From:
RRC
Date: 2001-04-18 05:20:00 UTC
Subject: Bob C: Playing the "Stump The Experts Game", or, Lookee at
Bear's Foot!
Just curious to see how many would be willing to go out on a limb,
trying to diagnose something from a photograph.
This left foot belongs to Bear, a 7 year old rescue from an Oregon
petshop. Bear was neutered at 9 months old, and has been quite healthy
most of his life until two years ago when he presented symptoms of
classic adrenal disease. During surgery, his left adrenal and part of
his right was removed and he recovered normally. Close to 1.5 years ago,
Bear began having problems with his left front foot; it would
occasionally swell up as if someone had stepped on it. Maybe a week
later, it would resolve on it's own. It was mentioned to my vet who did
a scraping (which came back with some undefined plasma cells, but
nothing that could provide a definitive diagnosis), and he wanted to
watch the foot until Bear had his second adrenal surgery (this time
removing as much of the right adrenal as possible). During the surgery,
what was thought to be a large tumor (seen in x-ray and by ultrasound)
turned out to be a huge spleen (longer than Bear's entire body less the
tail; approximately 15 inches). It was removed. After the adrenal and
spleen surgery, and at my insistence, a full thickness slice of skin was
taken from the top of the foot. The biopsy was little help; either the
location of the biopsy was poor, or the handling of the tissue was less
than optimal, because a diagnosis could not be made, but a lot of plasma
cells were present.
Treatments for the foot included four separate antibiotics; no change.
Two different anti-fungals; no change. Treatment with a topical steroid;
minor but short-lived improvement.
Regardless of all attempts, Bear's foot has shown no sign of
improvement. Usually it is enlarged like in the photo, hot to the touch,
but it doesn't seem to cause Bear pain when he walks on the paw.
Occasionally the swelling goes down, but for the most part it remains
that ghastly purple-red color as seen in the photos. When cut or
bruised, it can leak blood-tinged plasma. Bear is currently up to date
with all his shots for distemper and rabies, and has been since he was a
kit. To demonstrate the long-term unchanging character of the foot
problem, the posted photos were taken last year, and because they are
virtually identical to how the foot looks now, I had no reason to rephotograph.
Currently Bear is diagnosed with moderate ascites secondary to
cardiomyopathy, and is taking 0.3 ml Lasix (10mg/ml) and 0.2 ml Lanoxin
(= Digoxin) (0.05mg/ml). As a kit, Bear broke his right femoral head,
which healed more-or-less normally. He reinjured it twice, but didn't
refracture it. He has no other health problems, and recently caught
influenza and recovered rapidly. He ambulates about as well as someone
with degenerative hips can walk, eats well, and his urine and blood
tests come back within normal limits (for a guy missing his spleen). He
has no mental deterioration, and aside from his foot, baldness and
ascites, he would look normal.
The following suggestions have been made by various vets:
1. It is some type of allergic reaction.
2. It is some type of cancer.
3. It is a fungal disease.
4. It is a mystery disease.
So, any ideas?
Bob C
Attachment 76k (image/jpeg) L Manus Dorsalis.jpg
Attachment 71k (image/jpeg) L Manus Palmaris.jpg