It is one of those cases that I will never forget. I was working at the old Lewiston Raceway, and was going to be there all morning. A horse owner that I didn’t know called my office and told my office manager that she had to see me right away as her horse needed attention. Cindy told her that I was at the track, and was going to be there all day working on standardbreds, but if she wanted to truck her gelding to the track, I would see her there. Two hours later the owner unloaded her horse at the paddock, and I got word that she was there waiting for me.
I hardly had a chance to introduce myself to Becky when she started telling me her story. Three days before she was working her dressage horse in a sand arena. After a few minutes Becky noticed that her gelding was a little off, but thinking that he would warm out of it, kept him going. Ten minutes later the horse started to limp. Becky stopped, dismounted, looked at his legs, and saw that he wasn’t putting full weight on his right fore. Right before her eyes she thought she could see the leg start to swell. She hand walked him back to the barn and wrapped his leg snugly from pastern to knee with a polo wrap. She kept him in his stall for three days. Twice a day she unwrapped the leg, and each time she did, it immediately started to swell. She then quickly wrapped it again to prevent more swelling. This went on twice a daily for those three days. Unwrap the leg, note the leg filling, and quickly wrap it back up again to keep the leg from getting bigger.
I asked Becky to unwrap the leg so that I could take a look. She hesitated for a minute and then said, “Look Doctor, if I take the wraps off, it will start swelling, I just know it will, and I really don’t want to see that leg get big.” I told her that there was no way that I could begin to diagnose the problem with the wrap on. Very reluctantly she undid the leg. Sure enough, before our eyes the leg started to swell from just below the knee down to the fetlock. It was actually quite impressive how fast it happened. “Quick, quick,” she cried, “let me wrap it back up!” Understand, I had never met Becky before, and there had been no chance to build up any trust. Clearly she thought that I was wrong in not agreeing with her.
“Becky, listen to me. I need to get my hands on that leg of his so that I can know what to do about it.” I almost had to physically restrain her as we watched the leg swell before our eyes. “Oh, no!,” she cried! “Look what’s happening! We have to get that wrap back on right away.” I had to be a little firm. “Becky, I have to tell you that wrapping that leg to get the swelling down is probably exactly what is keeping it from healing.” I could tell from her face that she thought I was the biggest quack ever, but she did stand back and sobbed softly as the leg continued to get bigger. I watched it for a few minutes and noted that although the whole leg was rapidly filling, the swelling was concentrated mostly in the back of the leg, right over the flexor tendons. Within a few minutes it was as big as it was going to get, and it really was big!
I picked the leg up with my left hand supporting the cannon bone and ran the fingers of my right hand down to palpate the tendons. This was over 30 years ago, and ultrasounds were just being introduced in vet schools. I certainly didn’t have one. However, I did have a mostly race track practice at the time, and I sure knew a bowed tendon when I saw one. I told Becky that bowed tendons are relatively rare in saddle horses, and in my experience were usually the result of working horses in deep footing. I then told her that the great majority of “bows” healed in time. Now I faced the more difficult task of explaining why she should not wrap that leg.
Becky listened as I explained how inflammation after an injury is really a good thing. The signs of inflammation are familiar to all of us from our own experience. Think of the last time you got your toe stepped on by a horse, twisted an ankle, or had a car door shut on a finger. The result for you was pain, swelling, heat, redness, and loss of function. These are all the classic signs of inflammation that every doctor and nurse learns early in their education. The only one of those signs not usually seen in horses is the redness, which is only visible in very light skinned animals. The swelling and heat are the result of the local blood vessels “leaking” out the healing white cells and serum into the injured area. That influx of fluid and blood cells is responsible for the almost immediate swelling and the heat. It is what brings healing. Without it, injuries don’t heal. I explained to Becky that the swelling simply had to happen and that initially the best thing for her to have done was just cold hosing , and perhaps the use an anti-inflammatory drug to smooth out the acute inflammation. Rather than helping, her 3 days of tight wraps were arresting the healing process.
Another common mistake is to wet down a recently injured leg with liniments. Liniments have their time, which is later, once the leg has cooled down. Using liniments during the early stages of inflammation is like throwing gasoline on a fire. When in doubt about how to handle any acute injury, snap a picture of it the injury and send it by phone to your veterinarian.
Use good sense and let the process of inflammation happen. You might have to cool it somewhat by cold water and or medication, but to some extent it has to happen. It’s healing.
My wife proof reads all my articles. After she read this one she said, “Well, don’t leave me and everyone else hanging! What happened to Becky’s horse? I’m happy to report that after a few months of rehab he went on to compete and lived out a happy life, sound as a dollar.
–David A. Jefferson, DVM