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  Discussion on Strange swelling in both cheeks.
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Member:
kowal

Posted on Wednesday, Sep 23, 2009 - 10:52 am:

My 7 yr old gelding has soft swelling edema (squishy, fluid like) in both cheeks. The right is slightly worse and the swelling is soft enough that his halter made an indentation. The swelling is not painful to the touch at all and he is eating and behaving normally. His teeth were done 5 months ago.

I don't know if this is related, but he has had a mild alternating lameness for the past 2 months. He was lame on his left front for about 10 days at the end of July, came sound for a month and has now been lame on the right front for three weeks. He had a full vet work up at the end of July with x-rays (when vet came out he was sound but we did x-rays anyway to see if we could find reason for left front lameness). X-rays showed nothing that could explain lameness. There were very mild navicular changes in the right front only.

I don't know whether this is related either, but in February of this year he was treated with antibiotics for a strange systemic infection that caused extreme lethargy / mild fever (we initially thought it was colic because he kept wanting to go down) but no other symptoms. He recovered from this within a week.

Any suggestions as to what this might be? I do recognize the lameness and prior systemic infection are probably not related but thought I should mention them anyway.
Moderator:
DrO

Posted on Thursday, Sep 24, 2009 - 9:40 am:

Hello KL,
The lameness is probably not related. The swelling sounds like passive edema and for more on this see Diseases of Horses » Skin Diseases, Wounds, and Swellings » Swellings / Localized Infection / Abscesses » Diagnosing and Assessing Swellings in Horses. There is a specific subtopic in the article on swellings of the head but the parts of the article on characterizing swelling will be of interest also.
DrO
Member:
rtrotter

Posted on Thursday, Sep 24, 2009 - 11:36 am:

Hi KL,

Both of the articles Dr. O references are very helpful, but I'd like to address the systemic infection that your horse had and relate the experiences that I had with my racemare with very similar symptoms.

On October 16, 2008 my mare was involved in a very serious racing accident requiring several months off and a lot of antibiotics and wound care (followed Dr. O's suggestions).

This mare up until the accident was out in the field quite a bit. SHe was unable to go out due to the severe lacerations on her knees, but she was towed every day between 3-7 miles to keep the swelling down, for the first 10 days and until I got clearance from the vet her knees were done up mainly to keep them clean.

She eventually recovered and I started turning her out gradually building up her time outside until she got back to the same routine she was on before the accident.

The problem was every day she would come back in with swollen jowls, worse on warmer days then on colder days. This mare was in the same environment, the feed, pasture and buddies had not changed. She was acting normally except for this jowl swelling. I thought maybe it was from some seasonal weed. But around this time we moved to a new farm and I hoped that the swollen jowls would resolve by themselves. But, they did not and this kept happening for quite sometime, even though we had relocated.

Around this time, I also noticed, she was not her happy exuberant self, but chalked it up to the move. Then she started having weird fill issues with her legs which did not seem to resolve, no leg structures were involved just lumps and bumps and fill in weird places. The vet was at a loss to figure out what was going on. I told him about her accident and asked if he thought she had a recurring systemic infection, he said he doubted it, but it was a possibility and asked me what I wanted to do. I told him I wanted to try SMZ tabs for a few days to see if anything changed.

Within 3 days there was a noticeable improvement, so she remained on them for 15 days. All the weird swellings including her jowls went away with no change in her routine other than the medication and they have not returned.

My non-medical opinion about this was that there was a low grade systemic infection going on with her that was related to the accident and perhaps even the stoppage ( per the vet) of the antibiotics used to treat her. Whatever the infection was stayed in her system and was not detected by blood tests. The weird fillings, jowls, legs etc) was her natural attempt to clean out her own system and which was then hastened by the SMZ antibiotics.

Conjecture, maybe, but her symptoms have not returned and I have had other similar things happen to other horses.

Maybe the correct original response was to not treat her with antibiotics at all when the accident happened and see if the same series of events would have happened, but when faced with a racehorse with gaping holes in her knees, the thought to not treat was the furthest from my mind and the vet would have thought I was bonkers.

The other event that happened was that by the time I read Dr.O's articles, it was 4 days after the accident and she had been on antibiotics already.

Sorry for the long post, but I thought it important that you not discount your horses previous systemic infection, even though on the outside it may not seem to be related to what's going on now.

Rachelle
Moderator:
DrO

Posted on Thursday, Sep 24, 2009 - 12:06 pm:

The main difference in Rachelle's and KL's cases is the change in behavior. Depression is often the first sign of infection but KL's horses behavior is stated as normal.

Most often generalized edema in dependent areas associated with infection are viral infections. And if this is true in Rachelle's case suggests that whether an antibiotic was used or not the outcome would have been the same. I put this in because of the number of horses that die from antibiotic complications (mainly colitis but anaphylaxis is also possible). Caution is to recommended with the empirical use of antibiotics. For more on this see Treatments and Medications for Horses » Antibiotics and Antimicrobials » Antibiotic Use in Horses: An Overview.
DrO
Member:
kowal

Posted on Thursday, Sep 24, 2009 - 1:58 pm:

Rachelle, did you have blood work done before you put your mare on the SMZ, and if so did it show evidence of an infection?

Dr. O is it correct to assume that evidence of an ongoing infection will always show up in the bloodwork?

I actually never did follow-up blood work to determine whether my gelding's white blood cell count improved after I treated him with antibiotics. He seemed better, so I just assumed all was well.

It is interesting because over the past month I have noticed some fetlock swelling and puffiness, that comes and goes on all four legs....this is new for him, but I know it fairly common in horses in general, so I didn't think too much of it.

Looks like I may need to get the vet out again for bloodwork, and a consult on the swelling, and the ongoing lameness issue.
Member:
rtrotter

Posted on Thursday, Sep 24, 2009 - 2:59 pm:

KL,

Not right before, but when I was trying to figure out what was wrong with her performance wise, she had bloodwork done and was also scoped to rule out any kind of respiratory issues. She scoped clean and the bloodwork came back all in normal ranges, in fact the vet said it was very good. I am a pretty good analyzer of equine blood tests and I sometimes spot things even the vet doesn't think are issues only because I know the norms for my horses from taking bloods at different times during their training and racing careers (sometimes as many as three in a week), but in her case everything looked good.

While I did notice an attitude change, I would not have called it depression more like an I'm annoyed you moved me into a smaller paddock, so I am not going to run around like an idiot when you turn me out. She had previously been in a paddock 3 times the size of the one she was moved to and did not have as much room to run around. This suited me just fine because I was always worried she'd kill herself taking off and carrying on when turned loose in the larger paddock.

Basically, I can only conjecture at why the SMZ's worked but they did at least with her and since we have not had a repeat of the jowls or the leg bumps and filling, I am not going second guess myself as to what it could have been other than an infection and for her at that time the SMZ's were the answer. I would have thought if she had a virus, she would have spiked a temperature, which she did not, neither did she stop eating, drinking or pooping or acting sick in any way.

I am not telling you to treat your horse with SMZ pills, what I am trying to say is not to discount something in your horses history that might be important to his current state of health and well being.

Rachelle
Member:
scooter

Posted on Thursday, Sep 24, 2009 - 3:32 pm:

Hi Kl is it possible your horse is filling his cheeks with food? My mare does this for some reason when she doesn't feel well OR her teeth need floating. You can't really see it because they stuff it in there so well. I have a hard time even reaching in there and pulling it out. I would maybe have his teeth checked again in case he has a point rubbing his cheeks and irritating them...it's kind of a self defense.

Here's a pic of my old mare doing it. Took me quite awhile to figure out what that "swelling" was


Member:
kowal

Posted on Thursday, Sep 24, 2009 - 4:08 pm:

No Diane, the swelling is higher on the flat part of his cheeks and it is definitely fluid-filled.
Member:
scooter

Posted on Thursday, Sep 24, 2009 - 4:54 pm:

OK thought it worth a shot Nothing is that easy. I was trying to picture where you were talking about, now I have an idea
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