234. Cheaper medication...

Having searched around the internet for the antibiotics Spice is on and purchased in excess of 16 bottles worth i can thoroughly recommend petdrugsonline.co.uk who although not the cheapest are by far the most helpful and friendly and also live right on my doorstep which comes in handy. Further afield i can recommend: petmeds.co.uk and myvetmeds.co.uk both of whom i found to be very reasonably priced.

233. Is it too late...?

Having read just about everything i can on bone infections the one re-occurring point i keep finding is that if a bone infection is evident on an x-ray (as Spices was) then it is usually to late to treat especially if near other important structures such as a joint. I'd like to believe this wasn't the case but Spices rate of improvement since the first major improvement has been so slow. She is still noticeably lame in trot even though she has now been on antibiotics for almost 4 weeks so whilst i think the infection has definitely been arrested i still don't think it has completely cleared and can't say i'm all that optimistic that it will...:(

232. Piling on the pounds...

Due to Spice not being all that active (due to still being lame) she has started to get a bit porky so on the vets advice (due to the fact that she is on no hard feed and only has a moderate amount of haylage) she is now to stay un rugged at night to help her shed those excess pounds. She is stabled at night so it wont do her any harm to be kept naked but to be honest it is only in the past two weeks that i have actually started to rug her at night (due to temperatures being below freezing) so i'm not sure how much difference this will make. Hopefully the lameness will subside and she will become naturally more active and shed the weight that way. At the moment she is still lame in trot but the vet is pleased with her progress and remains hopeful...

231. Should vets be allowed to make a mark up on drugs?

At the beginning of Spices treatment for her bone infection i was informed by the vet that she would need to be on antibiotics for at least 6-8 weeks and that per day the antibiotics would cost at least £10.00-£20.00's. This being the case the overall treatment cost would be between £560.00 - 1020.00's plus any additional check ups needed and X rays. Having already been billed £600's for previous veterinary treatment for the same problem the prospect of having to spend an additional £1000's was rather worrying to say the least...

What i found shocking about this initial visit was that at no time did the vet inform me that the antibiotics could be prescribed and purchased for a third of the cost.

Fortunately, although i had no insurance i knew i could afford to go ahead with the treatment either with or without a prescription but i wondered how many other owners had perhaps faced the same scenario and felt they had no option but to end their horses life due to lack of finances. Would a vet actually let this happen? or would they make the owner aware of the options?

If purchased from a vet the antibiotics Spice is currently on cost £30.00's a bottle but if prescribed and purchased on the internet they cost less than £10.00's meaning vets are making a mark up of 200%!

My question is...Is it morally and ethically correct to withhold information which may affect ones decision to either continue treating their horse or cease treating their horse given that the consequences could mean life or death?

230. Perhaps it will be a happy new year afterall...

It has now been almost 3 weeks since Spice started her course of antibiotics for her bone infection and bit by bit she seems to be improving. She is still lame in trot but looks to be far more comfortable in walk and her hock is now far less swollen and only slightly warm to touch. We wont know that the infection has been killed completely until Spice has finished her course of antibiotics in 5 weeks time and shows no signs of the infection re-occurring for at least a month so we are still a long way off and by no means out of danger but at least we are seeing some improvement which for now is enough to put my mind at rest and feel a bit more positive about the new year...

229. Swab Results...

Because the swab was taken the day after Spice had been injected with her first lot of antibiotics the swab results have come back negative i.e no bacteria was able to be cultured which isn't a lot of help but the vet seems to think that she is on the right antibiotic as Pen & Strep apparently covers most of the bacterias most commonly found in bone infections and due to there being some improvement she thinks it is working. However, since last Thursday Spices condition hasn't improved, - she is still resting her leg and is still lame in trot. If there is no improvement whatsoever over the next 12 days which will be almost 4 weeks since the antibiotics were started the vet has said that the chances of Spice making a full recovery would be very slim and that even if the antibiotics were to completely clear the infection she could well be lame for the rest of her life... I am still hoping for a miracle but at the same time trying to prepare myself for the worst.

228. Still no swab results...

Yesterday the vet rang me to let me know that the results of the swab would not be back until friday due to the sample only having just arrived at the laboratory due to being delayed in the post. Would have thought something as important as this might have been sent via a guaranteed next day delivery service but obviously not...Spice is still resting her leg in stand and although walks quite soundly is still lame in trot. I think she knows she is ill. She has lost her 'flighty energy' that at times made her difficult to handle and is now calm and quiet most of the time. The worst thing is she is still so affectionate towards me which in a sense makes it a lot harder because in some ways i feel as though i've failed her and that i don't deserve her affections - if only i'd known more about this kind of injury at the beginning of this process perhaps we would not be in this situation. I know i've tried my best and i know all the vets did their best but the fact is we all failed Spice through lack of knowledge and inexperience and the only real victim in this is Spice and yet she still continues to trust, respect and love me more than ever and i realize i may just be losing the most loyal friend i ever had...

227. Am i just fighting a losing battle...?

Today i am a bit disheartened because although the swelling has gone down lots Spice has once again started to rest her leg again when standing - although she doesn't seem to be at all sensitive when i touch it. There is no longer any discharge coming from the wound but this may be because the granulation tissue which has formed form at the wounds entrance is preventing it from escaping...I spoke to the vet today who said that we should have the results of the swab back tomorrow in order to assess whether or not we are administering the correct antibiotic but in my heart of hearts i can't help but think the infection has become too severe and that even with the of strongest antibiotics we could be fighting a losing battle...

226. Showjumping...

As a nice break away from all the problems i have with Spice i went to watch my friend go jumping on her horse today....who when she first bought her just a few months ago stood at 15.2hh but now stands at 16.2hh! That's warmbloods for you...

225. Update...

It has now been 5 days since Spice started her course of antibiotics and she definitely seems to be improving - she is no longer taking the weight off of her leg whilst standing and is not lame in walk but is still noticeably lame in trot. There is no longer any pus coming from the wound just clear serum which is a good sign but as she is still lame it would still indicate that there is some infection/permanent damage. I am just hoping and praying that the antibiotics are able to clear the infection completely this time. Yesterday I saw the vet that treated Spice previously and she said she never suspected that the infection was that severe because Spice was never that lame but then again she wouldn't have been because she was being given painkiller and anti-inflammatories every day (as prescribed by the very same vet) which was obviously masking any lameness. Hence the reason why the vet i have at the moment only gave Spice a pain killer for the first day purely to make her more comfortable but after this stopped due to wanting to be able to tell whether or not the antibiotics were actually working.

I wish i'd have found the vet i am using right now a lot sooner as i feel both myself and Spice would not be in the situation we are in if i had and sadly it may now be too late for even if Spice does recover she may never be completely sound again.

Sadly it seems that me and spice are not the first to fall victim to a wound such as this - i know my last livery yard lost a horse under similar circumstances and after reading the following article almost definitely wont be the last....

Infections in joints and tendon sheaths are all too common conditions in horses and ponies. Unfortunately if treated incorrectly they are often career threatening and occasionally, if the infection is not brought under controlled, can result in the horse being put down. The key to a successful outcome is prompt recognition and aggressive treatment, and following this many horses return to full athletic function.

Wounds are the most common cause of joint infection. These often occur following a kick or the horse getting trapped in wire. Bacteria may also enter a joint via a blood borne route (haematogenous spread), which particularly happens in foals when they have not received enough colostrum in the first few hours of life. On very rare occasions infection can also be introduced following the injection of drugs into a joint.

The most commonly infected joints in the horse are the hock, fetlock, elbow, knee, coffin, and stifle joints. The digital sheath (windgall), extensor tendon sheaths (over the front of the knee and hock) and the tarsal sheath (thoroughpin) are the most commonly infected tendon sheaths.

In the early stages following a penetrating wound, the joint may merely be contaminated by the introduced foreign material (e.g. hair, grit) and the bacteria. The horse very quickly mounts an acute inflammatory reaction in response to this but unfortunately, the bacteria readily overcome these defenses and colonises the various parts of the joint. The presence of the bacteria and foreign material also leads to activation of various mediators that stimulates a rapid influx of the horse’s own white blood cells into the joint. These then start to release destructive enzymes that result in damage to the articular cartilage and synovial membrane (the lining of the joint). This leads to further release of enzymes and so a continuing cycle of joint destruction occurs. It has been found in some infected joints that 45% of some articular cartilage components are lost within 2 days. If left untreated a total loss of articular cartilage and osteomyelitis (infection of the adjacent bone) quickly follows. Often more than one type of bacteria can be involved in an infected joint.

Horses with an infected joint tend to be very painful and are often virtually non-weight bearing on the affected limb. The joint is usually very distended and synovial fluid may emerge from the wound edges.
There are several things that a vet can do to confirm whether a joint has been penetrated, including the detection of joint penetration on the examination of the wound, (indicated by the emergence of synovial fluid from the wound), if this is not present the vet may distend the joint with saline, at a site distant to the wound, and look for fluid coming from the wound, or he/she may also take a sample of joint fluid and have it analysed. The latter is the most accurate way to determine joint infection. Occasionally X-rays and/or ultrasound scanning may be used to help detect joint infection.

Treatment should be started as soon as possible following the diagnosis of an infection. The aims of treatment are: to eliminate the bacteria that are causing the problem; to remove any introduced foreign material; to restore a normal joint environment as quickly as possible (infected joints are more acidic than normal joints); to avoid any resultant joint degeneration; and to prevent spread of infection, both locally and systemically throughout the body. The two most important parts of treatment are the use of antibiotics and lavage (flushing) of the infected joint or sheath. Antibiotics are usually given either intravenously or intramuscularly. In addition to this sponges or beads or adjacent local veins may to used to get higher concentration of antibiotics into the affected joint. Antibiotics alone to treat a joint infection are very rarely effective because insufficient levels end up in the acidic environment of an infected joint and because antibiotics are is not particularly good at penetrating the surrounding damaged tissues. Obviously antibiotics alone cannot remove the grit, hair and dirt that are found in many infected joints.

The other vital part of treatment is lavage of the joint. Lavage removes much of the introduced bacteria, foreign material and the excessive protein build up (in many cases pus) and it also restores the pH in the joint to a normal level, allowing the antibiotics to work. Joint lavage should ideally be carried out by arthroscopy (keyhole surgery) because this provides the best technique to visualise the joint, remove debris, deliver high volumes of fluid, and to breakdown adhesions. With the use of keyhole surgery the surgeon can also use small-motorised equipment (less than 4.5 mm in diameter) to treat any damaged or diseased tissues. The design of the keyhole equipment means that virtually all areas of the joint can be inspected and fluid can be delivered at rates of up to ¾ litre per minute. This creates an excellent way to remove damaged and infected tissues. Rather than keyhole surgery lavage can occasionally be undertaken through needles or via the use of drains. These methods have largely been superseded by the use of keyhole surgery because of its greater ability to view the entire joint and the ability to use the hand and motorised equipment. They are a lot less successful. Following the joint flush the vet will monitor the response to treatment by walking and trotting the horse at regular intervals and possibly taking repeat samples of joint fluid. The antibiotic may well be changed and/or a second joint flush undertaken if the horse does not improve in 3 to 4 days.

Prognosis of infections like these are dependent on prompt recognition, aggressive therapy, quick alteration of the treatment based on close monitoring and good nursing. With the use of keyhole surgery and newer antibiotics many more horses return to a full and healthy life with no significant long term problems than ever occurred 10-15 years ago.

224. X Ray results...

Yesterday i had Spices hock X rayed and unfortunately it confirmed that she does have a bone infection...Whilst there are no bone fragments there is a small part of the bone which has deteriorated due to the infection and is therefore at risk of becoming detached which if being the case would need to be taken out. At this stage the vet has said that because the bone is still intact she does not think it is worth operating on as it has a chance of regenerating itself due to still having a blood supply albeit a compromised one. She has therefore suggested that we attempt to fight the infection with antibiotics alone...and basically keep our fingers crossed. I am doubtful whether the antibiotics will be able to penetrate the bone effectively as i have read that it is notoriously difficult for antibiotics to do this but i am trying my best to stay positive and hope for the best. Spice is a lot less lame than what she was four days ago but is still showing obvious signs of discomfort.

223. An anxious wait...

Today Spice was thankfully a lot more comfortable and i was able to turn her out. However, whilst she 'appears' to be better i am under no illusions that we aren't still dealing with a very serious problem. Unfortunately the vet didn't have the right equipment to x ray her today so i am still left wondering whether she has an infection in the bone or whether she has bone fragments floating about (both of which are potential possibilities).

If there are bone fragments she will almost definitely require surgery and if there aren't it is likely that the infection has gone to the bone and she will need a strong course of antibiotics for at least 2 months. However, it is notoriously difficult to treat bone infections due to very few antibiotics actually being able to penetrate the bone and therefore be effective so even looking at the more optimistic possibility doesn't look great. The worst case scenario would be that due to infection some of the bone itself has actually died in which case i fear we will be fighting a losing battle...

At the moment she is being injected with penicilin and strep which is particularly effective in killing Staphylococcus spp - a bacteria most commonly found in bone infections but results of the swab which should come back next monday will give us a more accurate result of whether or not we are using the right antibiotic although i have read that the only antibiotics that are able to effectively penetrate the bone are baytrill and chloramphenical...

222. Wound fully healed but lame again!

Last night which would be exactly 10 days since coming off the antibiotics we noticed that Spice looked stiff on the leg again - I thought she looked a bit stiff the day before but it was hard to tell as she was walking on snow but when we trotted her up it was obvious that she was definitely lame on it so we decided to see what she was like this morning and unfortunately she's a lot worse to the point that she can barely move and is barely able to put any weight on it whatsoever. So i had an emergency vet come out to see her (who is now the 5th vet to have seen Spice) and said it's very likely that she has a bone infection. She said that it was probable that the antibiotics which had been prescribed previously were just 'keeping the infection at bay' rather than actively destroying it hence the reason why every time she came off them the symptoms of infection would reappear. It makes me so angry to think that just 2 weeks ago the vet that assessed Spice gave her 'all clear' and even suggested taking her off antibiotics (which at the time i ignored due to wanting to make doubly sure that the infection was all out) so kept her on them for a further 7 days and now she apparently has a full blown bone infection. Four different vets from two different practices and all failed to notice what this vet seems to believe is a near certainty.

So at present the prognosis does not look good. At best we attempt to find an antibiotic that will actually kill the infection by taking a swab from Spices leg which will then have to be administered for at least 2 months but i've read that bone infections are notoriously hard to treat so even with the right antibiotic there is no guarantee that by the end of the treatment the infection will not re-emerge and in the meantime the bone could be susceptible to irreversible damage which could result in long term lameness.

It broke my heart to see Spice in so much pain this evening. She was laid down flat in her stable with such a sorrowful expression in her eye...every now and again mustering up enough energy to lift up her head and turn it towards the pain in her leg...I've never seen her look this lame...

To be sure with what we're dealing with the vet has recommended that we do an x ray so at least i will know once and for all exactly what the problem is...