Not So Twinkle Toes

They say things come in three’s. If that’s the case, then whoever is supposed to be keeping count may have lost track.  Over the course of the past month I have seen more than my fair share of digital problems, and I don’t mean the electronic kind!

CAUTION GRAPHIC PHOTOS

My run in with toes started about a month ago with Chispita, a somewhat common name here that translates approximately to “Sparkle”.  Her story was all too common as well.  She had run away for the better part of a week and come back injured.  The source of her injuries will alway remain a mystery, only she knows what she got up to during her island tour.  As soon as she was found she was brought into Saga.  The wounds were to her face and one toe.

Chispita’s Wounds

Clearly not good.  She was clipped and cleaned thoroughly under heavy sedation.

As a basic anatomy review, each dog toe has three bones just like our fingers and toes.  This does not include the dewclaws in a dog (or our thumbs and big toes).  If you bend your index finger, you can easily see the three segments.  Starting closest to the hand (foot) is the first bone, then the second, then the third.  Each toe or finger is called a “digit”.  Each bone in the toe/finger is a “Phalanx”, so we refer to them as P1, P2, and P3. Where P3 is the little one that holds the nail.

So, the end of this toe was visibly a loss and somewhat easily removed.

Bones P2, P3, and Nail

IMG_4174

I thought perhaps I could save the rest.  I tried medications and bandaging, meanwhile also treating her face.  Midway into trying to deal with the toe on a recheck exam I realized I needed to change course.  I reviewed the procedure, and after much bleeding, finding a tourniquet, sweating, and cursing under my breath, the entire toe was amputated.  It looked pretty good!

Post Amputation

IMG_4182

After a little more recovery time, she was looking happy and ready to finally go home.

Chispita Goes Home

Phewf, I thought to myself.  That’s done.

But a vet’s work is never done.  Very quickly I was presented with another toe with a different issue.  This dog had been clawing at her crate door and had caused a fracture and puncture.  She didn’t break the bone in half, she caused the P2 and P3 to separate, leaving the end of the toe wobbly.  Again conservative treatment was not effective and the toe was painful and swollen.  I decided to just remove the last bone, the same way you declaw a cat.  That’s why declaw hurts, it’s not just removal of the nails, it’s an amputation of the last bone and the nail of each digit.  This would be a declaw for medical reasons.  I left the pad attached.

Declaw for Fractured Toe, Before and After

Meanwhile, I was rechecking a dog that belongs to one of the resorts.  This is a very large, scary looking, well behaved dog that comes in with his caretaker.  I see a lot of dogs from resorts and large businesses with caretakers, this is someone who has many jobs and one of them is to look after the dog(s).  Just like with any job, the amount that this person cares or is dedicated varies widely.  Lucky for this dog, the caretaker is one of the most dedicated “owners” that I have come across in San Pedro.  This man’s wife complains that she thinks he takes better care of the dogs than of her!  So, he was concerned that the dog had a new growth near the tip of the toe.  After some medical treatment the growth was unchanged, a very hard, attached, spherical ball.  At the recheck I decided to get an xray, as I really have no way of testing the growth here.

Toe Growth

X-Ray (toe on far right)

 

xraytoe

Growths on a toe can range from infection, to ingrown hairs, to cancer.  I could see that in the x-ray that the middle of the mass was looking calcified (bony) and the P3 looked a little abnormal.  I didn’t like it.  I spoke to the caretaker and recommended amputation.  At surgery I removed P2 and P3 and covered the end with the pad.

Partial Toe Amputation due to Mass

IMG_4227

 

Then we ran into a few hiccups.  Hurricane Earl was bearing down, most dogs here live outside.  I was assured that he could be kept in a dry shed, and he was.  Despite wearing an e-collar, this dog was able to mess with his bandage, the caretaker feverishly doted on him and replaced it as best he could.  Due to the storm damage, he was a number of days late for his recheck.  At that point the toe was infected and I feared a second surgery would be needed.  We started aggressive antibiotic therapy.  At the recheck this week I was so pleased to see it improving!  I am hoping that in a few days this toe will be completely resolved.

Almost Healed

IMG_4344

Feeling a little better about the overall toes situation, I was surprised to receive yet another one!  This was for a dog bite multiple days before that was left untreated.  The toe was infected and too swollen to tell if there was a fracture.  The toe was clipped and cleaned with a light bandage applied for a couple days.  Antibiotics and anti-inflammatories started.  Up close the toe was not as clearly dead as it looks in the photos.  I will recheck this one soon to see if it needs amputation.

Dog Bite Toe

And so, I thought, my toe work is almost done.  Perhaps I could stop losing sleep over losing toes.  Then, a client walked in with a medium sized dog.  A nice lady that I had met previously.  Her dog was wearing a sock…suspicious.  She explained the dog had run away for 5 days, she had a small cut on her foot when she disappeared.  She had recently found her.  She described to me that she thought that the “foot was rotten”.  I sighed, I rubbed my eyes and covered my face for a moment.  I thought I said “why me” in my mind, but I think I may have said it outloud.  I examined the entire dog before removing the sock.  The dog was happy and active.  Finally, unable to avoid it any longer, I gently tugged on the sock.  Ingrid (veterinary technician) was standing a few feet back on the other side of the dog.  I looked down and smiled, because sometimes if I didn’t laugh, I’d cry.  “Is it bad doctora?”, she asked me.

Severe Foot and Toe Injury

“Yes”, I replied. “Are those her bones?”, the owner asked.  “Yes”, I replied.

Another challenge begins.

Advertisements

4 thoughts on “Not So Twinkle Toes”

  1. Ooooooh, Sam, that last case. Ugh. All I can think of is honey, and lots of it….but it is so hard to get anything to granulate over bone. Good luck!

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s