Canine Leg Swelling: Jasmine’s Mysterious Swelling And Another Experience With Telemedicine

Peripheral edema can be the result of allergies, immune, or heart issues.

Localized or single-limb edema may result from injury, such as from a car accident, burns, obstruction in an artery (due to a blood clot), contact with toxic agents, such as a snake bite or bee sting, abnormal tissue growth (known as neoplasia) in the lymphatic tissues of the body, or high pressure in the capillary fluids.

Further reading: Swelling in Dogs

Jasmine’s story

I felt that Jasmine’s hind right leg didn’t look quite right for a couple of days. It seemed chunkier than I believed it should. More staring didn’t bring more insight—I wasn’t sure whether I didn’t just see ghosts.

Then, Jasmine laid in such a position that I could really compare the two legs well. The right one certainly did look thicker. There was indeed some swelling—nothing better to mess with my peace of mind.

Swollen leg

There didn’t seem to be any pain or associated lameness. Jasmine didn’t seem bothered by it, just me. She did lick her rear right foot around the toes, but I couldn’t see any discernible reason.

I would have really liked to have taken her to see her vet right that minute. Unfortunately, that was not possible. Hubby was teaching till late that evening. No hubby meant no transportation.

Yet, I needed to talk to somebody with expertise and somebody available right then.

Turning to a telemedicine veterinarian

I had a prior positive experience with veterinary telemedicine. This was the ultimate scenario to make use of the option. I contacted them and laid out my concern. As much information as I provided, the veterinarian came back with a list of more questions.

Veterinarian: What does the swelling feel like? Is it kind of squishy? Then, 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?
• Does the swelling include the foot?
• what is the color between her footpads?
• Any lameness? Decreased energy? If so, estimate a percentage, please.
• When did you notice this? Has it worsened?
• 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 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.

I answered the questions the best I could.

Local observations

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 different 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 push down on the area that seems the “thickest/fleshiest,” the indentation comes 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 before the acupuncture treatment/I just wasn’t sure I wasn’t just making things up in my head)

General observations

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 a 5% decrease in energy, but I wouldn’t bet my life on it.

Her appetite is also normal/excellent.

I think I noticed this Sunday night but wasn’t sure what I was seeing. Definitely saw this on Monday. It doesn’t appear to have gotten worse. It seems the same. The licking of the top of her foot had gone on for a couple of weeks, but nothing we could find is a problem there, so I 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 a 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 them on the computer (complicated set up here); I will be happy to send those once I have them available medications:

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

I swear I checked that leg up and down, looked at the foot, toes, between them, didn’t see anything of note.

Veterinarian: My initial thoughts are that this is non-pitting edema based on your information, but I do want to look at those pics as they may not be that severe.

I don’t want to provide inaccurate information, so I will wait until we delve further. However, 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.

Photographing the leg

After several failed attempts with the camera, I took a few photos with my phone at least.

Veterinarian: 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 at 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. However, 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? Again, 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 sometime 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.

I’m 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.

Veterinarian: Not an emergency, 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. I really can’t think of why 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 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

Veterinarian:  It would be rare for it to have anything to do with neoplasia–scarce. There are some rare reports, but even then, they usually have a mass that you can see, feel, etc. So 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 didn’t make sense to either of us that something systemic would affect a single leg. Also talked about the possibility of tick-borne disease, but Jasmine was tested not too long ago, and everything was negative.

Veterinarian: 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.

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 the edema shows 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. The first order of business was getting the camera to work and take some proper photos.

Taking more photos

The swelling looked more prominent when Jasmine was standing, which was previously unobserved, as a normal movement was also involved.

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.

Veterinarian: Well, the pics do justify a vet visit. After an 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.

Hello!

I 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?

Veterinarian: 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 scarier, loses sensation, temperature changes, 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 gets 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 …

Waiting for veterinary appointment

The wait for Jasmine’s appointment felt endless.

I did send the photos of Jasmine’s swelling and the lump on the toe to her vet. He reviewed it all and said that it looked like an interdigital cyst to him.

Either way, it was a relief to hear— it would not pose any immediate or future serious threat.

Interdigital cyst

Interdigital cysts are quite common, and we kept our fingers crossed that’s what it was. So I researched the subject, and there were a couple of things that worried me.

1. I didn’t find any mention of associated swelling
2. There seemed to be no evidence of pain or lameness (these are supposed to be painful and cause lameness)

Of course, this thing is pretty tiny compared with photos I found online, so perhaps that’s why the lack of evidence of pain. The swelling, though, kept worrying me.

No mention of a swelling resulting from an interdigital cyst anywhere I could find. On the other hand, mast cell tumors do have the ability to cause swelling.

Veterinarian:  I have never seen edema caused by a cyst, but if it irritates her body enough, I can see the logic there.

Is it an interdigital cyst or not?

I kept checking the lump—which seemed unchanging—and staring at the swollen leg. The more I was staring at it, the more swollen it seemed …The lack of any other symptoms was somewhat comforting.

I did look up potential causes behind an interdigital cyst. Several seemed feasible:

• ingrown hairs
• foreign body
• yeast infection

Jasmine’s feet smelled kind of salty (for lack of a better interpretation of what I was smelling). However, I didn’t feel that allergies would be behind this–Jasmine is not an itchy dog.

I found that a typical treatment would be Cephalexin (an antibiotic used to treat skin infections), along with topical treatments. That would be good. Jasmine was on Cephalexin in the past with no adverse effects.

I found out that the most useful diagnostic tests include skin scrapings (for mites), impression smears, or fine-needle aspirates to confirm the presence of an inflammatory infiltrate. Source: Merck Veterinary Manual I wanted to be sure we know exactly what we’re looking at.

I wasn’t certain whether we could do a needle aspirate on such a tiny thing, but I made a list of all the things I wanted to do to confirm anyway. I really do feel sorry for Jasmine’s vet.

Seeing the local veterinarian

Finally, we made it to the time of Jasmine’s vet appointment. The diagnosis was in: Jasmine indeed had an interdigital cyst, secondary to Malassezia infection (yeast).

So now I knew what that salty smell means.

Physical examination and cytology confirmed it. We also sent some of it to the lab for further bacteriology.

All four feet actually had the yeast infection—possibly some virulent strain than Jasmine had previously encountered. The vet asked whether Jasmine met any new dogs. She didn’t meet them per se, but there were many new dogs in our complex…The rest of Jasmine’s body was infection-free. The vet checked her inch by inch.

The treatment, as I suspected, was Cephalexin and antifungal shampoo.

Updating the veterinarian

Veterinarian: I am SO glad it’s not a mast cell tumor! She really has the worst luck, so I was hoping it would not continue to this. But, unfortunately, some of the sweetest patients have the worst health luck if there is such a thing.

I was paranoid, alright—I even fasted Jasmine before the visit, just in case she needed any diagnostics or treatments that would need her fasted. I trust our vet 98%. But the remaining two are enough to drive me out of my mind in a case like this.

And the long wait only fed my worry. Finally, combining his expertise with the cytology results, I figured we could be reasonably sure that it was the interdigital cyst. I was glad to get a confirmation.

Veterinarian: Mast cell tumors practically scream their names on a slide. So that ought to be enough even for my ever-worrying heart. 

Jasmine’s interdigital cyst responded well to antibiotics and healed quickly. So that was the good news. The bad news was that the swelling remained.

Apparently, the cyst was just a coincidence, and the swelling was due to the yeast infection. We’re doing the medicated foot baths religiously, every two days. I also changed all her sheets after every bath. The salty smell was gone, but the swelling was not.

It has temporarily improved after Jasmine’s underwater treadmill session on Saturday. She also got cold laser treatment on all her feet. But the next day, it seemed to look about the same as at the beginning.

Jasmine’s vet, though, wasn’t surprised by this and said that he wouldn’t expect the swelling to go down that fast. He was right; it took a while, but eventually, the swelling did resolve.

Related articles:
Swelling (Edema) in Dogs

Further reading:
Peripheral Swelling in Dogs