‘And while we’re here can you also have a look at this nail, please?’ said Mrs Carter. ‘I think she must have cracked it while we were out walking but the split won’t heal. It’s probably because she keeps licking at it.’ Millie the black Labrador was in today for her annual booster vaccination when her owner mentioned a problem with one of the toes on her front left foot. Vets are quite used to minor problems being mentioned in passing at their annual check-ups, so Rachel bent down to take a look.
Table of contents
A troublesome toe
One of Millie’s toes on her left fore had a slightly abnormal-looking nail. The claw appeared to be slightly twisted with a small split in it. Rachel examined the affected toe in more detail, there was a small bit of discharge in the nail bed and the digit itself looked a bit puffy, compared to the other ones, and was a bit sore.
‘Hmmmm…’ said Rachel, alarm bells ringing. While vets try not to jump to conclusions, Rachel had some concerns about this toe. Millie was a large breed, black dog, who was starting to get on a little in age (she had not long turned 10). ‘This claw looks a little unusual, Mrs Carter. It could be a simple nail bed infection from accidentally pulling or twisting the nail. But I can’t rule out something more sinister. We can sometimes see nail bed tumours that act in this way’ explained Rachel. They both agreed to give Millie’s toe the benefit of the doubt and trial her on a course of anti-inflammatory medication and antibiotics initially.
Mrs Carter diligently administered the medication to Millie, but when she came back for her re-examination, Rachel the vet was still concerned. While Millie’s toe seemed more comfortable, things hadn’t resolved. Thankfully Mrs Carter had checked her pet insurance policy and had no hesitation about what Rachel was about to suggest next.
Investigation
It was recommended that further investigation be started. Cancer was very high up on the list of Rachel’s potential diagnoses, given Millie’s age, size and colouration, and she wanted to start exploring the problem further. At Millie’s stage of life, it was recommended that she had some initial bloodwork to check her organ function as well as for any markers of anaemia or infection, ahead of a general anaesthetic.
The next step was to take some radiographs (X-rays) of Millie’s left foot under anaesthesia to assess the condition of the bone in that digit. Millie received intravenous fluids to keep her blood pressure stable during this procedure. These images revealed that the bone was diseased, with severe damage evident. Rachel also recommended that Millie’s chest be x-rayed at the same time to check for any evidence of metastasis (cancer spread). This appeared clear. On that basis, Rachel went ahead with the next step of the treatment – amputation of the toe. While this might seem drastic, an accurate diagnosis can be tricky from cell samples alone in these cases, and Mrs Carter fully understood that this was a likely outcome.
The diseased digit was removed, the wound was carefully stitched, and the toe was sent away to the lab for analysis. Millie had a dressing placed on her left foreleg to keep the area clean and dry while the wound healed. Mrs Carter brought her in for repeat bandage changes, whilst she anxiously awaited the test results.
Lab results
The lab results confirmed the vet’s suspicions. Millie had a malignant melanoma, which was showing highly aggressive tendencies. Thankfully the margins were clear, Rachel had removed the tumour in its entirety, but there was no guarantee that microscopic cancer cells hadn’t already started to spread elsewhere in the body. While her chest X-rays had appeared clear, these only ruled out larger, visible growths, so more tests were recommended to stage her tumour further.
Specialist care
Thankfully Mrs Carter had a comprehensive insurance policy, meaning she could pursue a referral for specialist care at this point. Here Millie had extra screening tests, including samples taken from her lymph nodes, and a CT scan to check her organs in more detail. The referral centre also recommended that Millie start on a course of therapeutic vaccinations that only oncology (cancer) specialists stock. These injections can increase survival times in affected dogs, especially when administered promptly without too much delay.
Summary
Millie recovered well from her treatment and continued to do well with regular checkups. Mrs Carter was not only relieved that she had mentioned that troublesome toe at that routine appointment, but also that she had comprehensive pet insurance for Millie, as without it her prognosis could have been so much poorer.
References
- Marino, D.J., Matthiesen, D.T., Stefanacci, J.D. and Moroff, S.D., 1995. Evaluation of dogs with digit masses: 117 cases (1981-1991). Journal of the American Veterinary Medical Association, 207(6), pp.726-728.
- Smith, S.H., Goldschmidt, M.H. and McManus, P.M., 2002. A comparative review of melanocytic neoplasms. Veterinary Pathology, 39(6), pp.651-678.
- Manley, C.A., Leibman, N.F., Wolchok, J.D., Riviere, I.C., Bartido, S., Craft, D.M. and Bergman, P.J., 2011. Xenogeneic murine tyrosinase DNA vaccine for malignant melanoma of the digit of dogs. Journal of Veterinary Internal Medicine, 25(1), pp.94-99.