Oedema caused by inflammation
There are many causes of inflammation – infection, harmful substances, injuries such as strains and burns for example - during which additional protein loaded fluid enters the tissues from the blood capillaries causing swelling, whilst at the same time the lymphatic vessels leading away from the area close to prevent the cause of the inflammation spreading.  The presence of this ‘protein rich’ fluid can cause tissue fibrosis and a frequent result is that after the inflammation has been resolved, the swelling may have disappeared but tiny lymphatic vessels under the skin are damaged or destroyed and no longer function adequately, increasing tissue vulnerability. 

Consequently wounds or injuries to the horse’s legs in particular should always be treated promptly and if a pre-existing lymphatic condition such as ‘swollen legs’ is  present  a minor inflammation can cause serious oedema.

For the reasons given above, EMLD is contraindicated during some acute inflammations, but should be started as soon as the symptoms have abated and  used safely to  help remove the products of inflammation, ease symptoms, limit damage and speed up healing.

Idiopathic Synovitis, Tendosynovitis
Where there is no underlying cause of injury, these conditions (windgalls, bog spavin) are classed as blemishes not requiring treatment.  However, if they become very large they may cause a mechanical lameness and owners may also find them unsightly.  In these situations EMLD combined with the use of compression stockings can reduce swelling and soften hardened fibrous tissue without the need for drugs or box rest.  Compression stockings have the advantage of providing supportive pressure in places difficult to bandage.

Tendonitis
EMLD can be used as an auxiliary treatment for tendon injuries.  When EMLD and compression bandaging are started as soon as possible after injury, bleeding and oedema are reduced, and the increased transportation of toxic waste products diminishes further damage to the tendon  tissues.  The treatment also encourages longitudinal orientation of the new collagen fibres and recovery times are shortened.

Laminitis
Unfortunately the pathological changes taking place during this condition are initially ‘silent’ and by the time the distressing symptoms appear, the damage has started and the highly constricted space within the hoof is inflamed and congested.  Because EMLD can speed the removal of toxic inflammatory products from the hoof capsule it can alleviate the pressure and the injury to tissues caused by these, and is therefore a useful adjunct to veterinary treatment.  However, to be effective it needs to be used at the acute/sub acute stages of laminitis.

Tying up
‘Tying-up’ is one of many names for a collection of clinical signs or symptoms that used to be thought of as one condition but are now known to have several causes, although the symptoms, most strikingly muscle cramping, are similar in each.

EMLD increases the elimination of metabolic products from the muscles and is an effective auxiliary treatment for these conditions, resulting in reduced symptoms and quicker recovery.  It also has a prophylactic use with high performance horses and research indicates it may be useful in the treatment of horses that repeatedly tie up.

Equine Purpura Haemorrhagica
Although EMLD is normally contraindicated for acute allergic reactions, it can be safely used with EPH because this condition is systemic from the start.  It produces a faster and greater reduction of the massive oedema, which also affects an improvement in the horse’s general health and the clinical picture of the disease.  EMLD treatment should begin at the first indication of oedema formation, to control its potential development.

Swollen legs
This condition (‘idiopathic primary lymphoedema’) develops in some horses when their movement is restricted for any length of time, typically after being kept in overnight, with the swelling disappearing once the horse is exercised again. To perform adequately, the lymphatic vessels of the horse’s legs are especially dependent on additional factors such as movement to stimulate their activity and the flow of lymph, and if for any reason the lymphatics are damaged or not formed properly they will not be able to cope with the loss of this support, forcing the tissues to swell. Over time without treatment the condition can worsen and the legs become increasingly vulnerable to trauma leading to serious oedema, and risk of infections such as lymphangitis.

Research has shown that in these situations, using stable bandages can inhibit the movement of lymph.  EMLD followed by the use of equine compression stockings is an effective means of controlling this condition.

Incidentally, it is a fallacy that swollen legs are caused by high levels of protein in the horse’s diet, this protein is metabolised in the horse’s liver, and is different to the fluid-attracting protein molecules used to transport nutrients from the blood stream to the tissues.

Cellulitis
This is an acute infection with inflammation of the tissues under the skin, which causes oedema.  It can occur anywhere but in horses often affects the legs.  It must be treated with antibiotics which should resolve an attack.  However, it often harms the superficial lymphatic vessels and may develop into lymphangitis which can lead to obstruction and permanent damage to the lymphatic system, predisposing the horse to recurrent attacks.  EMLD treatment of cellulitis can begin as soon as antibiotics have cleared the infection, quickly reducing oedema and further potential damage.

Lymphangitis

This is a painful condition caused by an infection to the lymphatic system, usually in the horse’s leg.  Lymph nodes close to contain the infection to prevent it spreading through the body, inflammation causes more fluid to enter the tissues, and the leg swells.  Lymphangitis must be treated promptly by a vet with antibiotics.  Unfortunately, damage to the lymphatics often causes some swelling to  remain which over time becomes fibrotic, and the legs become vulnerable to further infection – a secondary lymphoedema.  EMLD or CDT should start as soon as the infection has been treated, to resolve any swelling, prevent fibrosis and limit the possibility of further infections.

Pastern Dermatitis
Pastern dermatitis is a general term for a number of conditions which affect the skin of the horse’s lower legs, including for example mud fever, mite infestation, contact allergic reactions and photosensitivity, and the treatment will vary depending on its cause.  Repeated attacks trigger further inflammation which causes recurring damage to lymphatic vessels under the skin, limiting the local immune system’s ability to respond and leaving the horse susceptible to increasing attacks.  These in turn create more damage, chronic inflammation and again, susceptibility to a secondary lymphoedema.

EMLD can begin as soon as any infection or allergic reaction responds to treatment.

Post traumatic and post operative oedema
EMLD can be used to reduce oedema and scarring and help speed recovery following injury, burns and after surgical procedures including castration, and for conditions such as mastitis to reduce swelling and enable the use of local instead of systemic antibiotic treatment.  EMLD is also effective for reducing oedema caused by long term box rest, for example when recovering from laminitis.

My own experience suggests that EMLD may be effectively used to reduce the symptoms caused by Equine Metabolic Syndrome in horses with laminitis.