218. Why i could kick myself...

I am pleased to say that Spices wound is looking fabulous! The scab fell of during the night in her stable but revealed a completely dry area of skin with no discharge whatsoever. 6 days since ditching the vet and allowing nature to intervene and the wound finally looks as though it has healed. I could kick myself for not listening to my inner instincts sooner but in a society that relies so heavily upon medical intervention it is sometimes hard to resist the urge to 'go along with the masses' and do what is deemed right rather than what is frowned upon...

Because i wanted to make sure the infection was completely out i did call out another vet so i could get some more antibiotics (preferably a different kind as i know that bacteria can build up a resistance against an antibiotic after a certain amount of time) but upon assessing the wound they said that they didn't think any more antibiotics were necessary...

He said that she was 1/10 lame and had considerable fibrosis which suggested some bursel involvement at the time of the injury but that other than her being left with a slightly capped hock she would be fine.

However, having taken her off antibiotics and seen her hock flare up again on numerous occasions i didn't want to take any chances so the following morning i insisted on having another 7 days worth (just to be on the safe side).

It was lovely to watch her gallop flat out around the field today and will be even nicer to see her being ridden again (I am now unable to ride her due to my bump) but my friend is taking her out tomorrow for the first time in 7 weeks!

So what lessons have i learnt went it comes to wound healing?

Well for a superficial wound that doesn't need stitching simply leave it alone.

Don't wash it, Don't spray it and definitely Do not bandage it!

Allow the blood which your horses body will produce to dry up and form a nice scab over the wound. If the wound swells up and becomes infected use antibiotics to kill the infection from the inside but leave the scab well alone!

The antibiotics will kill the infection and the scab which has formed on the outside will protect the wound from any new bacteria entering. Sounds simple doesn't it?

So where did i go wrong? I listened and took on board everything the vets told me to do!

I first called the vet the day after Spices injury due to there being swelling and warmth around the wound which gave me reason to think it could be infected and would therefore (to be on the safe side) require antibiotics. However, along with antibiotics the vet also prescribed 2 sachets of anti -inflammatories per day aswell as telling me to clean the wound morning and night. These two latter things are the things which i have a problem with...and here's why...

The inflammatory response is the body's natural response that occurs immediately following tissue damage. It's main functions are to defend the body against harmful substances, dispose of dead or dying tissue and to promote the renewal of normal tissue.

The inflammatory reaction is normally characterized by 5 distinct signs, each of which is due to a physiological response to tissue injury.

Pain (due to chemicals released by damaged cells).
Swelling or Edema (due to an influx of fluid into the damaged region).
Redness (due to vasodilatation- the widening of blood vessels and bleeding in the joint or structure).
Heat (due to an increase in blood flow to the area).
Loss of function (due to increased swelling and pain)

Tissue Healing
1.Collagenation

Wound healing occurs towards the end of the inflammatory process, however the two processes overlap considerably. Macrophages work tirelessly to clear the damaged area and make space for the regeneration of new tissue. After a number of days fibroblasts (collagen producing cells) begin to construct a new collagen matrix which will act as the framework for new tissue cells

2.Angiogenesis

Once sufficient cleansing of the area has been achieved the damaged area begins to sprout new capillaries to bring blood to the region- this is known as angiogenesis or revascularization. When blood flow has been re-introduced to the area specific tissue cells begin to re grow- for example in a muscle tear muscle cells will repopulate the area.

3.Proliferation

The proliferation phase lasts up to 4 weeks. In cases where the injury sustained has been more severe the affected area may be composed of a mixture between specific tissue cells (such as muscle cells) and other tissue known as granulation tissue. If this granulation tissue is not removed it will remain and form scar tissue, which can lead to a decreased functional ability of the tissue.

4.Remodeling

The stage of remodeling now occurs where by the new cells mould into their surroundings to once again produce a functioning tissue. This process of remodeling can take months even years, altering the new tissue slowly. The new cells and protein fibres become arranged in a way that is best suited to the stresses imposed on the tissue. Hence when a tissue is healing it is important to stretch it in the correct direction so to optimize the strength of the new tissue.

Given that inflammation is the bodies primary resource for healing wounds why on earth would a vet prescribe anti-inflammatories so soon and for so long especiallly when the horse at the beginning of the process wasn't even lame!? I strongly believe that the usage of anti-inflammatories was to blame for Spices wound not healing.

The anti-inflammatory Spice was prescribed was Danilon - the active ingredient being Suxibuzone. Suxibuzone is a NSAID with anti-inflammatory, antipyretic and analgesic properties and low ulcerogenic potential. Its mechanism of action is based on the inhibition of cyclo-oxygenase. The therapeutic effects are mainly due to the inhibition of the biosynthesis of prostaglandins, which act as peripheral mediators of pain and trigger the synthesis of endogenous pyrogens and mediators in the inflammatory process. It also inhibits platelet aggregation. After oral administration, suxibuzone is readily absorbed and it is metabolized by the hepatic microsomal system producing phenylbutazone, oxyphenbutazone and γ - hydroxyphenylbutazone. As happens with other NSAIDs, the duration of the clinical response is much longer than the plasma half-life. Significant concentrations of both active metabolites are found in synovial fluid for at least 24 hours after administration.

Wound healing, or wound repair, is an intricate process in which the skin (or another organ) repairs itself after injury.[1] In normal skin, the epidermis (outermost layer) and dermis (inner or deeper layer) exists in a steady-state equilibrium, forming a protective barrier against the external environment. Once the protective barrier is broken, the normal (physiologic) process of wound healing is immediately set in motion. The classic model of wound healing is divided into three or four sequential, yet overlapping,[2] phases: (1) hemostasis (not considered a phase by some authors), (2) inflammatory, (3) proliferative and (4) remodeling.[3] Upon injury to the skin, a set of complex biochemical events takes place in a closely orchestrated cascade to repair the damage.[2] Within minutes post-injury, platelets (thrombocytes) aggregate at the injury site to form a fibrin clot. This clot acts to control active bleeding (hemostasis).
In the inflammatory phase, bacteria and debris are phagocytosed and removed, and factors are released that cause the migration and division of cells involved in the proliferative phase. One of the main contra-indications of Damilon and any other anti-inflammatory for that matter is that they can inhibit phagocytosis and hence, during treatment of inflammatory conditions associated with bacterial infections, appropriate antimicrobial treatment should also be used.
The proliferative phase is characterized by angiogenesis, collagen deposition, granulation tissue formation, epithelialization, and wound contraction.[4] In angiogenesis, new blood vessels are formed by vascular endothelial cells.[5] In fibroplasia and granulation tissue formation, fibroblasts grow and form a new, provisional extracellular matrix (ECM) by excreting collagen and fibronectin.[4] Concurrently, re-epithelialization of the epidermis occurs, in which epithelial cells proliferate and 'crawl' atop the wound bed, providing cover for the new tissue.[6]
In contraction, the wound is made smaller by the action of myofibroblasts, which establish a grip on the wound edges and contract themselves using a mechanism similar to that in smooth muscle cells. When the cells' roles are close to complete, unneeded cells undergo apoptosis.[4]
In the maturation and remodeling phase, collagen is remodeled and realigned along tension lines and cells that are no longer needed are removed by apoptosis.
However, this process is not only complex but fragile, and susceptible to interruption or failure leading to the formation of chronic non-healing wounds. Factors which may contribute to this include diabetes, venous or arterial disease, old age, and infection.[7]

The next thing i have a problem with is being told to 'clean the wound'. By cleaning the wound every day twice a day i was never allowing it to dry out and at the end of the day what on earth was the point in trying to clean an area on a horse which within minutes was going to get dirty again???

The next vet who came to see Spice immediately recommended wet poulticing the wound to draw out the infection. This kinda made sense but in keeping the wound so moist for 6 days Spices body reacted by producing a mass of proud flesh which then had to be cut off - this would have been o.k had the vet done what i decided to do 6 days ago but instead they decided to cover the wound up in a bandage and cover it in undiluted hibi scrub which was likely to kill good cells as well as bad thus preventing Spices body from once again being able to heal itself. Aswell as this bandaging the wound was far from helpful for two reasons...firstly it didn't allow the wound to ever completely dry out and heal - (a wound needs to be exposed to air in order to do this) which then meant that as soon as the bandage would fall down which it inevitably would (even when on box rest) the wound was once again exposed to bacteria and likely to become re-infected which is exactly what happened. Recommending box rest is also something i have a big problem with as movement/circulation plays a huge part in the healing process so being on box rest once again massively compromised the healing process. With all these things it is no wonder that Spices wound couldn't heal.

It must sound as though i am being quite pig headed about all of this but the fact is when i decided to let nature take over the healing process rather than a vet Spices wound healed itself within 6 days.

And surely it is more pig headed for a vet or anyone of any other medical profession to assume that they can do a better job than something which has successfully evolved over thousands of years...