This picture is old. A couple days old, so not ancient but it's amazing how much things change in 48 hours. The injuries occurred 10 days ago, and things were going OK up until Tuesday, when all the sudden the area got really hot, really fat and really tender. The swelling had been sitting there for a while but it wasn't getting any worse. Upon my vet's recommendation I'd been sweating Stella's right leg for two days to no effect: the swelling stayed and the heat hadn't gone away. She wasn't running a fever but things still weren't quite right. I'd weaned her off SMZ's by that point, and in hindsight I wish I hadn't.
The vet came back out on Wednesday afternoon to check her again, and confirmed what I had hoped to not be the case: Stella had developed cellulitis in the area of the largest wound, the one above the hock. Based on the fact that she was (and is) weight-bearing, it didn't appear to have affected the joint capusule. If it had, that's serious bad news.
For those unfamiliar with cellulitis, it's not your garden variety infection. Cellulitis can occur in people, but in horses it can be extremely dangerous and hard to control and get rid of. Cellulitis is an infection of the sub-cutaneous space, i.e. the space under the deepest dermal layer. Normal infections are confined to dermal space: you get a break in the skin, bacteria enter and colonize and infect the area. Sometimes, in an attempt to fight the infection, the body builds blood vessels to the site and gives the bacteria a pathway into the circulatory system, causing sepsis or blood poisoning. With cellulitis, the infection is already beyond the dermal layer and into the connective tissue below it. This causes a range of issues, namely that the body can't as easily fight infection in connective tissue: blood supply is poor, and even poorer in the most susceptible areas, the horse's legs. Lymph movement is also poor, so trying to move fluid out of the area and decrease swelling is not easily done.
After two days of sweating the area with a bandage from her fetlock all the up to her gaskin, nothing had changed. The vet came back out and gave her an IM dose of penicillan and another IV dose of gentamicin, another antibiotic, in the hopes of covering all types of bacteria that could be causing the infection. She's back on SMZ's and Bute twice a day. I'm only wrapped the distal limb to avoid irritating the hock wound and in the hope that by trying to clear the lower swelling, the fluid in the hock will have somewhere to go and dissipate on its own.
Not so. Two more days of wrapping and drugs and nothing. There's maybe the tiniest improvement, but nothing substantial, although she is using both legs normally and walking fairly soundly. I'm happy to see Stella has stayed in good spirits, is eating, drinking and has normal manure. If nothing improves by the weekend, the vet will be back out to take an ultrasound and find out is we are looking at a pocket of pus that needs help getting moving, or if there is soft tissue bruising or, worst case scenario, joint damage.
Fingers crossed.
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