Hello I am Dr. Joey. Thanks for trusting me to help you and your pet today. I am a licensed veterinarian with over 15 years of experience. I look forward to working with you. I do apologize for the delay in having an expert jump in and answer your question.
Your question is tough and that may be why no one has answered yet. Given the longevity of the problem we can probably rule out an acute bite/sting or allergic reaction. There are some potential causes for this type of recurrent swelling for us to consider.
First I want to ensure she has had full radiographs (X-rays) of both limbs to rule out any sort of joint swelling or abnormalities of the paws
. And, that these radiographs were reviewed by a board certified radiologist. If not, then during the next swelling phase, this would really be an important step. Second, I want to ensure the regional lymph node (axillary) on one or both limbs has been aspirated and these results evaluated by a pathologist at the lab (not in house by your veterinarian). Third, I want to ensure there antibiotics used included at least one round of a fluroquinolone (such as enrofloxacin, marbofloxacin or ciprofloxacin) and/or a penicillin derivative (clavamox, amoxicillin
Assuming those tests were done and nothing was found, and knowing there is mild response to lasix but not cure with antibiotics or steroids, my top worry is that she is experiencing a vasculitis (inflammation of the vessels) which can be immune-mediated (tough to diagnose but a biopsy might be useful; we treat with pentoxyfylline and sometimes different dose of steroids), a growth
disturbance in one or more of the bones
(this would cause more joint swelling but would look like full paw swelling if the swelling is between the bones; this is why radiographs are so important and if there is effusion between the bones then a joint tap is warranted to know what is going on), or a tick-borne bacterial disease (such as lyme
disease) or an atypical infection (such as nocardia or sporotrichosis, etc).
I regret that I cannot diagnose the exact cause of her symptoms for you. I too would need to perform an exam and the testing mentions, but perhaps some of the potential causes I mentioned above have not been explored yet.
You can always request a referral to an orthopedic specialist at any time from your vet. Never forget that. Sometimes in these complicated cases that can be really helpful.
I am at a point I need to know what questions you have. We can continue our dialogue in this setting.
I hope that the information I provided has been helpful.
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