Neyla's Toe

[NeylasMom]

So we saw Dr. Canapp on Friday. He is AWESOME (btw Meredith, you neglected to mention that he's also quite handsome - too bad he's already married!). Anyway, he felt that based on Neyla's x-ray she has some bone deterioration in the P-1 part of her toe likely due to a fungal or bacterial infection, which would also be causing the nail to grow in damaged and then fall off. Unfortunately he said the only way to determine what's causing it is to get in there. Treating with antibiotics doesn't otherwise make sense since we wouldn't know which one to use, and he feels anti-fungals are risky in greyhounds b/c of their side effects unless you're sure that's what you're dealing with. He also pointed out that the bone really doesn't have much padding around it at the tip, so it seems to actually be pressing against her skin (there are some places that are red and hard and that made me think maybe she had gotten glass in her foot). This made total sense for me and really cleared that issue up. It's amazing what a specialist can see that a regular vet can't, isn't it?

 

Anyway, so Dr. Canapp basically gave me two choices: remove the P-1, which he described as basically an outpatient procedure, or wait and see. I ended up scheduling a recheck for 3 months from now, at which point we'll redo x-rays with the understanding that I would think it over and let him know if I wanted to just go ahead with the amputation or would contact him if things got worse.

 

So at this point, I've decided to give myself at least a week or two to mull things over. Want to see how she's doing, and also get your opinions and those of some other more experienced friends and let it all sink in. Then I'll go back to Dr. Canapp with some questions and give myself another couple of weeks before reaching any sort of decision. Right now, some things I'm mulling over:

 

- If the toe is infected (bacterial or fungal) is there any risk of it spreading to the P-2?

- If the bone is pressing against the skin, is there any chance the pain can lessen from that (I don't see how)?

- Dr. Canapp also felt there was a corn somewhere in that pad that is what we were seeing (it's now gone) and would resurface. If you buy into the friction argument for corn development, it's quite feasible that the corn is developing b/c of her odd gait, or just the odd shape of her toe from the underlying issue, so amputating might also relieve the corn problem, at least to some extent?

 

In all honesty, I am not one to just put my dog under the knife so to speak. And I recognize that although Dr. Canapp describes this as an outpatient procedure and that he could probably do it with his eyes closed, it's STILL surgery, and Neyla has a history of reacting poorly to anesthesia, making it even more risky. Having said all of that, I don't see how her pain is going to improve. There is also the small concern that someone with a similar issue brought to my attention - if things do improve or seem manageable and we don't do the amputation, and somewhere down the road Neyla (god forbid) develops osteo and has another leg amputated, then we no longer have the option to deal with this toe if the pain returns.

 

So that's where I'm at. I'm really hoping that amputation isn't the necessary solution, but am allowing for the possibility that it may be the best thing in the end. I would really appreciate any input, especially from those of you who have been following along this whole time. ETA: In particular, suggestions for any additional questions I should ask Dr. Canapp when I call him back would be appreciated. Want to do that by tomorrow I think so I can hear back before the weekend.

 

Thanks,

Jen

Edited September 5, 2007 by NeylasMom

[Greytlady94]

From what you have said I would probably go ahead and have the toe removed. She will do fine without it. You can make him aware of your fears about anesthesia.

[turbotaina]

Yeah, he is a hottie. Did you find yourself staring at him dreamily?

 

Well, I can say that if it were my dog, I'd likely go ahead and amputate. I would imagine that a bone infection could spread if it were left long enough. I'm sure you know what anesthesia it was to which Neyla reacted poorly, so just provide that info to Dr. C and I'm sure he'd find other options for you.

 

Specialists are worth their weight in gold.

 

 

[Tallgreydogmom]

I feel it is best to amputate a problem toe. We have had it done a couple of times. It gets rid of the problem before it spreads. If there is a problem I like to jump on it. Not wait two weeks and re-check it. It might have gotten more involved by then. For the cost of another set of x-rays I could have put that money into the surgery.

[lothianjavert]

I think at this point, I'd probably go for amputation. If it were going to improve, it would have. It sounds as if even if they figure out whether there's a bacterial or fungal issue, even after treatment of that, she would still be in pain/lame because of the bone against the skin. I can't see the latter (bone against skin) improving, and I'm sure that really hurts.

[Chicocat]

If it were my dog I would not hesitate to amputate. When the whole toe is amputated the recovery time is very quick.

[NeylasMom]

FYI, we're not talking about amputating the entire toe, just the P-1 (the very tip, where the nail grows). This is a weight-bearing toe and Dr. Canapp felt very strongly that amputating the whole toe is a whole different ballgame in terms of how that would affect her ability to run/play and overall health, and most importantly not necessary.

[turbotaina]

I've seen lots of dogs with weight-bearing toes completely amputated with no adverse effects. Deanna's girl Carrie is missing a toe (was amputated when she was 8 and she's now 11) and she runs with the best of them. Yes, there are special considerations, but by and large, I think most dogs do OK without them.

 

At any rate, if Dr. Canapp doesn't feel that it's necessary to amputate the whole toe to give her relief, then amputation of the first bit should be OK - I do trust his judgement.

Edited September 5, 2007 by turbotaina

[Lilysmom]

Jenn, you should talk to Deanna (dmswartzfager) about it. Carrie had one of her toes removed and you'd never know it!

 

Good Luck!

 

Karen

[Guest metgirl23]

Did your vet mention SLO( I cant remember the formal name).. Its a nail problem that seems to strike Greyhounds.. I think Susan Stack website has some info on there. too THere is a SLO yahoo group you can check out.. Not a lot of vets have seen it and it can be mistaken for Fungal infections.. Generally it can be in only one toe or many .

I have a friend with as Schnauzer that was just diagnoised( after they ruled out other stuff). I Know there have been a bunch of posts on here too about SLO..

Best of luck.. Amputations are hard.. If they dont have to amputate the whole toe then its a lot better. My dog that had to have a whole back toe removed took forever to heal due to not a lot of skin cover the bone and a undignoised thryoid problem.

 

 

 

[NeylasMom]

Did your vet mention SLO( I cant remember the formal name).. Its a nail problem that seems to strike Greyhounds.. I think Susan Stack website has some info on there. too THere is a SLO yahoo group you can check out.. Not a lot of vets have seen it and it can be mistaken for Fungal infections.. Generally it can be in only one toe or many .

toe removed took forever to heal due to not a lot of skin cover the bone and a undignoised thryoid problem.

 

I am familiar with it, and have read Dr. Stack's article. I didn't think this fit the bill, but I'll make sure to ask Dr. Canapp when I call back. We certainly didn't discuss it. Thanks!

[dmswartzfager]

Jenn, you should talk to Deanna (dmswartzfager) about it. Carrie had one of her toes removed and you'd never know it!

 

Good Luck!

 

Karen

 

Unfortunately, she is starting to show some effects, but the entire weight-bearing digit (right rear paw) is missing, and the outside toe has tweaked itself over into the middle. She still runs great, with ease and no hesitation, walks okay, but you can see that she's stiff when she gets up and she then limps on that leg for a few strides. This is a recent development. Dr. Patty watched her walk, and when I was standing there with her while DH took her for a walk through the parking lot, I could see it too - she's rolling that paw in to compensate for the missing toe, and that's throwing her hip out of whack, thus leading to the stiffness and unwillingness to sphynx to eat her RMB's as she usually does.

 

On the other hand, she IS 11 years old. Dr. Patty says she's surprised that's the only thing bothering her, and she'd be slightly worried if Carrie wasn't showing some signs of age!

 

If you can maintain some weight-bearing function and normal shape to the foot, absolutely do it.

[inugrey]

FYI, we're not talking about amputating the entire toe, just the P-1 (the very tip, where the nail grows). This is a weight-bearing toe and Dr. Canapp felt very strongly that amputating the whole toe is a whole different ballgame in terms of how that would affect her ability to run/play and overall health, and most importantly not necessary.

 

So my question on this would be, will the end of her toe develop a callous? I mean since she's only going to lose a small portion of the toe wouldn't it still hit the ground during walks? especially rougher terrain?

 

Good luck on the decision I have no comments on whether to amputate or not just those random questions.

[NeylasMom]

So I sent my list of questions off to Dr. Canapp a week and a half ago (two Thursday ago to be exact) and finally heard back from him on Sunday. I'm irritated to say the least with how long it took him to get back to me and the succinctness of his email response once he finally did, so I will probably try reaching him by phone to follow-up one final time, but here's what his email said:

 

All of your thoughts regarding performing the amputation sooner then later make sense. As for your concerns regarding complications I can tell you we use a very strict protocol for sight hounds and have never had a reaction. The only concern I have regarding this procedure would be the risk of dehiscence (the incision opening up). The chance of this is very low (less than 5%) however, the area around the toe has an increased risk of infection and stress to the surgical site due to the fact that they walk immediately post-op. Therefore, we will use extended antibiotics and keep a splint on post-op to protect the incision.

 

Now that we're here, I'm thinking about taking her to Dr. Radcliffe for a new x-ray and one final opinion. He did tell me to see him before I let anyone chop off Neyla's toe. The problem is, I don't have any time! I could maybe manage a visit with him next Saturday (the 29th) and I suppose I could start the process of scheduling the surgery with Dr. Canapp in the interim and cancel if I decide not to go through with it. It's just more and more time and Neyla has really been dragging on walks lately. I guess maybe I should also try giving her some Tramadol again. I hate to use those types of meds though. We had to stop the Rimadyl b/c she was getting bruises all over.

 

My vet also does acupuncture - I think I should talk to her about that as a possible way to manage Neyla's pain until we do the surgery or otherwise resolve the problem. For those of you who have used it, does that seem like a reasonable idea, or is it more effective for muscle injuries, etc.?

 

Are we really at this point???

[turbotaina]

Well, seeing as how it would probably be DECEMBER by the time you could get into Dr. Canapp for surgery ( ), Radcliffe wouldn't be a bad idea. I'd go ahead and call to schedule with Canapp and just get an idea about how far out it would be and then go from there.

 

[NeylasMom]

Another minor update: my vet had suggested on Saturday that we go ahead and try a course of broad-spectrum antibiotics in case it is bacterial. Obviously that wouldn't resolve the bone issue, but at this point we don't know what's causing her the most pain so it makes sense to me to do what she suggested and just see. I ran it by Lisa, who ran it by Dr. Canapp and he was at least okay with it, so we're going to try a course of Clavamox. They think I should notice a difference in 2 weeks or so, although it would take 4-6 weeks to see improvement on the x-ray, so we'll start her on them and play it by ear. In the meantime, I guess I'm going to schedule the surgery for about 6 weeks out - she'll have to be off of the antibiotics 2 weeks prior to the surgery so that we can biopsy the toe properly once removed.

 

This does mean in the meantime though no Tramadol or acupuncture as we need to be able to evaluate whether the antibiotics are doing anything. So no real sense of relief and while I'm happy to postpone the surgery, it means Neyla doesn't get relief for that much longer.

 

Does anyone have other suggestions for things I may not be thinking of? I'm starting to realize that these vets, as knowledgeable and even as dedicated as they are, are much like many doctors in that they often go directly to one of a few solutions they know rather than really thinking through the situation and evaluating all of the options. With multiple vets at least I'm getting different ideas to bounce off of them, but I still feel like no one's completely invested in figuring out the best solution - it's just chop it off, or wait and see. So I am open to and appreciate any and all suggestions.

 

In the meantime, fingers crossed that the antibiotics actually do something!

 

Oh, I asked for a ballpark figure on the surgery, just to brighten my Monday a bit more - $1200-1500! I figured it would be up there, but actually hearing it...

[Chicocat]

$1200-1500 for a toe amputation???? WOW Did you talk to Dr. Radcliffe?

 

[Tallgreydogmom]

I can get a leg amputated for that.

[turbotaina]

Oh, I asked for a ballpark figure on the surgery, just to brighten my Monday a bit more - $1200-1500! I figured it would be up there, but actually hearing it...

 

Yeah...That's what Toffee's was - took us totally by surprise because they quoted us $600. But I think the whoever quoted it to B. didn't take into consideration CBC, x-rays, antibiotics, etc. *sigh* Came up to $1k after our discount and I know there's at least one mistake on the bill, so it could go down a little more, but yup, for a vet who is giving the best possible care in our area yeah, I can see $1200. Radcliffe would likely be much less expensive and you'd get equally as good care but have to deal with a 4.5 hour drive. Tough call.

Edited September 17, 2007 by turbotaina

[NeylasMom]

I can't see not having Dr. Canapp do it since he's so good. I'd rather Neyla have the best care and pay more. That was just a ballpark, not an official estimate, but it did include everything - CBC, meds, surgery, and the biopsy once the toe is removed. Not sure how much the biopsy contributes to the cost, but I am guessing it's significant.

 

I could consider Dr. Radcliffe, but I still don't imagine he's done as many of these as Dr. Canapp. Making that up in my head? I just think this is something Dr. Canapp could do with his eyes closed...

[turbotaina]

I dunno - when I went to see Dr. R., there were 4 greyhounds and a Scottish Deerhound there. Since he sees a ton of track dogs, I'm betting he's done his fair share of toe amputations But yeah, the drive. And Dr. C is very good.

 

ETA: I'm not helping at all, am I?

Edited September 18, 2007 by turbotaina

[Guest Che_mar_Cody]

I'd probably take the toe too. I'd be afraid of spreading, or other soreness issues that could come down the road, and then you have to take the toe anyway.

 

I SOOOOO feel your fear with anesthesia

[NeylasMom]

ETA: I'm not helping at all, am I?

 

NO, NOT AT ALL! Well, my mom is only about 45 minutes from Dr. R, but the problem with that is my mom's cairn terrier, Molly, who terrorizes Neyla and Zuri when we visit. We could keep them separate, but it would still be really stressful, probably more so than just driving the 4 hours back.

 

I wonder if this will truly require overnight hospitalization. Lisa mentioned that was included in the estimate, but in our visit Dr. C said this could almost be considered an "outpatient" procedure, so I'm guessing that means barring any complications she'll go home that day and the fee will be much lower. Pure speculation at this point, if the antibiotics don't work and we're headed toward surgery, I'll get the real estimate and be back to pick people's brains.

[turbotaina]

Well, Toffee was kept overnight and then a few days because of residual oozing. Even if Neyla were kept simply overnight, it actually probably wouldn't cost that much or make a huge dent in the bill, sadly. I think overnight hospitalization at most vets runs about $40 or so, add $10 for a specialist