Deep Ulcer Between Beth's Toes

[PrairieProf]

I have toddler socks but no boots like therapaw. Just looked at the medipaw -- I think my vet has something like that, they showed it to me when we were treating the ulcer, maybe I can get it tomorrow. It says it's breathable though it doesn't look it. I don't need it for outside as the Pawz rubber booties have worked fine, but you can't leave those on as they don't breathe.

Edited May 30, 2011 by PrairieProf

[krissn333]

I'd be inclined to let it get some air too. She can also start adjusting to how she will need to walk.

 

Sounds like you're not having any problems...but make sure she eats before taking that Deramaxx...they can have some tummy troubles when it's used over time. I'm guessing her dosage will taper soon so you're probably in the clear as long as she's got some food in her before she's trying to digest it.

[PrairieProf]

I give her Deramaxx and Tramadol around 6:00-6:30 a.m. followed by a scoop of cottage cheese -- and then we both go back to sleep for a bit! Maybe I'll add a little of her breakfast kibble to it as well. I want her to have the pain meds on board for a while before we go out for our morning potty walk....

Edited May 30, 2011 by PrairieProf

[Guest MnMDogs]

Regarding the Deramaxx...I can't remember if it was Diane or Jey who recommended giving a pepcid about 30 minutes before the Deramaxx. It may help with possible stomach side effects

[PrairieProf]

I'll definitely keep the Pepcid in mind if she develops problems.

 

Meanwhile I decided it was OK for her to be out of her crate for a while (I blocked off all the bedrooms and stairs so she can't run/jump on anything). She is doing well and it's nice to be able to pet her more easily.

[XTRAWLD]

How is the update today?

[PrairieProf]

Very bad news; we have had a setback. I took her to the vet this morning, and she said we did indeed need to take the wrap off her foot so some toes getting raw could get air and heal. The innermost toe looked a LOT worse than yesterday. We went over all the techniques were were going to use with muzzle, sock, Medipaw boot at various times. But by the time we got home, there was blood on the sock, coming from the suture line near the top of her remaining middle toe. So I immediately took her back to the vet, where the most experienced tech confirmed that several sutures had ripped out on the foot as the toes spread out. So I left her there and she will be anesthetized (about the fourth time in six weeks!) for re-stitching this afternoon. The tech said that with a pressure dressing it was fine to wait until my regular vet is back from vacation tomorrow afternoon, but putting in a few stitches is simple and I decided to just go ahead -- they all know the greyhound issues regarding anesthesia (I checked) and that tech promised to do the anesthesia and monitor her closely.

 

Meanwhile, this means she's going to have to wear a wrap for weeks still until those stitches, now six days behind the rest, heal enough to hold reliably, and what's going to happen to her poor skin? The tech said they'd put cast padding under the wrap so there wasn't vetwrap rubbing on skin directly. But I'm scared about that; the vet was pretty clear about the wrap needing to come off.

 

So six days was just too soon to remove the wrap for her middle toe amputation with how the toes spread wide when she puts weight on the foot -- I can see how it wouldn't be a problem with an outer toe amp that doesn't get as stressed. It's just a good thing I didn't take it off yesterday and have her bleeding all night!

 

I don't know how I'm going to keep coping with this stress -- I'm trying to remember it's just about three stitches, it doesn't mean the foot isn't going to heal. And I did get to see in our short trips to the car and the house that she seemed to walk OK on the unwrapped foot.

 

Also on the positive side, she walked very well yesterday afternoon/evening and this morning before we went to the vet. This morning she even tried to chase a bunny that shot away right near us.

Edited May 31, 2011 by PrairieProf

[Batmom]

Argh.

 

Where is the other toe getting raw? Asking in case this will help: If at all possible, I wrap feet only down to @ the knuckle and leave the ends of the two middle toes sticking out naked, thus the main part of the foot is supported but the foot isn't totally covered up. You do have to use a plastic bag and/or sock when going outside so dirt doesn't get in there.

[PrairieProf]

The innermost toe was pretty much raw all over. That one is more of a concern than the other middle toe, according to the vet. And that too is more raw near the top, if I remember correctly. Weirdly enough, when I got home and noticed the suture-line bleeding, the inner toe already looked better (dried off).

[Guest MnMDogs]

Ugh, that really stinks.

 

Mork's foot was wrapped pretty much for an entire 2 weeks with regular changes (between 3 - 5 days). We didn't have a problem with his toes getting raw at all. You have to be very diligent with keeping it dry, but with Mork's obsessive compulsive licking of his feet, we really had no choice but to keep it on until it healed. It healed very well, too.

 

I'm sorry that she has to be re-stitched.

[PrairieProf]

What was your wrap exactly -- did you have padding under the vetwrap? Beth just had telfa where the amped toe was and vetwrap around the foot -- she will have what the tech calls "cast padding" under the vetwrap now. I do think that basically she just needed to be wrapped longer for the incision to heal better before she put stress on it by letting the toes spread. But now that area will need two weeks more.....

[krissn333]

When I wrap a foot, I always make sure there is plenty of padding between the foot and the VetWrap...it causes irritation to the skin otherwise.

 

My standard MO is gauze (with ointment if needed) on the wound, wrap the foot and about halfway up the hock with Kling or rolled cotton, then cover that area with VetWrap. Depending on the need, sometimes I run some bandage tape around the foot if some additional pressure or stability are needed.

 

Cast padding should do the trick. I'd place it in between her toes in place of the toe that was amputated also, to help the remaining toes understand where to sit while the foot is bandaged.

[PrairieProf]

She's had a little "cigarette" of rolled telfa where the missing toe is, so I assume they'll put that or something similar back there.

 

Oy, so nervous. She should be in or recovering from the procedure now. Waiting for the tech's call that she's awake again.....

 

Edited to add: OK, got the call, she's fine. I'll pick her up in about an hour, and will get to talk to the vet. That reversible anesthesia is really nifty stuff.

Edited May 31, 2011 by PrairieProf

[Guest MnMDogs]

What was your wrap exactly -- did you have padding under the vetwrap? Beth just had telfa where the amped toe was and vetwrap around the foot -- she will have what the tech calls "cast padding" under the vetwrap now. I do think that basically she just needed to be wrapped longer for the incision to heal better before she put stress on it by letting the toes spread. But now that area will need two weeks more.....

 

Mork had quite a bit of padding on his foot, with the telfa (is that the non-stick gauze) under that, on the toe. I assume that he had "cast padding" under the vet wrap. I know that I couldn't have wrapped his foot myself since it was pretty substantial. Once the pain lessened, he was walking like a champ on that foot while still wrapped.

 

Believe it or not, the time will go by fast . I just made sure to have plenty of IV bags on hand for turn outs in the wet grass, and for walking when we could start that.

 

Good luck to you both!

[greysmom]

She's beginning to feel better, which is a good thing and a bad thing. You need to be diligent in keeping her from putting stress on the foot, especially since she will be more prone to pull the stitches in the same place.

 

Dude had a hard plastic "splint" that cradled his foot and went partway up his leg. This was thickly padded and wrapped - he basically had a soft cast on. He had this on for two weeks before his first bandage change, which in hindsight was too long, but I think daily changes are too much. Beth has to walk too much and the wound gets disturbed and pulls the stitches out. I understand about wanting to get the wound air and healing, but that needs to be tempered by giver the wound time to heal together adequately.

 

Hope she's home and resting now. Good luck!

[PrairieProf]

Really really bad and complicated news. It was a lot to take in and I felt nearly beside myself, so I hope I'm getting it all right. The stitches didn't tear -- they are healing very well. Her skin tore above the stitches.

 

The vet put in subcuticular sutures to heal what tore, and that's closed up well along her toes. But the inner part (right on the foot where the toe joined) tore too, and that can't be closed all the way because it would be too tight or something and would just probably tear again -- a small square has been left open, closed loosely with what I think she called tension sutures, to granulate in and hopefully form some thicker scar tissue. She may need to have those tightened eventually, another anesthesia procedure.

 

But she said that the bandage really did have to come off, the raw toe is in bad shape and she's still worried about it -- we may have to take these bandages off pretty soon too (daily bandage changes for now). And there's nothing to say the same tearing won't happen again when the bandage comes off and her toes spread; they may have to come up with some kind of two-toed bandage or support. So it's a balancing act between getting the skin to heal and protecting the raw toe.

 

How can I deal with this?? Nothing like this happened with any of the other toe amputation stories I read. What will prevent her skin from just ripping and ripping?

[maggiespet]

I' ve been reading and following Beth's progress. What a roller coaster! I'm saying some healing prayers for your sweet girl. This has just got to turn the corner and resolve. Hugs to you Anne.

[Batmom]

It'll be OK. Really it will. Unfortunate complication, but if the stitches over the main wound are holding, you're headed in the right direction. Once that's healed, if she gets some small skin tears after, those are easily treated with (egad) a light bandage and SSD. The leash-walking you'll do after the stitches come out and bandages are off will help the foot resume its normal shape as it heals.

[PrairieProf]

I hope you're right -- I think all the stitches held. I don't recall if she said specifically about the part in the mid-point that's now open. But the vet said that the stitches make the surrounding skin weaker, or something. I can't believe my poor baby now has two lines of sutures in her poor toes, regular and subcuticular.

 

It did seem like she knows her business as a surgeon, which is reassuring.

 

The vet said I'm the best pet owner they see in the whole business, though.

Edited June 1, 2011 by PrairieProf

[Batmom]

Really ugly things heal, so I suspect this will too. Feet are difficult -- not much flesh and the skin gets pulled every which way by nature -- so it can take some time, but they do heal. Keeping my fingers crossed for you and your girl!

[greysmom]

Just one day at a time and you do what you can do. Stressing yourself and Beth will only make this harder to deal with. As someone said, even really *really* ugly wounds WILL heal eventually. It takes patience and calm and letting it heal as it will. You might see if they can do any more stitches or repairs with a local rather than general anesthesia. Most greyhounds will stay still for procedures like that.

 

You'll both get through this, I promise!

[PrairieProf]

Thanks for the encouragement. It was a rough evening with her whining for hours (post-anesthesia, I think, not pain). Finally she slept -- I'm hoping she is less wobbly this morning.

 

I want to believe it can heal but it's so different when you're talking about a foot, a foot that now is changed in how the skin pulls and moves. And where the skin evidently tears like wet tissue paper. Having had the abraded skin and the ulceration NOT heal before the amputation, I'm terrified. I lay awake trying to think of how it could get air with ripping again -- I wonder about crating her at the vet during the day with the wrap off, and the techs there to keep an eye on it and wrap the foot again if she needs to go out to potty (I guess I could do this at home after a couple of days, but right now I'm afraid to have her foot unwrapped out of the hospital). But would the skin rip when she even stands up to turn around in the crate, as she inevitably does? Could they mildly sedate her or something?

 

A friend also suggested a Therapaw -- it does look like that has good air circulation and might keep the toes from spreading too wide when she stands? I've actually never seen one "live," only in GT pictures. The fitting seems pretty complicated -- would I need a custom order for that foot?

[Batmom]

Wouldn't use a therapaw -- fits too closely and isn't flexible enough for your purpose, at least until the foot is healed. If you want to try one at that time, I might have one that would fit her, that I could send you. I'd gotten some for angel Zema, current dogs have much bigger feet!

 

Also wouldn't worry about getting air to it. IMHO the issue is more preventing rubbing, and that's hard to evaluate without seeing the foot and the wrap. Couple of things play into that:

 

1. Moisture. It's gotta be kept dry. If it gets wet, you have to change the bandage ASAP.

2. Balance. If there's a lot of padding in one spot and not others, sometimes you get rub opposite the padding. So you have to pad parts that don't need it to even out the pressure.

3. Tightness. If the bandage is a bit loose, it'll rub. It has to be snug, which frightens people. If you can leave the two middle toes (or one in your case I think?) sticking out, you can see at a glance if there's any swelling and therefore too tight of a bandage.

 

Feet really do take some time to heal -- can't tell a dog not to use a foot the way you can a person. I can recall B having a slice up the side of one of his toes. Wasn't even deep, more like an extra-large hangnail on a person. Took three weeks to heal to where it wasn't bothering him and he wasn't leaving little bloody spots all over the carpet.

[PrairieProf]

Hmmm. This is like the whole air/no air thing from the original ulceration. The vet was swearing it needed to be exposed, and I could really see that.

 

All the bandaging except on Monday was done by experienced techs or vets. It is very upsetting that they didn't pad it and evidently didn't do it right to prevent these problems -- I can affirm that it never got wet.

 

Where I first saw the skin torn was where it's been red and abraded and moist from the very beginning of the injury (on the inside of the remaining middle toe). It has never healed. A friend asked me if that made it more prone to tear -- I'll have to ask the vet. Otherwise, if the skin tore just from the stress of the toes spreading as she walked for a very short distance, that's almost scarier, since I don't know how it won't keep recurring.

[RaineysMom]

no advice, just more hugs. You both must be SO frustrated by this point. Your poor girl! :grouphug