From: Emily
Hello, I'm sorry to be a bother, but I have a fairly severe case of strangles on my hands that none of the local vets seem to want to touch. An aquaintance of my family owns a 28 year old Appaloosa here in Michigan. He got strangles (along with three other horses) when the new farrier brought it in on her boots after purchasing a healthy carrier. It began with nasal discharge, and because I had never seen strangles before, I didn't know what it meant. His owner has no idea of anything dealing with horses except how much to feed him, how to put on his tack, and basic stop go commands. She really seems to just like him as a pasture ornament which until now was fine.
His chest began swelling a few days after nasal discharge. The front area below his neck got very hard and puffy and I suspected something severe but I had never heard of bastard strangles. At this point, I was only visiting every few days. The next time I came out, his entire lower chest, abdomen and sheath were swollen. His sheath is swollen closed and he cannot extend his penis to urinate. He urinates painfully and slowly. I called the vet and she told me it was bastard strangles. She took a look at him and said that his vitals sounded alright and all we could do is wait. Now the poor guy is swelling all over. I have hot compressed several of his abcesses and the only one that has come to a head is one side of his sheath. He now has visable lymphnode swellings all over him- between his thighs, under his belly, up his neck and on one side of his face. His legs are swollen and his joints are painful to bend. His face is so swollen that his nose looks like it isn't getting good bloodflow. He is still eating and grazing and we have him at pasture with the horse I lease who also has strangles- though only a milder case with one abcess under his jaw. The vet insists that if he is still eating, grazing, drinking and passing urine and stool that he is likely to pull through this. I however am not convinced. He is in so much pain and all we have to give him is phenylbute or banamine. The vet has not advised me to give him either, but I have been giving him the phenylbute each day to help with the pain.
None of the vets I have called want to do anything for him, and all of them refuse to come out and look at him for fear of spreading the disease. The poor old chap is in such pain. Do you have any suggestions? I know it may be very inappropriate to email you, but I read the article listed on your web site about strangles and it was the only article i could find that sounded like it was written by someone familiar with bastard strangles. The owner of the horse with bastard strangles has withdrawn all support. She feeds him morning and night, but is at a loss for what to do now. She has even enlisted my help in cleaning his abcesses and caring for him because she is too squeamish to do this. We have both agreed that if he does make it through this, she will sell him to a better home but in this condition we cannot sell him.
Also, is it alright for my leased horse to be in the field with him? He does not have bastard strangles, and I'm not sure how bastard strangles works so I don't know if it's the same antibodies as with strangles. Please I am at the end of my rope. No one will help me and I am a full time college student and working part time and caring for four horses (and one donkey) with strangles because no one else will do it. I cannot stand to see them neglected and in pain. Thank you so much, Emily
You really need to talk with a good vet about this. Even if your regular vet won't come out to see the horse (although that seems very odd to me), you should be able to get some good general advice about treating strangles, and about managing horses with strangles. The vet who initially diagnosed the disease should be able to provide you with all the information you need. Please call her! In the meantime, I can provide you with some general information about these matters, but this is really a veterinary matter, so DO get the vet involved. If you can't find a local vet who will help, you may have to look for one at a greater distance, but this horse needs help. The vet will need some help too, in the form of information that the current vet may simply not have. More about this later.
Beginning with the last question first, in principle, NO, your horse should not be turned out with the affected horse - but in practice, it's too late now since your horse has been exposed to the infection. At this point, depending on his own immunities, he either will or won't get strangles himself. Whether he gets a mild case or a severe one, or whether he gets ordinary or bastard strangles, strangles as well. The normal procedure would be for the sick horse to be quarantined. It should have been quarantined from the very first second that anyone even suspected that strangles might be the problem.
Why is this horse in a field???? One of the first and most elementary (and essential!) actions to take when strangles is diagnosed (or even suspected, whilst you are waiting for a diagnosis) is to isolate the affected horse, keeping it well away from all other horses and all common equipment and materials. In other words, no group turnout, no putting the horse with strangles into a paddock for two hours and then putting another horse into the paddock, and no sharing equipment (buckets, feed tubs, brushes, hoofpicks, ANYTHING). People who touch the sick horse should be careful to wash their hands thoroughly and change their clothing before they go near any other horse - or any equipment or tack that belongs to any other horse. The horse's manure and soiled bedding should be disposed of in an area where flies can't reach it - strangles can be spread by flies - and it makes much more sense to keep the horse alone in a small isolated paddock where the infection and disease-shedding can be minimized.
This may sound like overkill, but it isn't. Strangles is not only extremely contagious, it's extremely persistent. Anything and everything that has touched an infected horse, including its stall and the paddock fence, will need to be sterilized to avoid endangering other horses that may be put into that stall or paddock next month or even next year. And when I say "everything", that means the manure and soiled bedding, the manure basket and manure fork, the walls, the water buckets and feed tubs and brushes and curry combs and hoofpicks... plan to sterilize EVERYTHING. Again, ask the vet for advice on the safest and most effective way of doing this. Obviously it isn't practical to boil your plastic water buckets... But take it seriously, because strangles bacteria can remain in the environment for many months (and sometimes even for years).
The only difference betwen strangles and bastard strangles lies in the location of the infection: strangles involves the lymph nodes in the horse's head and neck, and bastard strangles involves lymph nodes in other parts of the horse's body. The process of infection is the same, the degree of contagion is the same, and the bacteria (Streptococcus Equii) that causes the infection is the same. The DANGER to the affected horses, however, is very different; the mortality rate for ordinary strangles is quite low, whereas the mortality rate for bastard strangles is quite high.
Bastard strangles is more serious and more dangerous than ordinary strangles. Bastard strangles CAN be fatal, and often is, since it involves the infection spreading through the horse's body. I hope that the vet actually verified that the problem IS strangles, since there are other conditions that may present with similar symptoms. The vet could probably diagnose conventional, textbook strangles over the telephone because the symptoms are so recognizable, but bastard strangles really does require in-person diagnosis, because the symptoms can vary considerably, depending on which other parts of the horse's body are involved. And it can lead to other problems - more about this later, too.
Antibiotics aren't always the answer. Some veterinarians used to believe that antibiotics could cause ordinary strangles to spread and become bastard strangles; today, this is no longer a widely-accepted idea. However, the disease IS tricky, and antibiotics given in too-small doses or over a too-short period CAN turn a case of strangles into a case of bastard strangles, or make a case of bastard strangles worse. This may be the reason your vet doesn't want to use antibiotics - or she may have another reason. Don't take my guess as gospel - ASK HER.
I know that her recommendations - monitoring the horse's vital signs, keeping an eye on the horse, checking around the clock to be sure that it is eating, drinking, urinating, and defecating, and using hot compresses on its accessible abscesses - may seem low-tech and not very "medical", but really those ARE the most sensible things to do. More than that, they are really the ONLY things to do. The infection will take as long as it takes to run its course - perhaps a couple of weeks - and all you really CAN do is to keep the horse as comfortable as possible (that is, dry and fed and hydrated). Even with a healthy young horse, an ordinary case of strangles, and the best-case scenario, the horse will still need two to four weeks to recover AFTER the abscesses have broken open and begun to drain.
With ordinary strangles, when the abscesses break and drain, the horse will become more comfortable almost instantly. If the abscesses don't break and drain on their own, hot compresses may encourage them to break and drain; if they STILL won't cooperate, the vet may need to lance some of them. Again, ASK HER ABOUT THIS.
Bastard strangles is much more dangerous and much trickier to manage because there are so many different abscesses, including internal ones, involved (e.g., in the horse's abdomen, thorax, or brain), and severe internal abscesses can kill a horse when they rupture. This is why the mortality rate from bastard strangles is so high. DO continue to monitor his vital signs over the next few weeks. If he begins to show signs of unsually great distress (elevated temperature, pulse rate, and respiratory rate), be sure to call the vet at once.
Be aware of the possibility that he may NOT pull through, no matter what you do and no matter what the vet does. Geriatric equines don't typically have extremely strong immune systems, and the horses most susceptible to dying even from ordinary strangles are the very young ones and the very old ones.
Ask your vet about alternatives to bute - I agree that helping reduce the pain of infectious inflammation will make the horse more comfortable, but there may be other NSAIDS that your vet would deem more appropriate, or she may prefer to have you use none at all, for fear of slowing the eventual breaking and draining of the abscesses, or for fear that the use of drugs will mask some of the horse's symptoms. ASK HER.
And speaking of symptoms - again, I'm not a vet, and the person you need to talk to is either your vet or some vet or both (a second opinion is often a very good thing to have). But you should be aware that the same bacteria that cause strangles can also create something called "purpura hemorrhagica", which is a dangerous immune system disorder. According to the best vets I know, horses suffering from this condition will have a different treatment protocol, involving a lengthy treatment with systemic antibiotics AND corticosteroids. So it's very important to be correct in identifying the horse's condition. Much of what you've described here - especially the swollen legs and head, painful joints, and abdominal and scrotal edema - sound suspiciously as though this immune-mediated syndrome could be involved. If this horse were in my care, I would most definitely want the vet to come out and take another look. If the vet wouldn't come, I would continue to call equine vets until I found one who would, even if that meant contacting the nearest large university with a veterinary teaching hospital.
There's something else to consider here. I strongly advise you to discuss the horse's future with its owner AND with the vet, preferably at the same time, because at some point, it might be good to discuss the possibility of putting the horse down. This is an old horse that is suffering from an extremely painful infection or series of infections, and will have to continue to suffer for at least several more weeks before it recovers, IF (and that's a big "IF") it recovers at all. My question is, WHY put the horse through all of this? Even IF the horse manages a miracle recovery, what then?
Since the owner is "too squeamish" to nurse the horse herself, and has announced that she hopes to sell the horse if it happens to survive, someone really ought to think about what the future will be like for a very miserable, very sick, very contagious, 28-year-old horse. If its owner doesn't want this horse and doesn't want to take care of it, what are the odds of finding someone else who will provide it with a lovely, loving home? (Hint: most people who are kind enough to adopt such horses already HAVE horses on their property, and may not be able to take on an animal that will still be shedding infectious material for months...and in some documented cases, for YEARS.)
If a horse or any other animal can look forward to a long, happy, well-cared-for life after recovering from a severe infection, illness, or injury, there may be justification for putting the horse through a long painful process of treatment and recovery. But if the horse is already very old, is suffering from a terribly painful disease with a very high mortality rate, and its future, IF it beats the odds and recovers, will consist of a trip to the local auction followed by an uncomfortable journey to the slaughterhouse on the killer buyer's truck, then why make the horse go through all of that? Why not simply put the horse out of its misery immediately?
I have a thirty-year-old mare and a twenty-seven-year-old gelding (also an Appaloosa, incidentally) at home. I love them both dearly, but their QUALITY of life is far more important to me than their LENGTH of life. If they can live for another twenty years as happy, healthy pasture ornaments, that's fine. But if either of them were in the condition that you've described, whether from bastard strangles, purpura hemorrhagica, or both, I would be on the telephone immediately, demanding that my vet come over as quickly as possible with a needle and the bottle of "blue juice". PLEASE talk to the vet - and make the horse's owner be part of that conversation. She may not want to meet her obligation to her horse, but the obligation still exists, and even if you are kind enough to take over the onerous tasks of nursing and caring for her horse, this decision is, perhaps unfortunately, hers and not yours to make. It's something that BOTH of you need to discuss with the vet. The horse's owner has already made it clear that she finds the whole situation - and the horse itself - distasteful and inconvenient. The vet may not realize this, and may not know how old the horse is. It's possible that she is basing her suggestions and advice on some erroneous assumptions: for example, that the horse is fifteen or sixteen years old and could have a long life ahead of it; for example, that the horse's owner loves the horse, wants it to recover and spend many more years in its home pasture, and is doing everything she can to nurse the horse kindly and keep it alive.
I think that you all need to talk, and that the vet should take another close look at the horse, and that then someone should make a decision based on the welfare of the HORSE.
You've been put in a very unfortunate position. You're obviously doing everything you can and trying to learn as much as you can in very touch circumstances, but you may soon reach the point at which there will be nothing more that you can do. If this old horse does have bastard strangles, you are dealing with an extremely serious and highly contagious infection that will require an immense amount of time and hard work to manage (especially since you seem to be the only one looking after ALL the infected horses on the property). This may simply be too much. You have a kind heart, but the fact that the horse's owner is avoiding her responsibilities does NOT make those responsibilities yours - and the fact that you have taken on her responsibilities does not mean that you have also acquired her authority or decision-making power. The horse belongs to her, and she must take responsibility for it in some way. The position you've been put in is not only unfortunate and exhausting, but unfair. Even if you continue to do all the work, and even if you are the one who meets the vet at the door and holds the horse for treatment (or euthanasia), the owner MUST make a decision, for the horse's sake. Nursing and decision-making are all either of you can do for this horse. You have all my sympathy, and I hope you will let me know what happens.
Jessica
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