Thursday, July 26, 2012

Jasmine's Mysterious Swelling And Another Experience With VetLive

So I was going to write about Jasmine's acupuncture session ... meanwhile she prepared a different challenge for today. I'll post about the acupuncture later on.

For couple days, when looking at Jasmine sleeping at night, I felt that her rear right leg didn't look quite right. It seems somewhat chunkier than I believe it should. More staring didn't bring more insight and I wasn't sure whether I wasn't just seeing ghosts. Until today.

Today she was lying in such position that I could really compare the two legs well. The right one certainly did look thicker.

I decided I was not seeing ghosts and that there really appear to be some swelling. Nothing better to mess with my peace of mind.

Ok, so the leg seems kind of swollen. What is going on?

There didn't seem to be any pain or associated lameness. Jasmine didn't seem bothered by it, just me. There has been some licking of her rear right foot around the toes but I couldn't see any discernible reason.

What I would really liked to have done would be taking her to see her vet right that minute.

Unfortunately, that was not possible. Hubby teaching classes till late evening and no hubby means no transportation.

I needed to talk to somebody which an expertise and somebody who was available right then.

I have to admit that first place I turned to was I've had a subscription there for quite a long time now and it works well for simple questions. So I posted my question there. The answer I got was fine but came nowhere close to easing my anguish. Sometimes you get the answer you need and sometimes you do not.

It was time to turn to VetLive.

I have used them in the past and the thoroughness of the answers and the investment in each of their cases is amazing.

First thing to expect when you turn to VetLive is more questions.

Questions are good. There are no answers without questions.
VetLive: What does the swelling feel like? Is it kind of squishy? When you press on it (holding pressure for about two seconds), does it immediately swell back out again? How long does it take to "fill out?"

Is the swelling even up and down her leg, below the knee that is?

Is her foot swollen?

Is the color between her foot pads normal? What color?

Any lameness? Decreased energy? If so, estimate a percentage please.

When did you notice this? Has it gotten worse?

Any other abnormalities--changes in urination, thirst, appetite, cough, etc.?
What is Jasmine's current drug regimen and has anything changed?
I'll probably think of other questions but this is a good starting point. Can you can take pictures (several are better than one but one is better than none).

Thanks in advance for your thought in answering these questions. Also, has her vet taken a look at the swelling yet?

Of course that was when our camera refused to cooperate so I at least took a few shots with my phone. You know, those days when everything is bound to go wrong.

I answered the questions the best I could.
Jana: Actually, now, playing with it, it seems it is only from the hock down (hock area inclusive)

It doesn't feel like much, doesn't really feel like a swelling, not squishy. It doesn't really feel differently from the other leg to me, just the leg looks thicker.  It's quite subtle, just the leg doesn't look right and doesn't look as "bony" as it typically would and as the other one does.

When I do push down on the area that seems the "thickest/flashiest" the indentation does come right back.

I thought it seemed pretty even overall, now, when staring at it, it seems a little more pronounced on the top of the metatarsus(?) and foot and underneath the hock.

The top of her foot, just before the toes is swollen.

The bottom of the foot appears normal.

There is no lameness observed on that leg (there has been some on the left rear leg due to the angry muscles/just did acupuncture for this Monday/the swelling was present prior the acupuncture treatment/I just wasn't sure I wasn't just making things up in my head)

Energy seems consistent with her normal level; just one thing I noticed she might not be as quick to come to greet hubby at the door as usually last couple days; otherwise ready to go on walks, ready to rumble ... overall I'd say there is possibly 5% decrease in energy but I couldn't bet my life on it

Appetite is also normal/very good.

I think I noticed this Sunday night but wasn't sure what I was seeing. Definitely saw this on Monday. Doesn't appear to have gotten worse, seems the same. The licking of the top of her foot had gone on for couple weeks but nothing we could find being a problem there so figured to wait for her next appointment with that. It is not severe licking, maybe 20 minutes a day total ...?)

Urination and thirst are normal, appetite is normal, there was temporary decline in stool quality for couple days, seems resolved and not unusual for her (not diarrhea, just not as well formed as it should and some traces of mucus, now also resolved)

No cough, had a lot of sneezing yesterday, none today and none to speak of before.

I can take pictures but have to wait for hubby to get the on the computer (complicated set up here); will be happy to send those once I have them available

Gabapentin (for about a month her vet wanted that for those muscles; not doing anything, though)

A lot of supplements, do you want the full list of those? Nothing new was added in the past week.
I swear I checked that leg up and down, looked at the foot, toes, between them, didn't see anything of note.
VetLive: My initial thoughts are that this is non-pitting edema based upon the information you provided but I do want to take a look at those pics as it may not be that severe.

I don't want to provide inaccurate information so I will wait until we delve further. I take it you have given her leg and foot a very close examination to look for scabs, what could have been puncture wounds, bug bites, scratches, etc. If you haven't look over the affected area as closely as possible.

I'll be back with more thoughts (and maybe more questions too) after I can look at those pics.
After several failed attempts with the camera I took a few photos with my phone at least.
 VetLive: I got the pics and it does look mildly edematous, nothing too severe so that is good.

Do you have an appointment scheduled soon? I'll wait until the clearer pics but if it does look edematous you will need to find the cause. I'll help you out with possibilities and where I would start first.

Also, is the swollen area the same temperature? I'm assuming it is or you would have noticed it but I don't want to miss something. Just checking!

I suspect the bottom of her foot is normal because of the pressure that pushes the fluid up when she walks. The top part of the foot doesn't really receive this effect so unless the edema is moderate or severe (and I would say her's is indeed mild) the underside of the affected limb is usually unaffected.

One other question--can you say if the licking of the foot occurred before or after the puffiness? It is okay if you don't know.

Unfortunately, I was still waiting for hubby to come home to see when we might be able to take Jasmine to see her vet.

Jana: Doesn't feel warmer than the rest. I think the licking started before the puffiness, I'm fairly sure but not 100% whether the top of the foot might have had some swelling to it when it started; if so then the rest of the leg would have gotten puffy some time later (that is what I can figure, of course I could have missed it then as we were focused on foreign bodies, infections, wounds etc ...)

Not sure whether the swelling could have gone unnoticed by me, I would think not but, of course, it is possible.

How much do you think I should be freaking out?
I was freaking out plenty.

Still waiting for hubby to see when we can see the vet and get the stupid (it's a great camera, really and I love it--but not today I did not) working.
VetLive: Not emergency situation so I don't want you to be freaking out. I probably will recommend having her seen tomorrow or Friday if it's possible. Edema can take a very long time to find the cause of. I really can't think of a reason she should be seen immediately or be in danger by not being seen. Hang in there! Hopefully I can be more confident in calling it edema or not after seeing the new pics.
It didn't look like an emergency situation to me either but I was worried about something circulatory, lymphatic or neoplastic.

The good thing was that it didn't seem to bother Jasmine, just me.
Jana: ... this would be a good place to say this is not what cancer would look like

VetLive:  It would be rare for it to have anything to do with neoplasia--very rare. There are some rare reports, but even then, they usually have a mass that you can see, feel, etc. With that said, it is still possible. Not trying to scare you, I just believe in full disclosure.

Circulatory, lymphatic, inflammation from an undetected scrape or bite is more likely. Most cases of edema resolve without us finding the cause--I don't know if that makes you feel better or worse. It's simply that most pet parents choose to "try the meds" first for financial reasons and then go through diagnostics if that doesn't work.
There were several other things we discussed.

It kind of didn't make sense to either of us that something systemic would affect a single leg. Also talked about possibility of tick-born disease, but Jasmine was tested not too long ago and everything was negative.
VetLive:  I am glad she didn't get lyme. One would think that systemic causes wouldn't cause isolated edema but the body doesn't always make sense to us.

Considering the whole picture, as in the whole realm of veterinary medicine, this is so mild right, it could even be possible that it would be very rare for most pet parents to detect it at this point. I would consider it possible that it the edema is showing up in this leg first, and I wouldn't rule out that other body parts would follow. When symptoms or diseases are caught early, we know less about how they will progress. I certainly don't mean to say that I think this is likely, I just think it is best to keep an open mind, especially in something as difficult to diagnose as edema. 

Meanwhile, hubby came home. First order of business was getting the camera to work and take some proper photos.

The swelling looked more prominent when Jasmine was standing, which was previously unobserved, as there is normally movement involved also.

One of the photos revealed a red dot on the side of one of the toes. 

Yet still couldn't see anything with bare eyes.
VetLive: Well, the pics do justify a vet visit. After exam, if your vet thinks an x-ray is warranted, I would do it--I would want to do it to rule out a bony infection that could be easily missed. Basic blood work may also be recommended and this is very reasonable.

I can't see the bump you are talking about but our wireless Internet in our house went out due to storms tonight (Florida) so I am using 3G on my iPhone.

A red bump from a bug bite, puncture wound, etc. would be the most likely cause of edema. This would be awesome and I am encouraged. I would still definitely have her check out though.

Couldn't help but keep trying to find the source of the little red dot on one of the photos. And that's why we found it.

There is a bump on the inside of that toe; tucked away and very well hidden!

Is this thing behind the swelling? And what is it? A bite? Foreign body? How long has it really been there?

Now, when looking at it, I cannot understand how we didn't find it before!

Hubby can't make it to the vet until Friday afternoon. Can this wait till then?
VetLive: That could certainly be the cause. I would have it aspirated at the vet to find out what it is. I wouldn't skip that step. Based on the aspirate results, x-rays may/may not be warranted. Try and keep her from chewing it tonight.

If it does blow up, or more scary, loses sensation, changes in temperature, she can no longer walk on it, she really becomes painful...these are reasons not to wait until Friday.
So now we have a potential source but we still don't have a cause.

I'll be up all night watching whether the swelling or the bump get worse.

So far it seems the same.

We don't really have any venomous spiders up here. There are some rattlers here but we have never seen one; they are extremely rare ...

Thank you, VetLive, for always being there for me.

Did your dog ever had something like this?

Just when you think that you're observant enough, that's when you miss something ...

 Update: The Diagnosis Is In: Jasmine Has An Interdigital Cyst

Related articles:
The Diagnosis Is In: Jasmine Has An Interdigital Cyst
Jasmine's Acute Lameness
Jasmine Doesn't Like "Doing Time"
Our Of Jail Free Pass
When It's Looks Too Good To Be True … The Lameness Returns
The Day Of The Treatment
First Time For Everything: A Healing Crisis(?)  
From Zero To Sixty In Four Days: Stem Cells At Work
The Calm After The Storm 
If It Was Easy, It Wouldn't Be Jasmine
This Is What Jasmine's Episode Looks Like
Gotta Try Everything Once (Or Twice): On The Quest To Figure Out Jasmine's Episodes 

Meet Jasmine
I'm Still Standing! (Happy Birthday, Jasmine)
How Dogs Think (Well, Jasmine Anyway)
How The Oddysey Started: Jasmine's ACL Injury
Jasmine is Vet-Stem's poster child!
Rant About Quality Of Life Versus Quantity, And Differential Diagnoses
Jasmine Is Headed For Her Next Stem Cell Treatment
Jasmine's Stem Cells Are In
Arthritis? What Arthritis? 
Guess Who Is An Ever-Ready Bunny And Really Liking The Bit Of Snow We Got? 
Don't Knock It Until You Tried It: Animal Chiropractic 
Jasmine's Fur Analysis
Back At Chiropractic Care

Further reading:
Jasmine’s Story: Can Chronic Diarrhea and Soft Tissue Injuries be Normal?
Jasmine’s Story: An ACL Injury and a Cancer Scare
Jasmine’s Condition Deteriorates: Another ACL Injury and an Abdominal Abscess
Jasmine Recovers from Surgery and Jana Discovers TCVM
Who’s Minding Your Pet’s Health?
Pet Owner Perspective On Stem Cell Therapy
Difficult to Manage Lameness Treated with Physical Therapy
Our Journey to Traditional Chinese Veterinary Medicine


  1. I can see why you would be worried!

    I do hope that if/when you get to the vet on Friday, they have some answers for you, and that it's not anything serious.

    1. Thank you, Jen. Keeping an eye on it, if it starts looking worse can't wait till Friday. So we will see.

      If I had the money I'd buy our vet and have him live next door! Resident vet - that's my wish.

      Meanwhile, having a vet far away and hubby with ton of engagements sucks. Wish we could have a vet down the road, but this one is the only great one we could find. Normally the long travel isn't a major problem but in situations like this one it is.

      Fingers crossed, please keep Jasmine in your thoughts.

  2. While there is never "good" reason to consult with VetLive, I'm really impressed with the detailed information and advice they provided you. What a great service to have if you need a vet in a pinch or if you live in a remote area.

    Get well soon, Jasmine. Hugs from Karen, Jersey & Dexter.

    1. Thank you, Karen. Yeah, nobody goes to consult about good things. "Hey, my dog is doing great, what do I do?"

      I know Dr. Laci (together with her husband she founded VetLive) and I have used VetLive before. Their dedication is unprecedented.

  3. Can you believe it, this is exactly what we have been going through over here:

    They are so hard to find, it has probably been sitting there for a while. Maybe you can remember with Viva, we suspect even up to half a year. While we and the vet were wondering why she was not doing a lot better on that one leg, despite all the therapy. First when it started to swell, we noticed.

    Viva got surgery, in her case it was a foreign body. The vet tried first to see if it would not resurface after an AB cure. But it did. Glad she could find the little thorn, because we couldn't locate an entry point.

    Kenzo just had his first AB cure, and the swelling disappeared, now we are anxiously waiting if his body can process whatever there is left in there. If it returns he will need surgery too, and again no clear entry point :)

    Good luck with all of this. And to look at the bright side, glad it is not something life threatening! In Jasmine's case, that is pretty good news :)

    1. Hi Kenzo, wow, so sorry you're going through something like this also!

      Yours looks quite similar, though Jasmine's is more "glassy" in appearance; in the sense that it looks very shiny on the surface while yours looks matt.

      Yeah, I remember Viva's foot and the foreign body. Did Viva's look the same as Kenzo's?

      Did they do needle aspirate? AB seem to make sense to me to see whether it can deal with the problem before doing surgery.

      Jasmine's vet saw the photos today, he feels we're looking at an interdigital cyst. From the other things that it could be, though apparently these seem a bugger to treat, sounds about the best option. Jasmine is seeing him tomorrow early afternoon, unless something changes, so will know more then. Hopefully things remain stable till then.

  4. I'm really late in visiting..I'm glad Jasmine's vet was able to determine the problem. Hopefully she'll recover quickly.

    1. Thank you, Sage, the wait felt like forever. My dream is to buy him and have him on premises all the time! :-)