Open eldbow woulnd to bone

[Daisyzeuslilly]

Daisy (10 years old) was prescribed Rimadyl for apparent arthritis in feet.  Evidence of the arhtirtis was her licking and chewing her feet until raw.  Otherwise she was active, virgorous and playful.  She looks to be Shepard and Pyrenes mix.  Within 10 weeks of starting the Rimadyl she had lost almost one third her weight, her coat looked terrible, and she had no energy.  While on the Rimadyl she developed an open sore on her front elbow. Researching contraindications for Rimadyl I decided to take her off the Rimadyl.

The open sore on her elbow has not healed and is now the size of a silver dollar.  Our vet prescribed an antibiotic, told us to keep the would clean and covered (we have her wear a t-shirt) and use a cone to keep her from further licking the wound.  A blood panel revealed that her white blood cell count was high, red cell count was low and her bilirubin was high.  A subsequent blood panel revealed that her thyroid function was extremely low; this helped explain the lethargy.  Kidney and liver functions were OK.

It has been 3 weeks since we started her on antibiotics and 2 since starting the thyroid.  We feed her fresh food prepared as part of our meals and a little dog food.  She has gained very little weight but is not the 65-70 pounds she was; current weight is about 50 pounds.  Her coat has improved as we have added 400IU of citamin E to her daily diet and olive oil as well.  She has low days and some somewhat better days.  She suffers some constipation as well although she has access to fresh water and receives quote a bit of fiber in her diet.

The big question is what can we do to get the open wound on her elbow to close.  We are reluctant to keep her on the antibiotics for much longer.  Our vet has advised us that there is not enough skin to suture the wound closed.  Even if there were how do we keep the pressure off the elbow so it will heal?

[Daisyzeuslilly]

Thanks for the reply.  Your insight is most appreciated.

Vet has done Xrays on feet and thorax section.  Mild if any arthritis in feet.  The five Xrays in the thoracic section revealed that her lungs are clear (she has a slight coung at irregular intervals - almost like a heavy pant) and there are no turmors.  No skin scrapings have been performed.  We will have blood test results tomorrow and I will inquire regarding tick borne diseases as well as skin scraping.  What should we be looking ofr in the skin scrapings?

We were advised by another vet today to sustain the antibiotic and thryoid medications.  The second vet, an orthopedic specialist, claimed the elbow wound will take time but will eventually heal completely.

Interesting, I certainly thought the previous vet was mis-staing something when he mentioned surfactant.  Obviously, Sucralfate makes sense.  The new vet prescribed Pepcid but we have to collect a stool sample before starting the Pepcid so as not to contaminate the test results.  Daisy had a short course of Prenisone following her first visit to the vet when it was obvious her health was compromised.  She has not had more since the first course.

The new vet also mentioned the possibility of myositis (sp?) as evidenced by her loss of muscle especially noticable in her face and head.  The vet also recommended an ultrasound to evaluate her spleen.

We will investigate the Coptis Powder and luckily we have an Aloe Vera plant for gel.  The question is how do we maintain the wound other than keeping pressure off the elbow?  Also, are there any contraindications for the Coptis powder, particularly as she may ingest it?

Thanks again for your help.

[Aleda M Cheng, D.V.M., C.V.A]

Has your vet performed X-Rays on your pets joints including her feet and elbows, or  examined her skin using a skin scraping and other diagnostics?  Has your vet performed a blood test for tick borne diseases, which can cause joint disease and anemia?

Constant chewing on specific areas can be caused by pain or dermatological conditions.  Hypothyroid can cause skin conditions to be more severe, and harder to treat unless the hypothyroid is being treated.  She is currently being treated for her thyroid condition, which is great, but it may take another two weeks for the thyroid medication to kick in.  

I think that you meant Sucralfate, not surfactant.  Sucralfate is a safe, medication that acts like a bandaid for the gastrointestinal system to coat ulcers to allow them to heal.  I think that steroids along with the Sucralfate and Pepcid may help your dog.  Prednisone is effective short term to stop itching, which may be a cause of the leg and feet chewing, and also helps with joint pain and immune mediated hemolytic anemia.  An herbal remedy in powdered form called "Lian Coptis, or just plain Coptis Powder" applied topically acts to stop licking and chewing and is also a good topical antibiotic. Coptis Powder is available from a variety of companies online and in some Chinese Markets that have herbal departments.  Place Aloe Vera gel or olive oil on the wound and feet and sprinkle on the Lian Coptis.  It will help to prevent your dog from licking and will also help to heal the wound faster.  Please note: the Coptis powder can stain.

[ireneo]

I've seen AST on blood work results but had no idea what it was. I looked it up and it says: aspartate transaminase - an enzyme in serum and body tissues, esp. heart and liver. I get the impression they look for it in cases of heart attacks and liver damage.

Hang in there. The vet on board will have more information for you. I'm sure this is discouraging for you but like I said, some wounds do take quite awhile to granulate in. Let's hope all the other issues with her blood work and stomach get resolved soon as well.

[Daisyzeuslilly]

Thanks for the reply.

The wound is covered with a fresh t-shirt she wears.  Also, we use a small childs knee and shin protector (for very small motorcycle riders) to keep the pressure off the joint.  This straps to her forearm with velcro, the knee cap portion over her elbow.  She wears a cone to prevent her from licking the wound.  Periodically we irrigate the wound with distilled water.

She is on thryoid med which has improved her energy level slightly.  A recent blood panel showed bilirubin that was 1.4 is now 0.4 (we understand that 0.3 would be within an acceptable target range).  White blood cell count is still high at 33 (was 27 one week ago).  Red cell count is the same (still anemic).  AST is 97 (whatever this is).  Vet recommended staying on antibiotics and thryoid.  

I inquired about how to treat her for NSAID poisoning from the Rimadyl.  The vet said that once off the Rimadyl any intestinal ulceration that might have occured would normally heal itself.  A feces occult test is to be conducted this week with a followup vet visit to determine if there is any bleeding in her gut to explain the anemia.  The vet also mentioned the possible use of a surfactant to coat the stomach to aid healing of any ulcer.  I'm not too keen on the surfactant and will wait for the results of the occult test before subjecting her to more chemical treatment.

[ireneo]

Just a question: is the wound covered at all to protect it from her rubbing it on the floor? I don't work with pets but I have worked with electrocuted eagles, chewed up beavers, animals with large wounds that need to granulate in and it takes a long time. We also keep the wound covered but clean it regularly and debride any tissue that needs to come off. I understand not having enough skin to suture it together, especially over an area like an elbow. Perhaps her less than ideal health is slowing down the healing process. She is on thyroid meds?  I'm sure the doctor will have some advice.