Please Help! - Puncture Wound

[I'mForAris]

Hello,
Apparently my dear old lease-horse has gotten himself into some trouble. I went out to visit him today and I noticed his face looked funny. Please understand that I only lease Aris- he's not really mine.
He has a huge lump on the underside of his jaw. It's too far up to be strangles, and it's kind of puss-ee and crusty and soft and gooey feeling. He's really good about me touching it, but it's obvious that it's uncomfortable when I push on it. It's not interfering with his eating, which was my main concern. He's chomping away at the grass and grain like it's not even there...
My vet-school friend thinks it's a puncture wound that has "blown up" over night. It wasn't there yesterday, and it's likely that he got it by scratching his face on the new fence posts in his new paddock (I already checked for nailheads sticking out and I've ruled those out).
MY QUESTION IS: How should I handle this? His official owner HATES calling the vet out - she's downright stingy. She wouldn't even call the vet when I said he looked colicky until he actually tried to roll. *UGH*
So should I wait and let it do the natural, rather disgusting thing and POP, and then take good care to clean it up? Or should I force her to call the vet, even pay for it myself? Technically it is her horse, so she calls the shots- but this thing is nasty! It already has puss draining slowly out of it, so I don't know if I should just call the vet and see if she can give me some antibiotics for it, or if he'll even need antibiotics. Oh gosh his owner is so hard to deal with! She never listens to me when I say somethings wrong (including times when he's had abcesses, thrush AND colic!) and she generally just likes him as a lawn ornament.
Anyway, could anybody respond? I'll go out and see it tomorrow, so the quicker response I get, the better.
Thanks so much!

[galadriel]

First concern: Is he up to date on tetanus? If not, you may be in some SERIOUS trouble. You *will* need the vet out, and right away. He'll need the anti-toxin, not the vaccine (there is a difference).

Second concern: if you just leave it, it's really not going to go away on its own. If it's already infected, it will probably need at least antibiotics before it'll heal. I've seen punctures that were infected, when the infection wouldn't go away. It's not pretty.

The problem with puncture wounds is usually that soemthing got into the wound when the puncture happened, and it's near impossible to really get it clean from the outside. But you can try. If you can't get the owner to call the vet out (and I understand the problem) and he's up to date on tetanus, then you can try cleaning and flushing the wound to make it better.

You'll need to flush it *thoroughly*. Take some saline or water with a little iodine (enough to make it the color of tea) and syringe (just a syringe, no needle) the fluid up into the wound until nothing comes out but the fluid you syringed in. (No pus, no grit, nothing.) Get as deep as you can; stick the tip of the syringe way up in there. Be gentle, but use enough pressure to really clean the whole thing out.

Good luck convincing the owner to get the vet out. Once a puncture gets infected, it really should be seen by a vet.

[LynneAC]

At my yard we always get the vet to look at puncture wounds because, as Galadriel said, you just don't know what's up there and how far the wound goes!

Good luck

[artemis]

My horse had a very similar injury last year & I agree with all that has been said. Tetanus vac is vital. I initially flushed my horses wound out, but still called the vet. It will probably need a course of antibiotics. Mine did - healed up very quickly after that.

[Wally]

Keep io open and clean, get a syringe and swill out the whole wound with saline. Don't put anything on it which could seal it back up and breed up the bugs, let it stay open and heal from inside out.

If the owner will not call the vet do the best you can and try to persuade them to call if it doesn't look like settling.

Do the cleaning every day or more if you can. Don't let it heal over until the underlying tissue is knitted. It may abscess badly if this happens.

Anti biotics only work with a good blood supply, the body may have encapsulated the infection off by now so anti-biotics may have little effect.

[I'mForAris]

Thank you guys so much for all of your help,
I finally convinced his owner to call the vet. She'll be out tomorrow afternoon- in the mean time, it looks like the wound has sealed itself back up and is starting to fill. It wasn't ever really open all the way, it was just weeping.
I've been hosing it with cool water and trying to keep it clean, but I live 40 minutes away from him so I can only come out once a day. I also have put a light betadine wash on it, to encourage it to dry up.
His owner gave in to calling the vet when she saw how awful it looked (before, she was just looking at it from a distance.) She also says he's up to date on his tetnus, which is a big relief because up until a few years ago I don't know if he was getting his tetnis shots. Her horse care skills tend to be rather sketchy.
Honestly, at the expense of the horse, I'm learning some great barn management skills, what with making phone calls, checking for loose fence boards and nails, cleaning wounds and caring for her miniature horse who was trimmed wrong (the farrier cut into the quick pretty badly.) This is probably a good experience for me to have, even if it is bad for the horse.
Thanks again for all the help!
E Jenkins

[galadriel]

I'm relieved to hear that a vet will be seeing Aris :)

By the way, I didn't mention earlier...but for a horse, being up to date on tetanus means having had a shot within the past *6 months*, not the past year (like for people).

It's good to get experience and develop your skills...sad that you have to learn so much the hard way, though.

[I'mForAris]

ARG. So she called the vet and the vet has decided it's strangles. HOWEVER!!! the vet did NOT COME OUT! I am SO angry right now. How can she just decide it's strangles because he has a bump on his jaw? This vet NEVER wants to make farm calls and she's very unreliable.
Aris has no temperature, is eating fine and is acting totally normal. The ONLY thing wrong with him is the wound under his jaw. It's about halfway from the front of his head to his neck- I understand this is where the lymph nodes are but COME ON! a vet diagnosing a horse with strangles over the phone is completely unprofessional and LUDACRIS!
Is it really possible he could have strangles without any other symptoms? His temperature is fine and he was even trotting around and neighing at some horsese on the road yesterday, flagging his tail and showing off looking like the happiest horse in the world. I don't think a horse with strangles would be acting like that.
Sorry for all the caps lock. I hope you can understand how UTTERLY frustrated I am.
Any advice?
I'm calling the vet back today- I'll be talking to her personally, and with a strong tone. Even if it is strangles she should come out and take care of it - she told his owner to just keep a warm compress on it and he'd be fine, she gave no instructions for checking the other horses and donkey, and she said nothing about quarentine or anything!
ARG!

[galadriel]

I've read of a horse that was diagnosed with strangles, without actually being examined, and the horse died--because it was choke, not strangles. (in this book: Emergency! (http://www.amazon.com/exec/obidos/ASIN/0939481421/lorienstablec-20))

Diagnosing something like that over the phone is extremely bad practice, may even be malpractice.

[I'mForAris]

Well, I have decided to call it strangles.
I lanced the abcess today and the pus was yellow and creamy, and even though he still shows no signs of lethargy or fever, the other horse he lives with has a fever of 104.0 which is disturbing. We're going to treat it all like strangles, watching them very closely and keeping aris seperate from the rest of the horses (even though the other horse had a fever, it's best to be safe)
I managed to really thoroughly clean out the abcess first by expressing it, and then by flushing it with a betadine solution and then water. I also made sure that the holes in it would be large enough to keep it from closing up over night.
He's so incredibly trusting through all of this. It's obvious it hurts a lot, but he only licks his lips and scrunches up his nose at me while swishing his tail. It's neat because I think he knows that I'm trying to help.
Anyway, what about strangles advice?
I hope i'm not irritating anyone with my confused posts. I'm so flustery with all of this and his owner wont even mess with the whole thing. she was ready to just let him sit out in the field until he got better- a big mistake if you ask me.
is there anything more i can do for him, and the other horses (including the one with the fever?)
thank you SO MUCH, especially galadriel, you've been such a help
love,
em

[Wally]

You need some ministry approved disinfectant and disinfect your boots or keep a pair just for handling him. Change your clothes and wash hands before going anywhere else. It can spread like wild fire. It is possible to stop it spreading further by wasing, changing clothes and disinfecting everything.