Springer with tissue necrosis in foot

[Miserableolgit]

Posting this here for information and to see if anyone else has encountered anything similar - in any breed. This is rather a long story so bear with me..

I took on a just turned six year old ESS bitch back in May as her elderly owner could no longer cope working her. She settled down quickly and fitted in with our other spaniels and labs well.

Unfortunately she went down with pyometra in October so went in to the vet to be spayed. The op was a success and she came out looking bright but the following week her temperature was all over the place so she had to go back in to go on IV antibiotics etc for a couple of days. The same day she came out she developed a limp in a foreleg while going for a short on lead walk and toilet break along our farm track. I couldn’t see any issues with the foot or leg, no thorns, puncture wounds, cuts. Joints all good and no pain evident - nor could the vet when she went in for another post op check two or three days later.

The limp and lameness  persisted to the extent that she did not want to use that foot. No swelling or heat. A small blister appeared on the main pad which tore revealing pink flesh underneath. I cleaned the area with dilute Hibiscrub and it dried and scabbed as normal. She was still on the post pyometra op antibiotics at this stage. Four days later a pinkish non smelling fluid appeared from a small hole that also suddenly appeared in the flesh between two toes. That happened late on a Sunday evening, I cleaned it up with an antibacterial wash and put her to bed in her cage. Next morning the skin on a large part of the foot, pads etc had turned grey and the hole had got got bigger, the whole thing smelled foul, just like decayed flesh. I whizzed her back to the vet who took swabs of the foot which had worsened in the 45 mins it took to get to the practice. In fact the swab went right through the foot from one side to the other it had decayed that much. They kept her in on IV antibiotics and the vet suggested I get the swab to the lab rather than wait for the courier as time was obviously of the essence. So I left the dog there and drove fairly rapidly in order for them to get cultures started asap. Fortunately the antibiotics meant the decay did not spread up the leg but they kept her in isolation as the cause was unknown. Three days later the lab reported that three nasty bacteria were involved: Pseudomonas spp. Enterococcus spp. Escerichia coli. They recommending a cocktail of antibiotics - which she has been on until a few days ago. As the dog was not eating she was given nutrition via IV so we agreed that she come home to see if she would eat but that the foot would require dressing and topical medication changes every three days. We would do one then back to the vet for the next and assessment etc etc. This has now been extended to weekly dressing changes with the foot no longer treated with Intrasite but medical grade manuka honey. She recently had biopsies taken and sent to the lab for analysis but a week on they are saying they found nothing conclusive and need to do more tests. Ho hum. We have been taking pictures of the foot at every stage but I won’t share the initial ones as frankly they are horrific with exposed bone, ligaments, rotten pads and dead flesh. 

The vet has no idea what the cause was, I have never experienced anything like it in 60+ years of owning dogs. There have been many suggestions such as snake, rodent or insect bite but that is unlikely as she was on one short lead walk after the op and there were no signs of any puncture wounds anywhere. She was not in contact with any chemicals or polluted ground. Wasn’t a thorn or grass seed, there was no visible signs of infection. Not Alabama Rot as that usually attacks the kidneys and is normally fatal. Bloods show her kidneys are fine - it really is a total mystery. Having said that I understand there are very rare cases of a genetic disorder affecting tiny numbers of spaniels that causes necrosis or tissue dieback. Who knows, hopefully the biopsies will show something - although nothing reported yet.

She is a lovely dog and was a good worker and didn’t cost me a penny but the current vet bills have been somewhat eye watering! The dog is bright eyed and happy, eating, drinking and toileting as normal. I did consider having the leg amputated but the foot is responding to treatment and new flesh has started to grow but it’s far from over yet. Our other dogs here as as per normal.

Anyone seen or heard of anything similar?

went down with pyometra back in October so went in to be spayed. She came out looking bright but her temperature was all over the place the following week and had to go back in to go on IV antibiotics etc. She came out but developed a limp the same day which persisted for a few days. I couldn’t see any issues with the foot or leg, nor could the vet when she went in for her post op check. A few days later a pinkish non smelling fluid appeared from a small hole between two toes. That happened late on a Sunday evening, I cleaned it up with an antibacterial wash and put her to bed in her cage. Next morning the skin on a large parge of the foot, pads etc had turned grey and the hole had got got bigger, the whole thing smelled of decayed flesh. Whizzed her back to the vet who took swabs of the foot which had worsened greatly in the 45 mins it took to get to the practice. In fact the swab went right through the foot from one side to the other it had decayed that much. They kept her in on IV antibiotics and the vet suggested I get the swab to the lab rather than wait for the courier as time was obviously of the essence. So I left the dog there, drove from Wymondham to Harleston fairly rapidly in order for them to get cultures started asap. Fortunately the antibiotics meant the decay did not spread up the leg but they had to keep the dog in isolation as the cause was unknown. Three days later the lab reported that three nasty bacteria were involved recommending a cocktail of antibiotics - which she has been on until a few days ago. As the pup was not eating she was given nutrition via IV so we agreed that she come home to see if she would eat but that the foot would require dressing and topical medication changes every three days. We would do one then back to the vet for the next and assesment etc etc. This has now been extended to weekly dressing changes with the foot no longer treated with stuff called Intrasite but medical grade manuka honey. She recently had biopsies taken and sent to the lab for analysis but a week on they are saying they found nothing conclusive and need to do more tests. Ho hum. We have been taking pictures of the foot at every stage but I won’t share them with you as frankly the earlier ones are horrific with exposed bone, ligaments, rotten pads and dead flesh. The vet has no idea what the cause was, I have never experienced anything like it nor have people in any of the big spaniel / gundog groups either. Could have been a snake or insect bite but that is unlikeley as she was on short lead walks after the op only. Wasn’t a thorn or grass seed as there was no signs of infection. Not Alabama Rot as that usually attacks the kidneys and is normally fatal. Millie’s bloods show her kidneys are fine - it really is a total mystery! Having said that there are very rare cases of a genetic disorder affecting tiny numbers of spaniels that causes necrosis or tissue dieback. Who knows!

We had Flynn castrated in early October as one of his nuts hadn’t descended, that was £600+, then Millie had to be spayed and treated for pyometra, that was another £600 then this foot thing has added about another grand. I hate to think what the latest lab biopsy tests are going to be. That said she is a lovely dog that didn’t cost me a penny as Fred could no longer work any of his dogs due to old age. It looks as though the foot is responding to treatment and new flesh is starting to grow but it’s far from over yet.

Edited December 2 by Miserableolgit

[oldypigeonpopper]

Hello,  she sound a wonderful Spaniel so hope you can find a remedy 👍

[Miserableolgit]

4 minutes ago, oldypigeonpopper said:

Hello,  she sound a wonderful Spaniel so hope you can find a remedy 👍

Yes she is a nice little thing, I have grown very fond of her right from where she came and sat right next to me when I initially went to see her.

 

 

Edited December 2 by Miserableolgit
Added pic

[Lloyd90]

Not Alabama Rot is it?

Surely they’ve tested for it? 

 

 

[Miserableolgit]

2 minutes ago, Lloyd90 said:

Not Alabama Rot is it?

Surely they’ve tested for it? 

 

 

No, not AR. I think I mentioned bloods were normal inc kidney function. AR usually causes kidney issues and is usually fatal pretty quickly.

[oldypigeonpopper]

1 hour ago, Miserableolgit said:

Yes she is a nice little thing, I have grown very fond of her right from where she came and sat right next to me when I initially went to see her.

 

 

👍

[old'un]

Blimey, sorry to hear you and your dog have gone through such a bad patch, she looks a lovely biddable dog and know what you mean about getting fond of a dog, hopefully she is on the mend, must say I have never heard of such before.

Good luck with her.

[Miserableolgit]

2 hours ago, old'un said:

Blimey, sorry to hear you and your dog have gone through such a bad patch, she looks a lovely biddable dog and know what you mean about getting fond of a dog, hopefully she is on the mend, must say I have never heard of such before.

Good luck with her.

Many thanks. We are just back from the vet, it was their turn to change dressing and assess, our turn Thursday. 

Photo taken this afternoon is a bit more acceptable and less gruesome. This is after dressing off, saline wash to clean the manuka honey and dry prior to fresh honey and bandaging. The pink parts are all new tissue growth. While it does look puffy that is due to being enclosed in honey and dressings plus just having been washed. She will loose that last claw but the hope is tissue regrowth will continue and will recover the remaining exposed features at the end of the toes.

[London Best]

Poor little dog.

[WalkedUp]

Awful, but thank you for posting. 

[7daysinaweek]

I ain't no vet.

I do have  a fair knowledge of wound causation, treatment and management, and outcomes in humans.  Causative pathogens in wounds and infection have large degree of similarity, both in dogs and humans. The three pathogens which you mention that cultured from the swab above, have the same or very similar pathology in both humans and dogs.

I have given it a bit of thought, there are several scenarios, I start with the degree of possible cause likelihood.

The pathogens Enterococcus spp and Escerichia are both ecoli and are found within mammals, in the mouth at low levels, in gut and faecal matter at larger amounts, it can be spread into the urinary tract, and it is one of the most common causes of water infections.

Pseudomonas spp can be found in water courses, plant matter, and can also naturally occur in the upper respiratory tracts, nose throat, it is a cause of some lung and urinary infections and is commonly found in wounds.

Scenarios

1) The dog had sustained a penetrating foreign body in the foot (puncture from a thorn, small shard of glass or metal and stood stood in some animal faeces or urine which have penetrated into the wound bed.  If it was a FB, it may have not stayed in wound, if it was radiopaque, glass , metal, gravel etc, it would show on xray, wood is radiolucent and harder to detect on xray, if suspected wood FB, ultrasound is better.

2) The dog has licked it genitals, penis/anus, then licked the area of the toe wound and transferred the pathogen which has then tracked up into the wound bed.

3) A internal cyst had formed in the tissue over months or years, an inflamatory response has then occured at the cyst, and a internal pathogen such as a virus or bacteria has got into the area and forms into a abscess over a short period. This can also lead to acute infection within the joint know as septic arthritis. Most of the cases of septic arthritis I see in the foot, the patient cannot weight bear and the pain can start off as just an ache and be fully weight bearing. As the infection spreads into the joint the pain rapidly increases and the patient then cannot or has extreme difficulty weight bearing.

4) The soft skin tissue that surround the claw gets a small abraision or cut to it, pathogen then tracks up into the tissue and forms an abscess.

From how you describe the wound, the pad wound could have been the site for infection entering the foot, it appears likely then that as the infection has spread, it has formed what we refer to as a sinus tract. The sinus has then spread through the upper tissues and has tracked out between the toes. It is not unreasonable either for the webspace betweeen the toes to have been the portal for infection.

How wounds are staged:

 grade 4 , visible musculature, tendon, ligament, bone.

grade 3, all the layers of skin are lost and the damage infiltrates into the underlying tissue.

grade 2 the layers of skin are lost.

grade 1, the skin is not broken or lost, but the blood flow to it is delayed or absent to a area of the skin resulting inflamtion, heat, hardness to the area or pain. In lesser presentations the skin can be cool or similar temprature to the surrounding skin.

Wounds infection is staged in severity as follows, and the management of the staging is commensurate with clinical presentation of the wound and the patient, in your case the dog. Blood work up for inflamatory markers, crp to establish inflamation levels which can indicate the severity of infection. I have no idea what crp levels are in dogs, but I would hazard a guess, that is what a vet would firstly look at apart form renal function etc for when an animal is acutely unwell.

1) contaminated  

2) colonisation

3) localised infection

4) spreading infection

5) sytemic infection

The wound is a grade 4 from how you have described it.

 

Wounds heal in three ways, be they caused by surgery, infection or trauma:

1) primary intention: wound edges are brought together withing minutes or hours and sutured, glued or stapled, eg primary surgical wound.

2) secondary intention: the wound has skin loss so no edges to close the wound, eg trauma, pressure ulcers and the wound heals and closes itself over time.

3 tertiary intention: this is when the wound is left open, in most cases this is due to infection, as by closing a wound that has had degree of infection, this increases the risk of worsening infection. Wounds may be left to fully close themself as in secondary intention, or, may be sugically closed at a later date when it has been established that the wound has nearly healed, but requires surgical closure. For example, a full thickness burn with infection at the wound bed (third degree burn) Once has been left to heal and established that infection has cleared. the wound may require closure with a skin graft if over a joint or a large surface area.

Metrotop gel is good for treating certain infections and provides a moist enviroment in which promotes wound healing,

Manuka grade honey is excellent, provides a moist enviroment, has low microbial resistance, promotes autolytic debridement which helps the natural enzymes in the blood break down the dead and necrotic tissue. 

Appears she be on the mend now, and she has certainly been through the mill, poor thing.

 

 

 

[Miserableolgit]

10 hours ago, 7daysinaweek said:

I ain't no vet.

I do have  a fair knowledge of wound causation, treatment and management, and outcomes in humans.  Causative pathogens in wounds and infection have large degree of similarity, both in dogs and humans. The three pathogens which you mention that cultured from the swab above, have the same or very similar pathology in both humans and dogs.

I have given it a bit of thought, there are several scenarios, I start with the degree of possible cause likelihood.

The pathogens Enterococcus spp and Escerichia are both ecoli and are found within mammals, in the mouth at low levels, in gut and faecal matter at larger amounts, it can be spread into the urinary tract, and it is one of the most common causes of water infections.

Pseudomonas spp can be found in water courses, plant matter, and can also naturally occur in the upper respiratory tracts, nose throat, it is a cause of some lung and urinary infections and is commonly found in wounds.

Scenarios

1) The dog had sustained a penetrating foreign body in the foot (puncture from a thorn, small shard of glass or metal and stood stood in some animal faeces or urine which have penetrated into the wound bed.  If it was a FB, it may have not stayed in wound, if it was radiopaque, glass , metal, gravel etc, it would show on xray, wood is radiolucent and harder to detect on xray, if suspected wood FB, ultrasound is better.

2) The dog has licked it genitals, penis/anus, then licked the area of the toe wound and transferred the pathogen which has then tracked up into the wound bed.

3) A internal cyst had formed in the tissue over months or years, an inflamatory response has then occured at the cyst, and a internal pathogen such as a virus or bacteria has got into the area and forms into a abscess over a short period. This can also lead to acute infection within the joint know as septic arthritis. Most of the cases of septic arthritis I see in the foot, the patient cannot weight bear and the pain can start off as just an ache and be fully weight bearing. As the infection spreads into the joint the pain rapidly increases and the patient then cannot or has extreme difficulty weight bearing.

4) The soft skin tissue that surround the claw gets a small abraision or cut to it, pathogen then tracks up into the tissue and forms an abscess.

From how you describe the wound, the pad wound could have been the site for infection entering the foot, it appears likely then that as the infection has spread, it has formed what we refer to as a sinus tract. The sinus has then spread through the upper tissues and has tracked out between the toes. It is not unreasonable either for the webspace betweeen the toes to have been the portal for infection.

How wounds are staged:

 grade 4 , visible musculature, tendon, ligament, bone.

grade 3, all the layers of skin are lost and the damage infiltrates into the underlying tissue.

grade 2 the layers of skin are lost.

grade 1, the skin is not broken or lost, but the blood flow to it is delayed or absent to a area of the skin resulting inflamtion, heat, hardness to the area or pain. In lesser presentations the skin can be cool or similar temprature to the surrounding skin.

Wounds infection is staged in severity as follows, and the management of the staging is commensurate with clinical presentation of the wound and the patient, in your case the dog. Blood work up for inflamatory markers, crp to establish inflamation levels which can indicate the severity of infection. I have no idea what crp levels are in dogs, but I would hazard a guess, that is what a vet would firstly look at apart form renal function etc for when an animal is acutely unwell.

1) contaminated  

2) colonisation

3) localised infection

4) spreading infection

5) sytemic infection

The wound is a grade 4 from how you have described it.

 

Wounds heal in three ways, be they caused by surgery, infection or trauma:

1) primary intention: wound edges are brought together withing minutes or hours and sutured, glued or stapled, eg primary surgical wound.

2) secondary intention: the wound has skin loss so no edges to close the wound, eg trauma, pressure ulcers and the wound heals and closes itself over time.

3 tertiary intention: this is when the wound is left open, in most cases this is due to infection, as by closing a wound that has had degree of infection, this increases the risk of worsening infection. Wounds may be left to fully close themself as in secondary intention, or, may be sugically closed at a later date when it has been established that the wound has nearly healed, but requires surgical closure. For example, a full thickness burn with infection at the wound bed (third degree burn) Once has been left to heal and established that infection has cleared. the wound may require closure with a skin graft if over a joint or a large surface area.

Metrotop gel is good for treating certain infections and provides a moist enviroment in which promotes wound healing,

Manuka grade honey is excellent, provides a moist enviroment, has low microbial resistance, promotes autolytic debridement which helps the natural enzymes in the blood break down the dead and necrotic tissue. 

Appears she be on the mend now, and she has certainly been through the mill, poor thing.

 

 

 

Thank you for your comprehensive and much appreciated insight. I will read it again and digest it  over a coffee  later this morning.

 Thanks to all for the kind comments.