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Managing Chronic Progressive Lymphedema (CPL)

Chronic progressive lymphedema (CPL) is a serious trial for a horse, as well as the owner who has to do everything in their power to keep their horse comfortable.

There is good news though, in that rigorous management along the lines of the suggestions below may help to slow the process and lessen the lesions. Bear in mind, however, that every horse afflicted with this will need management on an ongoing basis.

My first experience with CPL was when one of our regular clients, Sarah, contacted me regarding her boy whose CPL was getting worse. After a couple of weeks or so she reported that she finally felt he was making progress when she de-feathered him. This act itself was very traumatic for him, even with heavy sedation, but ultimately worth it. She can now massage his legs, although he isn't too keen on the really swollen areas. She massages him a couple of times a week with a cheap emollient cream from Boots. I was already introducing a new gel in our EquiGel range, our M&SGel, and I asked if she'd be interested in trialling it alongside two clients with Mallenders' horses who were trialling it as well; reason being that progression of lymphedema can lead to a build-up of a thick keratin layer typical of Mallenders/Sallenders horses.

Post trial, Sarah said our M&SGel “definitely helped with the scabs when the feathers first came off and with some air and a couple of washes with Head & Shoulders it's all looking more healthy.” She also got him onto our LymphCARE immediately, and reported that this helped enormously.

I can't claim to be an expert on CPL in any way, but through some serious swatting after talking with Sarah, together with her input as well, here are some top tips for managing CPL:

  • Clipping the feathers Long dense feathering makes managing lymphedema more difficult, so clipping them off comes highly recommended in order to initiate rigorous treatment. From actual case studies I’ve read, clipping the feathers off allows the skin to dry out and improve, and with careful repetitive treatment, the legs can become healthy enough to allow the feathers grow back (around 10-12 months).
  • Exercise Regular exercise/turnout to encourage movement is crucial, as it increases the circulation and the lymph drainage. Lymph is like butter; the warmer it gets, the softer and more fluid it gets. The colder it gets, the harder it gets. Move, get a bit warm and it’ll keep moving and clear faster and more efficiently.
  • Treatment of skin infections Progression of lymphedema is associated with fibrous tissue and formation of fibrotic nodules. As a result, affected horses have a poor blood circulation and immune response in the skin of their legs, which leads to a build-up of a thick keratin layer. The long feathering further seals the skin surface, which then becomes humid which provides the perfect culture environment for infectious pathogens. This goes some way to explain why horses with CPL constantly battle recurrent infections with mites (chorioptic mange) and bacterial infections (staphylococcus, eermatophilus), so keeping the immune system as strong and healthy as possible is paramount.

Topical Tips

  • Careful washing, cleaning and drying of the legs on a routine basis is essential. Horses with long feathering may require blow-drying of their legs.
  • FOS (flowers of sulfur) is thought to be a useful and economical topical treatment, easily purchased on Ebay. Mix with an oil such as coconut or olive, both of which are considered antifungal and antimicrobial (coconut more so), to form a creamy paste, then apply to the ulcerated and/or affected areas of skin daily. This can be used indefinitely and is safe for pregnant mares.
  • Manual Lymph-drainage Manual lymph-drainage is regularly used in humans with lymphedema as long as there is no inflammation present within the tissue. For horses, dry brush upwards from hoof to heart, away from the direction of the hair, and then from neck to heart.
  • Bandaging and stockings Using special bandages developed for people with lymphedema is well known. For horses which always move around, short-stretch bandages can be used. Short stretch bandages have been successfully used in horses with clipped feathers; it’s not so successful on horses with long feathers. Make sure there’s good padding and keep the bandages fairly tight. If your horse can tolerate it, it’s said the best results will be achieved by keeping the bandages on 24/7, although personally I’d prefer to keep them off for some of the time so the skin can breathe. At the very least, bandages need to be redone at least every other day and better every day. At first, there may be oozing from the lymphedema through the skin, so the bandages will need to be changed every day until the oedema lessens. If the horse is only walked quietly the bandages can be left on for the exercise; bearing in mind that the legs will need to be rewrapped after exercise as the swelling will reduce. For harder exercise it may be better to take the bandages off, use working bandages and then switch back to the short stretch bandages after work. Make sure the skin is dry when you rewrap.
  • Horses suffering from CPL often are susceptible to repeated bouts of thrush, so check hooves regularly as an essential part of the health care management. ACV is an effective and very cost-effective spray to use - it's my personal favourite for thrushy hooves.

Meanwhile ...

I also found this case study on a forum regarding a Clydesdale called Surprise with CPL, dating back to 2005 and posted over a 6-month timescale, which might give some hope and ideas:

  • Posted on Friday, Mar 25, 2005 – 9:02 am: Also wanted to add one more piece of info that I forgot. Vet did blood tests earlier this month to rule out Vit. E and/or Selenium deficiency. Values on both were within norms. Haven't received my copies yet so I can't be more specific.”
  • Posted on Monday, Apr 25, 2005 - 2:29 pm: While 1-month is hardly sufficient time to measure any success and it could merely be coincidental that the nice weather is here, we've been riding on the beach and soaking her legs in sea water, and she's working more and losing her winter belly, I'm still pleased with her improvement in the past month.”
  • Posted on Wednesday, Oct 26, 2005 - 10:35 am: Treatment over the past 6 months consisted of an immune booster, shampooing her legs 2 times a week with the apricot/sulfur shampoo and painting the sores with a 1/2 & 1/2 mixture of mineral oil and sulfur 4-5 times a week.”

Useful links

https://www.facebook.com/groups/chronicprogressivelymphoedema/

https://www.facebook.com/watch/?v=268703734632354

Really hope this all helps with some ideas.