Advice Needed - Possible Osteo

[Guest joviemom]

Jovie has been battling an inflamed toe for the past two weeks. She has been on antibiotics and has been showing some improvement with the size of the mass on her toe. We took a fluid sample a few weeks ago and it didn't show much of anything.

 

This morning I woke up and she was fine, bouncing around, running. Checked her toe and it looked pretty good. I then went to lowes and when I got back she wouldn't put any weight on her foot and it looked completely swollen. When I looked in between her toes it was completely full of puss.

 

I rushed her over to the vet and didn't get the best news, vet thinks its most likely a tumor. She wants to do a full biopsy next week but gave me a few options.

 

1. X-ray and look for bone involvement, then biopsy.

2. X-ray and look for bone involvement, if there is involvement take the whole toe then send the whole toe off to the lab.

3. Take the whole toe. No X-ray and send it off.

 

 

I am really not sure what to do, if we just biopsy she said there is a 70/30 chance that we will have to take the toe anyway and the nail is 100% coming off during the biopsy regardless.

 

She said that even if it turns out to not be cancer there could be such a horrible infection that we may end up have to take the toe anyway. I worry thatt she would then have to have toe recoveries and be on antibiotics even longer, but it also don't want to just amputate the toe if I don't have to.

 

Thoughts? What would you guys do?

[greysmom]

Think about what you would do for each outcome.

 

If it *is* cancer, are you going to treat it aggressively with amputation (and chemo, if necessary), or are you more likely to opt for palliative care to keep her comfortable? If it's *not* cancer, will you need to amp the toe anyway to give her a good quality of life?

 

Yes, a toe amputation is major surgery. The have to be anesthetized and have part of them removed, then go through the recovery process. But it is a relatively simple procedure for a reasonably experienced surgeon, and the recovery process is about two weeks (with no complications) in a splint with antibiotics and pain meds, then most dogs hardly ever look back or have any further problems.

 

I think an x-ray is a reasonable first step to take, then go from there depending on what your answers are about your future plans. I probably would not biopsy as it seems like a redundant step. Either you're going to take the toe (and then send it out to be biopsied), or you're not (and the biopsy results may not matter).

 

Good luck.

[lovinggreysslp]

Cosmo battled a toe issue for a couple months. When antibiotics, two sets of xrays, cold laser therapy and rest/pain meds did not resolve his issue, we went forward with toe amputation. We also sent the toe off to the lab to determine what had caused his distress. Cosmo healed well and fortunately the lab results found massive infection and not cancer. Best of luck as you make your decision.

[macoduck]

Gracie had a weird thing going on with her toe for months and was treated repeatedly with antibiotics that didn't help at all. We wondered if it was SLO.

We finally had it amputated. Turns out it was a rare but benign tumor of the nail bed. Removal really was the only treatment. One comment the vet made regarding toe amputation - even though it was the end of her toe that was affected, he said we also needed to remove up to the next joint. That way the remaining nub wouldn't rub with ground contact.

[Guest june]

No advice, just sending positive thoughts and prayers your way.

[Batmom]

Full of pus sounds like a nasty infection. Has that been cleaned out and treated?

 

Not sure why vet wouldn't just x-ray if bone involvement or a foreign body were suspected.

[galgrey]

Sending good thoughts for Jovie.

[Guest joviemom]

We did X-ray initially and it looked ok, she saw a what looked to be a small tumor near the bone. the problem she is seeing with it is that it's a very unusual presentation of a tumor. The pus came from it rupturing out the inside of her toe this morning, that wasn't there initially.

 

With how fast it has grown, and the fact that it abscessed out I'm two areas is also concerning. The nail is basically being pushed out, which looks like it caused an abscess.

 

And yes, the vet cleaned the affected area, and I am doing that three times a day until Wednesday.

[TwiggysMom]

I would start with x-ray. My entirely non-vet opinion is that it doesn't sound like osteo. If x-ray is tentative for osteo and they think they can to needle aspirate of the suspected lesion I'd proceed with that, otherwise biopsy.

 

Also in your favor, is osteo isn't particularly prevalent in toes, so I would try to continue to be optimistic that this is something else entirely.

 

It certainly could be a horrible infection that will cause you to have to take the toe anyway, but it might be a horrible infection that can be cured with antibiotics. I'd probably like to try to find out if that is the case before amputating. (Also, -and I'm sorry about the harshness of this- if it does happen to turn out to be osteo, they will probably want to take the whole leg anyway - no reason to do one amputation just to have to do a bigger one later.)

 

Keeping you and Jovie in my thoughts, I hope things turn out as well as possible!

 

Edit: I just saw your last post, and that you did original x-rays. If they think they can aspirate the suspicious area, that's where I'd probably proceed next. (I still think this doesn't sound typical for osteo). My bias against biopsy is probably more relevant for weight-bearing bones, where further weakening of a bone already compromised by osteo would put a dog at risk for a break. Thay may not be as much of a concern in a toe.

 

Sill wishing you all the best!

Edited November 30, 2013 by TwiggysMom

[Guest joviemom]

At this point they cant just aspirate unfortunately, we did that initially for the first xray. She is going to attempt to carve out the entire affected areas tissue.

 

I think that what my plan is, is if the xray shows bone involvement I will tell her to take the whole toe. If it does not show bone we will do the biopsy and nail removal.

[TwiggysMom]

Ah, didn't realize about the initial aspirate.

 

It sounds to me like you've got a solid plan. I hope everything goes as well as possible for Jovie!

[tbhounds]

I would first perform a fine needle aspirate of the suspected area and also culture the discharge -yes, even while on antibiotics. Re radiograph the toe comparing to your first rad. Possibly sending the views out to a radiologist for a second opinion. Also, keep in mind that you can sedate and biopsy the toe to receive a sample for the pathologist to readprior to committing to a more advanced surgery (aka amp). I would be more afraid of other cancers than Osteo--we just had a briards path of the toe return as melanoma. Osteo while not impossible as usually not se in toes--typically seen in long bones (notice I said typically-it can been seen in toes, flat bones like skull.....). So, finally I would run a cylolog ASAP before jumping into surgery. If your vet isn't comfortable reading cytologys than send the slide to a pathologist the lab. (Or Dr Couto ). :-)

Edited cause I too just read that your vet initially did aspirate the mass--a confused why you can't aspirate again. Sounds like they decide do get a core biopsy--you will receive much more info that way but a sed will be required of course.

Edited again to apologize for the typos-just to lazy to fix them:-)

Edited November 30, 2013 by tbhounds

[Guest joviemom]

Had to do an ER visit this morning. She had two new craters on the side of her foot and she looked like she was in terrible pain.

 

Was able to meet with a specialist and he said removing the toe is the only option at this point. We did an xray and there is unfortunate bone involvement, we looked at her long bones and lungs and everything else looked ok.

 

 

 

Toe comes off on Wednesday, until then she gets good pain meds and lots of pets

 

[PrairieProf]

Poor girl! My toe-amp houndie Beth sends good wishes. She should feel much better almost immediately after the amputation.

 

If you are on Facebook, there is a whole group for Three-Toed Greyhounds to cheer you on.

[Guest k9soul]

No advice, but so sorry you and sweet Jovie are dealing with this. Rudy has been limping since November 11 and I have been stressed about it, but he has had 2 x-rays now of shoulder/elbow and wrist that show no sign of osteo, so treating as a soft tissue injury. I hope and pray for the best for your beautiful girl.

[JustSnoozing]

Sending lots of good wishes to your lovely girl.

[EllenEveBaz]

Poor pink-bandaged baby. Sending lots of cyberhugs to you both.

[carronstar]

Sending lots of good thoughts and prayers for your baby.

[MP_the4pack]

Good thoughts for an uneventful surgery and quick recovery.