Notes from Mediccal Record
- 10 year old Paint fell off trailer on the way to event
- Severe degloving injuries to right and left carpi, and hind left fetlock
- Right and left metacarpal-carpal, intercarpal, and left fetlock joints flushed with lactated ringers
- Right and left intercarpal, and left hind fetlock joint open to environment
- Initial treatment
o Sedation with Xylazine and Butorphanol
o Flunixin Meglamine Injecton
o Wounds cleaned, debrided
o Joints flushed with Lactated Ringers
o Wet to dry bandage using SSD and stack bandage technique
o Uniprim oral antibiotics daily
12/3/2011 – 12/8/2011
- Daily joint flushes with LRS
- ½ cc amikacin injected to each joint after flush
- Stack bandages changed daily with application of SSD
- Phenylbutazone 4 grams 12/3-12/5, then reduce to 2g/day
- Monitored daily for appetite, gut sounds, BM, Urination, pain
o All WNL and pain well controlled with 1g bute q12h
- 12/13 – right intercarpal and left fetlock closed!
- 12/16 – opening to left intercarpal seems to be decreasing in size
o Granulation tissue is filling in but seems slow, left carpus showing slow improvement.
o WeHealPlus unit placed on the left 12/16
12/20 – 1/18/2012
- EOD joint flushes/amikacin/stack bandages
- Owners to keep Blaze stalled, daily bandage changes
- Farm Call: Weekly joint flush/amikacin by Dr. Liz
- Granulation tissue growing faster with WeHealPlus unit. Seems healthier and a brighter pink just overnight.
12/28/2012 – Blaze discharged with WeHealPlus unit.
12/31 – owner called to say Blaze wouldn’t eat grain with powdered antibiotics. Injection of exceed given IM to be repeated in 4 days.
1/3 – non-weight bearing left hind fetlock – Grade 5 Lame, moderate cellulitis, pitting edema
- Wounds cleaned
- Applied WeHealPlus unit to left hind fetlock
- Grade 3 lame 1/5/2012, minimal swelling
- Unable to effectively evaluate lameness due to grade III lameness of left front carpus
1/5 – cellulitis resolved, minimal swelling, no pain on palpation
1/10 – radiographs of left carpus show mild arthritis however after Blaze gets excited and bucks around in the stall he becomes grade 5 lame for two days after event. Differential diagnosis includes arthritis, adhesions, and infection although no evidence of infection noted.
- Continue WeHealPlus unit on left front carpus
- Weekly joint flushes until 1/25/2012 – joint capsule decreasing in size significantly, granulation tissue filling in wound except for deep lesion in the center of the wound where the joint still drains. Possible fistula. Discussed going to LSU for joint closure.
1/24 – 3/15
- EOD bandage changes with SSD, wound cleaning by owners
- Continue Uniprim, Bute 2g/day, Ranitidine
3/15/12 – Blaze goes to LSU to have joint capsule evaluated. LSU assessed both carpal joints to be closed and took samples to rule out infection. No evidence of infection found. A cast was applied to the left front carpus to help skin sound heal faster. Bute was decreased to 1g/day however Blaze became grade 4 lame so owners increased to 2g/day 3/20/12. LSU discontinues Ranitidine.
4/2/12 – Blaze gets cast taken off at LSU. They decide to put it back on for two more weeks. The cast was bivalved and rewrapped to his leg. Blaze becomes grade 5 lame 4/4/12. Owners took the cast off.
4/5/12 – Blaze grade 4 lame but is weight bearing. Caudal half of cast was reapplied by Dr. Liz. The next day Blaze is grade 2 lame. Dr. Liz gets text message that Blaze feels better and bucking around in his paddock. No surprise, Blaze is grade 4 lame the next day! Stays lame between Grade 2-4 with 2g of bute per day.
4/6/12 – Blaze continues to kick at stall trying to get out, moderate wounds to left front fetlock.
4/28/12 – Blaze grade 4/5 lame. Not associated with carpus. Fetlock is moderately swollen, cellulitis, and joint effusion. Blaze won’t eat but powder in his food so owners give bute injectable. Owners were giving 4g IV q24 for 4 days.
4/30 – Blaze eats well in the AM, ADR throughout day and rubbing his side against the stall. By 10 pm he is recumbent and euthanized for presumed colic, totally unrelated to leg problem.