Jack . . .
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Case Study submitted by Gary Richter, DVM
Holistic Veterinary Care & Rehabilitation Center - Oakland, CA.
On April 1st, 2014, the owner of a 5 YO Intact Male Chocolate Labrador Retriever named Jack noticed that he was lethargic and experiencing pain his right hind leg. Upon presentation to the veterinarian, there was a small painful swelling on the medial aspect of the right thigh. Jack was put on Rimadyl and Simplicef and discharged. Over the course of the following week, the leg became progressively more swollen, edematous, and painful. By April 8th, the swelling had progressed to the entire right hind limb. Jack was brought to a specialty/referral veterinarian for evaluation. Jack was hospitalized with severe swelling and pitting edema of the right hind limb that was progressing into the right flank area. IV fluid and antibiotic therapy was initiated as well as aggressive pain control. The edema and swelling continued to progress along the ventrum, scrotum and into the left hind leg. The distal aspect of the right hind limb became edematous to the point of severely exudative with blood tinged serous fluid. The presumptive diagnosis was envenomation (probably a black widow spider bite) or some other kind of severe infectious or neoplastic pathology.
Although Jack remained systemically stable during his hospitalization, the progressive nature of the edema led to the discussion of this condition necessitating a limb amputation and/or possibly being ultimately fatal. On the day prior to Jack’s referral to Holistic Veterinary Care for hyperbaric oxygen therapy, the circumferential measurements of the right hind leg were progressively worsening from the earlier to the latter portion of the day. The referring surgeon had serious concerns about this progression and Jack’s overall prognosis.
Upon presentation on the morning of April 9th, Jack was alert and responsive and his right hind leg was severely edematous from the thigh down to the foot. Significant swelling and edema was also present in the distal left hind limb, scrotum and the ventral chest. The right hind foot was markedly exudative and dripping large amounts of blood tinged serous fluid.
Hyperbaric oxygen therapy was initiated at 2 ATA . Two dives were performed on the first day of therapy: Dive #1 was 60 minutes and dive #2 was 90 minutes. A single dive (60 minutes) was performed on the following day and two more dives (60 minutes) were performed on day three.
Treatment was initiated on April 9th. By April 10th, the leg was visibly and measurably smaller and the edema in the left hind limb and ventrum were resolving. This resolution continued into April 11th at which point the distal limb was no longer exudative, the original area of swelling on the medial right thigh had coalesced into a large abscess. The abscess was drained of approximately 250 cc purulent fluid and a Penrose drain was placed. Approximately 5 cm of skin at the apex of the swelling (presumed to be the original bite area) was very thin and purple and appeared to be necrosing.
Although no further dives were performed after April 11th, Jack continued to progress and improve. Upon presentation for drain removal on April 15th, the leg was markedly smaller and all edema/ swelling in the left hind leg, scrotum, and ventral chest were resolved. Some pitting edema remained in the distal right hind limb and was progressively resolving day to day. The Penrose drain was removed and the area of purple skin over the apex of the abscess had returned to a normal color and texture with no signs of necrosis.
As of April 16th, Jack was active and feeling great. He continued to be on antibiotics and was off most of his pain medications. The remaining edema is expected to resolve over the next 7-14 days and he should make a full recovery.