infected toe area

Our dog was limping on Nov 19 - we took to vet on Nov 20 when we couldn't see any damage. We thought he may have stepped on glass or a needle, etc. but nothing was visible.  Vet couldn't find anything either.  Sent him home with antibiotics.  Nov. 24 wound was more swollen, now bleeding.  Getting larger around the nail bed.  Back to vet Nov 26.  She expressed puss and blood but did not culture anything.  Sent home with stronger antibiotic (primor 600 mg).  Today Nov 29, dog is lethargic, not eating, wound appears larger. We have been soaking it in warm water for 10 minutes each day, but nothing has helped.  Should we change vets?  What is the next step to find out what is causing this?  It is not on the bottom of his foot - definitely between toes and the nail seems strong at this point. No blood work or x-rays have been suggested by vet so far.

[Kimberly Coyner, D.V.M., DACVD]

Potential causes for a swollen toe/non healing wound include a foreign object in the area, a deep unusual bacterial infection such as actinomyces or nocardia, deep fungal infection (such as blastomycosis or others), or a tumor. I recommend that xrays of the area be obtained as well as tissue biopsies for both pathology and bacterial (aerobic and anaerobic) and fungal cultures. Labwork to screen for internal diseases and fungal infections are needed as well, since he is not feeling well.  Additionally, if your dog is not eating and lethargic, then I recommend stopping the Primor; it is an excellent antibiotic but can cause rare adverse reactions in some sensitive animals. Talk to your veterinarian tomorrow about pursuing further diagnostics, or referral if needed. There is a veterinary speciality hospital not too far away from you:
Metropolitan Veterinary Referral Services
7562 Market Place Dr.
Eden Prairie, MN 55344
Phone [phone]
Good luck,
Kimberly Coyner, DVM DACVD