Aaargh, think I might have to PTS my in-foal mare

scarymare said:
I totally agree but have already changed vets so its really difficult. I think he wants the bandages on for months. I really really wish i was back in Windsor and Simon Knapp was my vet because then at least I'd know that the treatment was correct. My current vet is undoubtedly the best horse vet in Aberdeenshire but.......
Click to expand...

If you have so much faith in your old vet why not email him with some pics and all the details and see what feed back he can give. Anything is worth a try.
 
scarymare said:
So agree with you. The main problem with leaving it uncovered is that were the last rubbish vets stitched it (badly) there is a 'pocket' of gapping skin at the bottom of the wound. This gets filled with s*** (literally). I have told the vet that i think he should cut it off. He is loathe to do so though as expected (past tense) this to grow up the wound. The pocket is still 'viable' so I'm stuck between a rock and a hard place. He also makes the point that when there is such a huge amount of uncovered flesh - why would you want to cut more off (the wound doesn't meet by 4 inches initially - more than 6 now. Nightmare again
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Scarymare: can you not discuss with your vet the option of sticking a drain in the bottom of this pocket of skin you help the yuckiness drain out? Sure he should be able to make a small incision and fix a small tube in to help keep it draining from the bottom to enable it to heal top down (if that makes sense).

http://www.tpub.com/content/armymedical/MD0906/MD09060189.htm
 
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Had a look at your photo from your other post - not as bad as I thought it was going to be - just an awkward place!! I've had 2 horses one with a very similar injury to yours, it was at the top of his forearm - de-gloved an area the size of a dinner plate - and it was only a 4 month old TB! He did it downwards too so had a big flap hanging down, the vet initially stitched it but not surprisingly it broke down within a day so I just cut it off as it was dead anyway. It took an awful lot of dressings and Intrasite gel and about 6 months of keeping it clean with special dressings and getting any dead gunk off it everyday until it started to bleed - cost a bomb - about £600 or more, but he was back out in the field after 3 weeks to help it keep mobile. All that is left now is a tiny patch about the size of a penny of white hair. He was on antibiotics for 10 days and that was it.

The other one we had was again a foal, every few years we get an accident magnet!, who got a back leg, and how he did it I'm not sure but his head too!!, stuck in stock fence and basically de-gloved down to the bone the whole of his rear cannon bone from joint to joint it was just the skin at the top and bottom on the back of the cannon that was still attached - amazingly he missed the blood vessels and tendons but you could clearly see them flapping in the breeze!
The vet wasn't quite sure what to do to be honest and rang the edinburgh vet school for advice as he had never seen anything so bad - you could wrap your hand round the bone!! This time we didn't bother to stitch it, we sedated and thoroughly cleaned it, anti-b's for 10 days, and just put tons to start with of intrasite gel and special non stick dressings then loads of padding and a waterproof sticky bandage which held it all in place nicely, he was only kept in for 3 days as he was so well behaved and sore enough not to go flying round. That took again about 5 months to heal and required daily dressing changes to start with and then every other day and once it was just pink and gooey every 3 days, he got so used to us faffing with his leg we could actually just change it while he was loose and eating in the field - I think it got itchy after a while!
It healed with no proud flesh and he just has a zig zag scar running down the cannon, he is now a 5yr old stallion and training to be a stunt horse!!:D

So wound management is crucial but it is do-able it just takes time and patience - the amount of swearing coming from our stables to start with was interesting - one fidget and there's expensive intrasite all over the floor and dressings stuck to hooves!!!!:D And as for the skin flaps - just get the vet to cut them off - they are only a hinderance and hold all the gunk in place - get him to cut back so you have nice clean edges.
 
queenbee said:
Scarymare: can you not discuss with your vet the option of sticking a drain in the bottom of this pocket of skin you help the yuckiness drain out? Sure he should be able to make a small incision and fix a small tube in to help keep it draining from the bottom to enable it to heal top down (if that makes sense).

http://www.tpub.com/content/armymedical/MD0906/MD09060189.htm
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Agree.

This is what we did with Kitty last year as she had gouged a hole in her side which was deep enough for vet's fist only just missing her ribs (you could see the outline of them under the flesh that was left) . Yes, we could and did stitch the wound but it was expected to break down which it did in parts. Each day I had to wash off with saline, push some Antirobe capsules down the holes and also fill them up with Intrasite. You can hardly see the scar now.
002-12.jpg

001-11.jpg


Just after the drain was taken out
kittystitch019.jpg


a fortnight later
K002.jpg


This was nearly 4 months after it happened, her first day without a protective rug on for an hour as it had healed over completely just was still bald.
kittyout008-1.jpg
 
If she is clearly trying then I wouldn't give up yet. Skin graft might be the best possible option for a good long term prognosis and cosmetically OK result but maybe the vet could lower his sights and aim at getting her through the foaling. I'd ensure she has the best possible nutrition because she needs to heal herself as well as grow the foal. Supplements might be helpful. If you really believe the wound is gangrenous then it surely needs to be cleaned up before it can heal with whatever treatment. It might be necessary to sedate her for that but the maggot therapy can work brilliantly, they gorge themselves on rotting flesh, removing it from the wound without causing too much distress. Once the foal is born the foaling bureau could help find a foster mum and the mare's body would be able to revert to putting itself first. You could review the situation at that stage and treat or PTS if necessary. I don't think that three weeks is anywhere near long enough to make the decision the wound isn't going to heal.

I am sorry, this is an awful situation. If the mare becomes toxic or in distress then PTS might well be the best option, but until then I'd give her and the foal the best possible chance.
 
candyflosspot said:
None taken :). Can i ask why this is then? :)
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An example, that is nothing to do with pregnancy is that I am on sodium valproate, as a result I am unable to take certain forms of the pill, the combined version is not so effective as the progesterone only, I am also not able to take anti depressants, the same goes for the herbal version st johns wort, furthermore I am unable to take antacid tablets (I reckon that must be to do with the chalk, possibly inhibiting the uptake of the drug into my system) as for pregnancy:

http://www.americanpregnancy.org/pregnancyhealth/naturalherbsvitamins.html


http://www.swsbm.com/ManualsMM/HerbMedContra1.pdf (see below for info from this link)
HERBAL-MEDICAL
CONTRAINDICATIONS
by Michael Moore
PREGNANCY
Some of these herbs are relatively harmless, but considering the highly
reactive state of pregnancy, and the fact that fetal growth is a template
that can manifest pharmacokinetics VERY differently than for an adult,
they are mentioned. Others are obviously inappropriate because of
endocrine, autonomic or vascular effects.
PREGNANCY: TERATOGENIC/MUTAGENIC
Podophyllum (American Mandrake)
Baptisia (Wild Indigo)...theoretically
PREGNANCY: UTERINE VASOCONSTRICTORS
Arctostaphylos (Uva Ursi, Manzanita, Coralillo) if use is continued for
more than 3-4 days
Ephedra vulgaris (Ma Huang, Chinese Ephedra)
Ustilago (Corn Smut) A feeble ergot analog
Vinca major (Periwinkle) Idiosyncratic vasoconstrictor
Viscum album (European Mistletoe) May incorrectly be American
Mistletoe in commerce, a very vasoconstricting plant.
Xanthium (Cadillos, Cocklebur) More than 6-8 burrs a day can
cause potential placental separation
PREGNANCY: UTERINE VASODILATORS
Actea rubra (A. arguta, Baneberry)
Aloe (Aloes Socrotine, etc.)
Angelica sinensis (Dong Quai, Tang Kwei)
Apocynum cannabinum (Dogbane, Canadian Hemp)
Aristolochia serpentaria (Virginia Snakeroot)
Aristolochia watsonii (Indian Root, Raiz del Indio)
Arnica (A. montana, A. cordifolia, A. latiflora, etc.)
Artemisia absinthium(Wormwood)
Artemisia tridentata (Sagebrush)
Artemisia vulgaris (Mugwort. California Mugwort)
Asclepias asperula (Inmortal, Antelope Horns)
Asclepias tuberosa (Pleurisy Root)
Bryonia (Bryony)
Cacalia decomposita (Maturin. Maturique)
Chamaelirium (Helonias. Unicorn Root )
Chenopodium ambrosioides (Epazote. Wormseed)
Cimicifuga racemosa (Black Cohosh)
Corynanthe (Pausinystalia Johimbe. Yohimbe)
Crocus (True Saffron, "Azafran")
Daucus carota (Carrot, Wild Carrot) The seeds.
Euonymus (Wahoo, Burning Bush)
Fouquieria splendens (Ocotillo)
Galega (Goat's Rue)
Hedeoma (American Pennyroyal, Poleo Chino)
Iris versicolor, I. missouriensis (Blue Flag)
Juniperus (Juniper. Sabina, Sabino Macho, "Cedar")
Lilium tigrinum (Tiger Lily)
Lophophora (Peyote. Mescal Buttons)
Petroselinum (Parsley) Fresh leaves in large amounts
Podophyllum (American Mandrake, May Apple)
Polygala senega (Senega Snakeroot, Milkwort)
Polymnia uvedalia (Bearsfoot, Leafcup)
Ruta graveolens (Rue, Ruda)
Sanguinaria (Bloodroot)
Spigelia (Pink Root)
Stillingia sylvatica (Queen's Root)
Tanacetum (Tansy, Ponso, Tanse)
Thuja (Arbor Vitae, Flat, Red or Yellow Cedar)
Turnera diffusa (Damiana)
Xanthoxylum (Prickly Ash)
PREGNANCY: CATHARTICS / SACRAL IRRITANTS
Aloe (Aloes Socrotine. etc.)
Cassia marilandica (American Senna)
Chenopodium ambrosioides (Epazote, Wormseed)
Heliopsis longipes (Raiz del Oro, Chilcuan)
Iris versicolor, I. missouriensis (Blue Flag)
Leptandra (Veronicastrum, Culver's Root)
Podophyllum (American Mandrake)
Rhamnus californica (California Buckthorn)
Rhamnus Frangula (Buckthorn)
Rhamnus purshiana (Cascara Sagrada)
Rheum (Chinese or Turkey Rhubarb)
Senna (Cassia angustifolia, Te de Sena )
PREGNANCY: OXYTOCIN SYNERGISTS
Asclepias asperula (Inmortal, Antelope Horns)
Capsella bursa-pastoris (Shepherd's Purse,)
Caulophyllum (Blue Cohosh)
Gossypium (Cotton, Algodoncillo) Root Bark
Leonurus cardiaca (Motherwort)
Lophophora (Peyote, Mescal Buttons)
Scoparius (Cytisus Scoparius, Broom Tops)
Ustilago (Corn Smut)
PREGNANCY: OVERT DRUG PLANTS (and compounds)
Aconitum columbianum (Aconite, Monkshood) Aconitine
Apocynum cannabinum (Dogbane. Canadian Hemp)
Feeble digitaloid
Chenopodium ambrosioides (Epazote, Wormseed)
Cinchona (Peruvian Bark. Quinine Bark) Quinines
Convallaria (Lily of the Valley)
Feeble digitaloid
Corynanthe (Pausinystalia Johimbe, Yohimbe)
Yohimbine AND some reserpine relatives..an indole stew
Datura (Jimson Weed. Toloache, Estramonio)
Atropine effects
Ephedra vulgaris (Ma Huang, Chinese Ephedra)
Ephedrines
Garrya (Silk Tassel, Cuauchichic, Quinine Bush)
Garryine, Cuauachichicine - anti-cholinergics
Gelsemium (Yellow Jasmine)
Gelsemine...an indole alkaloid and CNS irritant
Hyocyamus niger (Henbane)
Atropine effects
Lophophora (Peyote, Mescal Buttons)
Nicotiana (Punche, Tobacco)
Peganum harmala (Syrian Rue)
Harmine (indole alkaloid, MAO inhibitor)
Pilocarpus (Jaborandi)
Pilocarpine and other muscarinics
Scoparius (Cytisus Scoparius, Broom Tops)
Cytisine, sparteine (simultaneous Hypo-Hypertensives)
Veratrum (Green, False or American Hellebore)
Cardiac depressant
PREGNANCY: MISCELLANEOUS WIERDNESS
Aconitum carmichaeli (CURED) (Fu-tse, Fo-tzu)
Peculiar adrenergic, wrong in TCM, and generally too potent.
Acorus calamus (Calamus, Sweet Flag)
Mildly co-carcinogen (Eurasian strain), and may interfere
with normal PG inter-reactions
Aesculus californica (California Buckeye) see below
--Aesculus glabra (Ohio Buckeye) see below
--Aesculus hippocastanum (Horse Chestnut)
All stimulate myenteric plexus, with unpredictable effects.
Amygdalis persica (Peach Tree)
Cyanogenic, unless prepared perfectly
Anemone hirsutissima (Pulsatilla) anti-dopimergic
Baptisia (Wild Indigo Root) CAN mimic Scoparius
Corydalis aureus (Golden Smoke)
--Dicentra canadensis (Turkey Corn)
--Dicentra formosa (Bleeding Heart)
--Eschscholtzia californica (California Poppy)
Above four have mixed protopine alkaloids
Ginkgo biloba (Maidenhair Tree) Many effects, unpredictable
Glycyrrhiza glabra (Licorice) Minerocorticosteroid effects
Guaiacum officinale (Lignum Vitae, Guayacan)
Unpredictable vasodilation, feebly muscarinic
Helenium hoopesii (Yerba del Lobo) Potential liver irritant
Hydrastis (Golden Seal) Mucosa stimulant, may age placenta
Larrea (Chaparral) Quirky anti-oxidant, w/hemolytic potential
Lomatium dissectum (Leptotaenia) Too bioactive to chance
Marrubium (Horehound, Marrubio) Can be mildly hypertensive
Mentha arvensis (Brook Mint, Poleo) Has Pennyroyal effects.
Oplopanax horridum (Echinopanax, Devil's Club)
--Panax ginseng (Asian Ginseng)
--Panax quinquefolium (American Ginseng)
Above three are anabolic/hypothalamic
Phytolacca (Poke) Idiosyncratic muscarinic effects
Prunus (Wild Cherry) Cyanogenic when gathered incorrectly
Ptychopetalum (Muirapuama. Raiz del Macho)
Idiosyncratic motor/sacral stimulant
Senecio aureus (Life Root) May be toxic relatives
Silybum marianum (Milk Thistle) May inhibit hepatocytes in
excess; pregnancy may alter therapeutic window
Solanum dulcamara (Bittersweet Twigs) Too bioactive.
Symphytum (Comfrey) Hybrids in commerce contain root PAs
Tribulus (Puncture Vine, Goat's Head) Ayurvedic Medicine
advises not to use in pregnancy
Viscum album (European Mistletoe) May be adulterated with
American Mistletoe: even if correct, it is too bioactive
PREGNANCY: MAY BE PRESENT IN MILK
Acorus calamus (Calamus. Sweet Flag)
Ailanthus altissima (Tree of Heaven)
Allium sativum (Garlic)
Aloe (Aloes Socrotine, etc.)
Aristolochia serpentaria (Virginia Snakeroot)
Aristolochia watsonii (Indian Root, Raiz del Indio)
Artemisia absinthium(Wormwood, Agenjo)
Artemisia tridentata (Sagebrush, Chamiso Hediondo)
Artemisia vulgaris (Mugwort, Altamisa)
Cacalia decomposita (Maturin, Maturique)
Cannabis sativa (Marijuana, Hemp)
Cassia marilandica (American Senna, Te de Sena)
Chenopodium ambrosioides (Epazote, Wormseed)
Commiphora (Myrrh Gum, Mirra)
Convallaria (Lily of the Valley)
Daucus carota (Carrot, Wild Carrot) Seeds
Dracontium (Symplocarpus, Skunk Cabbage)
Fouquieria splendens (Ocotillo)
Galega (Goat's Rue)
Ginkgo biloba (Maidenhair Tree)
Juniperus (Juniper. Sabina, "Cedar")
Ligusticum porteri (Osha, Chuchupate)
Pilocarpus (Jaborandi)
Rheum (Chinese or Turkey Rhubarb)
Sanguinaria (Bloodroot)
Senna (Cassia angustifolia, Te de Sena )
Ruta graveolens (Rue, Ruda)
Tanacetum (Tansy, Tanse, Ponso, "Altamisa")
Thuja (Arbor Vitae, Flat, Red or Yellow Cedar)
Xanthoxylum (Prickly Ash)
 
Apologies if someone has already mentioned this but I'm at work so can't read all the replies.

If you go into the veterinary page, go onto the pictures of your horses veterinary conditions, go to page 6 and scroll down to minxie's post. There are some horrific pictures (sorry to sound so gruesome) and subsequent healing. There is no final outcome post but I'm sure if you pm'd her (if she's still a registered member) she would have some good advice.

Good luck.
 
I really feel for you. It doesn't sound good with the gangrenous smell.
On the positive side I know of a young horse who had 3 legs where the skin all split after cellulitis and a reaction to danilon. One leg in particular had no skin from Pastern to knee. The vet wanted to skin graft etc and prognosis looked grim. The owners treated it with manuka honey dressings and she is now eventing, it's just amazing.
 
I work in an operating theatre and when patients come in with horrid abscesses we flush them out with hydrogen peroxide diluted 50/50 with saline. Gets rid of the anaerobic bugs
 
I'd second talking to intelligent woundcare / asking your vet about the possibility of contacting the veterinary wound library if they are stuck for inspiration as to where to go next with this
 
As I haven't seen the injury it's hard to recommend anything. But I will tell you about one of the horses at the racing stables I worked in. It ditched the rider and bolted off the track straight through a very thick wooden gate post. Ripped a massive hole in its chest and split the skin all the fron the bas of it's neck downwards and around the inside of a front leg.

It looked horrendous. It was treated with saline, made from boiling water and adding 1 teaspoon salt per pint of cooled water. The wound was then coated with Active Manuka Honey - don't worry about getting the medical grade tubes - go to a health food shop and buy it by the pottle. Slather it on, where the wound is deep, melt the honey and pour in with a syringe.

Where the flesh is decaying go for the maggot treatment - they will eat away the dead tissue. For this type of woound proud flesh is your friend as it will close over the wound.

The mare that had the injury recovered - we had her heavily sedated for around two weeks , on box rest on straw. She is now a proud mum.

Just seen the pics - it would be recoverable with honey and strap up - keep it covered 24/7 - the above mare was far worse with a gaping hole around 6+ inches accross
 
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Gosh what an awful sitaution::(:(:(:(

Sorry I dont have much advice, but I have seen similar pics of injuries which have been treated with manuka honey (as other posters have suggested) I would give the mare a chance if you can afford to. Its a really tough call...please keep us updated. Best wishes x
 
Good luck - whatever you decide will be the best thing for you to do - you obviously care deeply about the mare, and you are being practical about the costs - that does not make you a bad person in any way shape or form.

Your mare will tell you what to do and when - but whilst she is willing to fight on, if possible keep fighting with her

god bless you, your mare and the foal - your show name could be "fighting chance" if you are lucky enough to be able to be able to pull through this.

GW
x
 
Scarymare - I think I posted on your original thread. IMO 3 weeks is not necessarily long enough to see if its going to recover. Has the wound been swabbed/cultured? Have you any up to date photos? I echo the others, if you have a trusted vet the email him the photos. Also try Dr Knottenbelt - hes one of the experts on wound care.
As for skin grafts - they wont adhere to necrotic tissue and are usually used for cosmetic purpoes rather than as a "cure"(in equine mediicine at least). They CAN help wound healing but again no guarantee of success. I also agree with Queenbee - a drain in the pocket would reduce the deadspace and increase the chances of the pocket tissue being saved. Im not sure what went on with your first vets, but tbh wound healing is rarely as simple as it looks day 1 - even if it does not look simple on day 1!!
As regards the wound increasing in size, we had a foal this yearwith a wire wound (down to bone) that was left untreated (a little cream on in the field is all) and 3 months later thewound was 5inches wide. This was due to the growth of proud flesh across the flat cut surface of the wound (ie perpendicular to the skin surface). Now thankfully it has reduced to about 2inches with wound contraction (4 mths since accident)- no proud flesh has yet been removes as it is cosmetic only and will not affect athletic function ( foal will be a racehorse!)
Is she weight bearing and generally comfortable? If so, Id be inclined to keep going. As for bandaging I think Id be trying to open it up to the air for 3-4hrs daily and perhaps dry dressing it the rest of time (with dressings as suggested by many posters).

Best of luck, and please do keep us updated.


Levathian - I seriously doubt your horse ripped her knee cap off - they dont have one(except on the stifle)! ;)
 
053-1.jpg


This wound pictured a few minutes after being stitched.
Three days later the wound burst open, bit by bit we lost the all stitches, and it couldnt be re-stitched, so imagine a gaping puss filled hole.
After nearly three months of cleaning with an iodine solution and later hibiscrub twice a day, and then aplying manuka honey twice a day, mare had healed anough to be turned out, eventually scar could onley be seen in summer coat.
I also gave her Magnatude every day because she could be very stressfull, and that seemed to keep her at a chilled out level most of the time.
Where abouts are you, if you lived anywhere near me i wouldnt hesatate to recomend my vet, he is wonderfull!!
Good luck and dont give up hope yet!!
 
Awful situation. Only thing I can think of - If the wound is infected and you need to draw out the bad, then Epsom Salts are extremely old fashioned, but very good. Pour a good amount and dissolve in water as warm as your mare can stand it, then apply with a wad of cotton wool. Keep rinsing the cotton wool and reapplying until the water has cooled. Repeat several times a day or as often as you can. May take several days to start to draw the infection but if it does, you will know about it. Have used them to great affect on several wounds - dogs paw, geldings hock - wire injury that got infected, and my own infected wound after having a caesarian. If you can get it to draw the puss then you are onto a winner cos the infection is what usually stops the wound from healing. If the site is very large so cotton wool is not an option, a clean cloth is just as good. In my family we also swear by TCP ointment (that#s the smelly funny coloured cream in a tube) This also helps to draw infection but if the site is large may be difficult to cover and keep on.
Hope you find a way to save both her and foal xxx
 
nickih said:
Awful situation. Only thing I can think of - If the wound is infected and you need to draw out the bad, then Epsom Salts are extremely old fashioned, but very good.
Click to expand...

Epsom salts stings like hell on an open wound - I used it on myself once and couldn't believe the pain I felt with it and it doesn't wear off like salt does. In the end I had to wash off the epsom salts and use plain salt.

PLease don't give up on your girl, you may need to dress the wound twice a day at least to keep the infection down. Do apply a load of vaseline below the wound as the stuff oozing from it will eventually make the skin below sore.

Definately DO NOT expose the wound to the air - a wound that dries oout does not heal as well as a wound that is covered and kept moist.
 
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Some of you will have seen this before - my friends horse after coliding with the gate catch - initially stitched but broke open two days later. Was then dressed with Active Manuka honey daily and the horse was back in work in five weeks.
Pictures of the wound just after it happened and then again five weeks later.
Tracheostomy_003web.jpg
100_0431web.jpg
 
Thanks everyone.

Latest update - vet coming tonight and will speak to him about everything you have all uggested - will also get pictures. She's in fine form and very vocal this morning. Walked into spare box quite well.

Spoke to OH and he has suggested that we put a 'top line' of £5K on it of which he will pay £3K. After that it will just be down to me and the manuka honey if she ever lets me get near it. If he still wants to go ahead with the graft after seeing it today then I will allow it and take her there on Monday.

I've just got a bill in from the first vets of £1500 which I intend to contest as most of their dressings were off by next morning.

Will post again tomorrow thanks again x x xx
 
scarymare said:
Thanks everyone.

Latest update - vet coming tonight and will speak to him about everything you have all uggested - will also get pictures. She's in fine form and very vocal this morning. Walked into spare box quite well.

Spoke to OH and he has suggested that we put a 'top line' of £5K on it of which he will pay £3K. After that it will just be down to me and the manuka honey if she ever lets me get near it. If he still wants to go ahead with the graft after seeing it today then I will allow it and take her there on Monday.

I've just got a bill in from the first vets of £1500 which I intend to contest as most of their dressings were off by next morning.

Will post again tomorrow thanks again x x xx
Click to expand...

looking forward to hearing your update- hope its a positive one ;)
 
Is twitching an option for next time you need her sedated? It would save the chemicals from sedation going to baby.

Best of luck with her. xx
 
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