Deep Ulcer Between Beth's Toes

[Hawthorn]

No advice from me either as I've never been through anything like this, but I totally understand how stressed you are because I'd be exactly the same.

 

Sending healing thoughts to you and Beth.

[PrairieProf]

Finally some positive news! We went back to the vet this morning because I was too anxious to wait until our appointment this afternoon, and she said Beth's foot looks much better -- the rawness is decreasing, the area she couldn't suture and had to leave open is closing already -- it's not much more than pinhead size now. She thinks the subcuticular sutures she put in will really help (and apparently she did take out most of the previous skin sutures that she thinks may have irritated things; they're just left down near the pads where they weren't bothering anything). There are still issues ahead with how we will transition to no wrap so that the skin doesn't tear again (she's actively thinking about options and on my urging will call OSU), but it is GREAT to have something to feel optimistic about. As long as I know she IS healing I think I can deal with the situation.

 

She also reminded me she put in the subcuticular sutures with the toe in a "tension" position, so that they should help hold things together as it moves. They tested the toe this morning and it has a full range of motion with no suture issues.

 

We'll see my regular vet this afternoon as he'll finally be back from vacation, but I have to say this other young vet in the practice has been absolutely wonderful, skilled, concerned, and supportive. (She said she worries at night about her charges too, and sometimes comes in to the clinic at 1:00 a.m. -- texting the tech that she's there!) She's already texted my regular vet (who's driving in this morning after a late night flight back to Des Moines) about Beth's situation.

Edited June 1, 2011 by PrairieProf

[Patsy]

Sending all good thoughts to you and Beth this morning.

[JJNg]

Sorry to hear Beth is having complications from the toe amp. Glad you got a better report this morning and will continue to keep both of you in my thoughts that she heals without any further problems.

 

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.

I'm rather surprised they weren't keeping the bandage well padded. It's pretty standard to use cast padding (aka rolled cotton) as the intermediate layer to provide cushion as well as absorb any discharge or moisture. I looked back at the photo you posted of Beth roached the day after surgery, and while it's hard to tell, it looks like that bandage had some padding? Maybe they stopped using it when it looked like it was healing well?

 

I will occasionally use a non-padded bandage (just Vetrap + Telfa, or Elasticon + Telfa) for very minor wounds, or ones that are well on their way to healing, if my main goal is to keep it clean and prevent licking. But for the most part, I feel the padding is essential, especially for greyhound feet. I will often even put pieces of cotton in between the healthy toes, and under the dewclaw (if present) to prevent rubbing and absorb moisture. Learned this from personal experience with my own dogs when I started to notice redness and irritation even between the healthy toes due to lack of ventilation from the bandage.

 

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.

Skin that is already inflamed and unhealthy will absolutely be more prone to tear.

 

A couple additional thoughts...it sounds like the 2 (possibly conflicting) requirements for healing at this point are 1) immobilization of the foot to prevention excessive motion and 2) ventilation to help keep the skin dry and healthy. If the foot needs to stay bandaged, to help with ventilation, I'd continue daily bandage changes and leave the bandage off for 15-20 min to let the toes air before reapplying the bandage. During that time, I would just keep her still, laying down if possible.

 

However, I would suggest considering a spoon splint to help with immobilization. If your vet has one of the more 'cupped' splints, you might even be able to get creative and leave the toes more open, but you'd have to be extra careful to watch for swelling. Did a web search, and maybe a product along these lines would provide the stability and ventilation needed? This one's a front leg, but I couldn't find a good quality photo of the one for the back leg.

 

I haven't used these myself, but here's the site I found that makes and sells them. The Bootie Splint might be enough for what you need, but not sure if her foot would tend to slide forward in it. The Standard Rear Leg Splint might be less likely to slide but goes up past the hock. If your vet has a spoon splint that would work on the same premise, it would probably be less expensive.

 

Vets seem to vary in how aggressively they bandage/splint after toe surgeries. I had the local surgical specialist do both of my greys' toes, and both were sent home with spoon splints (and tons of padding). Willow had a toe fracture repaired, so she stayed in the splint until it healed. But Wiki just had an inside front toe amputated, and I thought the splint was a bit of an overkill. Plus he's a bit of a klutz, and I was worried he'd hurt someone with it. Kept the splint on until the first bandage change (I usually do ever 2-3 days), then replaced it with a soft padded bandage until sutures came out in 14 days. A couple pics of my pups after their surgeries (a week apart from each other).

 

[greysmom]

Jennifer, Dude had a spoon splint! I couldn't remember that name. It actually helped him to NOT use the foot/leg so he tripodded around quite adequately. It protected the bottom of his foot and held everything in place so it wouldn't move around if he did put his foot on the ground.

 

We'll be thinking of Beth today and hoping she does good!

[PrairieProf]

Thanks for all the info, jjng! The Orthovet Bootie Splint looks to me like it might be just the thing -- I'll tell the vet about it this afternoon. The thing is just to prevent her toes separating too widely while still getting air to them.

 

The bandage was never padded. Probably what you saw was just the white cloth tape around the top.

Edited June 1, 2011 by PrairieProf

[XTRAWLD]

Wow. What a roller coaster. I can only imagine how stressed you really are.

 

We bought Therapaw boots that were "fitted" by the manufacturer (yes, someone in person fitted Kasey) - but IMO are one size too small for Kasey. We used to use them in the winter and they are nothing but trouble. The top of the boot comes too close to the dew claw pad - and he's ripped that pad open because of those boots......however. I really like the gel padding that is on the bottom of the boot on the inside and the outside has a hard sole. I believe the "cuff" is made of neoprene so I don't know how breathable it really is. That's my two cents on the Therapaws, since I've seen it brought up in this thread a couple times. IMO, it's too tight of a fit to make it manageable for Beth and I agree that boot splint looks like just the ticket.

[Remolacha]

I've been following along, but not posting cause I didn't have anything useful to add It does sound like things are getting better. I do know feet (dog & human) are a major pain, it is so hard not to use your feet! Sallie had a spoon splint when she broke her toe. It was one of the inside toes, and the break wasn't "clean". She kept it on for, I think, about three weeks, with bandage changes every few days (and lots of padding). It really did help support the foot and keep the toes from moving.

 

I am sorry this hasn't been easy, but you and Beth will get through this

[PrairieProf]

Just came from a meeting with my regular vet -- though he didn't want to do a second bandage change today, so he (along with the other vet who's been treating it) will look at it tomorrow morning. I'm rather confused. He is pretty adamant that the foot just hadn't healed enough from the surgery, and that if we give it a solid (further) two weeks of healing with minimal activity the skin will knit together and not rip. He explained but I really didn't follow how the skin rather than the stitches ripping was part of this. But I guess it's good news that he's pretty confident the skin will all hold together if we give it enough time, even with the stress of the new foot configuration.

 

The bad news is that he implied I've been walking Beth too much, even though she's mostly been on crate rest. I feel guilty -- I thought I was doing everything right. The two or so blocks out, two blocks back we did twice a day so she could poop was too much -- I have to do the equivalent of just walking her around the yard (I don't have a yard I can use for this) and when she has to poop badly enough, she'll go -- she's on low residue food so it won't be too often.

 

We'll do daily bandage changes to make sure the skin isn't getting raw -- he agreed that if we need to leave it unwrapped because of the skin not healing enough, kenneling her at the hospital for part of the day might be the way to go, since techs can babysit her and rewrap her foot if she has to go out. Beth created a bad scar from licking the surgery site on her back, so he's really concerned about not letting her lick the foot (her muzzle with stool guard and the Medipaw boot I got yesterday are the likely options).

 

In the good news category, her test results came back and she's heartworm negative, titer shows she doesn't need to be revaccinated for the second year in a row, and best of all her TLI is even further down than on the last check so her pancreas is doing great on her low fat diet.

Edited June 1, 2011 by PrairieProf

[DesiRayMom]

This has been such an ordeal for you both.

 

Humble prayers to the patron saint of gnarly greyhound feet (surely there must be one) to send healing white light down on

Beth's foot so she & her mama can salvage some summer.

 

Thinking of you both.....

 

Kathy

[PrairieProf]

Mixed update from vet visit this morning -- I had both vets look at her this morning so everyone could be on the same page. The surgical areas of Beth's foot are looking good and my regular vet is confident that once everything's fully healed up there won't be future tearing. I finally got clearer on what happened with the skin tearing: it tore horizontally up from the suture entry points, not in a horizontal tear parallel with the original suture line, as I'd thought. This makes more sense and does mean the tear was related to the incision not being healed enough for the stress put on it when Beth walked with the foot unwrapped. It wasn't just her skin giving way. So this makes me more optimistic. The inner toe that was previously all raw is looking good, too -- not very red any more and you can even see the hair starting to regrow.

 

The less-good news is that she's developed a new pressure sore on the top of her remaining middle knuckle that wasn't there yesterday. My regular vet agreed with the other vet that the foot needs time unwrapped. So the deal is that Beth will be day-boarding in the ICU kennel today, tomorrow, and Saturday morning so she can have the foot left unwrapped under close observation by the vets and techs to forestall any problems. She should heal fast that way, though, both the sore and the area closed with tension sutures that needs to granulate in. I'll have to do the same thing Saturday afternoon and Sunday, which is kind of scary, but I'm reminding myself the foot will be more healed by then and less likely to have tearing issues. They rigged up something where they tied her muzzle with stool guard to her collar with a strip of gauze, so she can't easily get it off.

Edited June 2, 2011 by PrairieProf

[XTRAWLD]

Poor puppa and poor you. Soon this will all be over. Thanks for the update.

[Guest bethac]

I know it is going to be hard for you to be away from Beth so much, but it sounds like a good plan to really get her foot healed up. Patience is not my strong suit either - you have my sympathy and more hugs.

[PrairieProf]

Thanks for the support. You've got it right about the patience issue, Beth! I just want my dog back to at least semi-normal so badly. But I'm trying to hold on to the thought that this current plan should really help speed the healing process. And that if the eventual prognosis is good, that's the important thing.

[greysmom]

Two weeks. It takes two weeks at least. Patience patience patience!

 

Let her tell you when/if she needs to go O-U-T. She's otherwise healthy so she shouldn't have a problem. Just out and back in - no walking around. This is going to be frustrating for both of you. Our dear greyhounds are definitely creatures of habit, and they want everything in their daily routine to stay the same. She's going to be a bit agitated when your normal walking times come around and you don't go out. Be strong! Take her out only when she's most likely (as you've observed her) to go potty.

 

Hugs for you both!

Edited June 2, 2011 by greysmom

[PrairieProf]

Thanks for the bucking up. I hope I can read her signals -- I can't tell the difference between "c'mon Mom, let me out of the crate for a change!" and "I really have to go!" Beth is my first dog and I've always kept a rigorous outing schedule for her to avoid issues; the occasions when she's urgently needed to go out at off times have involved restless pacing etc. that she won't be able to do. Yet I do recognize she won't explode from a change in the poop routine; if she has to go badly enough she will. Or the worst thing that could happen would be she'd poop in her crate, which isn't the end of the world (especially now that she has reliably small, solid poops on prescription food). Seeing that pressure sore develop in a day really brings it home to me that walking is a problem. At least trips to and from the vet give her a chance to potty when we have to be outside anyway.

 

I can't believe it's only been eight days since the amputation -- it feels like so long. Maybe in a week she'll be OK to have the foot unwrapped and the sores won't be so much of an issue.

Edited June 2, 2011 by PrairieProf

[PrairieProf]

OMG -- stress city!! The vets sent her home with the foot in a short wrap so that the toes are held together but the red gross-looking middle toe is exposed to air. Good for healing that, BUT it means that she has to wear the muzzle all the time. Poor girl, poor me. So far she's settled down in her crate after fussing like crazy in the car, but I'm not expecting to sleep much tonight. I do have the Medipaw boot I can use as a fall-back, but it's not as good as full air exposure. Plus I'm nervous the new wrap will cause other problems.

 

Her muzzle is tied on with a ribbon of gauze tied under her throat, not onto the collar, which would move around. It does seem to work pretty well, and isn't choking her so far.

 

It now seems likely that this arrangement will continue for weeks -- obviously the foot can't be fully bandaged and obviously Beth can't be left unmuzzled until it fully heals.

Edited June 2, 2011 by PrairieProf

[lovinggreysslp]

What an ordeal for both you and Beth. I hope you both can get some much needed sleep tonight.

[Guest bethac]

So sorry to read you latest update on Beth. I hope the night goes better than you expect. Sending more hugs ...

Edited June 3, 2011 by bethac

[PrairieProf]

Well she's been roaching in her crate for much of the past hour even with the muzzle, so that's better than I expected... Guess she hasn't totally forgotten kennel life!

Edited June 3, 2011 by PrairieProf

[Batmom]

Joseph had to wear his muzzle quite a bit after abdominal surgery, and Zema had to wear hers after leg injury. They do their level best to make you feel guilty about it but when you're not watching they usually quit trying to rub it off and go about their business as usual. Fingers crossed that Beth continues to understand this protocol!

[Cully]

Anne

First to you and Beth.

You are doing a good job with Beth and her injury.

Just take it one day at a time.

Before you know it this will be a distant memory and you will be passing along all your information on to the next person who has this problem with their hound.

Beth will do fine with the muzzle on. They all do the rubbing thing with they get first get their muzzle on. When mine get their muzzles on everyday they rub them on everything. Then they figure out that it isn't going to them any good. They get their muzzles on everytime we leave the house so it isn't a suprise that it is going to happen.

 

Cully & the kids

[PrairieProf]

Another crisis. A few hours ago I noticed that Beth's middle toe was swollen up to at least twice its normal size -- clearly from the wrap that was tight but left it exposed. I badgered the answering service into putting me through to my vet (another service was on call) and he told me to take the wrap off but bandage the foot normally when I took her out. I waited a couple of hours and finally took Beth out to potty before we went to bed -- she walked a little more than I knew was good but she hadn't peed and I wanted her to go since she was out -- she did finally poop. But when I got back in and took the bandage off, the toe has ripped open again. It's not bleeding, just oozing a small amount, and doesn't seem to hurt her. But it's deep, at least a centimeter long, and I doubt it can be sutured again -- it looks like it will have to heal by granulation as well.

 

Also, there is a lump of swelling above the amp site that wasn't there yesterday but appeared after the rip last night (or maybe when the toe swelled up, but I couldn't see it then). Looks like another big problem.

 

Everything gets worse and worse, it seems! Each fix for one problem creates a new problem, and healing gets further and further away.

 

I did not sleep at all.

Edited June 3, 2011 by PrairieProf

[EllenEveBaz]

[Batmom]

Aw, crap. Just seeing this now.

 

But, all is not lost. If worst comes to worst, you'll simply need to let the amp site itself heal (with stitches -- really need them right there), and wrap the rest with something nice like granulex or SSD. It sounds awful, it won't look pretty while it's healing, but it will heal. We've had several uglies around the feet/ankles that could not be stitched, and they have all healed with no loss of function.