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joint infections, vet school notes

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  • smith2267
    Joint infections in foals are often secondary to failure of passive transfer of maternal antibodies (horses get ALL of their maternal antibodies in the
    Message 1 of 11 , Mar 1, 2002
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      Joint infections in foals are often secondary to failure of passive
      transfer of maternal antibodies (horses get ALL of their maternal
      antibodies in the colostrum, or first milk. this is due to the
      structure of their placenta). Although the prognosis is good for
      adults with joint infections, it's not as good for foals, who are
      usually systemically ill.
      These patients usually present as 3 legged lame, because
      these infections are very painful.
      In adult horses, joint infections are often caused by intraarticular
      injections. Owners and trainers sometimes like to give their own
      IA injections, and they don't do a sterile prep on the area first.
      When vets do it, the rate is quite low (.08%) because they
      surgicaly prep the area and often put an antibiotic right in the
      injection.
      Speaking of antibiotics--oral antibiotics are not appropriate for
      these infections. IV and / or IA is the way to go. Penicillins are
      not appropriate either, because most of these are staph
      infections, and penicillin doesn't get staph. Amikacin or gentacin
      is preferred. Baytril is known to be chondrotoxic, and shouldn't be
      given to foals or lactating mares. It's safe for adults however,
      unless they are on it for unusually long periods.
      Cytology is the best test to confirm a joint infection, and the cutoff
      is 30,000 cells per microliter, with more than 75% of them being
      neutrophils.
      Most of these cases should be referred, as they are very difficult
      to treat. The average bill here is $3,000.
      If necrotic bone is present , it MUST be debrided. Otherwise
      treatment will not succeed.
      PMMA beads are a promising new treatment. they are
      impregnated with antibiotic, and placed in the joint where they
      release the med over a period of about 3 weeks. sometimes
      they will migrate into a place in the joint capsule where they can't
      be removed, but this doesn't seem to cause much trouble.
      Infected joints should be flushed to remove bacteria and fibrin.
    • klbash2000
      I am trying to learn what else I can do to get this foal healthy. She has a good attitude and eats well but her left hind is a mess. She has had ankle, hock
      Message 2 of 11 , May 16, 2002
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        I am trying to learn what else I can do to get this foal healthy.
        She has a good attitude and eats well but her left hind is a mess.
        She has had ankle, hock and stifle flushed and has been on several
        different meds. Ankle appears to be fine, hock and stifle have
        osteomyelitis, stifle is badly swollen. She's on chloramphenicol and
        ketofen right now. She's pretty comfortable when the ketofen's in
        her, badly lame without it. She had her stifle flushed again this
        morning so hopefully that will improve. She's an orphan being raised
        on Mare's Match milk replacer, with access to milk pellets, creep
        feed and fresh grass. I've been adding Vit E and mare EPIC to her
        milk to try to boost her immune system. I am tempted to try
        echinacea, Vit C and/or GlutaSyn, but don't want to waste the money
        if they're not likely to help or might be a problem with her meds.
        Ideas or thoughts?

        Keri
      • smith2267
        A couple for starters.
        Message 3 of 11 , May 16, 2002
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          A couple for starters.
          <I've been adding Vit E and mare EPIC to her
          > milk to try to boost her immune system. I am tempted to try
          > echinacea, Vit C and/or GlutaSyn, but don't want to waste the money
          > if they're not likely to help or might be a problem with her meds.
          > Ideas or thoughts?>

          What are her IgG levels? joint infection makes me think maybe she
          didn't get colostrum. I don't know if at 5 weeks old a colostrum
          deprived foal could be expected to have normal IgG levels. I'd love
          to look it up, but I have exams coming up--sorry!! If you know,
          please tell us.
          I keep getting booted offline, so I'm going to post this, then look
          up some foal joint infection info, then post again.
          You're a vet, I'm assuming.
        • smith2267
          The following is from my vet school notes. Is a culture and sensitivity possible? Is this foal low in IgG, would a plasma transfusion maybe help? Treatment
          Message 4 of 11 , May 16, 2002
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            The following is from my vet school notes. Is a culture and
            sensitivity possible? Is this foal low in IgG, would a plasma
            transfusion maybe help?

            Treatment
            Septic arthritis in foals is an emergency. Immediate assessment and
            institution of treatment should be performed. The systemic condition
            of the foal must be addressed. Management of failure of passive
            transfer, and all other problems associated with foal septicemia,
            should be done.
            The principles of treatment of septic arthritis in foals are:
            systemic broad-spectrum antibiotics; local joint lavage and
            debridement; and local antibiotics. The most common organisms
            isolated in foal septic arthritis are: Actinobacillus; E.coli;
            Klebsiella sp; Pseudomonas sp; and Salmonella. In older foals, gram-
            positive organisms such as Strep sp may be isolated. In older foals
            with physeal lesions Rhodoccoccus equi is often involved. In young
            foals, systemic antibiotics should be effective against gram-negative
            organisms. A combination of a B-lactam and an aminoglycoside is a
            good choice, until results of culture are obtained. In older foals,
            gram stains of a physeal aspirate or of a trans-tracheal wash are
            helpful to identify Rhodoccoccus equi. If present, appropriate
            therapy with erythromycin and rifampin should be instituted.
            Local lavage can be preformed by through-and-through needle
            technique, with the foal under heavy sedation or short-term
            intravenous anesthesia. This technique may be sufficient in joints
            where the diagnosis was made early, where the infection is not
            severe, and in simple joints (fetlock, carpus). In joints with
            multiple compartments (stifle, hock), in cases of severe infection,
            or in cases of longer duration or lack of response to joint lavage,
            arthroscopic debridement is indicated. Arthroscopy has several
            advantages over simple needle lavage. It allows thorough debridement,
            removal of fibrin and lavage of all compartments; and it allows
            evaluation and debridement of cartilage lesions. Arthroscopy may have
            prognostic value in cases where radiographic lesions are equivocal.
            Intra-articular antibiotics are advocated for the management of
            septic arthritis. Aminoglycosides have been shown to maintain levels
            above MIC for 24 hours following a single intra-articular injection.8
            Other local treatment modalities include antibiotic-impregnated PMMA
            beads, or biodegradable antibiotic-impregnated disks. Regional
            intravenous or intraosseous perfusion has recently been advocated for
            the treatment of septic arthritis complicated with osteomyelitis. The
            potentially detrimental effects of temporary vascular occlusion on
            foal bone circulation need to be investigated.
            The presence of osteomyelitis may warrant the use of an antibiotic
            combination that reaches effective bone levels. Rifampin is often
            used for that purpose. Other antibiotics that reach effective bone
            concentrations include tetracyclines, chloramphenicol, and
            cephalosporins. Third-generation cephalosporins should be used, as
            they are more effective against gram-negative bacteria.
            Fluoroquinolones should not be used in foals, as there is enough
            evidence of cartilage lesions developing in immature animals with the
            use of this class of drugs.
            In the case of extensive physeal lesions, curettage, bone graft and
            external coaptation may be required. Angular limb deformities may
            result from growth disturbances, or collapse of the physis on the
            affected side.
          • klbash2000
            She started on Cephalexin for 5 days at 5 days old for a 450 IgG and a high white count. 450 is normal but if I had been told a number instead of a
            Message 5 of 11 , May 16, 2002
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              She started on Cephalexin for 5 days at 5 days old for a 450 IgG and
              a high white count. 450 is "normal" but if I had been told a number
              instead of a description I would've had her transfused and probably
              saved a lot of headache. (Always use 800 as your cutoff). But
              hindsight is 20/20 so moving on.
              Temp went down to normal, things went fine while waiting for a
              nursemare. Finally got one at 3 weeks old, ended up yet another
              problem. Mare would stand and let her nurse so long as the mare was
              held or tied. When she was turned loose with foal, she kicked the
              hell out of it. (Back to bucket). The next day hock swelled. Temp
              went to 105.5. Gave her Gentocin and Penicillin, temp started coming
              down. Next morning (Tuesday) took her to clinic. Ankle had swollen
              overnight. Xrays - NSL. Clinic flushed hock and ankle and started
              her on LA200 IV. Went back Thursday to flush hock again.
              Friday night she stopped eating. Pharmacy closed Derby day so had to
              leave her off meds until I could get new ones Sunday. Started her on
              Gentocin and Cefazolin IV. Stifle swelled Monday with heat and
              without lameness. Friday she went lame. Sunday wouldn't use leg to
              get up but would bear weight once up. Monday, wouldn't bear weight.
              Tuesday, took her back to clinic for stifle flush. Xrays of hock and
              stifle showed osteomyelitis starting, flushed stifle and switched to
              chloramphenicol and ketofen. Worse lame after Tuesday's flush, fine
              with the ketofen. Better after today's flush, not sound but less
              lame.
              I believe the clinic was avoiding plasma transfusions because of an
              usually high number of reactions this year, so at this point I'm
              exploring boosting her immune system nutritionally.

              Keri
            • smith2267
              I still think a culture and sensitivity is in order. I think bad nutrition can undermine a good medical plan, but good nutrition can t take the place of one. I
              Message 6 of 11 , May 16, 2002
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                I still think a culture and sensitivity is in order. I think bad
                nutrition can undermine a good medical plan, but good nutrition
                can't take the place of one.
                I would not abandon the idea of a plasma transfusion, either.
                Preventing rxns is what cross matching is for.
              • klbash2000
                It s sensitive to amikacin and chloramphenicol. But she s improving very slowly and questionably. I listed the other drugs since we went one by one through
                Message 7 of 11 , May 17, 2002
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                  It's sensitive to amikacin and chloramphenicol. But she's improving
                  very slowly and questionably. I listed the other drugs since we went
                  one by one through the list you mentioned in your reference. I
                  forgot to mention that she has had Amikacin injected directly into
                  the joint and is of course now on the chloramphenicol. I think I'm
                  going to have a fight on my hands for plasma at this stage. I would
                  really appreciate any nutritional thoughts. Obviously not as a
                  replacement for the medical plan but as a supplement. I am looking
                  for what has been tested and may prove helpful in nutritional support
                  given that it's a young foal getting its' nutrition in an abnormal
                  way and having a lowered immune system.

                  Thanks for your help.

                  Keri
                • smith2267
                  Potential Uses of Omega-3 Fatty Acids in Equine Diseases Compend Contin Educ Pract Vet 20[5]:637-641 May 98 Review Article 13 Refs * Margaret E. McCann, DVM,
                  Message 8 of 11 , May 17, 2002
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                    Potential Uses of Omega-3 Fatty Acids in Equine Diseases
                    Compend Contin Educ Pract Vet 20[5]:637-641 May'98 Review Article 13
                    Refs

                    * Margaret E. McCann, DVM, PhD and Joan B. Carrick, BVSc, PhD
                    * Dept. of Large Animal Medicine, College of Veterinary Medicine,
                    University of Georgia, Athens, GA
                    - Biochemical and epidemiologic studies demonstrate that omega-3
                    fatty acids have potent antiinflammatory properties. Although
                    clinical trials show that these fatty acids are beneficial in
                    treating several human and canine diseases, few studies have been
                    conducted to investigate the use of omega-3 fatty acids in diseases
                    of horses. This column considers studies in which omega-3 fatty acids
                    have been used to modify human or canine diseases and suggests
                    possible uses for these fatty acids in the treatment of equine
                    diseases. The principal antiinflammatory effects of ingestion of
                    diets enriched with omega-3 fatty acids are reduction in overall
                    eicosanoid production and modification of the spectrum of eicosanoids
                    that are produced. Potential therapeutic applications of omega-3
                    fatty acids in horses include cardiovascular disease, dermatologic
                    disease, arthritis, respiratory disease, renal disease,
                    gastrointestinal disease, systemic inflammatory response syndrome,
                    and reproduction and neonatal care. Ongoing clinical investigations
                    of the use of omega-3 fatty acids in the treatment of orphaned foals
                    and horses with endotoxemia, chronic respiratory disease, and
                    arthritis may provide equine practitioners with a useful adjunct in
                    the management of patients with these conditions. (Author Abstract)
                  • klbash2000
                    The foal is still alive and appears fully on the road to recovery with all 3 joints looking better. In contrast 2 other foals cared for by other family
                    Message 9 of 11 , May 29, 2002
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                      The foal is still alive and appears fully on the road to recovery
                      with all 3 joints looking better. In contrast 2 other foals cared
                      for by other family members on other farms with only the same stifle
                      infected are not expected to make it. All received the same surgical
                      treatment and were susceptible to the same drugs, all had the
                      infection move into the bone. The differences in treatment as far as
                      I can tell are small. None of the foals have access to fresh grass,
                      only mine received Vit E (several 400 IU caplets a day, ate them
                      right out of my hand). Mine recieved her chloramphenicol at 8 AM,
                      4:30 PM and 11 PM, as close to the 8 hr intervals as was
                      maneageable. One of the others gets 4 doses from 7AM through 7 PM
                      and then nothing through the evening. I don't know the 3rd's
                      medication schedule. Mine also receives a double dose of mare EPIC
                      daily, one scoop AM and one scoop PM. I don't know if the benefit
                      from the EPIC came from the fatty acids, the immune factors or the
                      high quality of the protein or if it helped at all though the timing
                      of her improvement suggests to me that the mare EPIC had a
                      significant effect. She'll be on the same schedule for another 2
                      weeks and then be reevaluated at the clinic.
                      The foal is willing to bear almost full weight on the leg at the walk
                      though still carries it if she goes faster. The swelling to the side
                      of the stifle is gone, there is still some bulging tight swelling
                      across the front of the stifle where the groove should be. The
                      swelling in the hock is smaller pockets instead of around the whole
                      joint, slight swelling in front and a pocket on each side in the
                      dip. The side pockets are decreasing slowly, the front swelling
                      comes and goes and seems to be related to her activity level. The
                      ankle seems fine with no swelling or heat for over a week. Her
                      attitude and appetite are excellent. She's drinking 1.5 gallons of
                      milk replacer diluted to 3 gallons of half strength to keep her
                      hydrated since she was staying slightly dehydrated on her own. She's
                      also picking at alfalfa and grass hay and eating 5 milk replacer
                      measuring cups of grain a day. Her back is almost but not quite
                      level so I while I would prefer a little more weight, I am not
                      worried as she is gaining nicely and catching up out of the stunted
                      phase.

                      Keri
                    • smith2267
                      It s not really possible to pin down the reasons for the different outcomes in this case. That s why good experiments have as many subjects as possible. There
                      Message 10 of 11 , May 29, 2002
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                        It's not really possible to pin down the reasons for the different
                        outcomes in this case. That's why good experiments have as many
                        subjects as possible.
                        There are just too many variables. Genetics, amount of colostrum
                        received, species and strain of the bacteria, which way the wind was
                        blowing...:)
                        Just say a prayer of thanks to whatever god looks after little foals.
                      • klbash2000
                        ... was ... foals. One other thing I forgot to note as a comparison was that mine had 450 IgG and the other 2 had over 800. But you are absolutely right we ll
                        Message 11 of 11 , May 30, 2002
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                          --- In equineveterinarymedicine@y..., "smith2267" <smith2267@y...>
                          wrote:
                          > It's not really possible to pin down the reasons for the different
                          > outcomes in this case. That's why good experiments have as many
                          > subjects as possible.
                          > There are just too many variables. Genetics, amount of colostrum
                          > received, species and strain of the bacteria, which way the wind
                          was
                          > blowing...:)
                          > Just say a prayer of thanks to whatever god looks after little
                          foals.

                          One other thing I forgot to note as a comparison was that mine had
                          450 IgG and the other 2 had over 800. But you are absolutely right
                          we'll never be able to know what the deciding factor was. On another
                          list the listowner's motto is "what works is real" Sometimes, a
                          study can't be found to back up an experience but multiple
                          experiences suggest that a particular action may make a difference.
                          That's the main reason I posted the follow-up, just in case something
                          in it could prove useful to someone else. I definitely am not trying
                          to go down any wild and crazy miracle cure path. :)
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