Puzzle Barton, a seven-month-old Appaloosa filly was brought to my farm, Sugarflats, in November 2004 as a medical lay-up. She had been diagnosed with Pythiosis. The common names for this infection are Florida Swamp Leeches, Swamp Cancer or Phycomycosis. The first veterinarian called to look at her thought she had stepped on something and prescribed antibiotics. A week later, Puzzle was worse, the bulb of her heel was swollen and sore. Puzzle belonged to my mom and dad, they had just lost their home during the hurricanes and they were determined to do everything that could be done to save her. Another vet, Dr. Sally Collins, was called in who immediately recognized Pythiosis and arranged for Puzzle to go the University Of Florida Veterinary School. There Dr. Nicolas Ernst, the Infectious Disease Specialist, decided surgery was not a good option due to her young age and very small legs. He was afraid a tendon or ligament could be severed while trying to cut out the organisms. We had no choice to bring Puzzle home with no real hope to save her.
The infecting organism Pythium insidiosum normally lives in plants such as grasses and weeds, but sends out a thousands of swimming “spores” when the host plant is covered with water. Many cases of Pythiosis are seen each year in Florida and the surge of cases seen in 2004 was surely tied to all the hurricane activity we had last year. In untreated cases this disease spreads rapidly and kills over 90% of all infected animals.
I called my uncle, Dr. Max Ray, DVM, knowing he would know what to do. A 30 year + veterinarian, he believes strongly in doing everything possible to preserve life and during his career had treated horses for “leeches”.
We immediately started supportive treatments to maintain her leg and at least make the environment within the leg inhospitable to the Pythiosis organism using treatments Dr. Ray had often used in his equine practice years ago. Most commonly the treatment for Pythiosis is surgery, cutting out as much of the damaged tissue and Pythium as possible. Another treatment is a potassium iodide IV drip which works in some cases but unfortunately most often it doesn’t. The invading Pythium grows rapidly resulting in huge rotting lesions making euthanasia the end result most frequently.
I sprayed the infected area (the whole bulb of her foot and the sole of her hoof) with Physofix, 3 times daily and then on the second day, wrapped and soaked her whole lower leg and hoof in ammonium alum. A week passed and then another, she was still up and moving around. The vet at the University had thought we would be putting her down in a matter of days as the organism destroyed her tendons and bone in the affected leg.
By now, I will admit, caring for her leg was not for the faint of heart or the undetermined.
Upon talking again with Dr. Ernst in Gainesville he mentioned an experimental immuno therapy for Pythiosis. I immediately called Bob Glass, Pan American Veterinary Laboratories in Hutto, Texas to see how to secure that product for use in Puzzle.
Mr. Glass immediately reassured me that I would receive the Pythium Immunotherapeutic Product (PIP) upon submitting to him a sample of Puzzle’s blood and clearing the use of the PIP with the State of Florida’s Agricultural Dept. Trust me, it was easier to pull the blood sample than get the approval. Unfortunately, it was Thanksgiving week when all this transpired and I couldn’t get anyone at the state to respond to me. Finally, the Wednesday before the holiday, I called every administrative assistant in the State Agricultural Dept. and explained, very emotionally, why it was so important for a quick response from the State Vet. It worked, by that afternoon the typed and signed release required by the lab was faxed to Mr. Glass. He shipped Puzzle’s PIP the Friday after Thanksgiving and I received it on November 30th. By now, Puzzle was rapidly approaching the stage where it was uncertain whether the vaccine would help her or not.
PIP had been proven to be 90% effective on horses diagnosed and started on within 30 days of infection, but only 75% effective in for horses started on it in the 45 day to 60-day range, which is about where Puzzle was on December first, the day of her first treatment. We were also giving her ½ cc of immunregulin, every third day, to boost her immune system. Mr. Glass had explained to me, that the horses that didn’t respond well to PIP usually had seriously compromised immune systems from trying to fight off the organism for an extended period of time.
Pythium Immunotherapeutic Product is a purified extract of the Pythium organism developed during 20 years of research. This therapy actually stimulates the animal’s own immune system to fight the infection.
Puzzle was still in good body condition but seriously sore on her left hind. She had been walking on her toe since arriving at the farm. Her lower leg from the hock down was 3 times larger than normal, raw, and I was keeping a heavy cotton bandage on her for support and protection. What a mess! By now I was alternating the alum soaks with Pet Milk soaks to soothe the damaged tissue. The Physofix really had no affect on the Pythiosis organism, so we stopped it. The infection had moved up to her haunch and we saw signs of it starting to break through her skin on her inner thigh.
Anxiously, I waited for the day I could give the 2nd PIP injection, all the while watching for some sign that the PIP was working. In the 14 days after the first PIP treatment there were no new breakouts and it appeared the lesions on her lower leg and around her hoof were shrinking. By now, the organism had almost completely taken over her lower leg, the coronary band appeared to be compromised and it was eating through her hoof wall.
I was cautiously optimistic, and then on December 14, she shed her frog and the whole sole of her hoof. I started to clean the area and pack the hoof with cotton for support when I noticed how clean and pink the tissue inside the hoof wall was. No sign of the organism or the decaying smell I now associated with it. A small victory!
With a few more days until her final shot on December 21st, we had a huge set back. Over the last week, Puzzle’s appetite had waned and now she spiked a fever. The worst possible had happened, the Pythium infection was clearing but a bacteria had infected the damaged tissue in her haunch, her leg swelled overnight to the size of a small elephant’s. Dr. Ray was out of town, so I started hosing Puzzle down to bring down the fever. I gave her banamine to help with the inflammation and waited for his call. Dr. Ray came out and decided we needed to start her on Cipro and Tetracycline to combat the infection in her leg.
A couple of days passed and the swelling in her leg was subsiding, her appetite was back and I was leaving her leg unwrapped. The leg was doing better, the raw and damaged areas were starting to close up and heal over. The 21st of December had arrived and I gave her the 3rd and final vaccination. The next few days passed uneventfully, her leg was still rather large, but not hot and fevered. Dr. Ray said she might go through life with a “Milk Leg”, the term for an overly large leg, caused by the lymph node being damaged and unable to function properly. That seemed like a small price to pay for her being alive.
On Christmas day I left Puzzle in her stall for the morning while I went to my sister’s house for lunch., When I returned I immediately went to the barn to turn Puzzle out for a little grass. I opened her stall and she walked out FLAT- FOOTED!! For the first time in over 60 days, she wasn’t walking on her toe At that moment I knew we had won.
The next few months passed rapidly, she shed most of her hoof and a new one is growing back in from the coronary band. Completely growing back in, not deformed as we first had feared.
She is walking, running and playing like any normal yearling. Her leg is almost back to normal size and we expect that within a year the only visible sign of what she went through will be the scar left were her lymph node burst open and drained. Upon the advice of Dr. Ray and Mr Glass, we decided to give her another series of PIP, since she was so young, perhaps the youngest horse to receive this treatment and survive. Puzzle will also receive the PIP once a year for life as recent research indicates that it may prevent infection for at least 1 year.
This story is about miracles, Puzzle is a miracle; she is one tough baby, a credit to her breed. We all need to remember that horses have miraculous powers of healing as long as we, their humans, don’t give up.
The great news is that Pan American Veterianry Laboratories has received a USDA liscense to manufacture and sell Pythium Immunotherapeutic Product to veterinarians in the USA. Now this treatment is available for any horse or dog that contracts this deadly disease.