Ask Horse Journal: 10/00

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Managing Lymphedema
I have an eight-year-old Thoroughbred mare. Four years ago she was diagnosed with lymphadema. I usually can control it with exercise and Naprasone, but this summer her leg got really swollen and painful. My vets aren’t familiar with the condition, and I can’t afford to take her to the university. She is turned out 24 hours, except in extreme weather. I use Lasix and Dex (sic) and Banamine. I can’t get the swelling down. We’ve used pressure wraps, liniments, poultice and exercise. This horse is my best friend, and I hate to see her uncomfortable.

Lisa Madren
Nashville, GA

Lymphedema is swelling caused by interruption in the flow of lymphatic fluid. Fluid in the tissue is drained by the circulatory system and by the lymphatic system. Interruption of either causes fluid accumulation. The usual cause in horses is an injury that cuts the delicate vessels, especially if a heavy scar forms. Other possible causes would be a tumor or scar putting pressure on part of the lymphatic system, cutting off flow, or destruction of the lymphatic network following an infection.

Treatment with drugs is largely ineffective, as you have found out. The key to managing lymphedema is through intensive physical therapy. Exercise is essential but often not sufficient to resolve the swelling. Your management routine is fine in that regard. However, too much exercise is likely to result in increased edema. This does not mean you can’t use your horse, only that you must be prepared to work on her after you use her.

The first part of the treatment routine involves skin care. Lymphedema can cause either microscopic or visible skin cracks. These are the perfect place for bacterial or fungal infections to start and make their way under the skin. Your description of more severe swelling associated with pain (lymphedema is not usually painful) suggests your horse has problems with infections under the skin, and this may be at least partially why you are having difficulty with control. If the leg feels warm, you likely have infection.

Gently wash the leg twice daily with either an iodine scrub or antibacterial soap, such as pHisoDerm or Nolvasan. The latter two are more gentle and available at your drug store. Wash gently beginning at the bottom of the leg and working your way up. Make small circles followed by strokes directed upward to encourage the flow of fluid out of the leg. Rinse thoroughly.

When infection is present, you may need to use an antibacterial and antifungal lotion/cream until that problem is resolved. Avoid oily products. Your most economical option is to get a generic antibiotic cream and generic athlete’s foot cream from your drug store and mix these together in a small container. Apply a thin coat to all swollen skin surfaces, then wrap. Severe cases may require a course of antibiotic injections and possibly antifungals such as Griseofulvin powder (given by stomach tube or mixed in feed). After the infection is resolved, we recommend pure aloe-vera for skin care and massage.

Massage is important in stimulating the flow of fluid from the leg. Using your fingers, feel for any lumps or hard areas above the level of the swelling that could be obstructions to fluid flow. Massage these firmly using small circles.

Next, beginning at the coronary band (or wherever the swelling starts), use the aloe vera and massage in small circles, using firm but gentle fingertip pressure, working your way up to the top of the swelling.

After this, return to the bottom of the swelling and use firm but gentle strokes upwards, in the direction of the body. Picture yourself as trying to squeeze the fluid up the leg. Massage at least 15 minutes for an area the size of the cannon bone.

A period of icing or hosing with cold water (keep the water flowing at all times) after massage may help with some horses. Your massage moved some fluid out of the leg. The cold helps constrict vessels so that it does not re-accumulate immediately.

Following this, dry the leg thoroughly and apply another light layer of aloe vera. The final step is wrapping, and this is important to achieving control.

Areas of lymphedema should be kept wrapped at all times, unless the horse is being used. Special compression bandages are available for people but don’t conform to horse legs as well and could be dangerous to use over the tendons.

Sheet cottons (not the fluffy rolls — use sheets of cotton made for wrapping legs) are easiest to get to conform to the pastern but are expensive to use as they only last a day or two at most. Try to find thick, extra-long standard stall wraps that will extend slightly above and below the entire area of swelling. Be sure not to start or end over the tendons at the back of the leg and apply the wrap with no wrinkles in the material. Secure this in place with an elastic wrap that allows you to put firm pressure on the area (don’t overtighten) — either a heavy Ace wrap or elastic polo wrap. Include the coronary band and pastern if these are swollen. Wraps should be laundered (use Ivory Snow) at least every other day, more often if they become soiled or wet.

For best results, you may have to do this routine twice a day until the leg is under control. After that, wash, massage and reset daily. The longer you massage and ice, the better the results will be. Controlling and preventing infection with good skin care is a must. This is definitely a lot of work, but the results in terms of appearance and your horse’s comfort will be worth it.

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Moonblindness Or Old Injury'
I’m looking at a horse to purchase, and we’re not sure we want to risk it because of a potential eye problem. The bottom part of his right eye’s iris seems to be stuck to the inside of the cornea (an anterior synechia) and the pupil is misshapen. He also has an oval-shaped area of a bluish haze-like corneal edema that appears quiet right now (corneal opacity) where the iris is stuck. Also, his lower eyelid is scarred and misshapen in the same place.

Could this all be due to an old pentrating injury (judging from the lower eyelid scarring) or would you worry that it could have been from a prior bout of periodic opthalmia (recurrent uveitis or moonblindness)' Also, how do you tell the difference for sure' My veterinarian suggests we do a fundic exam. Will this tell me anything'

D. Rose
Camillus, NY

A history would help, but we’ll assume the current owners don’t have any additional information for you. Based on the physical description, it appears to be much more likely these changes resulted from an old injury than periodic ophthalmia/recurrent uveitis. The lid scarring is a key finding.

The corneal clouding is also significant since involvement of the cornea usually occurs only very late in severe recurrent uveitis (a deteriorating health of the cornea from the inside out — the inflammation in the interior chamber eventually involving the cornea).

The well-localized synechia, which corresponds to both the corneal changes and the lid damage, also supports trauma. Significantly lacking from your description, and frequently found in old recurrent opthalmia cases are:

• Change in color of the iris to a deep dark brown, almost black.
• Irregularities to the border of the iris (usually “moth-eaten”).
• Evidence of debris in the anterior chamber (can be present even in currently inactive cases).

A fundoscopic exam is indicated (not a bad idea even with normal-appearing eyes) to help definitely rule out recurrent uveitis. With advanced changes, there is also involvement of the retina — the classic “butterfly” lesion — a zone of loss of pigment and highly reflective changes surrounding the optic disc.

Be forewarned the pupil may not dilate normally, though, because of the synechia. However, your vet should be able to get a good enough view of the optic nerve to tell if there are any surrounding lesions.

The only other precaution is that you should be aware that the horse may be “spookier” than most, especially in new surroundings, because that pupil does not react as quickly or as fully as an unscarred one.

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Is The Pain In Her Hocks Or Ovaries'
varian pain can cause a mare to move restricted or stilted behind. It is common for a diagnosis of hock pain to be made, but treatment of the hocks has no effect. The stiff gait is also sometimes blamed on back pain or “kidney problems.”

This is no surprise. These mares typically take short, choppy strides behind and refuse to engage the hindquarters well. Their back muscles are often rigid, especially when touched or brushed. They may exhibit muscular splinting and guarding to the point they are even confused with tying-up. Behavior changes and cycling abnormalities may or may not be present. This problem also tends to be present year round, although it may worsen during times the mare is cycling.

The exact cause of the pain is not clear. Examination of the flanks may show they appear full and doughy to hard in the upper portion. The ovary often feels enlarged and tender on rectal examination.

In some cases, the mare will have multiple follicles begin to mature, but they seem to shrink without reaching maturity. Adhesions around the ovary may also be a cause of the pain, possibly caused by rupture of an ovarian structure and release of fluid into the surrounding tissues or some other cause of inflammatory reactions.

Whatever the reason for the pain, it is significant. A history of nondescript stiffness behind, sensitivity on brushing and failure to respond to treatment of the hocks or tying-up is classical.

These mares often stand in the stall with one/both hind legs tucked underneath them and have a characteristic slight hump in the spine over the flank area, between where the ribs end and the pelvis starts. Their spine may also be prominent close to the tail base. A combination of rectal palpation and a careful diagnostic examination using acupuncture points will make the diagnosis.

If your veterinarian can pinpoint the type of ovarian dysfunction, hormonal therapy may correct the problem. However, we have seen the best results with acupuncture. When performed correctly, relief is dramatic and immediate. Duration is unpredictable, however. It may need to be repeated. If there is an anatomical problem at the root of the pain, these may not go away with acupuncture or any other medical treatment and you may need repeated acupuncture treatments or chronic analgesics for control. Surgery may be an option.

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Do-It-Yourself Eye Protection
If your horse has an eye injury, contact your veterinarian inmediately. Never decide to just “see how it is in the morning.” Eye problems are serious and should not be handled without veterinary advice. Even minor swellings can itch, and the horse can seriously damage the eye by rubbing it.

When the vet examines the eye, you may be told to limit the amount of sunlight your horse is in. This recommendation could be due to the injury itself or because the ointment prescribed dilates the pupil, making excessive sunlight painful (such as when your own eye doctor dilates your eyes and you are forced to wear dark sunglasses until they return to normal).

Instead of simply forcing the horse to stay in a dark stall until he’s healed, we’ve had success limiting sunlight by taking a fly mask and covering the half that the injured eye is on with strips of duct tape.

Our horses have reacted calmly, and it allows us to continue at least limited turnout, but do check with your veterinarian to be sure it’s acceptable for your horse’s specific eye problem.