Scary Bleeding

[macoduck]

Percy is 12.5 years old. Any previous medical history is unknown because he was picked up as a stray.

He had a horrible, horrible time with anesthesia and bleeding when getting 6 of his remaining teeth removed at the end of last summer. He was treated with Amicar/Tranexamic Acid at the time.

 

About 2 months ago he began wheezing after light exertion. Vet diagnosed onset of laryngeal paralysis .After I learned about Doxepin here my vet agreed to try it and it made a big difference.

 

Percy has had a "bubble" slightly on top and beside a large surface blood vessel on his rear leg. Some days it's flat, some days it's bubbled up. The tissue is very very thin.

One evening I noticed that it was oozing blood from a little hole on the side. Even with putting pressure on it, it soaked through 3 paper towels. I got the bleeding to stop long enough to place gauze and a pressure wrap over it.

 

Vet checked it the next day. Although vet had noticed the bubble prior to this event, she'd never seen anything like it before. She did chemical cauterization with silver nitrate to stop the bleeding and wrapped it. Percy was on antibiotics and I was to change the dressing every couple of days.

 

Even with pushing the dressing change to 3-4 days, the bubble will again start oozing blood. I used plain gauze at first, then teflon gauze. This area will not form a scab. Some days I can see break through bleeding.

 

The pictures will show the progression of the bubble. I think it is behaving like an aneurism. (It looks round like a histiocytoma but it is not one.) Yet the large surface vessel that it sits atop and beside never changes size. His foot is otherwise healthy. Even with the wrap on there is no swelling of the foot. Fortunately, Percy does not fuss with the bandage.

 

I have sent pictures to Dr Couto. No response yet other than the "out of office" reply.

 

My vet is not willing to attempt suturing or clamping off the "feeder" vessel because of 1. the laryngeal paralysis and 2. his history of excessive bleeding. Because there was more leakage blood on the dressing I changed out today I have put him back on the Tranexamic Acid 650mg. I will email my vet tonight and followup tomorrow.

 

GT veterinarians:

- given his age wouldn't it be worth trying to keep Percy on TA, even if the dose was lowered?

- could closing off that feeder vessel be worth trying unless it would hurt blood circulation to his foot?

 

I'm going to ask for a referral to the specialty vet in Wilmington NC. However, when I called them in early January about an LP evaluation, they were booked out for over a month just for the consult. Fortunately the Doxepin fixed the LP.

 

My greatest fear is that this thing will really have a blow out and that Percy will slowly bleed to death while I am not home.

 

 

[Remolacha]

That is very weird, and scary

[tbhounds]

Looks like a mass.

[macoduck]

Looks like a mass.

It's just odd that before it burst, some days it would be taller and other days completely flat.

 

Editing to add that in the last picture I had just removed pressure and the blood was beginning to ooze up.

 

And could a dog be intubated for anesthesia if they have LP and are on Doxepin to control it?

 

What are the odds that a topical anesthetic could be used when cutting and suturing this area?

Edited February 18, 2016 by macoduck

[FiveRoooooers]

Geez Ducky, just for you both.

[NeylasMom]

Fwiw, Neyla had a torn ear from a dog bite sutured without anesthesia because of a prior history. I think it's possible something on a leg that didn't require delicate work could be with sutured without anesthesia if the vet were willing. Maybe something like Trazodone to mellow him out that wouldn't interfere with the LP and you could test out in advance?

[4My2Greys]

Sending you a big hug and Percy lots of white light. I hope you can get this resolved safely.

[Batmom]

LP: Wouldn't think intubating would be a problem, as that would keep the airway open. Might need extra care before/after??

 

We have done some things not quite that big with local anaesthesia. Worked fine for a calm, easy to immobilize dog. Owner has to remember, dog may not be able to feel the foot on that leg for some time, so you really have to be careful that they don't stumble and injure themselves.

[macoduck]

Thank you all for the encouragement.

 

I am going to contact my favorite vet who moved a few towns away and opened a new practice. My current vet is his former partner.

[ramonaghan]

Sending good thoughts to you and sweet Percy. Hope you get some answers soon.

[Houndtime]

I just wish you and him all the best.

[spottydog]

Good wishes for Percy!

[Zachary]

Ducky,

 

So sorry Percy is going through such a frightening health issue. I understand why you are concerned about the use of anesthetic and especially bleeding. Have you ever heard of Domitor? It is a reversible sedation that might be useful in this situation. http://www.petplace.com/article/drug-library/library/prescription/medetomidine-domitor

 

This is a two injection medication. The first injection sedates the dog and the second will bring them around. There are precautions regarding protecting the dogs eyes because they remain open while the dog is under. Also it is suggested the treatment room be kept very quiet to keep the animal calm as well.

 

Hugs to you and Percy.

[greysmom]

Can dogs have an epidural like they give to women in labor??

[NeylasMom]

I know you can use nerve blocking agents because Turbotaina was finally able to diagnose Turbo's corn using one on a toe, but I don't think you'd want to do that to a whole foot or portion of a leg.

[3greytjoys]

I'd ask your specialty vet to please squeeze Percy in as an urgent appt. (if their next opening isn't within a couple of days).

 

FWIW, one of our senior excessive bleeder hounds, who has advanced LP, was placed under general anesthesia for removal of subcutaneous hemangiosarcoma and other masses about 5 years ago. (Margins were not clear.) Although she's not on aminocaproic acid (aka: Amicar) 24/7, we do keep tablets stocked at home for emergencies. The tablets have worked successfully on all of our excessive bleeder hounds during off-hours emergencies. A couple years after that hemangiosarcoma surgery, she underwent a successful toe amputation (while on aminocaproic acid). Now, she's 14 years old, so surgeries are weighed even more carefully. That said, this particular hound doesn't over-stress terribly during hospital recoveries. (Our other advanced LP hound + excessive bleeder could not tolerate hospital stress as well.)

 

Hope the T.A. helps eliminate Percy's bleeding for now. Looking forward to seeing answers to your veterinary questions.

 

Did your vet try a FNA? One of the reasons I think you're smart to involve a (surgical) specialist is location of that mass to vessels, tendons, thin skin, etc. Surgeon's expertise would be most important if that surged opening bleeds excessively. Also consider if Percy isn't under general anesthesia, could Percy and the surgeon handle it successfully...

Edited February 18, 2016 by 3greytjoys

[tbhounds]

You would need general anesthesia to remove that. Because it's laying immediately on the lateral saphenous vein that would need to be ligated and excised. To be honest it's too large a vessel to make Amicar or TA to be of benefit (pre-op). My guess is this will continue to bleed because of the vascularilty of the area until it's removed.

Hope I'm wrong-please keep us posted.

[DesiRayMom]

S-C-A-R-Y!!!!! Hope you find answers & a resolution sooner rather than later. Best wishes to Percy.

[MP_the4pack]

My Onyx (who made it to 15.5) had an LP tieback at age 11. She had several surgeries between that and when she left. There is no problem with the intubation, however, the tube needs to remain in as long as possible. That's the tricky part is to keep it in but remove it at just the right time so as not to scare the dog. But that was it.

[macoduck]

Glad we were able to get in to this other vet today. He's Mr No-Nonsense/Don't Panic. He's got a great last line in his bio:
Dr. Martin served on the North Carolina Veterinary Medical Board for 9 years and served as President for one term. Currently, he serves on the Onslow County ABC Board and the Onslow County Health Services Advisory Committee. His hobby used to be fishing until he found out he could buy fish.

 

Tracy, you are correct. He thinks it is a growth and not a good one. It's not attached to that vessel. And it's infected again even though first vet had us on Simplicef for 10 days starting Feb 2.

 

Starting another round of Simplicef today. He did not remove the bandage but was able to peer down inside the wrap with a light and could see pus. He does want me to change the dressing Saturday.

 

We will return on Wednesday when he will do an "impression smear" to check for cancer cells or other nasties. Then we'll see where we go from there.

 

Thank you all for your good thoughts. It meant a lot.

[FiveRoooooers]

So glad Dr Martin (what a great guy) could see Percy today. Hang in there Ducky.

[Jenbo]

Come on, Percy, get well!

[Houndtime]

Glad we were able to get in to this other vet today. He's Mr No-Nonsense/Don't Panic. He's got a great last line in his bio:

Dr. Martin served on the North Carolina Veterinary Medical Board for 9 years and served as President for one term. Currently, he serves on the Onslow County ABC Board and the Onslow County Health Services Advisory Committee. His hobby used to be fishing until he found out he could buy fish.

 

Tracy, you are correct. He thinks it is a growth and not a good one. It's not attached to that vessel. And it's infected again even though first vet had us on Simplicef for 10 days starting Feb 2.

 

Starting another round of Simplicef today. He did not remove the bandage but was able to peer down inside the wrap with a light and could see pus. He does want me to change the dressing Saturday.

 

We will return on Wednesday when he will do an "impression smear" to check for cancer cells or other nasties. Then we'll see where we go from there.

 

Thank you all for your good thoughts. It meant a lot.

 

Not necessarily the best news, but something to work with. Hoping for the best.

[Roo]

Good thoughts for you and Percy! How scary (and strange) it is...

[tbhounds]

Thanks for the update-was thinking of you today. <3