Lymphangitis...help please! Pic heavy. And a heart murmur for good measure!

[ESW]

Hi,

Apologies in advance for this lengthy post. On Saturday 4th of August, I bought my 8yr old 16hh warmblood gelding in from the field and he had huge back legs, both of them were swollen like tree trunks to the base of the hock. He wasnt lame didnt seem too uncomfortable about it, he had what looked like mudfever/sunburn in both back pasterns. I should mention both back legs are white socks with pink skin and also there were no such scabs 12hours before. I called the vet immediatley and he came out, said it was lymphangitis, took his temp which was 39.5c =(, injected intravenously, steroids and anti biotics. He left me with a 10 day course of Norodin to start the following morning and prednisolon steroids to give 100 a day in feed. He told me to hibiscrub/active wash the whole of both back legs twice daily and scrub off scabs and then coat the pasterns in flamezine, but to keep him out 24/7, lunging morning and evening as well.
By Sunday morning his legs were starting to come down, so we continued as per vets advice, his legs were normal by Monday morning and cold, but by Wednesday morning they were starting to fill again, so called the vet who came out, mixed some aqueous cream with steroids and antibiotics in, told me to stop washing the entire legs, just wash off the scabs if they form or if the legs get dirty, and put the cream on twice daily, the left...Thursday morning, surprise surprise his legs were back to where we were to start with only this time he was sore and lame as well, so called the vet (had a different vet) who injected with steroids, anti-inflamatories, and a different anti-biotic. She then listened to his heart and turns out he has a grade 3 murmur (pansystolic murmur, over the mitrial valve) he has developed this over the past 18months, so very worried about this...anyway, she left me with baytril (35ml daily), told me to up the prednisolone steroids to 120 a day until his legs returned to normal and then drop to 100 then 80 then come off them. She then came out the following day to re-inject everything, so over the weekend his legs returned to normal by Sunday morning, so we started to reduce the steroid dose as of Monday to 100 and Tuesday his legs were fat again, had a different vet come to visit, he said he thought it was vasculitis caused by hypersensitivity to uv rays, (I had already bought him some uv boots and he had been wearing them since Friday during daylight hours, he also religiously wears a nose uv visor as he got horrendous sunburn on his pink nose a few week prior - he wont let me put suncream on it, and if i do get it on he rubs it all down his legs and then in his eyes!!) he took blood to check for viruses, his white blood cell count and his liver, everything was normal, he injected with everything again, left me with more baytril, told me to maintain the dosage of 120 steroids daily, and he made me up a stronger aqueous cream with steroids, antiinflammatories and baytril in to put on his legs twice daily. His legs went down completely by Thursday, and stayed down and cold and completely normal till Thursday morning this week (so 7 days!) Thursday am I noticed the smallest orange spec on his hind left pastern, tried to remove it but it wouldnt come off so cleaned and put cream on as normal, by Thursday after work, the yellow was all over the pastern ad felt slimey/scabby. So I washed and did some very light scrubbing to remove it, then whilst waiting for the leg to dry, it started oozing yellow serum (not nasty smelling just serum) neither legs were swollen at this point, just the one leg oozing serum. I put the cream on both and turned him out, well aware they were going to be big in the morning...sure enough, arrived in the early morning and both back legs were as big they were originally, also his sheath appeared to be enlarged. He was very very very sore and uncomfortable, he was reluctant to walk and when he did he walked like a bowed legged horse, whilst waiting for the vet you could tell he was trying to sit down and both back legs hurt. He was also shaking with the pain. His temperature was normal though, but both back legs appeared to be leaking this yellow serum now, the right one through the pastern and the left through the bottom of the fetlock, disguised by his light feathers to start with. This was the first day he was threatening to kick you for looking, let alone treating his legs, he is normally such a good patient. Original vet arrived, was shocked at how aggressive it is, how sore he was and why it hadnt shifted by now....he had been normal for 7 days so we were beginning to look at ending his course of anti bs and lowering the steroid dosage and stopping the cream, but back to square one for no obvious reason...vet injected with steroids and different anti biotics, told me to keep him in during daylight hours, only turn out in the dark. He has given me flamezine to put on his oozing yellow bits, he has also taken a culture of the yellow serum but wont hear back for a while, so that was Friday, he went out friday night which appeared to bring the swelling down ever so slightly when I brought him in at dawn this morning, but not as quickly as the previous treatments have bought it down...had the vet at 9am to give more intrvenous steroids and antibiotics think we are on doxycilin now, and he was in all day, by this evening his legs had doubled again, both are oozing yellow serum and he isnt a happy bunny at all. After I walked him out they come down very very very slightly, I am just aware that histrically he has had his legs fill, he is jabbed then 12hrs later they have halved, then 12hrs after that he is almost normal etc etc we havent improved on this latest treatment at all as far as I can tell. The serum oozes, then dries crusty (in hindsight I think the original 'scabs' and all the scabs there after have been this fluid seeping out and drying on) once you wipe off the yellow serum with a baby wipe (I havent wanted to get his legs wet as such, in the week of normal legs, he had his legs wiped clean with antibac wipes, then cream applied and boots put on, twice daily) you are left with what looks like slimey dandruff, or a slimey film of either new skin or dead skin, the cream keeps it moist so difficult to say, will try attach a pic, since this started we have been cleaning and creaming and if necessary scrubbing these scabs off, the vet has said he doesnt want them to form...however, is the body not just trying to protect itself, the cream doesnt seem to have worked so far, and he is so unhappy about it being dealt with I have decided to leave his pasterns for a day or two and see if it makes a positive or negative impact. I just think he is being treated from the inside out with antibiotics, and his immune system is going nuts with the lymphangitis, if we scrub or irritate the skin arent we just asking for the system to over react...? Anyone have any experience on this serum leaking, the vet is lost to be honest, it isnt responding to anything, we just seem able to surpress it for a limited time and it comes back worse than ever each time! Also if anyone happens to have any experience of the heart murmur too...not really sure what to do, poor boy is so uncomfortable and already fed up on being stabled for 12hrs daily, just hope it wont become something he gets every year... =( help!

Here is a pic of Thursday pm before washing, note the yellow 'scabs'
http://i1225.photobucket.com/albums/ee392/esw3/thurspmprewash.jpg

Here is a pic of Thursday pm after washing to remove yellow 'scabs' note the seeping serum
http://i1225.photobucket.com/albums/ee392/esw3/thurspmafterwash.jpg

Here is a pic of Saturday am, note we are now swollen and this is the slimey type scabs that i just cannot get behind to remove, i am not sure if it is dying skin, or new skin or nasty stuff etc, but without rubbing and rubbing and rubbing i cannot get it off, so I coated it in the steroid and anti b cream:
http://i1225.photobucket.com/albums/ee392/esw3/satam.jpg

Sat pm the better of the 2 legs is now huge and seeping serum at the fetlock and the pastern
http://i1225.photobucket.com/albums/ee392/esw3/satpmrighthind.jpg

Sat pm the worse of the 2 legs, even bigger and angry looking, he wouldnt even let me look at this without lashing out...poor boy! I had to leave this as it is and turn him out
http://i1225.photobucket.com/albums/ee392/esw3/satpmlefthind.jpg

here is a pic of both back legs, it doesnt really do justice to how swollen they are, but note the folds in the back of his pasterns =(
http://i1225.photobucket.com/albums/ee392/esw3/bothhindsatpmnotefolds.jpg

here is are two pics taken of each leg at the beginning of the normal 7 day period, as you can see he has some of that dandruff/slimey scabby looking skin that i couldnt get off, but like i said he was normal for 7 days so i dont think this had anything to do with the latest flare up...
http://i1225.photobucket.com/albums/ee392/esw3/goodishleft.jpg
http://i1225.photobucket.com/albums/ee392/esw3/goodishright.jpg

If you have taken the time to read this far thank you so much and I hope someone has something genius to say as myself and my boy are mightly fed up =( thanks Emma we wouldnt wish this on anyone! x

 

[Box_Of_Frogs]

Your poor lad! The serum you see oozing out is part of the content of the blood in his legs that is being forced outwards by the swollen tissues. It's not scabs. I wouldn't be scrubbing this off as the issue isn't the OUTSIDE of the leg, it's the INSIDE. I'd stop scrubbing at all as you could be doing more harm than good. After all this failed treatment (and the high doses of steroids would worry me) I'd get a referral to a specialist horse hospital for a proper work up, diagnosis and treatment. It sounds as if this is an odd presentation: local vets, no disrespect, see the run of the mill stuff mostly but to the specialist horse vets, the "odd" and "strange" is their bread and butter. Good luck.

 

[ESW]

Thank you for your response it has helped give me a little peace of mind as i agree we have been doing more harm than good =) I have left them alone entirely as of last night, and although they havent improved they havent gotten any worse overnight, they are hot and angry but that hasnt changed since the flair up Friday morning. I am waiting for the results from the swab taken, which hopefully i will get early next week and hopefully this will give us some specific bacteria to treat! He is on Doxycilin now, and the good news is he loves the taste of it...it doesnt smell very nice, but maybe this will work, given the zero improvement so far i dont hold out much hope though. And yes I think if he hasnt improved by Tuesday at all then I will be looking for a specialist opinion, although my vets are horse specialists and have the full hospital set up they do seem at a bit of a loss, apparently there is quite a bit of lymphangitis going about but all the other cases have cleared up with norodin and steroids and are completely recovered, all except for my poor chap, so if anyone can recommend a specialist for lymphangitis that would be perfect =) thank you and wish us luck, Emma

 

[Slightlyconfused]

My mare has a systolic heart murmur. My vet said its the most common one you can get and that 99% of race horses have it. We were advised to keep her fit and in work as much as possible to help keep her heart strong.

A lady up my yard bandages her mare when she gets lymphangitus other than that I don't know how to advise.
Hugs to you both.
Xxxx

 

[happy_talk]

What a rough time!

I'm not sure if anything in this article will help
http://www.horsehero.com/editorial?feat=84996

Is your vet seeking specialist advice?

 

[ESW]

thanks slightlyconfused, it is good to hear the heart murmur is probably nothing, I think we will be trying to look into that next but we want him well and off all the drugs etc first, but as it has developed recently it does worry me more than if he had already had it. The vet told me not to bandage, I think if they stop leaking serum I will bandage then, if he will let me.
And happ_talk that was a very interesting article, thank you. They are very complicated creatures! And as far as I know my vets arent seeking any advice yet...but they will be when I next chat to them. thanks again guys. Off up the yard again to drag him about for a bit now =/

 

[tontoandtigger]

My old mare used to get lymphangitis so bad that she looked like he had an elephants legs, you couldn't see any definition to the legs at all.
The vet used to treat with anti inflamiteries and antibiotics, but I had to hose her legs 3 to 4 times a day, starting from the hof and working up this is supposed to help force the fluid buildup back up the leg.
She was also bandaged with ice cold wet bandages to help bring down the swelling (I nearly got kicked doing this but once on you could see how much better she felt). I was also advised not to box rest as its the moving around that also helps shift the fluid.
When my new horse got lymphangitis (she like your has white legs) I just left her out and

 

[tontoandtigger]

Sorry iPad decided I had finished!!!!!!!!

I always leave her out and hose legs and they go down.
Good luck hope all clears up soon.

 

[MerrySherryRider]

My mare suffered with this last summer. Initially it looked like mud fever on her pink skinned heels, it then travelled up her pasterns and looked like a yellow scaly dandruff. Vets said it was pastern dermatitis and said to wash every two or three days and apply sudocrem daily and she was given antibiotics.
A week later her leg swelled quite dramatically like your boy, so she was put on a course of 100 Prednisilone, turned out 24/7. The swelling disappeared quickly within 24 hours. However the scabs took weeks to disappear. I used flamazine but really, with her, the sudocreme worked best as it is a sun block and stayed on better than anything else.
The vets warned me against using too much hibiscrub, so I used either salt water or T gel shampoo over this period.
Your boys case seems much more aggressive than my mare's as the swelling was short lived.
I think the folds in your geldings heels indicate that he has had a problem before. I have a H/W feathered cob who has these folds, which is quite common in draft horses.
Reading about my mare's condition, literature did warn me that she would be susceptable to further episodes, so this year I have watched for any scabs which appeared -and they did, at pretty much the same time of year-August, but the inflammation has not reoccurred. I have used Sudocreme on her heels as a precaution against photosensitivity causing the infection and this seems (?)to have prevented a repeat of last year.

 

[Mynstrel]

our old mare had lymphangitis which oozed like that, with her it was up to her hock or stifle depending on how bad the dose. We had all the same treatments your vet is using & it'd go down, down, down for days then BANG back to square one overnight.

In desperation trying to help her we contacted the herbal firms to see what else we could give her that might help & we were advised fenugreek & it did seem to help the drugs to shift the swelling. Is your horse on any water tablets? She was on quite a big dose of them when it was swollen to help shift the fluid and they helped a lot too.

We were advised cold hosing & walking as much as possible to try & stimulate the lymph drainage in her leg and we found walking in long wet grass seemed to be a good soother for her (plus it tempted her to eat while she was being walked so that made it a bit more pleasant for her when it was bad).

It's a horrible illness, best of luck and read up as much as you can, the more you know the better you can fight it.

 

[ESW]

Thanks everyone, I have been advised not to get it wet, not to bandage it, not to walk him in sunlight. I am very much starting to doubt my vet...anyway, I havent touched the serum/scabby bits over night and they havent gotten any worse. Any swelling he gets whilst stood in all day goes down over night when he is out but his legs are still twice normal size, they just swell to 3 times normal size during the day. He is not on any water tablets, just the steroids and antibiotics. I personally think he would be better off out, he would certainly be happier and his legs have not improved from being in. Historically he has had the vet out to jab him then within 48hrs his legs are pretty much normal, they are still hot, fat and havent improved at all...so I dont think this is the right way to go about it. I will certainly look into the fenugreek and its properties, I think I fed him this over winter for weightgain or something...cant remember. I did put sudocream on a few nights ago but it didnt appear to help and was a nightmare to get off, he is on chopped straw so this had a field day sticking to it. The vet didnt want me using sudo cream or the aqueous stuff as it s oil based and therefor the serum cant come out (???) hence suggesting flamezine...he does appear happy for now with nothing on though..will be phoning the vets on tuesday providing he doesnt get worse, as he certainly isnt getting better...thanks again!

 

[tontoandtigger]

I am afraid I would get another vet out. The fluid in your horses legs is building due to the horses inactivity and surely this is why you are seeing this sticky substance and I don't understand why they have said don't hose? Every vet I have ever seen with me mare said hose with cold water and fast running to help move the build up of fluid. My mares legs got so hot I think it was a relief for her to stand with the hose running and within a week it had cleared up.
What is your gut instinct.?

 

[ESW]

Hi, I agree my vets are being beyond hopeless and I am far far from impressed! We have already gone well above 1000 pound bill...I have turned him out early this evening as I dont feel he is benefiting what so ever from being kept in and out of the sun, i think they are clutching at straws, I will bring him in early tomorrow am and cold hose for 10-15mins each leg and see if it helps. May well keep him out tomorrow dependent on how powerful the sun is as nothing is helping him so far. I am in Northamptonshire so if anyone can recommend a second opinion in this area it would be hugely appreciated. thanks again everyone! x

 

[mjcssjw2]

ESW - at least your vet came out, I have called mine twice today and have been told to hose, bandage apply fly repellant and turn out,
my horse came in this morning with one fat leg and one fat fetlcok, called vet as I was on my way to work.
Got back from work two fat legs and one huge leg and four oozing coronet bands.
My horse has black legs though. I think his problem is being caused by fly bites, I could have cried tonight. He is knawing at his heel areas so its only a matter if time before that causes problems. He also have a damaged check ligament on one leg so cannot be exercised.
Have hosed, washed coronet bands with hibiscrub, applied sudocreme, bandaged and put on overreach boots and turned out with snuggy hoods show fleece to cover up as much as possible left out for a couple of hours and then brought him in as the flies were awful, will turn out tomorrow day hopeing flies will be less of a problem. Sorry to hijack your thread, just really fed up like yourself and if you have any advice I would be very grateful.
Hoping the wine will make it seem better !! lol.

 

[SO1]

I can't offer you any advice but it sounds terrible and I feel so sorry for you and your horse. It is so frustrating as well spending so much money on the vet and the treatment not working.

 

[ESW]

Wow, mjcssjw2 I feel for you and your horse, if you have it in all for legs to certain degree I would be way more concerned. I cannot believe your vets have not been out!!! Lymphangitis is to be treated as an emergency, you run the risk of them turning sceptic or at least irreversible damage to their lymphatic system meaning permanently swollen legs. Did you take his temperature? Anyway, lets hope he is ok, I think you have doe all the logical things, just be careful with the scrubbing and make sure it is watered down so as not to irritate too much. Hopefully you bandaging them will help to control the swelling to a point. I cannot understand why they havent come out! Your right at least my boy got the intial painkllers, anti inflams and steroids, and anti b's...hope your fellow isnt any worse in the morning, feel free to keep us posted here and best of luck! xxx

 

[ESW]

Hi again, to anyone interested, I have brought him in this morning, as usual they had returned to the smallest version of big they can currently get to. It was cold this morning so legs not raging, but still warm. I have cold hosed both legs for 10/15mins each, this helped quite a lot on the not so bad one and a little on the bigger one. I then used sensitive carex to do a very very gentle clean of both his legs and they are certainly looking less angry

http://i1225.photobucket.com/albums/ee392/esw3/lessangrylegs.jpg

http://i1225.photobucket.com/albums/ee392/esw3/lookinbetter.jpg

So it looks like they are starting to calm down and the leaking may have stopped from within...we shall have to see, will go up at lunch time and find him with super huge legs due to the standing in, but maybe the antib's are finally starting to do something from the inside? Will continue to cold hose once or twice daily and see how they react =)

 

[mjcssjw2]

thanks ESW, just about to go back and put plan b into action, if no better calling vet again and going to text pictures, will take temp. Going to put him out during day as I am sure flying things were chomping at him coronet bands! tried overreach boots but the field is muddy in the gateway and think that may alos be irritating with boots over top, he was cetainly knawing at them last night when I brought him back in so i hosed and dried then again, the sudocrem was still there though
Its funny how the true size of there legs will not photograph isn't it.
Hoping for much improvement from both of them today

 

[mynutmeg]

It's not something I've dealt with but I think in your situation I would be asking for a referal to one of the large vet hospitals based at an university. In the North I'd highly recommend Edinburgh, otherwise Liverpool is good as well but not sure about further south. Even with a hospital set up your local vets simply won't see the unusual cases that a referal centre like the university's will.
Good luck

 

[putasocinit]

there is a powder on the market called Coopers powder it has fenugreek and magnesium and other stuff in it, smells like liquorice, lovely, well this stuff is like a diuretic tablet and is good for horses on box rest or who are just generally holding a bit of fluid/water in the their joints, as it makes them have a good wee and also flushes their system, they do not get the squirts.

 

[ESW]

Thanks again guys, will have the vet out tomorrow and will discuss a referral elsewhere also and keep you posted x

 

[madhoss]

So sorry to read what you and your horse are going through. Fingers crossed things start to improve quickly.

May bare no relevance at all, but worth mentionin...I knew a horse with similar symptoms- cracking, yellow scabs and swellings- only on her white socks. It was a good few years ago so I can't remember all the details. I know it was very complicated and lengthy process to get to the bottom of but it ended up being some kind of reaction due to UV/buttercups/clover, and it was also related to a deficiency in (I think) white blood cells, just in her white areas. It came on very suddenly- fine one day, not fine the next.

Sorry details are so sketchy, but just something else to be aware of.

Wishing you both the best with it.

 

[ESW]

Hi, thanks ref buttercups etc, he was out with these with no issues about 3 months ago...not convinced about the sun as a catalyst in his case but who knows! I put him out at 6pm last night as it was overcast and raining, and didnt bother to bring him in until 8am this morning to see if it made a difference to his legs and just to confuse me they have come down, not entirely by any stretch but enough to notice and definitly more than usual. So now I dont know if the meds have finally kicked in or whether it was just the turn out for more than 8hours...probably the turnout but I cant say to the vet we have had absolutley no improvement now...have left him in and will check him at lunch time, if his legs are filled or huge depends on when i call the vet...may put him out at normal turnout time tonight (9pm) and bring in at 5am tomorrow and see how they look then so I can determine if its the turnout or the meds...flipping horses!

 

[mjcssjw2]

ESW how are you managing to keep the flies at bay? my horse is very cross at them and keeps stampoing inspite of much fly spray and gel, have resorted to putting his sports medicine boots of as its about the best I can do, I assume they are attacted to the oozing sores! doh.

 

[toestubber]

Have been reading along as I have a horse that currently has lymphangitis and has had it before. Second bout in 6 months, it is differant though no weeping sores, just a big leg and only one, that has gone down significantly although not completely after anti b's, steroids and bute. More inflammatory due to twisting it in the field this time, than cellulitis, starting with a small wound like mud fever, which does sound like the case with your horse. Excercise does make a differance to her, if she comes in to rest from the flies, her leg does start to fill again, she is out 24 hrs and only comes in for treatment, excercise, hosing /compresses hot and cold to get the circulation going and massage from the fetlock upwards. Turning out again with plenty of fly spray ( Deet), although she may be troubled about the flies, keeping her leg down and stopping it from getting big is the main priority, otherwise it does have long term damage. Keeping the circulation going is really important.
Unfortunatly it seems that once the lymphatic system is compromised, it is an ongoing problem that has to be managed, I really sympathise with anyone that has to cope with this. My mare is only 5 yrs old, and it really is a condition that seems so simple yet so complicated.

 

[ESW]

Hi, in response to dealing with the flies my fellow hasnt been out during the day and they arent too bad by us anyway, so havent had an issue with them...and as for the cause of my boys bout, we have no real idea, i think the stuff that looked like mudfever was actually just the serum having leaked out and crusted to look like mudfever as 24hrs before there was nothing wrong with his pasterns at all...i am quite anal about my horses legs...anyway, had the vet out today and we have upped the steroid dosage to 100 in am and 100 in pm, he is ordering in some different steroids to give him orally for a few weeks. He agrees we have done the right thing by leaving the serum/scabby bits alone. He is of the opinion that we are no longer dealing with a bacteria issue, but his immune system its self is over-reacting to everything, we think in his case uv...however we also note that when he is in obviously his legs swell, an the more they swell the more serum oozes, and the only thing that brings his legs down significantly is turnout. So as of tomorrow he can go out as long as he has his legs bandaged and with uv boots over the top. It is quite simply a waiting game, waiting for his immune system to stop attacking itself...in the mean time we try to minimise exposure to uv, and hopefully the serum will stop oozing and the scabs will brush off eventually, but my vet has gone back up in my estimations today, he had also had a chat with a referal vet about this case who is in total agreement...so steroids and movement but no sun will hopefully be the cure! fingers crossed!!! x

 

[Mynstrel]

ESW how are you managing to keep the flies at bay? my horse is very cross at them and keeps stampoing inspite of much fly spray and gel, have resorted to putting his sports medicine boots of as its about the best I can do, I assume they are attacted to the oozing sores! doh.

Our vet told us to use this:

http://www.carrdaymartin.co.uk/product_details.html?cid=Mw==&pid=NDQ=

it's like pink vaseline but with anti bacterial stuff & citronella so it helps the skin to stay soft & prevents flies or bugs getting in any cracks the swelling may have caused. Our mare seemed to like us putting it on as it must have soothed the heat in it her leg as well. You can buy online or tack shops are starting to stock it now as well.

 

[kellybrown11]

Hi,

I have been following this post with interest as i am suffering from something similar.

Would it be safe to turnout with this on, just concerned about it reacting with the sun and burning the skin?

 

[ESW]

my vet has said if i am to put any cream on it is to be sun block, very very thick sunblock of a very high factor...

 

[Fragglerock]

Speak to Rebecka Blenntoft mentioned in that article. I know she uses a particular machine about which she is very passionate (so much so I bought one!). I don't want to advertise but if you PM me I could point you in the right direction.