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Discussion on Purpura Hemorrhagica care

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Jacquie Ansell
Username: Jacquie

Post Number: 9
Registered: 3-2001
Posted on Tuesday, Apr 15, 2003 - 11:19 am:   Edit PostPrint Post

Hi Dr. O.
On 4-2-03 i had all of my horses mare, Joy, recieved a 4way, wnv, and the strangles shot (not the nasal vac). On the 3rd, her chest was swollen at the injection site, she was larthegic (sp), and had problems moving, acting like she had the flu. Didn't think too much of this, since 6 out the 7 horses vac all exhibited some signs of swelling at injections sites and moving a little slower...however, Joy was the worse. By the 8th she appeared much better -- swelling gone, appetite good, more energetic, basically back to normal.

the morning of the 10th, i noticed she had a little swelling in the front right fetlock, and slightly lame...i figured she just twisted it a little, someone kicked at her, etc...didn't think much of it. 2 hrs later the swelling and lamesness had increased...i hosed her down for 15 minutes and gave her 2 grams of bute then left for work. 8 hrs later her whole leg was 2 to 3 times normal size -- I'm thinking broken leg. call the vet, he couldn't see her right then but advised hosing again and more bute. While hosing, i noticed the right rear was also swollen and further examination the front left was beginning to swell. Called my vet and Davis Univ -- both felt it was an alergic reaction to the strangles vac and she has purpura hemorrhagica. I got to her our vet and he gave her a shot of dexamethasone and penicillin and banadine(sp). Temp was 102, hr 52. He also wrapped her legs. Treatment perscribed was: 10 cc dexamethasone 1x daily and 30cc penicillin 1x daily, 1 gram bute 2x daily, 15 minutes cold water hosing per leg, and leg wraps.

all is going pretty good -- she had seepage from her legs the 10 and 11 (vet advised to scrape dried seepage off during hosing down), and most of the swelling is gone. the cannon bone and knee joints are still a little swollen, but not much -- I'm hoping all of the swelling will be gone today. Yesterday, he had me decrease the amount of meds: 8 cc of dexamethasone and 15 cc of penicillin.

Here's my question: my vet is concerned with the possiblity of the skin sloughing off due to the amount of swelling that took place. He has only seen this happen once, but doesn't know/remember how long the other horse was swollen up. His prognosis is that if this should happen to my Joy, she will have to be put down. I've asked about a time frame, will this occur in a week, two weeks or month from the time of swelling? And what should I look for if this is going to happen? Unfortunately, he really doesn't know the answer. I'm not expecting an exact date, but a general idea of when this might occur would be greatly appreciated. I know we aren't out of the woods yet, but it sure would give me a bit of relief to have an idea of when we might be out of the woods and danger.

Thanks for your input, Dr. O!
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Jacquie Ansell
Username: Jacquie

Post Number: 10
Registered: 3-2001
Posted on Tuesday, Apr 15, 2003 - 2:24 pm:   Edit PostPrint Post

Update: After giving Joy her shots this morning, I checked her capillaries -- her gums are turning black. Still pink around her teeth, but along the upper inside of lip and back of her mouth has turned black. Any thoughts?

An hour later: Ok, i might just be a silly nilly...checked one of our other horses -- he has some black on his gums too -- so it just could be she has black gums. She has never been good about looking into her mouth, I've been working with her on that I've only seen pink gums in the past. Anyway, vet wants me to bring her in, check her overall progress and the gums just in case i'm not loosing my grip on reality. Thanks, jacquie
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Robert N. Oglesby DVM
Username: Dro

Post Number: 8145
Registered: 1-1997
Posted on Tuesday, Apr 15, 2003 - 7:20 pm:   Edit PostPrint Post

Now that the swelling is down if you had that type damage the dead skin will begin to degenerate within the next week. Depending on the underlying tissue's condition it could become soft and necrotic or if over bone or other dead tissue may become hard and leathery (eschar like). This is a bit morbid however, take heart, chances are good you will not see any such problems of this sort. If your horse is feeling well and eating I assure you her gums are not turning black: you are seeing areas that have always been pigmented and just not noticed before.
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Jacquie Ansell
Username: Jacquie

Post Number: 11
Registered: 3-2001
Posted on Tuesday, Apr 15, 2003 - 10:28 pm:   Edit PostPrint Post

Hi Dr.O, thanks for responding so quickly, I really appreciate it!! Yes, Doc Pyle confirmed it was just her pigmentation and nothing to worry about. :-) But he was glad i brought her in anyway. Come to find out, Thursday (the 10th), he didn't give her much chance to pull out of this. He had told me a 50% chance at that time, but unknown to me he really thought it was less. However, after todays visit, he is really impressed with her improvement and feels extremely well that she will fully recover! Yippeee!!!! He checked her skin condition and thought it looked and felt really good, and now feels he will be very surprised if the worst happens. Said the skin is soft and suptle and isn't showing any indication of damage. He still cautioned it could be too soon to tell for sure, but at this point he feels really good about it. Now he is doing research regarding weaning her off the dexamethasone. He dosn't want to take her off too soon, but doesn't want to keep her on it any longer than we have to.

Again, thanks for your response and I'll you posted if there are any changes. Thanks, jacquie
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