doclogo

Friday, 09 July 2010 08:25

“DOC, HE’S GOT “LOCKJAW!” – A CASE REPORT”

Written by  A.J. Neumann, D.V.M.
Rate this item
(0 votes)

Lockjaw is the common name used by many people to identify a case of tetanus. Tetanus can affect a whole host of mammals–almost all of which may be found on a farm. Different species have varying degrees of susceptibility to the organism and its toxin. For instance, horses, sheep and goats are often known to get the disease, while it is rarely seen in cattle, swine, dogs or cats. The human can contract lockjaw and his susceptibility to the disease probably ranks just after that of the horse, sheep and goat families.

Since I have lived here, I have known of two cases of tetanus that were diagnosed in human individuals. One lived and one died of the disease.

Since the horse can easily develop lockjaw, you will notice that almost all of the vaccines available for use in horses contain tetanus toxoid. It is recommended that horses receive an annual vaccination of tetanus toxoid which can be a component of a mixed vaccine or just a straight dose of
the toxoid.

This picture of Rocky with the blanket on is taken about three days after the onset of the disease. It was abnormarlly cold in October, thus the blanket. We left the blue nylon strap around his girth so we could simply hook a chain on it and lift him with the skid-loader if needed. His penis is just poking out. That was the barometer by which we regulated the tranquilizer. When he was just right it would drop out about two inches.

 

Rocky is ready to rejoin his buddies about a month after the onset of the disease. He is 100%.

 

This is Rocky the first day with harness on. They are all started this way, pulling this around with open bridles for as many days as it takes for them to consistently walk with their head down. They also spend a lot of time standing. Usually after a couple of one hour sessions, they are switched to a blind bridle for a day or two and then hitched with a breaking horse on the wagon or bobsled.

Sometime ago, after certain drugs became available for the veterinarian to use, I developed a treatment for use on tetanus patients. To date I have treated 38 cases, either by myself or by supplying the needed instructions over the phone. Of the 38 cases, I saved them all, except one. I misdiagnosed that one and it was so asymptomatic that it was dead before I realized it had tetanus.

This case which you are going to read about is my 39th. The patient is a very good coming 3-year-old Belgian gelding, who belongs to a very good friend of mine, Robert Mouw. Robert is an extremely knowledgeable horseman and very adept in handling a horse. We are partners in a four-day horse clinic which we offer at least three times each year.

Bob did almost all of the prescribed treatments and kept a written daily record of the 21-day ordeal, which I will now share.

Saturday, October 3, 2009

I was called to Bob’s farm after dinner that day to look at this horse. (We still have breakfast, "dinner" and supper here in the Midwest.) The animal to be examined was a red roan Belgian gelding which Bob had raised out of his best mare. The horse is a good one.

The history was the animal had been fine Friday evening. Bob had put him in the barn for his grain and the horse was normal. On Saturday morning, he found the gelding lying on his side with his rear legs straight out. This position of the rear legs led Bob’s wife to believe the horse was dead when she saw him.

By using a strap around the animal and a skidloader, Bob was able to get the horse up onto its feet. He then led it a short way into a large metal building which was partly full of round hay bales. This was an excellent place to house the roan as he was in a very big area which could be bedded and a skid-loader could be brought in to aid him if he got down. The floor was dirt which provided the animal with excellent footing. The building kept the patient dry, as it rained and snowed during his stay in the shed.

It did not take long to diagnose his condition. His rear legs were “stiff as a poker” and stood out from his body. The muscles in the back, rump and quarters were very firm and hard to the touch. When he walked, he took very short steps with the rear legs and much longer strides with his front limbs.

His neck was in an extended position and did not bend from side-to-side.

He exhibited the two classic symptoms of a tetanus-stricken horse, one of which is seen if you make a loud noise when the patient is somewhat relaxed. The animal will immediately go into muscle spasms or tetany and “stiffen out like a sawhorse.” The other symptom is diagnostic of lockjaw. I tapped him on the bottom of his lower jaw and his “third eyelid” came up and covered his eye for a second or two.

This roan had a classic case of tetanus. The symptoms start first in the rear part of the horse and work their way forward. Usually the last symptom is the inability to move the jaws.

He still ate and drank very well and that is a great plus in treating the patient.

I checked and so did Bob, but we couldn’t find any evidence of a wound on the 2-year-old. Both of his rear pasterns were slightly swollen but he was not lame. I thought perhaps he had a puncture wound which provided an entrance for the tetanus bacteria. It could be so small that we would never find it. The gelding had been given a tetanus toxoid vaccination at the time he was castrated about 14 months prior. Apparently the horse showed little or no immunity for tetanus as a result of the shot. His immunity had simply “run out.”

Clostridium tetanus is usually introduced into the animal’s tissue as a result of contamination of a wound. The bacteria flourish without oxygen and produce a toxin which is absorbed by the blood stream and is the direct cause of the tetany or contractions of the muscles. It is thought that the stricken animal dies from suffocation as it will reach a point when it cannot “breathe.”

Okay–he’s got lockjaw. How do you treat him?

  • You must provide adequate shelter or stall space where the patient is out of the weather if it becomes inclement!
  • You must have some arrangement to get him on his feet if he should lie down and not be
    able to get his feet and legs under him.
  • You must provide good hay, grain and water to the animal. Feed it all the hay it will eat and divide the grain ration into three feedings per day.
  • You must prepare yourself to medicate this horse at least five times at evenly spaced intervals in a 24-hour period.
  • You must be on time with your medications or have someone you can trust do it for you. If you cannot arrange this timely medication of your horse, you may have to take it to a veterinary hospital for a 21-day stay, but you may find this results in a "redistribution of wealth."

In treating an uncomplicated case of tetanus in the horse, there are only two drugs involved which will have to be given at regular intervals for as long as three weeks. The drugs are:

1. Regular injectable water-based penicillin. Do not use the so called “three-day, long-lasting penicillin.”

2. Acepromazine Maleate Injection,
10 mg. per cc.

The penicillin is given twice a day, starting with large doses to destroy the tetanus bacteria, thus eliminating the source of the toxins.

The acepromazine is given to prevent the tetany of the muscles. Starting with the initial shot, the effective dosage (which will be higher than the manufacturer's recommendations) must be determined by trial and error. Then the drug is given
at regular intervals to prevent the muscle spasms and stiffness from occurring.

I believe antitoxin given at this stage of the game does very little good. However, I usually give the patient 7,000 units of tetanus antitoxin–simply because the literature says to do it.

It's still Saturday, October 3 and the disease has been diagnosed, so now the treatment begins.
Penicillin: 40 cc (10cc in one area only) in the muscle on top of the rump. 40 cc again this evening.
Acepromazine [Ace]: horse weighs 1,300 to 1,400 pounds. 6 cc intravenously (IV)–I waited a half hour to see if the Ace controlled the muscle tetany. It did not, so I gave another 5 cc IV. It worked fairly well but at 10 p.m., Bob gave another 6 cc IV.

Sunday, October 4
Penicillin: 40 cc two times today. Horse was up eating and drinking but he was stiff.
Ace: gave two doses of 5 cc IV and two doses intramuscular (IM) at five-hour intervals. Alternated IV and IM.
We should have given another 5 cc for better control of the spasms.

Monday, October 5
7,500 units tetanus antitoxin.
Penicillin: 20 cc two times a day.
Ace: 4 doses of 5 cc about five to six hours apart. IV and IM alternated.

Tuesday October 6
7,500 units tetanus antitoxin.
Penicillin: 20 cc twice a day.
Ace: 5 cc six times a day. IV and IM staggered.

Wednesday, October 7
Horse was down the first thing in the morning. Strap and skid-loader got him up.
Penicillin: 20 cc twice a day.
Ace: 8 cc IV at time horse was lifted up. four 5 cc doses the rest of the day.  Alternated between IV and IM.

Thursday, October 8
The roan didn’t want to walk to water. Had to coax him to feed.
Penicillin: 20 cc two times a day.
Ace: 8 cc IV in the morning. Four doses of 5 cc alternated IV and IM.

Friday, October 9
Horse dragged his left front foot and leg.
Penicillin: dropped dose to 10 cc twice a day.
Ace: 5 cc IM five times a day. Veins were giving out.

Saturday, October 10
Horse was down early a.m. Strap and loader got him up.
Penicillin: 10 cc twice a day.
Ace: five 5 cc doses IM.

Sunday, October 11
Penicillin: 10 cc twice a day.
Ace: five 5 cc doses IM.

Monday October 12
Penicillin: 10 cc twice a day.
Ace: five 5 cc doses IM.

Tuesday, October 13
Penicillin: 10 cc twice a day.
Ace: five 5 cc doses IM.
Gelding much improved. Walked out of the shed and ate grass on the lawn.

Wednesday, October 14
Penicillin: 10 cc twice a day.
Ace: five 5 cc doses IM.
Gave tetanus toxoid to boost his immunity.

Thursday, October 15
Penicillin: 10 cc twice a day.
Ace: five 5 cc doses IM.

Friday, October 16
Penicillin: 10 cc twice a day.
Ace: five 5 cc doses IM.

Saturday, October 17
Penicillin: 10 cc twice a day.
Ace: cut down to four doses of 5 cc each a day.
Second tetanus toxoid given.
Horse lays down and gets up very easily. When tapped on chin, the third eyelid still becomes slightly visible.

Sunday, October 18
Penicillin: 10 cc twice a day.
Ace: four doses of 5 cc each a day.
Horse much improved.

Monday, October 19
Penicillin: 10 cc twice a day.
Ace: four doses of 5 cc each a day.
Horse appears much improved.

Tuesday, October 20
Penicillin: 10 cc two times a day.
Ace: three doses of 5 cc daily.

Wednesday, October 21
Penicillin: dropped to 10 cc a day.
Ace: 3 doses of 5 cc.

Thursday, October 22
Penicillin: 10 cc.
Ace: two doses of 5 cc.
The roan goes into the barn two times a day for his grain with the other young horses.

Friday, October 23
Penicillin: 10 cc.
Ace: 5 cc.
Last shots – we call him "recovered."

Yes, a horse with tetanus can be saved! It takes a lot of dedication on the individual’s part that will treat and care for the patient. Bob is an “excellent caregiver” and has the ability to give the correct meds at the right time. As he puts it, “I don’t care how you cut it, you have to get up at three in the morning!”

I knew that he wanted to go to the Waverly Sale (October 6-9) but he stayed home to attend to this horse because, as he said, “If I had gone, without his meds he would have died.”

The roan received the best feed available–alfalfa hay and the grain fed was about ½ gallon three times daily. He was blanketed, as the weather was cold. He was well-bedded and in a large area where the skid-loader could be used both times he was down and needed some help to regain his feet.

The reason a tetanus-afflicted horse may have difficulty in getting to its feet is the fact that when they have spasms their legs stick straight out, resembling a sawhorse, and they cannot get their feet under their body. As soon as they are lifted a foot or two, they will throw themselves over and come right up.

Saving your horse if it has tetanus can be done if you are willing to spend the time and money to do it. However, it is much better for all parties concerned if “Old George” is just vaccinated on a regular basis when he needs it.

POSTSCRIPT by Bob Mouw

The shelter we kept this horse in during his treatment made a huge difference. If I had left him outside, he would have died as he wouldn't have been able to get around in the mud. We had 24 days of one kind of precipitation or another during the month of October. We also had temperatures in the teens on several mornings. The size of the shelter was also important. The area the horse had in which to move around was about 30' by 40', so I could easily get to him with the skid-loader to get him back on his feet. I also use the building for foaling.

The nylon strap is 3" wide. I tied it in a square knot right around the girth and it stayed on reasonably well. I left it on him until he was getting up and down on his own. When he was down, I slipped a short chain under the strap and hooked it to the loader bucket.

During the first four days, I could just walk up to him with the syringe and give him his shots, both IV and IM. By the fifth or sixth day though, I could tell he was getting better, as I had to put a halter on him to do it.

This horse is a good-natured fellow. As many shots as he had, you would think he'd be people-shy like no other, but I can catch him anywhere.

Read 7302 times

SUBSCRIBE: Sign up to receive a notification when the new quarterly journal is published, enter your email address below

Purchase This Issue