Swollen leg not responding to any antibiotics - any suggestions

[Crazydancer]

I'll try and keep this brief, please bear with me!
About 5 weeks ago, my mare had an abscess eruption half way down the inside of her near-hind cannon bone. We have no idea what caused this, but must have been building for a while as the hole left went nearly to the bone. It was cleaned and flushed, and vet called the next day (I was away at the time)
Vet suggested box rest, keep it clean, and left ABs. Mare was not lame.
Mare (who lives out) stressed so much they had to turn her back out, but cleaned the wound regularly.
When I came back, we reviewed, and decided as it still looked nasty, to cover it, to protect from infection and flies. Mare still not lame.
In the space of a few days the leg started to swell. We stopped covering it and left it open.
So end of week 2, mare had a huge fat leg, from hock to fetlock, and was horribly lame, on 3 legs. We upped the bute to 2x a day. She was still on AB's at this time. Leg was x-rayed and nothing was found.
Vet came (3rd time? maybe 4th? lost track) and changed AB to something stronger, and gave a steroid injection. No response.
Vet came again, we decided it looked like cellulitis, she took a swab to test what AB would work best, in the meantime the swelling did star to recede a little.
So 3rd AB was given (Baytrill) and she's been on that for 5 days.
So today, 5 weeks on, and she still has a significant swelling (although much reduced) and not much heat, and the wound looks ok, not infected, no puss, nice clean edges etc. But she's still lame.

So, any ideas why she's still lame? Why the AB, tested in a lab and proven to be effective, is not working? The vet is stumped, and I'm at a loss.

(And just to add to this, to keep the wound clean we've been washing twice daily in dilute Hibiscrub, and now she has mud-fever type scabs where the leg has been constantly wet - is this significant??)

Any suggestions anyone? Vet is coming back next week to re-run the x-rays and scan, as she still thinks there SHOULD be no reason why this is not improving.
Thanks

 

[Meowy Catkin]

I don't have any good ideas about what could be going on, but I hope that she improves soon.

*vibes*

PS, my mare did get terribly huge, filled, elephant-like legs once and it was due to too much protein, but it doesn't sound like this is the case for yours. Unless you're terribly unlucky and she has two things going on at the same time.

 

[Crazydancer]

Thanks Faracat. xx
Nope, she's only on grass, and getting a handful of AlphaA with the bute in. She was on much more feed during the winter.
A friend has suggested her immune system may be compromised (maybe by all the ABs) Might explain the low resistance to the mud fever scabs, I wouldn't have expected that to happen from washing legs in warm weather - they are usually dry in 15 mins.

 

[Goldenstar]

Have the vets swobbed the wound to see what bug you are dealing with ?

 

[Maesfen]

Thanks Faracat. xx
Nope, she's only on grass, and getting a handful of AlphaA with the bute in. She was on much more feed during the winter.
A friend has suggested her immune system may be compromised (maybe by all the ABs) Might explain the low resistance to the mud fever scabs, I wouldn't have expected that to happen from washing legs in warm weather - they are usually dry in 15 mins.

Quite possible IMO. I wouldn't do her any harm to be given some booster whether that's a B12 jab or something orally like Red cell.

Also repeated washing with Hibiscrub, even when well diluted is very bad for the skin as it breaks it down amd strips all the oils from the skin; it's something that should only be used as little as possible; I wish it was by prescription only, it's not meant as a general cleanser at all.

There's also the possibility that the original injury bruised the bone from pressure so that will take time to repair and won't disappear just because it's healed over.
There's also the possibility that there is still a foreign body in there which doesn't show on any x-ray so the skin is reacting.

Personally, I would stop the washing, use a decent poultice over the whole lower leg and see if anything comes to a head; if it doesn't, no harm done but at least it's helped discount something.

Some injuries do take time to heal and if it was that deep, it has to heal from the inside out which takes longer. It might be that the leg will never get back to its former shape/size, there might always be filling there. Incidentally, has your farrier had a look, it might be she's putting up a corn from putting pressure on her good leg.

So many options and there's nothing more frustrating than trying to fix something that you can't find the reason for.

 

[cptrayes]

I would be wondering if the original abscess was osteomyelitis breaking out. Have you had her x rayed? If not, I would.

 

[fuzzle]

I would be wondering if the original abscess was osteomyelitis breaking out. Have you had her x rayed? If not, I would.

Agree with the above post!!!! also i would have her turned out moving around xx

 

[magicmoose]

Last year, The Moose, who is admittedly a "special" case, came down with simultaneous hind foot abcesses, plus scabby elephant legs. Treated and thought nothing more of it. Exactly the same thing happened this year, so I'm convinced that he is reacting to something in the field.

OP, could it be an allergy in your horse, or at least partly an allergic reation?

 

[Crazydancer]

Have the vets swobbed the wound to see what bug you are dealing with ?

Yes - and that's part of the puzzle - the AB she's on did the job on the swab culture. But no noticeable difference on her.

 

[Crazydancer]

Maesfan - she is getting a vet-prescribed pro-biotic, but that's more to protect her gut from the ABs.
The washing was under vet instruction - I've never used Hibiscrub much before. That makes sense with the scabs forming then.

 

[Crazydancer]

I would be wondering if the original abscess was osteomyelitis breaking out. Have you had her x rayed? If not, I would.

Yes she was x-rayed, all clean and clear. I will go google that ^^^ though!

 

[Crazydancer]

Agree with the above post!!!! also i would have her turned out moving around xx

She is out - the box rest lasted less than 24 hours, and would never have been attempted if I'd been home.

 

[Crazydancer]

Last year, The Moose, who is admittedly a "special" case, came down with simultaneous hind foot abcesses, plus scabby elephant legs. Treated and thought nothing more of it. Exactly the same thing happened this year, so I'm convinced that he is reacting to something in the field.

OP, could it be an allergy in your horse, or at least partly an allergic reation?

Thanks, but don;t think so. I've had her for over 3 years and not had anything like this before - in fact the vet says she never dealt with anything quite like it either!

 

[Crazydancer]

Thanks all, really appreciate all of the comments. Will have a think, and see how we stand next week. I feel happier that we aren't washing every day, and hope we can find something next week on the x-rays/scans. xxx

 

[9tails]

Quite possible IMO. I wouldn't do her any harm to be given some booster whether that's a B12 jab or something orally like Red cell.

Also repeated washing with Hibiscrub, even when well diluted is very bad for the skin as it breaks it down amd strips all the oils from the skin; it's something that should only be used as little as possible; I wish it was by prescription only, it's not meant as a general cleanser at all.

There's also the possibility that the original injury bruised the bone from pressure so that will take time to repair and won't disappear just because it's healed over.
There's also the possibility that there is still a foreign body in there which doesn't show on any x-ray so the skin is reacting.

Personally, I would stop the washing, use a decent poultice over the whole lower leg and see if anything comes to a head; if it doesn't, no harm done but at least it's helped discount something.

Some injuries do take time to heal and if it was that deep, it has to heal from the inside out which takes longer. It might be that the leg will never get back to its former shape/size, there might always be filling there. Incidentally, has your farrier had a look, it might be she's putting up a corn from putting pressure on her good leg.

So many options and there's nothing more frustrating than trying to fix something that you can't find the reason for.

The poultice is a great idea. I wouldn't be surprised if there is more infection in there that hasn't come out. Hibiscrub is the devil's own work and I've only used it as an initial wound cleanse with clean water thereafter.

 

[Pinkvboots]

I also agree about ditching the hibiscrub, I cant use it on one of my horses it makes him very sore, I use Hypocare now on most cuts and wounds heals them up very quick, I wish her a good recovery.

 

[mrfarrier]

Has it been scanned? An x-ray should show damage to the bone but it won't show something like a splinter or thorn wedged in there.

 

[Moomin1]

The best equine vet I know bangs his head against the wall at the use of hibiscrub other than for the very initial cleansing stage with wounds. He advises clean on initial discovery/treatment with hibiscrub, then leave well alone to let nature take it's course with the healing, along with antibiotics.

 

[honetpot]

The best equine vet I know bangs his head against the wall at the use of hibiscrub other than for the very initial cleansing stage with wounds. He advises clean on initial discovery/treatment with hibiscrub, then leave well alone to let nature take it's course with the healing, along with antibiotics.

Fully agree with this, Hbicscrub should never be used to clean wounds, normal saline or water and do not use cotton wool swabs. If you can get a colloid dressing or gel that's the best for wound healing and try not to physically clean the wound because the action of cleaning it can remove the growing new cells.
Depending on how sensitive her skin is the swelling could be a reaction to the Hibiscrub as now she has effectively go mud fever so that could cause the swelling and lameness. I would try a few days of doing nothing.

 

[Crazydancer]

The worry was that flies in the wound could infect it, and trying to keep a dressing on a swollen leg wasn't easy. So to keep flies off the wound she advised summer fly cream, that bright yellow stuff. That certainly has worked. We're stopping the cleaning, and will see how she goes. I certainly looks like she has now got mud fever in reaction to the cleaning.
Scans booked for next week, along with more x-rays. Will update the thread then, and if there is any significant changes. Thanks guys x