Fall Colors Between Rhio's Ears

Fall Colors Between Rhio's Ears

Thursday, June 25, 2015


There is no such thing as a "simple" puncture wound.  Since Red's May 30th injury, things have gone from bad to worse. I had a nice, long, descriptive post written.  I was just getting ready to add the photos.  And it disappeared into cyberspace.  So, instead you're getting a descriptive photo essay.

June 1, less than 24 hours after injury.  Swelling is marked, he's not using it, and I'm using cold hosing and icing along with bandaging and wound care. 

June 2. The view from behind bars - little did we know at the time how much time he'll be spending in his stall (months).
June 3.  I've removed all my foolhardy sutures and am flushing the wound daily with hydrogen peroxide, followed by saline solution.  I'm bandaging with a poultice pad to help draw out the pus.  (The other leg is just wrapped for support).

June 3. Copious cold hosing helps with swelling and pain, and cleans out the wound.  It's looking pretty good.

June 4.  I paid a ridiculous amount of money to have this therapy boot (Easy Boot RX) overnighted to me.  He is not using the injured leg and I'm worried about over-stressing the good foot and the possibility of developing supporting-limb laminitis. This boot helps support the good foot.

June 4.  This is his stance most of the time. 
June 7.  This is what the discharge looks like right after I take the bandage off, before I've cleaned him up.  

June 10.  Standing at the hitching rail with Rhio, either before or after going for a little handwalk for grass.  He's walking pretty well by now!
June 11.  Working on his leg in the barn, with Rhio for company.  Maybe you can see that he's putting some weight on it even while just standing.
June 12.  The wound is filling in with healthy granulation tissue, but he's still really sore on it.   I'm beginning to be suspicious there's something else going on...
June 15.  Selfie time!  I've been at the barn every single day since the horses moved, twice a day some days. And it's 22 miles one way from home. 

June 15.  Still hosing the leg.  The wound looks great superficially but there is still copious thick yellow drainage and serious lameness.  He's spending some time in the small paddock, but most of his time stalled.
June 16.  It's time for more investigation.  This is joint fluid from the lower carpal joint.  It's cloudy and dark yellow.  It should be clear and pale yellow.  Looks like infection - off the sample goes to the lab for analysis, and culture if it is indeed infected.  Results: obvious infection, and there are two types of bacteria - E. coli and Streptococcus zooepidemicus.

June 18.  On the left is a bone fragment, which I located when cleaning the wound after having injected antibiotics directly into the infected joint.  The body had been trying to push it out, hence the copious thick drainage from the wound.  Now, where did this come from???
June 19.  The wound doesn't look quite so healthy as it did back on June 12.  Red's feeling pretty punky still, with pain indicators (high heart and respiratory rates despite antiinflammatory pain relievers).

June 19.  Icing the leg makes him feel better, so I do it every day between bandage changes.
June 19.  Plain film radiographs show an obvious and serious fracture of the lateral splint bone.  This is where that chunk of bone came from, and it looks as though there may be one other small loose fragment that will work its way out.  The fracture is non-displaced, meaning all the pieces are still in their original location.  This is VERY GOOD, especially since he has not been kept on strict stall rest but has been walking around in a small paddock and handwalking on lead.  This bone is non-weight bearing, meaning that it can actually heal on its own.  The pieces, if they were to move, however, could get lodged in some very important structures, such as tendons, ligaments, or the joint.  So it's really important that we keep him from walking much, so that we have the best possible chance it will heal on its own.  Of course, the fracture is further complicated by the fact that not only the joint, but the fracture, is infected.  So the first order of business is to knock the infection out thoroughly, if possible.

June 19.  Right before the local vet came to xray.  Red's last day in the paddock for months to come. 
June 20.  Red gets his first regional limb perfusion.  I'm still waiting on final culture and sensitivity results to make sure he's on the correct antibiotics.  He's currently getting both injectable and oral antibiotics twice daily.  This procedure allows me to infuse a very high concentration of antibiotic into a vein in the area of the infection.  With the use of a tourniquet (thanks to a noble sacrifice by my mountain bike, as a bike inner tube works great!), I can leave the antibiotic in the area for 20 minutes, long enough for it to diffuse into all the local (infected) tissues.  This should achieve a killing dose of antibiotic into the joint, into the fractured bone, and into all the other tissues of the area.  It's a very targeted treatment for situations like this, and also a new technique to me.  By the end of this, I'll feel like an old pro!

June 20.  Red now sports not only a lower leg wrap over the wound, and supporting the lower leg, but a bandage up over his knee as well.  This technique is called a 'spider' bandage, as you have lots of long tails which you tie together to allow the bandage to bend as the knee bends.  This is also a new technique to me, but so far, it's working!  I have used a dish towel to make my spider, place over normal bandage quilts for padding. 

June 20.  Red loves having a window on his stall so he can hang his head out. 
June 22.  We've finished another regional limb perfusion and are waiting for our time to take the tourniquet off and bandage him back up. He gets to walk three steps out of his stall each day for me to clean it, and I do his treatments in the aisle.  Poor guy.  He's such a trooper, though.  I couldn't ask for a better patient.

June 22.  Get well cards made by the little girls whose horse Lucky is next to Red.

June 24.  View of his front legs from behind.  Can you see how swollen the left still is?  And it's so much better! 

June 24.  View from the front.  This left front injured leg is on the right side of the photo.