Sore Of Unknown Origin - Please Help!

[Guest Prematurelygrey]

I’m hoping someone in the Greytalk community has seen something similar to what we’re experiencing with our Matawan & offer advice or guidance. This has been a long & winding road to get to where we are, so I’ll try to stay brief and to the point.

 

Matawan has been undergoing treatment for cancer – the issues we have encountered may or may not be linked to the cancer treatment, so I’m posting here in the general are in the hopes of reaching a wider audience.

 

Two weeks after his treatment in January, Matawan developed sores on the leg in which his IV is administered. No one was sure why – our primary care vet theorized vasculitis and/or bad reaction to chemo drugs. His oncologist said no way & that he’d probably just been licking and caused the sores (this seemed less than likely to us). Over the course of about two weeks (during which we were in frequent contact with his oncologist), there wasn’t much progress towards healing & finally the wounds began to obviously fester. At this point, we took him back to our primary care vet & she insisted that the oncologist seek a consultation with a surgeon in the vet hospital where he was being treated. The surgeon said the wound had to be debrided, but was fortunately able to treat him over several sessions with local anesthesia, rather than doing major surgery. Apparently, the vein had also turned necrotic & also had to be removed. He is now healing fine and should be fully healed in another few weeks. This is a link to a picture of what the leg wound looked like at its worse: https://www.dropbox.com/sh/0lvihkrr5f81qzr/AABfdZMmvnq2UuONetZPelbWa?dl=0

 

So far…so good….but then….

 

About two weeks ago, I noticed a patch of hair that was standing up oddly above his hip. When I pulled the fur back, the skin underneath looked dry & scaly and the hair pulled out in clumps with very little pressure. We were in the process of switching to an oncologist in a different vet practice (largely due to how the above issue was handled) and he was due for his first consult with Oncologist 2 the next morning, so we asked her to have a look at the dry patch. She pulled the hair back, said, “Huh, looks little red & irritated, but it’s a small area, so I wouldn’t be concerned.” We could see the skin she was looking at & it looked a little pinkish, but agreed just looked like dry, irritated skin. Oncologist 2 knew we had a bandage change coming up with the surgeon, so suggested we asked the surgeon to have a look.

 

The *next* day, on 3/13, at the bandage change for his leg, the surgeon wanted to shave the hair to get a better look at the whole area. This is what she uncovered:
https://www.dropbox.com/sh/5kc65r67r694ztl/AAD7sNBBhsUjTy5UjzFnyHsla?dl=0

We were shocked. And the surgeon was at a complete loss to explain what this was or how it had emerged like this in just over 24 hours.

 

Our primary care vet saw the report (but has not seen Matawan) and theorized it was another episode of vasculitis, because the sore is in the general area of where a vaccine or similar would be administered. However, he has not had any vaccines since his cancer diagnosis. We mentioned this theory to Oncologist #2, who saw him on 3/17 – she said this seemed unlikely, since his last injection to this site (according to records transferred to her by Oncologist 1’s hospital) was over 6 weeks ago. She also said this is not the type of “lesion” she’s seen in any other cancer patients she’s treated. A bacterial culture of this wound came back negative (not surprising since he’s been on antibiotics since his leg sores emerged back in January).

 

This past Sunday, I had Matawan back to the surgeon for a bandage change to his front leg (which is looking great). At the same visit, she took Matawan “to the back” to remove some necrotic tissue from the hip wound that seemed to “go a bit deeper” than the top layer of skin. She was very alarmed when she brought Matawan back to me. Apparently the wound is much deeper than she first thought – she said it looked like there was a large blood blister under his skin that goes down to (and possibly into) the muscle tissue. Her advice was full-out surgery to treat & close the wound, as well as biopsy to try to determine the cause.

 

We are bringing Matawan to Oncologist 2’s hospital to get a second opinion from one of their surgeons later this week.

 

In the meantime, has anyone seen or experienced anything like this?? Everyone seems at a loss to explain what’s happening to our poor doggie. Oddly & thankfully, Matawan does not seem to even notice he’s got anything going on on his backside – but he is on a lot of painkillers for his cancer…. Any thoughts or theories welcomed with gratitude!

[Guest Scouts_mom]

I have absolutely no idea what is going on with your sweet boy, But I will sure be praying for him.

 

PS It might help people if we knew what kind of cancer he is being treated for. Also we need a photo of your pup.

[seeh2o]

Where are you getting your liquid chemo from?

[tbhounds]

Well it would appear to me that the wound on the leg was most likely caused by the chemo agent used. It appears that either the catheter wasn't placed properly and the chemo wasn't administered directly into the vein or the cath wasn't flushed properly because when it was removed allowing the chemo go go SubQ---this would cause necrosis--of course just a guess on my part but, this is something you need to be very careful of when placing caths for chemo. Are they entirely sure that an injection wasn't given in that hip area? Something that wasn't given in the proper route--intramuscular rather than SubQ??

[greysmom]

No clue about the hip wound, but the leg was most likely caused by the chemo drug. One of them particularly will cause the surrounding tissue to necrotize if it doesn't go into the bloodstream cleanly through the vein.

 

I would send an email to Dr Couto and see if he has any thoughts.

[silverfish]

Well it would appear to me that the wound on the leg was most likely caused by the chemo agent used. It appears that either the catheter wasn't placed properly and the chemo wasn't administered directly into the vein or the cath wasn't flushed properly because when it was removed allowing the chemo go go SubQ---this would cause necrosis--of course just a guess on my part but, this is something you need to be very careful of when placing caths for chemo. Are they entirely sure that an injection wasn't given in that hip area? Something that wasn't given in the proper route--intramuscular rather than SubQ??

 

Have to agree with you there. Looks like necrosis over/around the vein caused by the chemo agent and that maybe - just maybe - somebody started to administer it intramuscularly before realising that it was strongly contra-indicated and stopped, or was stopped from continuing (I remember a case in the news here a few years ago when it happened to a human patient).

 

 

[4My2Greys]

Well it would appear to me that the wound on the leg was most likely caused by the chemo agent used. It appears that either the catheter wasn't placed properly and the chemo wasn't administered directly into the vein or the cath wasn't flushed properly because when it was removed allowing the chemo go go SubQ---this would cause necrosis--of course just a guess on my part but, this is something you need to

be very careful of when placing caths for chemo. Are they entirely sure that an injection wasn't given in that hip area? Something that wasn't given in the proper route--intramuscular rather than SubQ??

Concerning the wound on the leg, Beanie developed a similar wound when she was receiving chemo for lymphosarcoma. I too have suspected that the chemo was not administered carefully.

 

I also suspect the theory regarding the wound on the hip. If they did this though they won't admit their error.

 

Op, I'm so sorry that Matawan is experiencing these problems with his treatment.

Edited March 25, 2015 by 4My2Greys

[CharlieRhea]

I am sorry Matawan had to experience this. Perhaps unnecessarily. You have good advice here and also Dr Couto may be able to confirm? Of course he'd only have a picture to go by but considering the chemo treatment he may be able to.

[Guest Prematurelygrey]

Thanks to everyone who provided their thoughts on this. I think everyone except oncologist #1 is of the opinion that chemo reaction is the root cause of the leg wound. I suppose we'll never know for sure.

Just to answer a few of the questions that were asked, Matawan has "presumptive osteosarcoma" - presumptive because we chose not to put him through a biopsy to get a definitive diagnosis. D. Couto did review his X-rays when we were getting his initial diagnosis. The vet hospital sourced the chemo - not sure where they bought it from.

Second opinion appointment was today. Surgeon 2 also recommends surgery to close the wound & biopsy to rule out a possible (other?) cancer. I asked if she thought we could "wait & see" to see if it healed on its own & she seemed open to it, but then she showed me the wound under the bandage and I changed my mind. I had (maybe naively) not realized fully what "removed some necrotic tissue" really entailed when Surgeon 1 took him to the back to do that on Sunday - I was thinking like picking a scab off, I suppose. But she cut away what looks like all the skin in the area, and there's now a gaping hole seemingly down to the muscle. I suppose it would be possible for it to heal on its own in time, but it would not be fast. So we're going to move forward with the surgery - trying to see if they can get us on the schedule tomorrow, so we'll have the weekend home with him. Our hope is that a stitched wound will heal significantly faster & have him back to a more normal life sooner.

All good vibes & prayers appreciated. Thanks to everyone for "listening."

[silverfish]

Many good thoughts coming your way - I'm sure the surgery will go well and you know, we've seen some horrific open wounds here on GT which have had to heal by second intention (ie, not able to be stitched closed). It looks horrible. I'm sure it's also horribly painful. But it can be done with diligence and patience and the appropriate therapy - dare I suggest manuka honey? So if the surgery doesn't completely close the wound as you'd all like, don't panic.

[duncan41]

I cannot contribute anything as to the cause, (poor Matawan!), but I cannot recommend anything more highly than Vetericyn VF for healing. (Make sure it is the "VF" formula.) Sure hope you can identify the origin of those sores. Ouch!

[tbhounds]

Please ask if doing this surgery concurrently with chemo should be performed.

[Guest Prematurelygrey]

His chemo has been suspended since the leg sores emerged in January & will most likely not be resumed. We will mention to the surgeon again - he is scheduled for the surgery tomorrow.

[GeorgeofNE]

Wait...he has bone cancer, but they're doing surgery on the sore?

 

Oh dear...I'm so sorry for your dear dog.

[turbotaina]

How's the pup today? Hope the surgery went well and he's in recovery mode.

[Guest Prematurelygrey]

Hi -
Matawan had his surgery last Saturday - only took half an hour. They had to cut away more tissue, including some of the fat layer, as that was necrotic as well. He came out of anesthesia just fine & by Sunday morning, seemed to have forgotten anything had been done to him at all. He's his complete normal self and the challenge has been to keep him from tearing around & popping his stitches.

We got pathology report back today. Negative for any bacteria, negative for cancer. Which is all good news but still leaves a mystery of "What the heck caused this to begin with?"

We had him back to our primary vet practice for bandage change to the leg (which should be his last, as the wound is almost entirely closed - Hooray! ). The vet who saw him today looked at the hip & immediately theorized black widow spider bite (a suggestion which still has me with the heebie jeebies). But she said pathology should have come back with some abnormality, if that had been the case.

His stitches to the hip comes out next week. If all looks good on the leg & hip, looks like we can finally get him out of the "cone of shame" & back to some semblance of peace, comfort & normalcy for his time that remains - which is all we ever wanted for him from the beginning.

Thanks so much to everyone who offered advice & support!

[Batmom]

Aw, glad for some good news!

[tbhounds]

Thanks for the update-glad he's on the mend.

[silverfish]

Still sounds like an accident with/reaction to the chemo to me if there's no bacteria, no cancer, and no abnormality to suggest a spider bite - especially since he had a similar area over the vein. The important thing, though, is that he's healing and bouncing back so well! That's GREAT news!