# chronic progressive lymphedema..... advice!



## jennie1000 (25 May 2010)

I found this on the internet and the photos match my mares legs exactly. My first vets had never heard of it so I recently moved to ashbrooke vets who have hear of the disease and have done biopsys.

When I bought my mare 2 years ago (she is age 12 now) she has always had these hard swelling around the pastern area that have crusty/scar like edges. They have been difficult to feel through the feathers and dint seem to cause her and problems. The only time they created a problem is when i needed to wash the legs as I stuggled to get into the pastern area properly. In the 2 years ive had her she has suffered 2 bouts of mites. one I managed to sort with frontline (fipronol) spray. The second was more severe and needed the vet to give a dectomax injection. she also repetedly gets sore areas on the front limbs about the height of the knee that have mud fever appearances..... these never go completly but i seem to manage them with hibiscub washes and various mud fever treatments during times of flare up.

Early march my mare went lame on her back right leg. the vet came out and advised to clip the feathers. This was done and he said she had a case of cellulitus. The legs were swollen up to her hocks and felt squishy to touch. The skin appeared to be leaking clear/yellow sticky fluid. for 2 weeks the vet was out every other day injecting her with engemycin, finadyne and colvasone while i was applying ubro red tube creme to the affected sores. There appeared to be very little improvement so the vet took my mare into the hospital where she remained for 2 weeks. he changed the treatment to cobactan (15ml), prednisolone (100mg) This seemed to work and the legs stopped oozing fluid and the sores healed, although some crusting was left. While stabled there she had to have bandages on her back legs to stop them filling. I also noticed that the previously unaffected front feet had started to develop the colleflower hard lumps, especially the white leg.

She has now returned home. still isnt totally sound on her right leg, especially on soft ground. This is the leg with the most colleflower groth like lumps. at present she has one large lezsion on her front white leg that looks like a mite wound that im monitoring. apart from that its just the hard lups that seem to stop her flexing properly. Does this case sound like chronic progressive lymphedema and if so do you have any advice for managing it? At present the vet wants the mare living out 24.7 so the legs dont swell.

 I have changed vets who have recently taken biopsys and im awaiting the results of these. My mare has had a follow up dectomax injection but still has sevral scabby areas on all of her legs. The colliflower growths are growing in size and are now obviously pesent in the front legs. she has also had cracks below all her ergots which have grown and eventualy a scab falls of to leave yellow pussy thick gunge whic dries and then the healthy flesh undernath just appears to ooze  clear fluid. She dosnt seem to be able to fight any sort of infection and every last little cut is getting infected, despite being on antibiotic noradine granules.

Does anyone have any experience with this condition........


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## Amymay (25 May 2010)

Nasty condition - managed, not cured.

You may find this useful

http://www.completerider.com/pasterndermatitis.htm


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## jennie1000 (25 May 2010)

Thanks for the link. DO you have experience of the condition. I was just wondering if you knew if there is a way to definatly diagnose it?


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## Amymay (25 May 2010)

Not directly, no.  But have heard of a few cases.


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## jennie1000 (25 May 2010)

Apparently sulphur washes can help with this condition. Does anyone know where you can get sulpher shampoo from?


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## Yertis (25 May 2010)

Hi Jennie
Have been keeping this under control for 6 years now with my Irish Cob mare, once you have made sure all the mites have gone the trick is to keep the legs moisturised and massage well into the lumps, they will soften over a matter of weeks and allow the joints to move better. Muddy Marvel Descab is good to clear a fair bit of the dry skin, I then use a mix of neem oil (to keep infections at bay, also mite repellent) in vaslene/petroleum jelly. If you like to PM me with your e-mail I can send you some pics to compare with your mare


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## jennie1000 (29 August 2010)

http://www.facebook.com/home.php?#!/photo.php?pid=5502493&id=509991560&ref=fbx_album

http://www.facebook.com/home.php?#!/photo.php?pid=5502493&id=509991560&ref=fbx_album 

Hopefully the link should take you to a photo album on facebook showing pictures of her legs after the last clip that we did.


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## jennie1000 (29 August 2010)

Currently we have the mare on 30ml linseed oil to help with skin condition, 15g clivers and 15g marigold made into an infusion with hot water, 20ml of immunity which is a product by james hart that contains echnicia and cats clam to support the immune system and inflamation. Her legs are washed once a week in tea tree shampoo then bandaged until todally dry. I then use equimins udder cream and liberally rub that in all over the bottom halves of her legs. This seems to keem the skin moist and supple and stop it cracking. We tried the sulpher washes which were good while it was really scabby but seemed to be too drying in the long term. Her legs are clipped every 2-3 weeks at the moment so I can see what Im dealing with.This was all working really well until the last clip and we seem to have abit of a flare up. The condition is so frustrating as I dont know what causes the bad days.


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## Heather 1 (20 December 2012)

Hi, treating the dermatitis that results from lymphoedema is of limited value, it can sometimes help to slow down the condition's progress but doesn't otherwise affect it.  Horses with CPL are also more vulnerable to lymphangitis and cellulitis because of compromised immunity.  Lymphoedema can't be cured but it can be controlled and improved with combined decongestive therapy, as described in the following article:
_Combined decongestive therapy including equine manual lymph drainage to assist management of chronic progressive lymphoedema in draught horses
H. Powell, V. K. Affolter, Article first published online: 9 OCT 2011, DOI: 10.1111/j.2042-3292.2011.00311.x, © 2011 EVJ Ltd_
Googling this leads to information and the article's abstract.  There's also information on the website *www.equinemld.com*, and you are  welcome to contact me.


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## Queenbee (21 December 2012)

jennie1000 said:



			Apparently sulphur washes can help with this condition. Does anyone know where you can get sulpher shampoo from?
		
Click to expand...

My whippet get something very similar sulphur baths are great but I use sulphur tablets when I see it starting now and it really keeps it in check.


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## Heather 1 (21 December 2012)

Hi, the link below is to the best article I've found on the use of oil and sulphur. Bear in mind that this cannot have any direct effect on CPL, it is to help with mite etc control.  The article is American but similar products must be available here, it does make a point that is often overlooked, that it's important to source the correct ingredients, and that even so, some horses react badly to them.  No doubt the price of some of the ingredients may have gone up as their use has become more popular, but I imagine that it's still cheaper to mix this up yourself.

*OILING & SULFURING THE FEATHERED HORSE - Wolf Manor Estate www.wolfmanorestate.com/files/printable.pdf*


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## Black_Horse_White (21 December 2012)

I bought a horse who had very bad thickening of the skin on his legs. I had the vet out and he was treated for mites. It didn't stop the  sores and stamping. I read up about CPL and the similarities were obvious. Although the vet had not diagnosed it. I removed his feathers but it never seemed to stop it. Sadly he was PTS with ringbone.


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## redandblue (21 December 2012)

Sorry for hijacking post OP but... I have been treating my lovely little irish coblet for mites using powder and clipping off her hefty feathers to very little effect. My vet is coming out next week to treat the mites, however, she has substantial thinkening - rippled skin, lumps and bumps -  around her knees and has lots of white lumpy scabs all over her legs (only noticed properly when the feathers were removed). She does the usual stamping and scratching associated with mites and will use anything (favourite being the wheelbarrow - though only when it's full ) to relieve the itching. I've been reading some of the articles on CPL and quite frankly am starting to become worried! Any opinions or am I becoming paranoid!


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## Yertis (21 December 2012)

See my earlier post on this thread from May 2010, my mare is still going strong - now been treating for 8 years, legs are still better than they were before treating. I have found that not taking the feathers off too close to the skin does help, I use Moser clippers with a 7F blade which leaves 3mm of hair. Human Nizoral dandruff shampoo helps loosen dead skin, but it seems to be the moisturising and the massage that keeps the dead skin from building and causing problems. Her hoof horn is now starting to be affected slightly though.


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## Heather 1 (23 December 2012)

Chronic progressive lymphoedema is a disease of the lymphatic system affecting the skin and adjacent tissues, which needs to be treated with combined decongestive therapy.  Although skin care is part of this, trying to treat pastern dermatitis alone will be ineffective as it does not touch the underlying, causal condition.

Very little is written about CPL (admittedly my own website needs updating, and the much consulted UC Davis one is now very out of date and incorrect in some places), but the website about human lymphoedema, &#8216;lymphoedema people&#8217; has lots of information about the condition, some very technical and complex, but also lots of straightforward stuff, and is maybe a good place to find out what lymphoedema does.

It&#8217;s very important that CPL is properly diagnosed so that appropriate treatment can be offered.  Currently lymphoedema can&#8217;t be cured, but it can be controlled, and the sooner treatment starts the better, not just in terms of results but financially, as it requires a longer course of treatment when more established.  I am frequently contacted by people who have spent a great deal of time and money because their vets have not recognised it, or have tried to use inappropriate treatments, have maybe used up all their insurance and then cannot afford to pay for the  lengthier course of CDT now required.

The most common cause of lymphoedema in horses is damage following lymphangitis, CPL tends to take a different path, although the resultant reduced tissue immunity means affected horses may also be more vulnerable to lymphangitis and cellulitis.  CPL was originally identified in Shires, Clydesdales and Belgian Drafts, but is now frequently seen in Gypsy Cobs and more recently in Friesians.  Because of patterns of breeding in affected horses it is believed to have a genetic component and to be due to an alteration in &#8216;elastin&#8217;, a component of lymphatic vessels which is particularly important in horses for the transport of lymph.  

CPL starts at an early age and progresses throughout the life of the horse.  Oedema prevents oxygen and nutrients from reaching the tissues adequately and metabolic waste products are not properly removed, affecting the local immune system.  Large protein molecules which carry nutrients from the bloodstream to the cells and can only be transported away by the lymphatic system are not removed, and with time these change consistency, creating hard &#8216;fibrosis&#8217; similar to scar tissue, which forms nodules primarily on the lower leg.  This can block the flow of blood and lymph, and can create an effective &#8216;hiding place&#8217; for bacteria.  The skin quality is disturbed, greasy patches can appear but it mainly becomes too dry, lifting the superficial layers and allowing mite and infection entry, and the skin also becomes thickened.  Fibrosis can impede the action of joints, especially the fetlocks, affecting movement, and in serious cases can severely damage tendons.

The early signs of CPL are usually overlooked because of the feather on affected legs, and because people often don&#8217;t know what they are feeling.  On a healthy lower leg the structures will be clearly felt, but as oedema develops they feel less clear, and there is softness to the tissues which if pressed will leave an indentation.  With the development of fibrosis the tissues feel more rubbery and resistant, and first obvious signs may be rolls of fibrous tissue at the rear of the pastern.  Fibrotic folds often also appear at the back of the cannon between hock and pastern.  As fibrosis develops it takes on a &#8216;rock hard&#8217; consistency, nodules may join up, e.g. around the pastern/fetlock, or many individual nodules may entirely cover the lower leg, but at this stage the response is individual to each horse.

Lymphoedema is exacerbated by inflammation, so made worse by mite and fungal infestations and bacterial infections, whilst also reducing the skin&#8217;s immunity to these.  Therefore, although treating for pastern dermatitis cannot control lymphoedema, it can slow down its development by reducing these provoking factors.  

Clipping the feather is important when treating lymphoedema, it&#8217;s often only when this is done that the extent of the skin changes become obvious. Mites should be treated for even when there are no signs of them, we found a combination of an oral treatment such as ivermectin and a topical one such as fipronil, used generously and right into the skin, helpful.  However fipronil is expensive and as it&#8217;s not licensed for equine use, should be avoided with pregnant mares and foals.

The skin should be kept clean, using gentle cleansers, anything too astringent will dry it out further, and no scrubbing!  It should be kept moisturised, I have found good aloe vera to work well, but because these horses have extra sensitive skin, care should still be taken to avoid reactions.

Because the equine lymphatic system is significantly reliant on movement for stimulus, horses with lymphatic problems should not be stabled unless this is really necessary, and should be encouraged to move around.

If fibrosis is present, massage can help by breaking this down, followed by exercise of some kind to stimulate the lymphatic system and help to remove it from the affected tissues.  However, massage of the non fibrosed oedemic areas should probably be avoided.  Normal massage pressure compresses the lymphatic vessels in the skin, preventing the flow of lymph, while encouraging further fluid to enter the tissues from the blood circulation, creating extra work for the lymphatic system.

I would not recommend bandaging for CPL, as research has shown that stable bandages can also slow down the flow of lymph and the transport of potentially damaging metabolic waste products.  Bandaging does form part of CDT, but it is very specialised and supports the flow of lymph, reducing oedema.

Combined decongestive therapy has two parts, an intensive phase used to reduce oedema and fibrosis (pastern dermatitis usually clears up without specific treatment during this) and a long term maintenance phase, which requires wearing a compression stocking and occasional follow up intensive treatment to help reduce the fibrosis which the body will continually try to produce.

CPL requires life long care.  Skin care from an early age can be a real help but unfortunately it is possible to acquire a horse with CPL where significant fibrosis is present because it  was never treated by previous owners. It&#8217;s important too to remember that the disease can be more severe in some horses than others but, although treating such horses can initially appear expensive it is still lovely to see their increased mobility, suitability for work and new enjoyment of life.

I understand that some people will want to compete horses in future, and are therefore put off intensive treatment by the need to clip legs, so I am interested in developing an approach to treatment which could allow the regrowth of feather for showing, whilst keeping the CPL under control.

I suspect it needs pressure from owners of horses with CPL to encourage vets to take it more seriously, to dissuade breeders selling affected horses from denying CPL exists and to persuade publications to include information about it, instead of e.g. describing it &#8211; when the do! - as &#8216;mud fever&#8217;.


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