Help! I Can’t Hold my Licker!

It’s barely a month since the last National, and I’m already thinking about the next one:  will Parker still be wearing duct tape on his foot?  There are many other things to think about, of course, but at 4 months and counting, this seems to be taking f-o-r-e-v-e-r.  And while his foot is healing, his muscle mass is decreasing, probably from lack of exercise since he is required to keep from putting weight on his foot, and he has now begun holes in the backs of his elbows – yes, BOTH elbows.  There are two holes in one elbow, and one in the other, and one in each elbow is all the way through the skin.  For one thing, old skin can’t endure the impact that younger skin could.  At 11.5 years, I’m only beginning to get used to the idea that he is becoming geriatric.  Those years just fly past!  Plus, like his dad, and his g,g,great Aunt Holly, he just doesn’t seem like the kind of dog who can get old.  He has fun and spark in his personality – youthful vigor in so many ways but impaired mainly by his own undoing.  If I could only protect him from himself!

Parker is a very intelligent fellow, particularly good-natured and fun-loving, a bright problem-solver as most Newfs are.  There have been times when I have been less confident about that, given some of his choices that I’ve witnessed.  He can create his own problems, but he also arrives at solutions by himself pretty well, like dismounting the bed:  he did this by sliding down waterfall-style, reducing impact on his elbows.  (I also keep a resilient pad under a rug at the side and foot of our bed for their beds.)  He has recently discovered that hopping up with both front feet at the same time is better than walking up steps or into the van – less weight burden on the recovering foot.  One of the issues for bright-minded Newfs is that when they can’t burn their energy on physical activity, they have to do something.  Things that may escape their attention when they are otherwise busy can become focal points when they are under restriction.

Until recently, I’ve considered myself a resourceful person, and like a Newf, good at problem-solving, but my resourcefulness has been taxed in the past few months.  Parker has been faster at creating problems than I have been at deterring the consequences.  The latest, the holes in the elbow skin, have been difficult.  Devices, such as boots or denim shirts, helped until the damage was too bad.  Wearing boots 24/7 would help his elbows, but this leads to decreased toughness in his rear pads and infection between his pads.  I trimmed the vinyl pad off the boot, since traction wasn’t the need, to help with air flow.  Still, the boots annoy him if used too much, so his licker comes out, and a lick granuloma will be started at the top of the boot.  In the past I’ve been able to use heavy denim shirts to deter damage to his elbows from his toenails, and I discovered a way to cut out the seat of an old pair of jeans to make front leg covers.  However, there is no give in the jeans, which irritates his spondylosis, so I had some “britches” made with 3 inch wide elastic at the top.  Heavy denim shirts work pretty well too but are hard to find these days.  There are medium weight denim shirts at some farm supply stores, so I got one of those.  However (and I use the word “however” a lot when using appliances, as these all seem to have another consequence), he was still able to do damage through the denim, and the plasma kept the shirt wet and held the bacterial media next to his wounds.  Infection began quickly on one side.  As I mentioned, old skin can’t endure the stress of scratching as well, plus I suspect that his “off switch”, which has never been that sensitive, is even less sensitive now.  He may also have developed a habit of scratching harder because of the denim layer.

There aren’t many commercially available solutions for these issues, and following the National, I began to run out of novel ideas.  I made a plea to other Newf owners for ideas, and there were three that have been helpful:

1)  Use a Comfy Cone instead of the plastic e-collar:  The XXL Comfy Cone is almost 2 inches longer, and this prevented him from being able to reach his foot toe and work the bandage loose enough that it slipped up, exposing the wound, or pull it off the end of the toe.  (I only wrap it to two Velcro strips, leaving an extra section; it is tight if fully wrapped.)  He has to wear this so often that I got three Comfy Cones, one that could be in use while others were cleaned and thoroughly dried.  In addition, his vet switched us to the adhesive backed tan-colored fabric bandaging in the 4 inch width (Elastikon).  That works very well, and when his hat is off, it is difficult to remove.

2)  Bandage, layer with a sock and bandage some more:  I had been adding duct tape, mainly around the bottom of his foot to protect the bandage from dirt and moisture, and to leave the top of the bandage open to keep moisture from building up under the bandage.  I began adding more layers of duct tape.  If in a few minutes of distraction he could pull off some duct tape, but he must be busy for quite a while, ripping a small strip off then another and buying me a little more time.  One of his vets switched to an adhesive-backed fabric bandaging, as mentioned in 1).  This has been a marvelous improvement.  Before this, he had been able to get the bandaging off in a matter of a few seconds.  Now it takes several minutes.  Using the adhesive-backed tape also keeps the sterile pad from slipping out of place, where the VetWrap would slip, irritating the wound.  The adhesive tape, along with the duct tape, also slows down his removal process.  The hair is thin over his foot now, but thin hair is a minor inconvenience.

3)  Use long-sleeved T-shirts:  I only need to do this for the front legs, and the purpose is to keep the bandages in place on his elbows.  I tried bandaging his elbow using VetWrap above and below the joint once, but this led to pressure when he was down and swelling in his front leg.  The vets had both said that you can’t bandage an elbow, but I thought I had found a way to do that without creating a restriction in circulation.  Now, I use the 4 inch wide adhesive tape with a pad like a giant Bandaid, and it doesn’t go all the way around his arm. (see change below dated 8/8)  I apply the ointments and Accelerator to the sterile pad and press that into the wound, wrapping the bandage around the sides of his arm.  The only reason this stays in place is the adhesive on the tape.  One scratch and it would easily be wiped off, so I went T-shirt shopping, to have a cover for the bandage.  Long-sleeved tees aren’t available locally at this time of the year, but baseball shirts are, and those sleeves are long enough to cover the bandaged area.  [Now he’s either a Mets or Marlins fan – he wouldn’t care as long as a ball was involved.  ; )]  I may stitch some elastic into the part of the shirt that goes under his belly to keep his back foot from getting into the shirt.  He is doing some “substitute licking” on the top of his arm, and that skin is a little irritated now.  I’m hoping this is a minor consequence that will resolve when the elbows begin to heal.

Last week, Greg and I took a short trip to San Francisco while a niece and nephew did the farm-sitting and took care of the Newfs.  The one person I would trust to do this was finally old enough to make the drive by herself.  This is the first time in more than a decade that Greg and I have taken a trip together, without the Newfs.  The weekend before we left, Parker’s foot was looking very bad.  There was proliferation of tissue under the skin and it was pushing back the dermal layer.  Greg’s dad, a retired veterinarian, and his wife, a veterans hospital nurse, stayed with us one night that weekend.  They had seen this kind of situation before, and had some suggestions for dealing with it.  One of the treatments I was using was a botanical salve, used by one of the vet clinics.  It had remarkable success in the beginning, so I applied only the salve that night.  It was much worse the next day.  I quit using the salve, and the proliferation of the underlying tissue stopped, and the weeping of plasma receded.  Whether he was reacting to something in the salve or whether it was having too much effect on stimulating cell growth, I don’t know.  Within the next couple of days, it looked better, but I had to leave with some uncertainty about progress.  I showed Julia how to change the bandage, and it still looked better.  I trained her on supervision with Parker, and to be sure that he had the Hat (Comfy Cone) on when she couldn’t see him, then left the kids with a chore list and some fun things to do.  The next day, she called and said with some conservative optimism that she and Jacob were surprised at how much better it looked.  This continued, and now the foot looks promising. However (yet again), during the last night that Julia was here and the following night under my surveillance, I learned that he was able to reach the back of his elbow with his tongue!  Had he not been able to get the bandage off his foot at the National and lick the wound, he could have probably been swimming by now.  When I look at the pre-National photos, I almost feel silly about how worried I was then.  It was only the size of a nickel at that point!  His foot may be ready in a few more weeks.  Now, if his elbows will only comply!  Rather, his back feet, and his LICKER!  When my sense of humor returns, I may get him one of those bibs!

6/26 UPDATE:  His foot has been healing nicely, so I’ve been able to start light walking in the yard on the carpet of grass.  The bandage also forms a pad to reduce impact.  Progress is good!

8/8 UPDATE:  His foot has been healed for a while, but the elbows have been a challenge.  I’ve uploaded a file showing how his elbows have been bandaged.  Both veterinarians were cautious and said that elbows couldn’t be bandaged very well, but given the degree of damage that he did, I had to find a way.  The problem is in creating a restrictive situation around the joint, decreasing blood flow.  One of the elbows is almost healed, but the other has been reinjured several times from bruising where he scratched the back of the bandage or from direct damage when he scratched the bandage far enough down to reach the top of the wound.  (He doesn’t scratch much any longer, but when he does, he does it with a vengeance.  Once the wound healed on the other elbow, he hasn’t bothered it much, so I’m hoping this resolves once the wound heals.)  The images show how the bandage is applied.  Eventually, there was too little hair, which led to irritation of his skin.  I had to quit using the adhesive tape as the first layer, switching to applying a layer of adhesive tape to the outside of the sock.  The adhesive tape is applied without stretching the fabric so there is no pressure.  This still keeps the inner pad with antibiotic in place.  Progress has been very slow, but it looks much better now.

Update 1/19/14:

His elbows healed, one then the other, although something would cause an itch and we had to repeat the process, alternately with one elbow, then the other.  During August, I found that swimming helped his elbows to heal, as well as strengthening his muscles and his heart.  Once he started swimming again, his general health improved significantly.  His foot was nearly healed when I let him start swimming, and it healed completely in a short time.  However, for his foot and his elbows, the tissues were not as strong after healing.  During the winter, the weakened area in his foot became abraded and opened from walking.  One of the elbows that had been looking very good for a long time became the subject of an itch attack and was badly damaged.  This time, to shorten the stress from healing, I opted for having that tissue removed surgically while some bumps were removed for biopsy.  His muscle tone, although not his overall energy, as decreased again also.  As soon as the water is a little warmer, we will take him out for short swims, to rebuild his condition for hopefully a good spring, summer and fall.

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