Big Bear Award – Esme

golden-labradorEsme’s Story

Our Big Bear Award for bravery goes to Esme, a 12 year old labrador and ex guide dog. At the end of 2012 Esme had split a nail on her front right paw. Initially the split did not seem to bother Esme, however over time the appearance of the affected toe slowly changed and the nail failed to heal.

For several months Esme’s toe had been treated with extended courses of antibiotics with no improvement. In April 2013 she came to see the team at Vet4life for a second opinion. Over time Esme’s toe had transformed from having a small, seemingly innocuous crack in the nail to a swollen and deformed digit. Esme’s family were understandably very concerned for their beloved lab.

Alex the Vet trimmed the broken nail back, revealing a severely swollen nail bed and toe.  She examined a swab in the clinic, finding a bacterial infection. A second swab was submitted for bacterial culture and sensitivity. Had the split nail become infected, with infection slowly spreading into the bone (osteomyelitis)? Or had the nail split because of existing pathology, such as a tumour, and then become secondarily infected? An answer would be revealed with histopathology- the toe was severely deformed and unfortunately the only option for treatment at this point would be amputation.

X-rays of Esme’s toe revealed significant lysis (bone loss) had occurred, with the nail and lower phalanges (bones of the toe) had been slowly eaten away. To ensure there was no evidence of metastes (cancer spread), chest x-rays were also taken, which were normal.

x-ray melanoma

The culture results were very concerning. Three different types of bacteria had been cultured, all showing multiple resistance to all common antibiotics. In fact, Esme’s infection was sensitive to only one remaining antibiotic! This particular antibiotic has potential for adverse effects on kidney function, so  prior to any treatment Esme’s general health was thoroughly screened with blood tests . She was then hospitalised on a drip while multiple doses of the antibiotic were given intravenously. Esme’s health and kidneys were monitored closely.

Following several days of treatment the infection had been brought under control and surgery could go ahead. The toe was successfully amputated in an hour long surgery. Esme remained in hospital overnight to continue antibiotic therapy and ensure adequate post-operative pain relief. She was discharged the following day to recover at home with orders of strict rest and plenty TLC from her family!

The whole amputated toe and surrounding tissue were submitted for examination.  A diagnosis of digital melanoma was made on histopathology. Surgical margins were clear, so the surgery was successful in removing all cancerous tissue. Unfortunately, digital melanoma does carry a guarded prognosis with an average survival time of approximately one year. However, advancements are currently being made in the treatment of canine melanoma patients.

Esme is now doing well and has adapted to life with one toe less. At this point in time there are no signs of spread of the cancer, but will require regular check ups in the future. She is enjoying getting back to her walks in the park with her family and doggie friends. After facing a serious infection and major surgery with much courage we believe that lovely Esme is a worthy recipient of a Vet4life Big Bear Award.

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Ian Stroud

Veterinary Surgeon at Vet4life
Ian Stroud is a highly experienced small animal veterinary surgeon with over 15 years working in practice. He has particular interests in several areas including minimally-invasive surgery, orthopaedics and oncology (cancer treatment). He currently practices in Teddington, Shepperton and Surbiton where he is the director of Vet4life.
Ian Stroud

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One Response to “Big Bear Award – Esme”

  1. Mckenzie DeRaspe-Bolles

    I read this story after several days of desperate searching on the internet about nailbed infections and melanoma /scc cancer in dogs.. while waiting gfor the biopsy results for my 8 year old baby Bear (shepard husky lab mix from alaska). He has a similar story only– the X-rays show clear bone deterioration in the lower phalange (his nail is broken but still in tact). But the biopsy came back negative- with diagnosis as skin tag? It makes no sense, my vet is skeptical and recommends surgery to amputate and mentioned that maybe she didn’t get a sample of the tissue deep enough or close enough to the nail? He was sedated and a pretty big ordeal to do the biopsy- , I’m trying to get 2nd opinion on what to do from here since I’ve seen this same vet starting over a year ago when Bear first injured his nail and i noticed it was bothering him. And she’s only just now (after several vet visits) appearing to be concerned…??

    We did the biopsy last Saturday but 2 weeks before that was the first time she ever did a culture on his toe to see what bacteria were present and to make a recommendation for antibiotics to treat it. ..THe culture showed 3 bacterias and 2 antibiotics were prescribed (which he is still taking). We resorted to the biopsy last week because i did not see any improvement on his toe infection (or maybe its cancer?:-/)

    Anyway, he’s taking Clavamox & Baytril to try treat:
    -Pantoea
    -Hemolyctic Strep
    -Staff Pseudointermedius

    But I’m wondering if he needs to be cured of the infection before going into surgery ? From the story you’ve shared, it sounds like that piece is important?

    Also, is there someone in the bay area that you would recommend to me? I’m concerned that one of the vets at the pet hospital is suggesting that its arthritis and not to have surgery because the biopsy came back negative, the other vet at the same clinic is suggesting just the opposite- and i don’t know who to trust?

    Thank you so much for any advice you may have for me. I’m desperate here.. :-/

    Also: here were the conclusions from the Pathologist & Radiologist.. (which seem very inconsistent?:-/ Do i go in for surgery asap? so anxious about this all and want to do the right thing, but i also know removing his weight bearing toe (middle toe) might be a tough thing at his age (8 yrs)..

    Radiologist:
    – There is mild remodeling of the distal phalanx of the right there is degenerative with mild bone lysis evident distally or the cortex is indistinct. Moderate overlying soft tissue swelling is noted. No additional abnormalities in the right front foot are seen. The left foot and both carpi are within normal limits.
    Conclusions
    1. Mild lysis and remodeling of the distal phalanx of the right front third digit with moderate overlying soft tissue swelling; differentials include pododermatitis or neoplasia such as melanoma, squamous cell carcinoma or mass cell tumor.
    2. No additional abnormalities are seen.

    Pathologist:
    There is a small pedunculated mass with a central core of fibromatous stroma covered by a hyperplastic squamous epithelium. There is a marked infiltrate of neutrophils, lymphocytes and plasma cells with fewer macrophages. The surface of the mass is ulcerated and hemorrhagic.
    MICROSCOPIC FINDINGS: Fibromatous polyp (skin tag) with marked chronic active inflammation and ulceration
    COMMENTS: The histologic findings reveal an inflamed skin tag. Skin tags are common benign incidental findings with little pathologic significance. There is no evidence of neoplasia. No infectious agents are found. I do not see any evidence of onychodystrophy.:

    Even if you don’t reply-perhaps you can point me to a website or blog or somewhere online where i can get some opinions from others dealing with this same sort of toe problems in their pets.. it seems like you are quite the expert- but you are just too far from California for me to bring my bear to see you. 🙁

    Sincerely,
    McKenzie

    Reply

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