Truman is a 7 year old neutered male boxer belonging to a wonderful family. He is
also a laid back couch potato that loves to snuggle with his family! He came to Rock Bridge Animal Hospital to see Dr. Susan Sappington for his annual wellness exam and vaccines. During the history, his mom mentioned a new mass on Truman’s inner left knee. After looking at the mass, Dr. Sappington recommended a needle aspirate to collect cells to look at under the microscope for identification. Dr. Sappington diagnosed a mast cell tumor due to the shape of the cells. Mast cells are part of the immune system and are responsible for triggering an immune response to allergens by releasing chemicals including histamine. When these cells form a tumor, it is most commonly found in the skin. In Truman’s case, surgical removal was recommended to prevent the spread of the cancer. She also started Truman on prednisone (a steroid), Benadryl (an antihistamine), and omeprazole (an antacid) to attempt to reduce the size of the mass and side effects of the tumor.
A week later, Truman was placed under anesthesia and the tumor was surgically removed. He was sent home with pain medications and an e-collar to prevent him from bothering the incision site. His sutures would be removed in 10-14 days and the doctor would check how things were healing.
A few days later, Truman’s mom called to let us know that Truman had been reaching around the cone to lick at the incision site. There was still quite a bit of swelling, bruising, and drainage from the incision site. We modified his cone by taping two of the largest sizes together to extend their length and prevent Truman from bothering his knee. Truman was brought in for an exam and Dr. Sappington recommended microscopic cytology to look at the drainage under a microscope. A small sample of the fluid from the wound was applied to a glass slide and stained to help the bacteria become visible under the microscope. A shape of bacteria called cocci was seen as well as neutrophils, a type of white blood cells that fights infection. Truman was started on clavamox, an antibiotic that treats bacteria most commonly introduced to wounds by a dog’s mouth.
A week later, the incision site on Truman’s knee pulled apart. Dr. Sappington decided
to use a type of bandage called a tie over bandage. This involves sedation to add sutures (stitches) around the open wound to allow a bandage to be tied down. Sugar has been used for centuries in wound care due to its ability to pull out moisture, preventing the growth of bacteria which thrive in a moist environment. The bandage needed to be changed daily to replace the sterile gauze and sugar being used to dry the wound. Dr. Sappington sent a sample of the drainage to a veterinary pathologist to culture the bacteria (grow in a laboratory setting) and test for it antibiotic resistance. Antibiotic resistance is when an antibiotic is unable to kill bacteria due to biologic properties of the bacteria that allow it to defeat the antibiotic.
Truman would need to be sedated daily for his initial bandage changes due to the sensitivity of the open wound. Due to his pre-existing conditions including a mild heart murmur and mildly elevated kidney values, special sedation drugs were selected by Dr. Sappington. He was monitored by the technicians and doctor throughout his procedures, just like his surgery. When the wound had healed enough to allow at home care, Truman had his daily bandage changes performed by his family. Truman’s mom described using treats and lots of head scratches to keep Truman still during the process. After flushing the wound and applying an antibiotic ointment, they tied the bandage. This was the tricky part, but Truman’s parents were up for the challenge. They carefully tied down the non-stick padding, gauze, and outer bandage using umbilical tape which looks like a long string. They carefully weaved this through the loops made by Dr. Sappington to hold the bandage in place. Truman got used to this process over time and even fell asleep during his bandage changes!
Six days after sending the bacteria sample to a lab for culturing, we received the
results. They showed that the bacteria were resistant to clavamox, as well as most other oral antibiotic options. Dr. Sappington spoke with a veterinary pathologist who recommended a “bacteria blast” using forceful flushing with chlorhexidine to remove the bacteria, followed by another flush with an ear cleaning solution containing TrizEDTA, a compound that breaks down bacterial cell walls and the biofilm that protects them. A biofilm is a complex structure of bacteria colonies at the surface of the skin or an open wound. Care is taken to flush from top to bottom so as not to let the blasted bacteria land back on the wound surface. An antibiotic cream called mupirocin was applied topically and had the right antibiotics for Truman’s bacterial infection.
During one of Truman’s recheck appointments, his knee was healing well so Dr. Sappington recommended sedation to reclose the wound with sutures and allow it to finish healing so there would be no more bandage changes. Unfortunately, this opened up again a few days later, likely because the incision was over a very mobile part of the knee. The wound was left to heal by second intention which is a process of healing involving granulation tissue which covers the entire wound over time. His family continued bandage changes and wound care at home.
Finally, two months after the mass was removed and two weeks after he was started
on the biofilm blast and ointment, Dr. Sappington determined that Truman’s wound was fully healed. Thanks to the patient and thorough care provided by Dr. Sappington and the Rock Bridge staff, his loving family, and the laboratories that consulted on his samples, Truman is doing great! His family tells us that he loves to play with his coonhound brother and human little sister. Truman’s mom told us that although it sometimes it felt like his wound would never heal, they are thankful for the care he received.
Written by Robin
