Embrace Pet Insurance Blog

Ask Laura: the impact of toe amputation surgery

I received the following question from Regina as a comment to another post on toe amputations and I asked Dr Riggs, one of our advising veterinarians:

Regina's question:
I have a 8 year old Boxer mix that has a bad foot infection from being poisoned. She will be loosing the two middle toes on her left hind and some dead tissue with it. Will she be able to run and play normally again?

Dr Riggs' answer:
I just did the same type of surgery on an 18 year old cat with a lymphocytic tumor of the the left rear paw. I had to remove the two middle toes and subsequently gave her a "Spock" like look to that paw. She is walking great. Dogs and cats are amazing. They can compensate so well. Your dog will not miss a beat. I was just at a lecture given by a surgery professor from Colorado State, about reconstructive surgeries of the feet. Her quote was "dogs and cats are born with more toes than they need" and she showed some pretty interesting cases to prove that. Your dog will do fine.

Pretty interesting don't you think? I had a friend who lost his big toe in a construction accident (a human friend, not a cat or dog!) and he said it did hinder him more than he thought it would so I had no idea cats and dogs could be so flexible.

Have any of you had to have some of your cat or dog's toes removed? How did it go?

Related articles:
Toe amputations for cats and dogs
Ask Laura: dog weight bearing toe amputation appropriate or not?

Perineal Urethrostomy, incontinence and bladder atony

Wendy posted the following question as a comment on my blog post about  perineal urethrostomy, which I thought was worthy of a blog post all of its own.

 

Has anyone else had issues with incontinence after the surgery? My cat Henry had the procedure done almost one year ago. Everything was going great until this last month...No matter where he sits or lies, he leaks urine. I love my cat and I am heartbroken that this is happening to him. I have heard that in rare cases there can be permanent nerve damage during the procedure, but why would it have just started??? Any advice????

 

I passed Wendy's question on to Dr. Riggs, one of our consulting veterinarians and this is what he had to say in response.

You can see incontinence in this situation occasionally but it probably is not nerve damage from the surgery; more likely a result of bladder atony.  The sphincter of the urethra is at the base of the bladder, not at the end of the urethra.  When cats get "blocked" he is not able to urinate and the bladder gets distended.  The muscles in the bladder wall that are responsible for constricting the bladder are stretched and are not able to work as well.  This is called bladder atony.  When the bladder becomes full enough, the pressure within the bladder overcomes the urethra and he dribbles. 

 

Have Wendy ask her vet about  two drugs that can help in some cases, phenoxybenzamine and bethanechol.  The phenoxybenzamine will help decrease the urethral tone and the  bethanechol helps the bladder muscle contract.  I would also look to see if there are no strictures in the urethra. 

 

Lastly, bladder infections are common after PU surgeries since the urethra is wider and bacteria can get in the bladder easier. This is the same reason bladder infection is more common is female cats as compared to males. So I would  check a urinalysis and do a culture of the urine. 

  

I hope all goes well with Henry.

 

Have you had this issue before and were you able to resolve it?

 

UPDATE 3/8/10:
Sadly, I received this message from Wendy today:

Unfortunately I had to put Henry down yesterday.  X-rays revealed he had developed eight more stones in his bladder and although he had the surgery to help him with this issue, he was unable to pass them on his own. 

 

Henry had several more infections after the original surgery, he was facing another surgery, and there were no guarantees that this would be his last.  It was a very hard decision, but in the end I did what was best for Henry.  He filled my life with unconditional love and companionship and I did not want him to continue suffering. 

 

I want to thank you for your kindness and your concern.

 

Sincerely,

 

Wendy

RIP Henry

 

Related Posts:

Perineal Urethrostomy: description and costs

More discussion about anesthesia-free teeth cleaning

Dr Riggs started off a conversation last week about why a veterinarian should clean your dog's teeth (Guest Post: Why Have Your Dog's Teeth Cleaned By A Vet Anyway?) and there were some interesting comments about other alternatives. Dr. Riggs asked me to post his response to these comments:

Wow...who would have thought we could stir up this much controversy with a little dental blog!

In response to the comment about Vet Economics:
Veterinary medicine is a business. We do need to make a living through the services we perform. I can assure you the vast majority of vets do not recommend services(or "pad the bill"), such as dentals ,when they are not needed. We need to offer the best medicine and let the owners decide. One of the mottos we follow is, "Always offer what is indicated, nothing that is not". 

In response to the comments about anasthesia-free teeth cleaning:
What people don't realize is that you cannot do a thorough sub gingival curetting without anesthesia. The dogs will not let you. Anesthesia in animals, using the right equipment and agents, is safe. Our veterinary technicians are extensively trained and we use pulse oximeters, blood pressure machines and warming devises (bair huggers) to ensure the patients safely.

Can you do a little scraping under the gums without anesthesia? Sure, but not a true cleaning. The difference with human dentistry and veterinary dentistry is that animals will not open their mouth for you to clean under and around the teeth and gums on all four sides. You must clean all sides of the teeth to clean properly. When you scrap the enamel, you must then polish the teeth to help eliminate the microscopic grooves left in the enamel. This is done with a low speed polishing drill. If not, these grooves act as a scaffolding for tarter to grab hold. This is another step not done by the groomers.

The dentals we do also include dental radiographs. You can not tell tooth root abscesses without radiographs. It is the same reason dentist use dental radiographs on us. These require anesthesia in animals. (some pictures below) 

Finally, one misinterpretation from the article I think, was that you need to do a prophylactic dental each year. You normally do not. If the people brush the dogs teeth regularly often you can wait 3 to 4 years between dental. Owners have a lot of power in determining their pets dental health. We evaluate each animal yearly on their normal vaccine exams.

Rex C. Riggs D.V.M. Best Friends Veterinary Hospital Powell, Ohio. BFVH.org

First picture: The black on the xray is where bone has eroded away. So you can see the roots on the middle tooth is just barely on the bone. If more then 50% of the root is exposed then that tooth need to come out. We removed this tooth.

Second picture: The bottom tooth has total destruction of the roots and now has an infection of the jaw bone. On this xray you cannot rule out even a tumor. we tooth this tooth out and biopsied the jaw. This came back osteomyelitis.

Third picture: This is a good example of a root abscess on two teeth . The big 2nd tooth has the black halo area under the bifurcation. Then the third tooth has the classic halo around the first root. Both of these teeth needed removed.

What do you think?

Guest Post: Why have your dog's teeth cleaned by a vet anyway?

Today, we have a guest post from Dr. Rex Riggs, owner of Best Friends Veterinary Hospital in Powell, Ohio. He is a veterinarian, and an Advisory Board member of Embrace Pet Insurance. Dr. Riggs and one of his vet techs, Ellen Winkler RVT, writes about dental health and teeth cleaning. _________________________________

If you are ever curious as to what happens if teeth go for years without brushing (or you want to show your children what will become of their teeth if they fail to brush regularly), you have only to look at your pet’s teeth and smell your pet’s breath.

The leading sign of periodontal disease is bad breath. Periodontal disease is a problem that affects 85% of pets by three years of age. Daily tooth brushing and regular dental cleanings are crucial to the health of your pet.

There is little difference between the dog or cat’s tooth and the human tooth. We all have a set of baby teeth that come in and fall out to make way for adult teeth. We all have nerves and blood vessels in our teeth surrounded by dentin, which is surrounded by a hard coat of enamel. The enamel is bathed in saliva and quickly covered by plaque which is bacteria mixed with saliva. If we do not regularly disinfect our pet’s mouths and brush away the plaque, the plaque will mineralize into tartar (also called calculus– the gritty material the dental hygienist scrapes away). The bacteria that accumulate can cause damage by infecting the bone and ligament that holds the tooth in.

Eventually the tooth is lost and, if the bone damage is severe enough, the jaw can actually break. Gingivitis is reversible. Bone loss, once it starts, is not reversible. Worse still, bacteria of the mouth can invade other areas of the body leading to infection in the heart, liver, kidney, or virtually anywhere the blood stream carries them.

It should not be surprising that dental health requires regular professional cleaning. Home care of the teeth, while great, does not replace the need for professional cleaning. The cleaning done performed at your veterinarian is done while under anesthesia and includes many steps.

Here is a brief overview of what is involved in a routine dental cleaning for your pet:

• Gross (visible) tartar is removed with hand scalers.
• More delicate tartar deposits are removed from the gum line with ultrasonic scalers.
• Periodontal pockets are probed and measured to assess periodontal disease.
• The roots are planed, (meaning tartar is scraped from below the gum line) until the roots are smooth.
• The enamel is polished to remove any unevenness left by tartar removal.
• The mouth is disinfected and treated with a fluoride sealer.
• Professional notes are taken on a dental chart, noting abnormalities on each of the dog’s 42 teeth, or the cat’s 30 teeth.
• X-rays are taken of any abnormal teeth.

Below are pictures of a before and after of a typical dental cleaning. An abcess shows up as a black halo around the tooth root in an x-ray, which just goes to show the importance of dental x-rays because we could not see this on a normal dental exam.

It is important to note that a non-anesthetic teeth cleaning, what groomers sometimes offer, is not comparable to the above service. It is impossible to perform a total cleaning on a pet without general anesthesia. Cosmetic cleanings do not address periodontal disease where it occurs; under the gum line.

Related Posts: other posts by Dr Riggs ___________________________________________

Dr. Rex Riggs grew up in Wadsworth, Ohio, near Akron. Dr Riggs is co-owner of Best Friends Veterinary Hospital in Powell, Ohio. He is also on the board of the North Central Region of Canine Companions of Independence, a board member of The Ohio State College of Veterinary Medicine Alumni Society and Small Animal Practitioner Advancement Board at The Ohio State College of Veterinary Medicine. Dr. Riggs lives in Lewis Center with his wife Nancy, their two dogs Boo and Maggie, and two cats Franklin and Speeder. Outside of work, Dr. Riggs is an avid golfer and enjoys travel and photography.

Guest Post: early detection and preventive measures

Today, we have another excellent guest post from Dr. Rex Riggs, owner of Best Friends Veterinary Hospital in Powell, Ohio. He is a veterinarian, and an Advisory Board member of Embrace Pet Insurance.

Dr. Riggs writes about the benefits of early detection of disease and wellness care. Some great advice on what you can do to help your pet's quality of life and even help he or she live longer.

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This year I hit a milestone. The dreaded 50 year mark. I do have to say, it is better then the alternative! Well I guess it is a mile stone in the medical profession also because when I had my annual physical this year, boy did they do a lot more tests and “procedures” on me. I will spare you the details but it got me thinking about the importance of wellness programs for our pets.

As we and our pets age, extra care needs to be taken to ensure that we all remain healthy. Since our pets cannot speak to us and tell us how they are feeling, they often do not show any signs of illness until the illness is advanced and serious.

Remember, the same rule that applies to people applies to your pets: early detection is the key. With wellness testing and exams, many diseases can be identified before they are a serious problem. Early detection and preventive measures is also much less expensive then treating the diseases. We recommend blood work, urinalysis, blood pressure and glaucoma check yearly for animals over 7 years of age (approximately 45-50 “human” years) and for any animals under 7 years where the owner requests. We have to remember that each year in our pets lives equates to approximately 5 to 6 years in our lives. A lot can change in that time.

We can find many early signs of disease on our annual wellness program. The 5 most common abnormalities are diabetes, kidney disease, thyroid disease, hypertension, and glaucoma.

Diabetes
Just like in humans, diabetes is a growing problem in our pets. It is seen much more prevalent in our overweight animals. Diabetes is due to a lack of insulin produced by our body. Insulin is needed to move the sugar from our blood into the cells so they can use it as food. If there is too much sugar in the blood it can cause a number of problems such as cataracts, liver and kidney disease. It is imperative to catch diabetes early to prevent some irreversible injury to these organs. The treatment of diabetes has advanced greatly in animals and can be managed with special insulin and in some cases with cats, with diet.

Chronic kidney disease
This is probably the most common disease we seen in our middle aged to older pets. As the word implies it is a slow chronic illness that can be hard for the owners to detect. The kidneys filter our blood of toxins, so when they don’t work properly, the toxins back up in the blood and can cause damage to a number of organs. If we catch kidney disease early we have a very good chance of delaying the disease processes. The treatment begins with a special diet and we can add medications are needed.

Hypothyroid Disease
Dogs can have hypothyroid disease just like people. Hypothyroidism means too low of thyroid hormone being made by our body. Just like in humans it is normally a disease in middle age to older age. Thyroid hormone helps maintain our metabolism. When the levels are low, dogs tend to gain weight, have a poor hair coat and also be more lethargic. We detect it by a simple blood test and the treatment involves giving a pill of replacement hormone daily. Normally within 2 weeks the animal is back to normal. The treatment is life long but the medication is reasonably priced.

Hyperthyroidism
Cats on the other hand do not get hypothyroidism but hyperthyroidism. They can have a benign mass on their thyroid gland that produces an excess of thyroid hormone. The hyperthyroid cat is a thin, hyperactive cat with a ravenous appetite. The treatment involves either administering medication, surgery or radiation therapy. This is a very rewarding condition to treat because they often return to normal.

Hypertension
This is a condition that the veterinary profession is really starting to take notice. Just like in people hypertension can be a silent disease. It is caused by a number of conditions. The two most common diseases that are associated with increased blood pressure are kidney disease and hyperthyroidism. Taking the blood pressure of our cats and dogs in more difficult then in humans and does require some expertise and special equipment. Treatment of hypertension involves first treating the underlying cause and then using some of the same medication we take for increased blood pressure. This is a condition that requires ongoing monitoring.

Glaucoma
The final condition is glaucoma. Glaucoma is the elevation of pressure in the eye. Often times this is a hereditary problem with certain breeds more affected. Such breeds are the American & English Cocker Spaniel, Basset Hound, Cairn Terrier, Chow Chow, Samoyed, and Siberian Husky. Glaucoma, as well as most diseases of the eye, needs immediate attention once the pressures get in the danger area. Dogs can lose sight in the eye within hours. Treatment involves applying drugs to the eye multiple times daily.

In summary, prevention is much cheaper then treatment and one that's sure to make you both happier in the longrun. Wellness testing is a crucial part in monitoring your pet’s health. Detecting and correcting medical problems as early as possible can prolong the life of your pet and give you many more years of happiness with your best friend.

Related Posts: other posts by Dr Riggs

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Dr. Rex Riggs grew up in Wadsworth, Ohio, near Akron. Dr Riggs is co-owner of Best Friends Veterinary Hospital in Powell, Ohio. He is also on the board of the North Central Region of Canine Companions of Independence, a board member of The Ohio State College of Veterinary Medicine Alumni Society and Small Animal Practitioner Advancement Board at The Ohio State College of Veterinary Medicine. Dr. Riggs lives in Lewis Center with his wife Nancy, their two dogs Boo and Maggie, and two cats Franklin and Speeder. Outside of work, Dr. Riggs is an avid golfer and enjoys travel and photography.

Claim story: Squiggy the cat hit by a car, $12,170+ claim

I wanted to share with you the story of Squiggy the mixed breed cat who was hit by a car in September 2009. The words below are from Tracy, Squiggy's owner, who describes what happened:

We adopted squiggy from a shelter when he was 2 months old. He acted more like a puppy than a kitten. Likes to play fetch, hide and surprise you!!

The accident happened on 9/14/09 There was a knock at the door, a woman said she'd hit my cat and believed she had broken his leg, said sorry and promptly left. I found Squiggy in the bushes where he had dragged himself, could not get that image out of my head when I closed my eyes for weeks. It took 15 mins to get to the ER ( longest car ride ever) at which time he had already gone into shock and his breathing very labored.

The preliminary vet exam showed multible fractures & breaks. His back was broken in two places. He was bleeding internally. Initially we were told he'd be paralized with no neurologic function as they couldn't get any pulses in his lower extremities. They stabalized his breathing and were able to get faint pulses back. He was put on pain medication, made comfortable overnight.

Next day we saw Squiggy, he licked my hand and looked at me and I knew I had to do all I could to save him. He was operated on shortly after we saw him. The neurosurgeon told me it would be a long road to recovery with pins in his toes,leg & pelvis on one side of his body and no bowel or bladder function. We would not know if that would return for weeks or if he'd walk. He fought hard to get through this horrible ordeal.

Nine weeks later he's not only walking & climbing up on the bed, bowel & bladder function have returned. We hope Squiggy will be with us for a lot of years to come. He has of course used up about 7 of his 9 lives!!!! 

I was very distraught when Squiggy was injured and every person I spoke to at Embrace treated me like family with kind words of encouragement and lots of help submitting my claim. The claim was processed quickly. Thanks Embrace, you helped us to save Squiggy's life. 

Sadly, we got this update just 4 days later.

Unfortunately my story doesn't have a happy ending. Squiggy had a bladder infection that couldn't be controlled. He went from great one minute almost dead the next. He spent the last two weeks in the hospital where I thought he should stay till the infection was gone but no amount of medicine could fix him. I really thought if he stayed in the hospital he'd get better I'm heartbroken! I took him home and put a christmas collar on him wraped him in a christmas blanket and buryed him in a spot under the bay window in front of our house where he loved to hang out and watch the world go by. Thanks for everything.

Tracy's coverage included an annual maximum of $10,000, which Squiggy needed in totality.

RIP brave Squiggy.

Accident Month - Rocket uses two of her nine lives in a month Part 2

Continuing yesterday's post on Rocket's accidental "adventures", here's Accident #2.

[Just so you know in advance, no kittens were harmed in the making of this story.]

Last Monday night, I was multi-tasking the laundry downstairs with some blogging and email catch up in my office upstairs. It was about 11:30pm.

You know the routine: buzzer goes, run downstairs, fold prior load of laundry, pull next load from washer to dryer, put in next washer load, press go, run back upstairs again... repeat 5 times (kiddy laundry does go on and on and on...)

So, all this runnning up and down stairs gets the kittens all in a quiver. What is this very exciting activity and how can we get into mischief in it? And so they bound up and down the stairs, boing in and out of every laundry basket, and chase every sock thrown into the laundry hamper. Such an adventure!

And Rocket keeps jumping in the dryer. Why not? It's warm and cozy and seems like a very good idea to a 4 month old kitten. 

Every time she'd do it, I'd have horrors of a tumbling kitten while I pulled her out and put her across the laundry room. But she'd soon be back in as I continued folding the laundry. So I pull her out for the last time after the last piece of clothing was done, then I put the clothes from the washer into the dryer, closed the door and switched the dryer on.

[Remember, no kittens were harmed in the making of this story - just in case you were getting anxious.]

So, as I was loading the washer with yet more laundry, I couldn't help notice the clunking in the dryer. What is that noise? Did I wash one of the girls' shoes by mistake? I finished loading the laundry, put in the detergent, started the laundry and that noise kept bonking and clunking.

[no kittens were hurt in this story - just remember that]

So I opened the door to see what was going on and my heart literally stopped - Rocket rocketed out from under the towels "me-elping" (no other word to describe it). I'll never forget it.

I was rooted to the spot. I felt ill. My life rushed before my eyes. I ran after her.

By the time I caught up with a very frightened kitten, her heart was beating out of her chest, her face was so afraid. I picked her up and her breathing slowed down and the purring began. I felt so awful; what had I done? How could I have been so careless? How could I not have realized immediately what had happened? (I still don't know how she got back in - must have been when I reached into the washer to pull out the last sock.)

Rocket tumbled around in the dryer for at least 10 seconds. FOR AT LEAST 10 SECONDS :(

Miraculously, Rocket is fine. She was lining up for food with Rosie when I put her down just a few minutes later as if nothing had happened. I do marvel at the elasticity of kittens (but do not test this at home - take my word for it).

Boy oh boy though, I'll be locking the kittens up early when I do laundry next time. An angel was watching over Rocket that day; there's no guarantees she'll be there next time around.

So Rocket, please don't give me any cause for Part 3 of this series. We love you in one piece with no broken bits. No more kitty adventures. We like a quiet life.

Accident Month at Embrace - literally. I think January is going to be Wellness Month...

Guest Post: Three Surprising, and Even Excruciating, Dog Accidents

Today, we have a guest post from Dr. Rex Riggs, owner of Best Friends Veterinary Hospital in Powell, Ohio. He is a veterinarian, and an Advisory Board member of Embrace Pet Insurance. Dr. Riggs writes about orthopedic issues from a small animal practioner's perspective.

Dr. Riggs writes about three dog accidents he's seen in his clinic - from the unexpected to the excruciating. Don't worry though - all the dogs survive thanks to their excellent veterinary care.

Beware! These stories are not for the faint of heart. And whatever you do, do not look at the pictures at the bottom too closely if you are squeamish (really!) Don't say I didn't warn you.
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Dogs will do crazy things. They are unpredictable and just when you are sure they can’t hurt themselves, they will surely surprise you. I have included three such surprising events.

1. Surprise! Puppies really can eat - just not what you'd expect...

A lady with her small four year old daughter came in with their rambunctious 16 week old Golden Retriever puppy. The puppy seemed happy to be at the vet as he was running around inspecting all the corners of the exam room.

The little girl though had a concerned look on her face. I asked her why she brought her little puppy in to see me. She said that her puppy, Sadie, had just eaten one of her daddy’s golf balls. Being an avid golfer, I just happened to have a golf ball in my office (you have to practice your putting!). I showed the ball to the little girl and explained that Sadie was unable to swallow a ball that size. She insisted that she saw her do it. So to prove to her that her dog would be fine I decided to take an X-ray.

I was right. Sadie had not swallowed a golf ball… she had swallowed three golf balls! Just imagine swallowing one ball and thinking it was such a great idea that you would swallow 2 more! I showed the X-ray to Mom and $1800 later, I presented her with her husband’s three PINK golf balls.

2. A Family Dog Fight Turns Into Major Plastic Surgery for a Little Pug

Madison is an adorable little pug that has been visiting our practice for years. She is gentle little soul that would not hurt a fly. Unfortunately for her, her mom’s boyfriend’s Husky was not as congenial. Madison was attacked and had several bite wounds on her body.

Madison presented to us bloody and in shock. We admitted her and aggressively treated her shocky condition and she was hospitalized with us for a number of days. She was sent home on antibiotics and some good pain medication.

On the recheck exam though, I saw that Madison’s skin was so damaged that it was dying and sloughing off. She had lost about 50 % of her skin on her right leg and neck. Since she did not have enough skin to suture together the conventional way, we had to do a plastic surgical procedure called a rotating pedicle flap. This involved moving the skin from her belly, including the mammary glands, and rotating that skin around, while maintaining a good blood supply, and suturing it in to place.

This is a delicate long surgery but it was successful and Madison looks great today after the $3700 treatment. The only difference now is that she has two nipples on her knee!

[if you are interested, I have posted pictures of the procedure down below - don't look though if you faint at the sight of blood]

3. What Can Happen Throwing a Stick for Fun - Nothing Fun At All For Dolly the Lab Mix

Probably the strangest and most unusual accident happened with Dolly, a lab mix. Dolly is a happy fun loving dog who lives to chase balls and sticks. She would do this for hours upon hours with her owner, Sally.

On this particular day, Sally was throwing a 3 foot long stick. Dolly eagerly would run after the stick and retrieve and wait to chase it again. Sally launched the stick and Dolly happily took chase. Dolly put her head down to get the stick and froze. Sally called her and Dolly would not move.

Sally ran up to her but the stick was nowhere to be found. She tried to lift Dolly’s head when she noticed the tip of the stick in her mouth. The stick had landed on end and Dolly had impaled the stick down her throat.

Sally rushed her in to see us and when they arrived, Dolly was very calm, wagging her tail for me. We sedated her and realized that the stick had traveled down her esophagus, exited at the level of the shoulder traveled under the shoulder blade and ended outside of the ribs.

It was a dicey surgery but we were able to removed the stick with remarkably little trauma to the esophagus. A couple of weeks after the $2500 surgery, Dolly was again out running after…..a ball. Never again a stick.

Related Posts: other posts by Dr Riggs
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Perhaps a few lessons learned from these? I think so!

Dr. Rex Riggs grew up in Wadsworth, Ohio, near Akron. Dr Riggs is co-owner of Best Friends Veterinary Hospital in Powell, Ohio. He is also on the board of the North Central Region of Canine Companions of Independence, a board member of The Ohio State College of Veterinary Medicine Alumni Society and Small Animal Practitioner Advancement Board at The Ohio State College of Veterinary Medicine. Dr. Riggs lives in Lewis Center with his wife Nancy, their two dogs Boo and Maggie, and two cats Franklin and Speeder. Outside of work, Dr. Riggs is an avid golfer and enjoys travel and photography.

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Q&A: issues with an amputated toe in a dog

One of my more popular posts is on the topic of toe amputations in dogs and cats.

Recently, one of my readers, Heather Z, posted a question about her lab's post-surgical toe issues that I thought was worth separating out as its own post.

Hi. We have a 111 lb black lab and just had his third (III) toe removed on the front right paw in the middle of October. He still walks with a limp and holds it up when he stands. We keep it wrapped in a sock with a cone on his head all day every day because he wants to lick it. When he goes out, we wrap it to keep it dry.

He has been on antibiotics and about the 2nd week it started to pus and the swelling of his fourth (IV) toe was still huge and didn't go away. Brough him in and they upped his antibiotic. Nothing was said if it was infected but that's what I think. We also put a drying solution mixed with water on it twice a day and blow dry it as recommended.

I'm just worried that something else could be wrong with swelling not going down still going on a month. It is a pain. I think we did the right thing but its just hard seeing him like this and there's no improvement with the swelling! Anybody know of this?

I passed the question on to Dr. Heather Carleton, one of Embrace's veterinary advisors and this is what she had to say in response:

My question would be why was it initailly amputated? Was is broken, arthritic, had a tumor, etc? If it was amputated because of a tumor, I would be concerned that there is recurrence. If not, I would have the foot x-rayed and make sure there is no bony involvement with the infection (i.e. with the bone above the ampuatation site). If there is, the area may need to be debrided. If it is just soft tissue that is infected, antibiotics should take care of it.

Heather Z's got back to me with an answer for Dr. Carleton:

We had it amputated because it had a hard tumor growing connected to the bone. We had it sent into the lab and it is benign. He has been on cephalaxin and ciprofloxacin, which did not work, and now we went to clindamycin. I took him in last Thursday and had the desolvable stitches they left in taken out. I started to cut them out and they took the rest out. Our vet says it should clear up and to call and talk to him Monday. Well, that is tomorrow and it is still swollen. He said the next thing will do is move up to a more expensive antibiotic that costs $100 bucks or so.

This is still really frustrating because it is not getting that much better and he still limps. I hope this next option he has in mind works or else the next move will be going somewhere else and getting a second opinion and probably an x-ray and possible debridement as you suggested.

Here's an update from Heather Z.

When I brought him in last Wednesday, the vet thought he was doing much better now that the desolveable stitches had been romoved and the swelling around the scar tissue started to heal better. I just don't get why they left them in there. I heard from other people that desolveable stitches can cause inflammation. I also think when they wrapped his foot postoperately with the sticky wrap they did it too tight and was supposed to remain that way for 7 days. I also talked to other people and they said that they rewrap and change around the 3rd day.

The vet said he looked like he was healing well and the inflammation of his big toe should not be a concern because it is part of his healing process. He is moving around better and the outside toe looks almost back to normal size but the middle toe is still very swollen but may have improved a tad since suture removal. I am supposed to check back with him in two weeks and keep giving him his clindomycin 4 pills twice/day.

So, somewhat better but he still has to have a cone on his head when we are gone and something on his foot so he doesn't lick it like mad. I left the house for an hour and he somehow pulled it off and yanked his booty off and was licking it till it bled. Uh. But that is how it is going so far. It is now one month and 1 day. Buddy is a crazy licker anyway and is always grooming. I just hope things start getting better faster!

Have you found yourself in this situation? Let us know what happened in the comments...

Related Posts:
Toe amputations for cats and dogs

Patellar Luxation Surgery: Destino, A Chihuahua Mix with Bilateral Luxating Patellas

You might not have imagined that jumping off the couch for a little dog could be the start of big knee issues but poor Destino was destined for 2 major knee surgeries before he reached the age of 4.

Patellar luxation is a slipping knee (the patella) that can move out of position too easily. It's measured in grades (grade 1 being the least problem, grad 4 being the worst) and is treated with pain medication in less severe cases and corrected with surgery for the higher grades. 

After Destino jumped off the couch one day, he started to limp a little and after a veterinary exam, his owners discovered he had a 3.5 grade out of 4 patellar luxation in his left knee as well as a grade 2 of 4 patellar luxation in the right knee. His pet parents had no idea.

Destino had two surgeries over 2 years and is now back to his old self.

Here's an example of the costs associated with the most recent surgery on the right knee performed in Parkland, Florida in January 2009.

ITEM	BILLED AMOUNT
Baytril 68mg Qty 7	$ 21.70
Clavamox 125mg Qty 14	$ 16.80
Tramadol 50mg  Qty 21	$ 21.00
Metacam 10ml	$ 26.50
CBC	$ 43.00
General Health Profile IH	$ 84.00
Electrocardiogram Pre-Anesthetic	$ 60.00
IV Catheter	$ 45.00
Fluid Intravenous per Day	$ 38.00
Infusion Pump daily	$    5.00
Anesthesia General	$   105.00
Anesthesia 1/2 hr	$ 50.00
Anesthesia Electronic Monitoring	$ 28.00
Buprinex Inj x4	$   108.00
Baytril Inj	$ 37.00
Hospitalization per night	$ 40.70
Daily Dr. Exam	$ 21.40
Metacam Inj	$ 36.00
Infectious Control Fee	$    5.00
E-Collar	$ 19.50
Surgery	$    1,100.00
	$    1,911.60

Destino's refund check was $1,463.04 after a $200 deductible and 10% copay (the Prescription Drugs & Dental Illness add-on was not chosen for Destino's policy) for a monthly premium of $24.76.

Related posts:
Guest post: A General Discussion of Orthopedic Issues in Dogs
Guest Post: Four Most Common Orthopedic Problems in Dogs
Top 10 ways to prevent orthopedic issues in dogs
How much did you say patella luxation cost to treat in my dog?