Blood travels to the horse’s limbs via arteries, delivering oxygen and nutrients to the tissues, then returns back to the heart via veins. \u00a0The blood in the arteries is under pressure, which is determined by the heart rate, vascular resistance of the blood vessel and blood fluid volume. \u00a0This pressure drops once the blood begins to return to the heart in the veins. \u00a0Given the lack of significant pressure to assist the flow back to the heart, it is generally accepted that movement and pressure within the equine foot, actually serves as a heart, helping to pump the blood back up the leg. \u00a0Horses are often referred to as having 5 hearts, implying a true heart in the chest and one heart per foot. \u00a0<\/strong><\/p>\n Fluid tends to shift out of the blood vessels, nourishing the tissues as part of normal physiologic processes. \u00a0In some cases, due to poor return of blood via the veins to the heart, fluid can back up in the blood vessels, and begin to actually ‘weap’ out into the surrounding tissue, adding more fluid to the equation. In either case, most of this fluid outside of the blood vessels is generally taken up by the lymphatics, which are similar to blood vessels, and then returned back to the heart to be rejoined with normal blood circulation.<\/p>\n When we have a horse with a swollen leg, in most cases this implies that fluid has accumulated in the tissue outside of the blood vessels. \u00a0Often, we will use the term ‘edema’ to refer to this fluid accumulation. \u00a0If we put pressure to the swollen tissue or leg with our thumb, it will often leave an indendation, almost like mashing dough. \u00a0The leg or swollen area will also be tight, but in regards to overt pain, it can be variable. \u00a0So, we know that when we have a swollen leg, it is fluid accumulation, technically stocking up, but the cause is not always the same.<\/p>\n The term “Lymphangitis<\/strong>” refers to overt inflammation within the lymphatic system, leading to non-functional or compromised lymphatics, often blocked or damaged. \u00a0This inflammatory process then impairs normal fluid circulation by the lymphatics and in the end, fluid pressure builds within the lymphatics and then weaps out into the surrounding tissue. Lymphangitis is not only an inflammatory process but usually connected with a bacterial infection. Advanced cases of Strangles in the horse can lead to lymphangitis as can other bacterial infections.<\/p>\n The term “cellulitis<\/strong>” refers to inflammation within the soft tissue of the leg, including muscle tissue. \u00a0This condition is often secondary to a wound or spread of a bacterial infection from another location within the body. \u00a0Again, here we have inflammation and infection in most cases, but involving soft tissue structures. \u00a0The swelling within the soft tissue actually can impair blood and lymphatic circulation, just from shear constriction, leading to increased pressures and poor blood and fluid flow. The category of cellulitis to me also includes general wounds to the leg, which can be lacerations or even soft tissue injuries. \u00a0Dependent on the extent of these injuries, blood vessels and\/or lymphatics can be involved with resultant damage. Inevitably, this leads to fluid accumulation outside of the lymphatics and blood vessels, leading to the swollen leg.<\/p>\n The term “lymphedema<\/strong>‘ is a general term to imply fluid accumulation or retention, without an inflammatory or infectious cause, leading to a stocked up appearance or swollen leg. \u00a0These patients are usually chronic, stocking up after a night’s stay in the stall, no pain or lameness but resolving after turnout or increased work.<\/p>\n There are other causes of fluid accumulation or edema in the legs of horses. \u00a0Again, we have to remember that we are dealing with the cardiovascular system and fluid which abides by certain physiological laws of nature. \u00a0First, if the heart is not functioning correctly or there is overall poor circulation within that horse, fluid will likely accumulate as a result. \u00a0Second, fluid is retained within blood vessels based on oncotic pressure, which is dictated by certain proteins including one in particular called albumin. \u00a0Albumin generally holds fluid within the blood vessels and when albumin levels drop, for whatever reason, fluid generally will leak out of the vessels into the surrounding tissue. \u00a0Albumin is a protein made by the liver from protein taken in from the diet. \u00a0In cases of liver problems, severe infection, endotoxemia, low protein diets and starvation, it is not uncommon to find swollen legs. However, in cases of low albumin, we will also generally see fluid accumulation on the underside of the belly and sheath region in geldings.<\/p>\n All cases of fluid retention in the legs of the horse often improve with movement and pressure wraps. This includes situations of stocking up and lymphedema. Movement helps to increase heart rate and increases the rate of return of blood and fluid back to the heart. \u00a0The more efficient the cardiovascular system, the more fluid that is absorbed and removed from the tissue space. Through movement, we are also moving the feet at a more rapid pace, which in turn helps to force blood and fluid back up the leg and towards the heart.<\/p>\n Pressure wraps also assist the problem in two ways. \u00a0First, they help to force fluid in the soft tissue space back into the lymphatics and general circulation. Second, through their pressure, they also help to minimize fluid loss from the lymphatics and blood vessels. \u00a0Caution should be noted in cases of impaired circulation however, as with too tight of a wrap or too prolonged use, one could actually impair or cut off circulation to the lower leg and digit. \u00a0In most cases, pressure wraps are applied for 10-12 hours at a time, then off for 10-12 hours.<\/p>\n Water therapy is also helpful in many of these cases. \u00a0In cases of infection and\/or inflammation, cold hose water therapy is general very helpful at reducing some of the heat from the leg and pushing fluid back into the circulation. \u00a0In cases of plain lymphedema, warm water therapy is more effective in my experience as often these cases are due to poor overall circulation and the added warmth appears to help improve or enhance circulation. \u00a0This is analogous to cold hands in the winter time, which are often then pale in color. \u00a0The cold temperatures actually make a weak circulation even weaker, disrupting and impairing blood flow, but if we add heat through gloves or otherwise, circulation is then enhanced, tissues warm up and color gets better.<\/p>\n Topical therapies are also helpful in chronic cases of stocking up and lymphedema, often including DMSO alone or combined with a steroid. \u00a0DMSO is a great anti-inflammatory and antioxidant with tremendous healing potential. \u00a0It many cases, it is combined with a steroid to help boost anti-inflammatory properties and used as ‘sweat’ under a breathable wrap. \u00a0Usually, the sweat is applied for 10-12 hours, then removed for the next 10-12 hours along with cold or warm hose therapy.<\/p>\n In cases of inflammation and infection, often oral or injectable anti-inflammatory medications are also used along with appropriate antibiotics.<\/p>\n In most cases of infectious lymphangitis and cellulitis, the horses respond nicely to appropriate therapy and are not impacted negatively in the future. \u00a0However, in some cases, long-term damage is done to the blood vessels, overall circulation and lymphatics due to the infection and uncontrolled inflammatory response. \u00a0This can then lead to a long term tendency for fluid retention in that leg which can be difficult to manage.<\/p>\n I believe that cases of uncomplicated lymphedema or stocking up are usually the result of overall poor circulation. \u00a0It is important in these cases to rule out liver problems via blood work and to evaluate the heart and blood pressure if possible. \u00a0It is not uncommon to have older patients develop lymphedema as often with age, circulation and heart function becomes impaired on certain levels, impacting fluid circulation. \u00a0I do think that in these cases, if there are no other health problems, they benefit from nightly standing wraps if stalled but ideally respond best to constant turnout where movement is encouraged.<\/p>\n Are there other options and means of controlling the problem? \u00a0I think there are, personally.<\/p>\n When it comes to stocking up, lymphedema, and cellulitis in the horse, there are many pathways which lead to the creation of the problem.\u00a0 However, no one remedy will often work for every horse because they are different in their presentation and underlying cause.\u00a0 Correct the cause and you will correct or improve the situation.\u00a0 One of the biggest things is to look at your horse’s breed.<\/p>\n When it come to the horse, we really have two different types; easy keepers or more harder keepers.<\/p>\n The vast majority of horses with stocking up issues and cellulitis, at least in my experience, are your heavier breeds and those breeds are more prone to becoming easier keepers.\u00a0 They are heavier, stockier, and often have metabolic problems now or in the future.\u00a0 The root behind these guys is digestive health and the concept of ‘dampness<\/a><\/strong><\/span>‘.\u00a0 This is what we desire to target in our therapy.<\/p>\n In these heavier horses, I generally recommend a combination therapy of the Cur-OST EQ Total Support<\/a><\/strong><\/span> and the Cur-OST EQ Tri-GUT<\/a><\/strong><\/span> formulas.\u00a0 If the swelling is marked and there are other signs of ‘dampness’ in the body, such as oily skin, preputial discharge, or loose stools, then I would recommend the Cur-OST EQ Tri-Guggul<\/a> <\/strong><\/span>instead of the EQ Tri-GUT.<\/p>\n In the cases of the harder keepers, which are usually the hotter natured horses who are thinner and more full of energy, the approach is slightly different.\u00a0 In these cases, we desire to combat inflammation and cool the body down a bit, while also addressing gut health.\u00a0 Here, we would recommend a combination of the Cur-OST EQ Plus<\/a><\/strong><\/span> and the Cur-OST EQ Tri-GUT<\/a><\/strong><\/span>.<\/p>\n If there are indications of infection, as in cellulitis, then we would add in the Cur-OST EQ Immune Full Spectrum<\/a><\/strong><\/span> for added immune and gut health support.\u00a0Through this combined approach, we are able to help balance the inflammatory response, address gut health, and enhance the immune response, aiding potentially with clearing of the infection. \u00a0It is not uncommon in these cases to have an unresolved infection persist for months to years with a likewise swollen leg and impaired fluid circulation. \u00a0Even in these chronic cases, I have found the combined regimen of Cur-OST formulas has made a huge difference, especially when combined with topical sweat therapies.<\/p>\n![\"Cold](\"https:\/\/nouvelleresearch.com\/wp-content\/uploads\/2013\/11\/images_iStock_000003093963XSmall-e1516757638139.jpg\" "\\"Cold")
Causes of Leg Swelling in the Horse<\/strong><\/span><\/h3>\n
Therapy Options for Stocking Up and Lymphedema in the Horse<\/strong><\/span><\/h3>\n
Outcomes and Options for Stubborn Cases of Stocking Up and Lymphedema<\/strong><\/span><\/h3>\n
Stocking Up and Cellulitis in the Horse; Look at the Breed!<\/span><\/h3>\n