Summer Sore Time is here!!

Although I have already written a blog concerning summer sores in horses (go to: http://michaelporterdvm.blogspot.com/2013/06/habronemiasis-summer-sore-in-horse.html) , the condition is a recurring one and it deserves another visit!! Below are several images from different horses that suffer from recurring habronemiasis or equine summer sores. The horse in Figure 1 suffers from recurring habronemiasis in all 4 limbs, whereas the horse in Figure 2 recently developed summer sores along his sheath!! These summers sores are medium in size and treatable with topical and systemic medication. However the horse in Figure 3 is suffering from a horrible summer sore of his lower limb that has not been treated but allowed to grow unabated and permanently disfigure the limb. It is frustrating to the horse owner that these lesions tend to return every year with the return of flies however if treated early and aggressively, management of this condition is quite do-able!!

Figure 1

Figure 2

For horses with recurring or first time habronemiasis, I recommend the following:

1: Systemic treatment with a dewormer containing Ivermectin. Treat twice, approximately 3-4 weeks appart.
2: Topical treatment with Dr. Porter's summer sore cream!!
3: If the summer sore is excessively large or in a location that is difficult to treat with topical medication, I recommend systemic therapy with corticosteroids. I prefer to medicate with a tapering dose of oral prednisolone over 30 days.

It is critical that the barn management incorporate a fly control program of their choosing. In addition, horses which suffer from recurring summer sores need to be treated the moment there is any redness or mild irritation present in the old summer sore sites!! If treated early, the lesion will typically respond favorably to topical medication without the need for systemic corticosteroids! 

Figure 3

Fractured Spinous Processes in a Horse

A 10 year-old gelding arrived to a horse show and was seriously injured during the unloading from the trailer. The rear gate was lowered and the horse remained standing in the trailer with the "butt bar" in place (Figure 1). For some unknown reason, the horse panicked and attempted to unload with the butt bar in place. The horse became trapped below the butt bar and struggled for several minutes before the owner was able to release the bar. Within moments of the event, the horse's withers became swollen and very sensitive to the touch. The gelding was treated with systemic anti-inflammatory agents and returned home in the trailer WITHOUT the  butt bar!

Figure 1

Two weeks after the injury, the gelding presented to PHD veterinary services for a radiographic evaluation of the withers. In Figure 2, the green line outlines the withers of the horse. The bone-like fingers projecting upward below the green line are the spinous processes which make up the withers. On physical exam there was minimal swelling over the withers however the horse was very sensitive to any pressure and there appeared to be a "dip" in the very bottom of the withers (yellow arrows).

Figure 2

Radiographic evaluation of the "dip" in the withers confirmed multiple fractures of 3 spinous processes (yellow arrows in Figure 3). The first spinous process that is fractured appears to be in several fragments and displaced from its normal position. The second spinous process appears fractured but not displaced and the third process appears to have an avulsion of the most proximal aspect of the spinous process. Although it is likely that these fractures will heal in time and be some what stable, the current concern is the development of a frustrating condition known as fistulated withers. This  occurs when a piece of fractured bone becomes devitalized of blood supply and subsequently "dies" becoming a sequestrum. The body's natural response is to rid itself of the sequestrum and will develop a draining wound that originates from the sequestrum. These wounds do NOT resolve until the sequestrum has been removed and this can be extremely challenging from a surgical stand point. Currently there is not evidence of a sequestrum however it will take several weeks/months to determine if one will develop. Prognosis for return to riding will depend the development of fistulated withers and how comfortable the horse is once the fractures have stabilized.

Figure 3

Rehabilitation of horses through controlled swimming!!

The images below were taken at The Sanctuary Sports Therapy and Rehabilitation Center in Ocala Florida. The horse that is entering the water and swimming across the equine swimming pool is in the process of being rehabilitated for a ligament injury. This horse has already under gone 8 weeks of strict stall confinement and several doses of extra-corporeal shockwave treatment for his injury. Horses that have spent extensive time in stall confinement are at risk of re-injury or a new injury once they are returned to work. This is because the are out of condition yet willing to run, buck, jump, and generally misbehave!! Unfortunately, most horses lack a good sense of self preservation!! 

 Depending on the type of injury, low-impact exercise is advantageous for rehabilitating horses after a lengthy confinement. Unfortunately, due to their significant weight and relatively small cross-sectional area of their hooves, horses tend to stress their musculoskeletal structure even at the walk. In addition, many can be fractious and unsafe to handle and/or ride after an extensive period of confinement. As such, swimming provides an excellent form of exercise that is very low-impact and safe. Fortunately, most horses enjoy swimming and are quick learners!!

My recommendation for horses returning from a lengthy period of stall confinement includes 30 days of swimming for 20 minutes, 4-6 days per week. In addition, the horse will be hand-walked for 10-20 minutes per day. The remainder of time the horse remains in stall confinement. In my opinion, this is far superior to simply turning the horse out in a small paddock for 30 days.

http://www.sanctuaryequinerehab.com/