Tuesdays with Tony
Many of you have followed the story of Highway. He fell off a trailer on the interstate, then was unclaimed by owners. The Alachua County Sheriff’s Office, my amazing Docs, Equine Medical Center, and a whole lot of people via GoFundMe got him through the first few weeks of a very severe injury. My Docs were feeling pretty good about Highway’s future, despite the severity of his wounds, and it was time for him to spend his days healing, and being loved. The great people at Dreamcatcher Ranch and Rescue agreed to give Highway a great home. If only Highway’s injuries had felt the same.
What’s in a joint?
I’m going to start by talking a bit about how joints are put together. This description works for most of the joints in the body. It also applies to cats, humans, horses, even dogs (I try not to discuss those loud, smelly creatures). The joint is basically a balloon that encloses the spot where two bones meet. That balloon is called a joint capsule. That capsule is lined with stuff called synovium. Dr. Lacher describes this as really bad 1970’s shag carpeting. I’m not old enough to have seen this in person, but it seems like really fuzzy carpeting. There are also the cartilage-covered ends of the bones inside the joint. Just outside the joint capsule there are lots of tendons and ligaments. To make things slightly complicated, this same balloon setup is also around some tendons without the bone part of things.
Joints and bacteria don’t like each other
In Highway’s case the joint capsule got torn when he slid down the interstate on his knees. Not only did he open his joint capsule, but he also got tons of debris, including asphalt into his knee joints! I’m no expert. Ok that’s a lie. As a cat, I’m expert in all things, but I digress. I doubt asphalt and knees go together well. The asphalt helped carry bacteria deep into the joint. Once in the joint (his middle carpal joint, to be specific), bacteria go to town in all that shag carpeting wannabe synovium stuff. Synovium provides a warm, snuggly place to cuddle up and make more bacteria. And if anyone has ever tried to clean shag carpeting, you understand how hard it is to get the bacteria out of all those nooks and crannies! While that bacteria is hanging out in the joint, the body is fighting to get it out as hard as it can. Unfortunately, that process is incredibly bad for the cartilage on the bones, and the joint capsule itself.
Get out, bacteria! Get out!!
Bacteria are bad, and they’re hard to get out a joint, so what’s a Doc to do? The first step was establishing that Highway had in fact opened the joint capsule. To do that, Dr. Vurgason cleaned the area around the joint really well. She also clipped all the hair away from the wounds. Then she put a needle into the joint from another location as far away from the wound as possible. This needle was attached to a bag of sterile fluids. Pressure was applied to bag, and the wounds watched closely. Nearly as soon as fluids started to flow through the needle, Dr. Vurgason could see the fluid coming out of the wound opening. This meant the joint was definitely compromised. To try to get as much bacteria out as possible at this stage, Dr. Vurgason ran the entire bag of fluids (1,000cc) through the joint, and finished up with some antibiotics. This was Step 1.
You guys are the reason Highway got to go to Step 2! A little bit of fluid was OK, but with a joint this open, and with this much stuff in it, Highway needed lots of fluid through that joint. And that means surgery. You awesome humans (wow, I don’t say that very often) stepped up, and off to Equine Medical Center of Ocala he went. While there, they put a camera and very, very big needle into the joint, and ran about 10,000cc of fluid through his joint. They also picked out as much asphalt as they could find.
To keep up the fight, Highway had high concentrations of antibiotics placed directly in the joint, along with daily regional perfusions of antibiotics. Regional perfusions work to increase the antibiotics to one specific area of the body. To do them, a tourniquet was placed above the wounds on Highway’s right front leg. Then antibiotics were injected into a vein. The tourniquet was left in place for 20 minutes, then removed. Highway also got IV antibiotics, and some bute for pain. His bandage was replaced every day with a new sterile bandage. This helped minimize the amount of bacteria near the joint. Most importantly, Highway stayed very, very comfortable. Horses can’t bear all their weight on just one front leg for very long without developing founder in the other one. Thankfully, Highway was never terribly uncomfortable, so the Docs didn’t have to worry about this.
Fighting and Hoping
Highway did great! The flushing, regional perfusions, and antibiotics, and a whole lot of fight from Highway himself seemed to do the trick. The knee joint closed, and still Highway was comfortable. If there had been a raging infection still going on in there, he would have been really painful as the immune system kept up the fight. My Docs gave him ten days off antibiotics, and two and a half weeks after the joint closed to be sure things were looking good. Then it was time to send him to Dreamcatcher, where he could get the long-term care he would need to heal. Horses being horses, it couldn’t be that easy. It turns out there was a simmering infection in the extensor tendon sheath, which is one of those joint-type things around a tendon. This one is located right over the knee joint.
This one still had bacteria, and even some tiny bits of asphalt in it. You see, even with all those fluids used to rinse the wound and joint the first time, it’s pretty much impossible to get it completely clean (think about that shag carpeting), but Highway’s body had been working hard to get that asphalt out. The tiny cells of the immune system had encapsulated it, and brought it to the surface of the wound to get it out of the body.
Highway has been back through the lavage, regional perfusion, bandage routine again with the Docs at Peterson and Smith Equine Hospital. He’s back fighting to clean the bacteria out of the joint, and trust me, it’s a fight. The bacteria have been in there since November 30th in the wee hours of the morning, when Highway decided he wasn’t going to stay in that horse trailer to face certain death. The bacteria have had time to get into all those nooks and crannies. They’ve withstood lavaging, regional perfusions, and antibiotics. It’s going to be harder to get them to leave now. But the Docs are fighting, Highway is comfortable, and you guys are supporting him through it! You humans are amazing sometimes! That’s high praise coming from a cat!!
Want to learn more about Highway? Or follow his story? My minions post regular updates on the Springhill Equine Facebook Page.
Want even more great info? Listen to the podcast the humans do: Straight from the Horse Doctor’s Mouth. The latest episode is all about deworming protocols, and you might not be as up to date with this as you think you are!
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Until next week,
Tuesdays with Tony is the official blog of Tony the Clinic Cat at Springhill Equine Veterinary Clinic in Newberry, Florida. If you liked this blog, please subscribe below, and share it with your friends on social media! For more information, please call us at (352) 472-1620, visit our website at SpringhillEquine.com, or follow us on Facebook!