Second Opinion? Paw Injury

Diseases, proactive care, geriatric issues, etc.

Moderator: Moderator Pack

Second Opinion? Paw Injury

Postby Quill Gordon » Fri Sep 26, 2014 11:34 am

My boy Creek received a puncture wound Sept. 17 to his front left paw. I pulled out a wood splinter & thought he would be fine. He was not. When we arrived home his paw swelled to twice the size & was limping so I ran him to the vet. Anti-biotics & steroid shot was administered. The next morning the paw still swollen with pus discharge so I took'em back in. They knocked him out to explore and flush the wound they also performed an x-ray. They found nothing inside the wound and over the course of last weekend the swelling went down. I noticed a dark spot next to the puncture wound slightly larger than a pea a day after they explored the wound. This dark spot ended up being dying skin or necrotic tissue & has left a small hole in his paw. He also still has the same amount of swelling he did as of last weekend. Big toe twice the size of the others with a yellow mark on the top inside side of the toe. Anyways the necrotic tissue hasn't changed and the swelling hasn't changed. So I went back to the vet yesterday they said at this point it's kind of a watch and see if any other abscess forms but did put him on a stronger anti-biotic which he started last night.They also want to leave the necrotic tissue in place to protect new tissue to form. There is no festering & Creek walks on it fine but I'm getting frustrated & thinking of getting a second opinion as I'm not really fond of these two vets I've been seeing. One of them is "Oh yeah he's doing great" and the other is "Boy, I dunno this is really weird & I'm afraid there is something more going on." The old vet who used to run the place has now passed.

What ya think am I a impatient SOB or should I go with the hunch of it's time to find somebody else?
Quill Gordon
 

Re: Second Opinion? Paw Injury

Postby Misskiwi67 » Fri Sep 26, 2014 11:53 am

Get a culture of the wound done. Thorns and dirt can have some wierd bacteria in them and sometimes you need more than one antibiotic, or one you wouldn't use as first or second voice.

Once you have culture results, give it 2 weeks of rest, appropriate antibiotics and Epsom salt soaks to let the body do it's thing - UNLESS it is clearly worse. There may be a bit of thorn still stuck in there that needs to work it's way out.

If this doesn't work, instead of blindly searching, go get a CT scan. This will help the surgeon identify if and where any foreign material may be. I've done multiple explores on feet before and have learned to just go straight to CT instead of mucking around several times first. If your vet didn't find anything the first go round, he's not likely to be more successful the 2nd or 3rd look.
Vivian II vom Jagdkonig- VJP 71 HZP 191 VGP 262 Prize III
Arabella vom Hoheren Boden- VJP 74 HZP 181/189 VGP 281 Prize I
User avatar
Misskiwi67
Champion Poster
Champion Poster
 
Posts: 1808
Joined: Tue Sep 03, 2013 4:04 pm
Location: Iowa

Re: Second Opinion? Paw Injury

Postby Quill Gordon » Fri Sep 26, 2014 6:31 pm

Thank you for the reply. I had no idea about using a culture test to identify the bacteria but it makes sense. The CT scan I did know about. How good is the CT scan at pin pointing wood splinters? Is there still a chance a CT will miss a foreign object? The antibiotic he is on now is Antirobe/clindamycin 150 mg twice a day. Two pills so far no improvement. He is also taking Rimadyl 75mg also twice a day. He is walking and running around the house with no sign of lameness. You would never know he is injured if it wasn't for the swollen toe and hole in the bottom of his pad. Just came runnin downstairs chasing our Dachshund...

Image
Quill Gordon
 

Re: Second Opinion? Paw Injury

Postby Misskiwi67 » Fri Sep 26, 2014 8:28 pm

CT is the absolute best for identifying things like wood in tissues. There's some things CT is not good at, but this is one of the things it excels at.

Clindamycin is a good antibiotic for deep tissues and abscesses. The lack of swelling and discomfort is a good thing. It takes time to process dead and damaged tissues, I'd really give it at least 7-10 days before you decide there's no progress.

If there is drainage, get it cultured. Culture takes 2-3 days to get results so the sooner you get it done the sooner you get results. Even if nothing grows or you find out the antibiotic you are using is a good choice, at least then you have the peace of mind that you are on the right track. We do our own cultures in my clinic so we can charge less, and we do a lot of them. It's almost always worth doing. I'd expect a send-out culture to run around $125 so it's not usually the first step for a lot of vets.
Vivian II vom Jagdkonig- VJP 71 HZP 191 VGP 262 Prize III
Arabella vom Hoheren Boden- VJP 74 HZP 181/189 VGP 281 Prize I
User avatar
Misskiwi67
Champion Poster
Champion Poster
 
Posts: 1808
Joined: Tue Sep 03, 2013 4:04 pm
Location: Iowa

Re: Second Opinion? Paw Injury

Postby Quill Gordon » Fri Sep 26, 2014 9:13 pm

Yah, that's the prob I see no drainage. The hole with necrotic tissue seems separate from the swelling in the toe and the original puncture wound has closed over. Is it still possible to get a culture?
Quill Gordon
 

Re: Second Opinion? Paw Injury

Postby Misskiwi67 » Fri Sep 26, 2014 9:30 pm

Sure, stick a needle in the area with the necrotic tissue and see if you get fluid, or culture the surface.

If there is no drainage, I'm a lot less concerned until enough time has passed to prove it's not healing (2+ weeks).
Vivian II vom Jagdkonig- VJP 71 HZP 191 VGP 262 Prize III
Arabella vom Hoheren Boden- VJP 74 HZP 181/189 VGP 281 Prize I
User avatar
Misskiwi67
Champion Poster
Champion Poster
 
Posts: 1808
Joined: Tue Sep 03, 2013 4:04 pm
Location: Iowa

Re: Second Opinion? Paw Injury

Postby Coveyrise64 » Fri Sep 26, 2014 9:40 pm

Had a run in with locust thorns earlier this year. Epsom salts soakings and antibiotic but couldn't get it to drain, ended up lancing it..... :(

Image

cr
VC TJ's Highfalutin Hawkeye MH, UTI

VC TJ's Miss Filson MH, UTI R.I.P. 5/13/03-10/15/14

Thunderhead's All Jacked Up R.I.P. "My Buddy" 9/9/09-1/27/14

"I'd rather train for perfection than fix the problems of mediocrity" ~ Me

"There are always going to be those who prefer to freeze in the dark rather than put forth the effort to light a fire." ~ Lvrdg07
User avatar
Coveyrise64
Champion Poster
Champion Poster
 
Posts: 595
Joined: Sat Apr 10, 2004 10:49 pm
Location: Oklahoma

Re: Second Opinion? Paw Injury

Postby Quill Gordon » Fri Sep 26, 2014 9:43 pm

Misskiwi67
Very good & I thank you for the education. In the meantime I'll see if I can get a decent pic of his paw and post it up. I think u have proved I am indeed an impatient SOB ;)
Quill Gordon
 

Re: Second Opinion? Paw Injury

Postby Quill Gordon » Fri Sep 26, 2014 9:55 pm

Covey rise I had similar experience many yrs back when sneaking up on a flock of Mallards. I kneeled on a Russian Olive thorn. Long story short I barely made it back to my truck with my knee about the size of a football. Got home soaked the knee and luckily the thorn came right out. Nasty thorns for sure. Thanks for your reply...
Quill Gordon
 

Re: Second Opinion? Paw Injury

Postby Quill Gordon » Sat Sep 27, 2014 8:27 am

Pics this morning after Epsom salt soak

Image

Image

Image
Quill Gordon
 

Re: Second Opinion? Paw Injury

Postby Misskiwi67 » Sat Sep 27, 2014 8:40 am

Is he licking at the paw at all?
Vivian II vom Jagdkonig- VJP 71 HZP 191 VGP 262 Prize III
Arabella vom Hoheren Boden- VJP 74 HZP 181/189 VGP 281 Prize I
User avatar
Misskiwi67
Champion Poster
Champion Poster
 
Posts: 1808
Joined: Tue Sep 03, 2013 4:04 pm
Location: Iowa

Re: Second Opinion? Paw Injury

Postby Quill Gordon » Sat Sep 27, 2014 8:49 am

Yes, but not often... I try to clean it after he does but I'm not with him the entire day...
Quill Gordon
 

Re: Second Opinion? Paw Injury

Postby Misskiwi67 » Sat Sep 27, 2014 9:00 am

Put a cone on him when you aren't home, he's probably licking more than you realize. Licking will increase the inflammation and slow healing. You want that paw clean, dry, and untouched except during the epsom salt soaks.

I thought it looked like he'd been licking, but wasn't sure if it was because the vet shaved and you just finished a soak.

Overall it doesn't look too bad. Give it a week, absolutely ZERO licking, and let us know how its going.
Vivian II vom Jagdkonig- VJP 71 HZP 191 VGP 262 Prize III
Arabella vom Hoheren Boden- VJP 74 HZP 181/189 VGP 281 Prize I
User avatar
Misskiwi67
Champion Poster
Champion Poster
 
Posts: 1808
Joined: Tue Sep 03, 2013 4:04 pm
Location: Iowa

Re: Second Opinion? Paw Injury

Postby Quill Gordon » Sat Sep 27, 2014 9:09 am

Ya I think the soak made the paw appear redder than usual in the pics but he is licking it right now... I just so happen to have a cone from a previous injury so will use it.

Great advice, thank you again...
Quill Gordon
 

Re: Second Opinion? Paw Injury

Postby lanco » Sun Sep 28, 2014 4:29 am

I had a bunch of these with my dog over the years and have treated plenty for other folks. 90% of the time just lancing them and flushing them solves it. Here I think you are going to have to have someone lance the top on that. It's too swollen to be residual cellulitis or irritation from licking. It could be that there is retained foreign material or it could just be that the most distal part of the original wound track didn't get adequate drainage and resealed forming a new nidus of infection. We did this with Ava 3 years ago and I wound up taking her to surgery (I had initially just lanced it at home) and opening up a track clean through her foot before I got all the bad out. Many of these foot injuries are anaerobic infections so once they are properly lanced ( in such a way that they can't re-seal prematurely, I actually cut an oval of skin out at the lancing site to make sure the skin heals last) the problem is mostly solved. Antibiotics don't work in dead tissue (clindamycin and metronidazole can in small amounts of devitalized tissue) so this isn't necessarily a resistance issue, but at this point culture won't hurt. A CT could be useful but being a "cut to cure" kinda vet, I might just pack my beastie up and find a board certified surgeon to treat the injury. Really it looks as though it's about to rupture spontaneously but at this point a sedated looksee by a bold and confident surgeon would be a good thing. If you happen to feel like driving to LA bring him by tomorrow night, I love these kinds of injuries (although its slightly less fun surgery when it's my dog :Fade-color ). Keep us posted
lanco
Champion Poster
Champion Poster
 
Posts: 869
Joined: Fri Jun 25, 2010 4:41 am

Next

Return to Healthcare

Who is online

Users browsing this forum: No registered users and 8 guests