Deep Ulcer Between Beth's Toes

[Guest Shermanator]

Oh, I also wanted to add- we did not take the decision to amputate lightly. We were really concerned about cutting off his toe- what if he developed another corn, are we just going to start cutting off his toesies? We just to joke, anymore corn problems, we'd just cut off all his feet, put him on rollerskates, and just him wheel himself around. Hee hee

 

As concerning and scary as amputation was, it improved the quality of his life dramatically, losing the toe that always bothered him. If one of my pups had the same problem as yours, & an amp was recommended, I'd do it in a heartbeat. 2 weeks post Patton's amp, and he was barreling through the house, and was full of zoomies, like nothing ever happened.

[PrairieProf]

Thanks -- I've been reading all the old GT toe-related posts I can find. I'm so torn up about this -- between the completely torn ligament and the deep ulcer (which must have gotten rubbed somehow yesterday because there was a lot more blood on the gauze last night, though much less this morning) the toe is really a mess. It might be possible do to more to support the toe in healing if it didn't have the ulcer that needs a dressing change twice a day, but it does. I certainly don't want to rush into amputation but I'm also aware that it would probably give me my girl back sooner -- and might well end up being what eventually happens anyway even if we put it off.

 

Meanwhile I'm going Monday for a second opinion from a vet that some neighbors with a grey see and like very much -- apparently he used to work for the track we used to have here, and had greys as pets, so I thought he'd have good experience in greyhound orthopedic injuries. (I didn't know about him when I got Beth -- the track closed a few years before I moved here and it never occurred to me that there would be vets with that kind of specific greyhound knowledge still around.) I'm hoping he'll be able to give me a good perspective on how this might heal, whether there's anything less conservative we could do to help it heal, and/or whether amputation would be a better option.

[PrairieProf]

I saw the other vet for a second opinion this morning. I knew he'd worked for the former track here, though it seems talking to him he did mostly spay/neuter for their adoptables, and he had a bunch of greys of his own.

 

He thought the wound wasn't healing too well for the time it's had (though I do see some granulation now, and will get my own vet's take on it tomorrow) and thought there might be a surgical procedure he could do to try to pull it together a bit. She'd have to wear a full e-collar then for several weeks.

 

But the larger problem is that the toe is completely deformed -- it lies over to one side with the pad barely on the ground and the knuckle pressing into the adjoining toe. I realized after I left that I'd forgotten to ask him about surgical options for stabilizing the toe in a better position, but he didn't bring up anything -- would this require a consultation with a veterinary orthodpedist?

 

He was reluctant to make a categorical recommendation for amputation since he can't guarantee she would have no consequences from the loss of a weight-bearing toe. But on the whole, he did seem to think amputation was the best option. And I hate it but I do tend to agree, because I can't imagine that as is that toe won't cause all sorts of problems and get torn up and ultimately need to come off anyway.

 

God though, what if my five-year-old loves-to-run girl ends up limping around for the rest of her life?

[Guest Liz_in_PA]

 

God though, what if my five-year-old loves-to-run girl ends up limping around for the rest of her life?

 

Make the best decision you can for her. It won't change how she feels about you.

But if you're feeling guilty, Beth would like you to know that she needs a bigger sofa.

[Guest zombrie]

We had a greyhound at the kennel who had two amputated toes on the same foot (the middle toes, he only had the two outside toes), and he did just fine. It was like he didn't know they were gone. He could still go on long walks and run around in the field and keep up with the others. The only time he limped was walking on the pea stone in the runs.

 

Ultimately it is your decision. I hope whatever route you go Beth feels better soon

Edited May 23, 2011 by zombrie

[Guest d0ggiem0mma]

If the toe is completely dislocated like that, I fear it will cause more problems down the line. If the pad is turned to the side it cannot protect the toe and you could see more injuries. If the toe just flops around it could also get stuck on something etc.

 

Of course this is 100% your call and none of us are there to see how your hound is coping. If it doesn't seem to bother him, I would be inclined to let it heal and see how he does. If it seems to bother him I would probably just amputate and get it over with.

 

I know several greyt dogs that have lost middle toes and they didn't seem to miss them. If you decide to amputate, there's nothing to feel guilty about!!!

[PrairieProf]

It bothers her tremendously -- not too badly when it's wrapped, but a lot when it isn't. I suspect it would be many weeks or months before she could walk unwrapped and pain-free.

[Guest Gert]

My first grey had to have a weight-bearing toe (right hind leg) removed. The first surgery, they didn't take the entire toe. He ended up getting his stitches out and they had to go back in and remove the entire thing. If you choose to amp, as someone already mentioned, I would have them take the entire toe.

 

He was a bit older than Beth, and probably not as active, but, aside from an accident right after his stitches were removed (he caught his outside toe on the door frame and ripped his suture line open again), he didn't have any issues with losing his toe.

 

Best of luck wtih whatever you decide.

[PrairieProf]

Thanks. The vet has already said that he would take the entire toe if we did it, since among other things the ligament issue affects the whole toe. And the ulcer is right in the middle.

[BauersMom]

I would not recommend trying to surgically stabilize the toe - it'll be more effort and pain then a toe is really worth, and the one dog I had seen with a surgically repaired broken toe limped horribly.

 

If the toe truly is that out of whack, I would go for the amp. There's no guarantee she won't limp, true, but there's a chance she will have issues with that toe at some point into the future, too.

 

Good luck!

[Guest tinams8]

I think you are headed in the right direction as well. One less toe would probably be no problem for Beth, think of all the tripod dogs who do just fine! It seems like many greys lose a toe for one reason or another with little ill effects. I'm glad you are exploring your options so you can make an informed decision that you won't second guess. I hope she is better soon one way or another!

[JJNg]

I agree that amputation is probably the best option for the fastest recovery time and elimination of the pain. Most greys do well even with amputation of weight-bearing toes, although I've also known a couple that developed a limp, usually mild and sometimes only evident with long walks and strenuous activity.

 

Given your description of the significant instability in the toe, I would probably not recommend just allowing it to heal on its own. It would almost be guaranteed to continue to have problems, especially with an active dog.

 

If you're interested in considering surgery to repair the ligament and stabilize the toe, it wouldn't hurt to do a consult with an orthopedic surgeon, but as others have mentioned, these surgeries don't always succeed. I know of one grey (and multiple whippets) who successfully returned to lure coursing and racing after having surgery and rehab for toe ligament injuries. If you decide to try surgery to fix the toe, amputation is always an option later if the surgery doesn't work, although this would mean having to do a 2nd surgery.

 

I've dealt with some toe issues with both of my greys, and because we participate in lure coursing and amateur racing, I tend to lean toward trying to repair injuries rather than going straight to amputation. When Willow broke her toe chasing a rabbit in the yard a couple years ago, I had the local orthopedic surgeon fix it with a screw. She's been able to get back to racing and coursing without problems.

 

However, fractures are different from ligament and tendon injuries because a healed bone is just as strong, if not stronger, than the original bone. Ligaments and tendons usually don't heal as well, and even when repaired, are often at risk for re-injury in the future. Chronic ligament injuries also lead to secondary arthritis within the joint from the instability.

 

My male Wiki injured one of the collateral ligaments on the upper toe joint (P1-P2) while lure coursing, and I just let it heal with a period of leash walking because it didn't seem too bad at the time. He developed arthritis in that joint, and later dislocated the lower joint on that same toe, probably because the arthritis caused a decreased range of motion in the upper joint. At that point, I had the toe amputated - it was the inside toe on his left front, and he was back to normal a couple weeks after surgery. I stopped lure coursing with him, but still let him straight race on a limited basis.

 

Unfortunately Wiki dislocated the toe next to the one that was amputated last fall, and we've been dealing with that for the last few months. Not sure if missing the toe contributed to the dislocation, since he also dislocated a middle toe on his other front foot at the same time - he was trying to stop too suddenly on hard, dry ground. However, I do think that missing that inside toe has made it harder for the one next to it to heal, and makes it more prone to re-injury without the support inside. He's has no further problems with the toe on the other foot, but he's popped this one back out twice more since then.

 

Considered surgery and even talked to our local orthopedist, but ended up trying some less invasive options with a rehab specialist (prolotherapy, therapeutic laser and ultrasound). So far he's been doing pretty well with this. Wiki's toe was fairly stable when it was popped back into position, though. With the severity of Beth's toe, these more conservative approaches probably wouldn't be an option for her. Anyway, this got a lot longer than I was planning and probably a lot more than you wanted to know. Best wishes for a quick recovery for Beth, regardless of which route you decide to take.

[NancyB]

I'm so sorry Beth is having toe troubles. I hope it heals for her soon.

[Guest Shermanator]

I would not recommend trying to surgically stabilize the toe - it'll be more effort and pain then a toe is really worth, and the one dog I had seen with a surgically repaired broken toe limped horribly.

 

If the toe truly is that out of whack, I would go for the amp. There's no guarantee she won't limp, true, but there's a chance she will have issues with that toe at some point into the future, too.

 

Good luck!

 

I agree! With Patton, we tried to surgically remove his corn. The vet went very deep into the pad, and the healing time was several months before he was completely healed. And, Patton was my drama queen, so it was several months of screaming, when he bimped it.

The amputatation was done at the top of the toe, where the toe meets the foot. 2 weeks later, he was back to his zoomies. He had far less number of stitches than he did when we tried to cut out the corn. It was a middle toe on his back left paw. He never knew the difference.

[PrairieProf]

Thanks everybody, especially jjng for such a detailed response.

 

One more question I've never seen addressed -- what about walking in snow and ice, which we have here close to four months of the year? Pretty awful footing -- and Beth gets leash walked for virtually all her potty needs, so there's no avoiding it.

 

Of course now that I think of it, that wonky toe would be a big problem with ice etc. anyway, and would probably need at least a Pawz boot.

Edited May 24, 2011 by PrairieProf

[Guest d0ggiem0mma]

I think you're right on- the wonky toe would be a BIG problem in the snow & ice. I live in Ohio and we get a lot of snow and especially ice in my area though it's only for a couple months. I have friends whose greys are missing toes and it doesn't bother them at all even in the snow/ice.

 

After you expressing how painful it is for your hound, I would really be inclined to amputate it as soon as possible. I think having it gone will be a huge relief. As you said, the ulcer could take many months to heal and the wonky toe will continue to cause problems. The amputation will only take a few weeks to heal.

[PrairieProf]

Well, I just got back from seeing my own vet and we are going ahead with the amputation. I started to pitch to him why I thought we should do that but when he examined the toe, he completely agreed -- I think he really saw just how much it flops over. And he studied the ulcer for a good while and said that it's not healing well/enough -- some granulation on the edges but nothing in the center. It is also clear that Beth is very uncomfortable with the foot unwrapped and not happy putting weight on it then.

 

He said that if Beth were his dog he'd probably just have amputated the toe the first day -- but when I pointed out that's not the approach he took with me, he said "Yes, but can you imagine yourself if I'd told you that right when it happened?" And he has a good point -- he clearly knows me quite well.

 

What majorly sucks, though, is that we can't do the amputation until Thursday, June 2. He'll be in tomorrow, but then he's going out of town for a number of days. And I can't face going through this if he won't be around for moral support afterwards, even though there's another vet in the practice who could do the bandage checks. But my vet and I are pretty close at this point, so I need him there.

 

I told him about Dr. Couto's protocol of using Amicar for greyhound surgeries to prevent excessive bleeding, and while he didn't think bleeding was going to be a problem, he agreed to call OSU for the exact protocol and order it. So the delay will allow it to come in, too.

 

So please send good thoughts both for the operation and for us getting through the nine days of waiting for it -- he said Beth should be fine if we just keep doing what we're doing with wrap/bandage changes/antibiotics. And she's not in too much discomfort with the foot wrapped. Such a long time to wait though when it's just waiting.....

[Guest KennelMom]

Good luck with everything. I was pretty sure you'd end up with the decision your at now. We have Stella home from a toe amputation (due to cancer) on Friday and she's having a rough time of it. Hopefully it goes better for Beth. When Melody had her toe amputated she really took it all in stride and recovered pretty quickly.

[PrairieProf]

Sending good thoughts to Stella, poor girl. What pain control protocol are you using with her? He explained to me but I'm not so sure I followed it (just why he wasn't a fan of using a pain patch).

[Guest KennelMom]

Not sure what they used at the hospital..I supposed I could look at the bill, but it was pretty scary the first time I looked at it and I don't need any reminders . She had a large tumor on the toe and going on to the actual foot, so the surgery was done by a specialist and was more invasive than just removing a single digit. I know they had a patch on her at the hospital b/c she has a shaved area. They actually kept her overnight after the procedure. We've just been using tramadol since she also has Cushings and using an anti-inflammatory as well wasn't really a great option.

 

When Melody had her toe amputated, the surgery was just done by our regular vet and we just did a standard mix of Rimadyl and tramadol.

Edited May 24, 2011 by KennelMom

[XTRAWLD]

I've been following Beth's (and your) story since day one and so sad to hear of the turn of events. and scritches to her.

[Laurenbiz]

He said that if Beth were his dog he'd probably just have amputated the toe the first day -- but when I pointed out that's not the approach he took with me, he said "Yes, but can you imagine yourself if I'd told you that right when it happened?" And he has a good point -- he clearly knows me quite well.

 

What majorly sucks, though, is that we can't do the amputation until Thursday, June 2. He'll be in tomorrow, but then he's going out of town for a number of days. And I can't face going through this if he won't be around for moral support afterwards, even though there's another vet in the practice who could do the bandage checks. But my vet and I are pretty close at this point, so I need him there.

 

Anne, I don't know your vet, but he sounds like a great vet! You obviously have her in good hands - and in hands that are willing to go the extra mile to make sure things are done correctly and precisely to ensure that she will be happy and healthy with the operation!

 

I am thinking about Beth!

[PrairieProf]

Rapid change in plans: on a greyhound friend's urging, I went back to the vet and scheduled the amp for tomorrow. She pointed out to me lovingly but firmly that wanting my regular vet around in the days afterward was for my well-being, not Beth's, and it would be better for her to do it sooner. The other vet in the practice is highly competent to cover the follow-up (even if surgical intervention were required, say if the stitches reopened) and has been following Beth's case. (It's just that she looks about 18 to me!) But now Beth will be on the mend by next week rather than just facing the surgery then.

Edited May 24, 2011 by PrairieProf

[45MPHK9]

Thinking good thoughts for Beth as she undergoes her toe amp procedure tomorrow.

[Jackandgrey]

I'm sorry she needs it but I think this is the right decision and absolutely the sooner the better! We'll be rooting for her.