Nugget – Eenie Meanie Miney Toe!

Nugget is the sweetest 6 year old English Bulldog you’ll ever meet! Nugget presented to Animal Care Center for a swollen toe on his back right paw. Nugget’s owner had noticed that he would occassionally develop a draining lesion on the toe.

Recently the toe has become more swollen and developed a foul odor. Radiographs of the toe showed soft tissue swelling and an area of lytic bone. A culture swab of the discharge was obtained, and Nugget was started on an anti-inflammatory medication and a broad spectrum antibiotic.

Nugget’s culture showed that his infection consisted of three bacteria: Proteus Mirabilis, Pseudomonas, and Methilin Resistant Staph Pseudintermedius (MRSP). MRSP is a very dangerous bacteria, because it is resistant to many antibiotics. It is a cousin of the commonly known dangerous bacteria, MRSA.

In Nugget’s case, MRSP was sensitive to only one antibiotic and aggressive antibiotic therapy ensued. At Nugget’s two week re-check, radiographs were repeated and showed that the bony lysis had gotten worse. At this point, I recommended amputation of the toe to remove the nidus of infection.

Nugget’s owner agreed to this aggressive therapy plan, and we took precautions to ensure that Nugget would be safe under general anesthesia. Nugget is a bracycecphic breed, meaning his squishy face makes oxygenation during anesthesia a little more challenging. I recommended thoracic radiographs and pre-surgical bloodwork to make sure that Nugget would be safe for anesthesia and to rule-out any possible infection spread from the toe to the lungs. Nugget’s bloodwork and chest radiographs were normal, and I proceded with digit amputation. The surgery was successful and Nugget’s toe was submitted for biopsy.

Due to the extensive infective process, Nugget required daily bandage changes for one week, which were then extended out to bandage changes every 2-3 days for two more weeks. Nugget enjoyed his frequent vet visits so much, that he had to be carried out of the office when it was time to go!

As if Nugget needed anything else on his plate to deal with, the biopsy came back with bad news: Nugget had cancer in his toe. Squamous Cell Carcinoma is an aggressive cancer, with a 20% pulmonary metatstatic (spread) rate. At this point, Nugget does not evidence of cancer elsewhere. I recommend that Nugget follow up routinely for cancer screening checks at his physical exam appointments.

Nugget’s owner was a trooper through all of this, and her supportive care at home and compliance with veterinary visits was key to Nugget’s recovery. I am so happy that Nugget recovered so well, and that we were able to catch this growing cancerous lesion and treat it, before it became life-threatening.