock. A look inside the stall confirmed that she had not touched her morning grain, and her hay was mostly uneaten.

Yes, her inner thigh was that thick; her tail is tied in a knot in this photo. The swelling on the lower leg doesn't look as bad in photos as it was in real life. You couldn't see nor feel any of the tendons in Lily's leg; she had pitting edema all the way up, starting at the fetlock. Note that there is no swelling at the pastern nor coronet band. 
We started walking, not just to watch her move, but so we could get out from under the steel roof that cuts off phone reception inside the barn. Lily was stiff on that leg, and initially resistant to walk forward. I dialed my vet. 

She had an appointment to see another horse at our barn, and was already on her way. I was told to cold hose the leg while we waited. 

In the wash stall Lily went. While cold hosing, I discovered that the swelling didn't stop at the hock, no-it travelled ALL the way up the inside of her leg, following the path of Lily's saphenous vein, right into her groin. It was obvious that the infection had travelled up through her bloodstream. I checked the puncture wound while the hoof was still dry, but there were no changes in the hoof, and it was nowhere near as sore as it had been the day before. However, the swelling did hurt, all the way up the leg-Lily fidgeted a little and lifted the leg initially until I changed the hose setting to "Shower". I texted Sally; she was on her way immediately. 

What stumped me was that you'd think this was an infection that had stemmed from the puncture wound reopening and bleeding 2 nights ago. But, if it had been that, shouldn't her ENTIRE leg be swollen, from the coronet up? Her coronet and pastern were completely normal-the swelling started at the fetlock, which was where we figured the real issues lay. I couldn't find any cuts, nicks or scrapes anywhere on the leg that would explain the swelling. We had a young horse at my barn that was put down recently due to an infected sesamoid fracture. Lily's leg didn't look that different from his. I could not stop the tears.

After a good 15 minutes of hosing, I moved her to the cross ties in front of her stall, and strapped her ice boot to her lower leg, then pulled out a huge ice pack Sally had given me a few days ago, and wrapped it around Lily's gaskin, holding it in place with Vetrap. 

I groomed my mare, then sat down to wait, and this is where Dr. R found us, after following Lily's wet hoofprints from the wash stall. 

I removed the ice from the leg, and Dr. R took a quick initial look at it. "Lily, why did you do this? You weren't supposed to do this!" She looked at me and nudged me in the shoulder, "You know we weren't supposed to become this close friends this quickly, right?" This made me laugh. Dr. R had me walk Lily, and she thought Lily looked much better than last week when she first saw her. She said she wouldn't call her lame, just sore and stiff from the swelling. That made me feel a little better.

She examined the leg just as I had, and couldn't find any superficial wounds to explain this new event. We debated the same thing: puncture wound vs something more complicated going on with the fetlock vs an entirely separate issue that just happens to be on the same leg. If it's a separate issue, we have no explanation for how or why it happened. The only other explanation would be that Lily kicked out in her stall and fractured a sesamoid or worsened her soft tissue injury, but she has never been a kicker. When annoyed by another horse, Lily will rear, not kick. Dr. R said that no matter what, she's pretty sure this is cellulitis. We discussed treatment options: antibiotics, possibly a steroid, NSAIDs, cold hosing/icing, and sweating the leg. Lily got started on Naxcel right away-20 mls IV, which I will be following up with IM (intramuscular) injections every 12 hours. A horse's carotid artery runs directly underneath their jugular. One poke in the carotid and they can die-they can bleed out. This isn't that hard to do if the horse flinches and twists their head around like they sometimes like to do when poked with needles, which is why, despite being able to place IV catheters in tiny 1/2 lb puppies, I do not feel comfortable giving Lily her Naxcel IV. I know how to angle that needle to avoid this, but Lily is one of those horses that likes to twist her head around. My feeling about giving my mare her antibiotic IV might change, but right now, I'm going to go IM for starters. 

We decided we're not doing the steroid yet, just the antibiotic and the other treatments for the leg itself. Lily is also on diarrhea watch. One of the big side effects of Naxcel is life-threatening colitis. 

Yup, that's how serious this is. Joy. If the leg isn't 50% better by noon today, we have to re-ultrasound the leg and take more radiographs. 

Sally, who had not been planning to go to the barn at all yesterday, arrived halfway through Dr. R's exam, and she stayed with me until it was time for me to go. I have the best friend in the world. 

After Dr. R had left, I iced the leg again, then walked Lily for a little under 10 minutes. The vet wants me to do shorter, more frequent walks. I scrubbed the left hind hoof with antibacterial soap and water, and wrapped that as well for good measure. Just in case. The swelling did go down a bit with all of this, but it was back to square one when I returned at 8:00 pm for another round of treatments, though Lily was walking a lot more comfortably. After walking, cold hosing, icing, and re-wrapping the hoof, I put Furazone all up the inside of Lily's leg, applied plastic wrap over that, and then stacked standing bandages, below and above her hock so she could still bend the leg. It looked kind of goofy, but as long as it stayed on and did its job, I didn't care.



Off to the barn to see how she's doing. We're allowed to go earlier, but technically the barn doesn't open until 9:00 am. BQ lives above the barn, and she does veterinary research, which means she is often up late. A plus, because the horses get checked at 11:00 pm, one by one, and they get an extra meal of hay when they're indoors for the night.










6 comments:

  1. *hug* I'm sorry, I hope the swelling resolves soon.

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    1. Thankfully about 90% back to normal again today. That was terrifying there for a minute...

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  2. Yikes, scary scary! Thoughts and prayers for you and Lily--hope it's better today!

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  3. I'm sorry, that's terrifying. Cellulitis can be pretty treatable though. Fingers crossed all this ends for you soon!

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    1. Thank you Lauren! It wasn't so much the cellulitis that was freaking us out, it was the cause of it, or the possibility of it being something more serious, like a fracture. Thankfully she responded to the treatment. Phew!

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