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I have a nearly 9 year old english bulldog with a curious

Customer Question
case of leg swelling JA: I'm...
i have a nearly 9 year old english bulldog with a curious case of leg swelling
JA: I'm sorry to hear that. Have you looked to see if there is a wound on their foot?
Customer: 6 months ago, she presented with swelling of her L front leg. she was unable to bear weight. x rays were normal. wbc was quite elevated. she responded well to a course of antibiotics and rimadyl
JA: What is the Old English Bulldog's name?
Customer: she was noted to have signs of arthritis on the xray, and has been maintained on a small daily dose of rimadyl and a joint supplement
JA: Is there anything else important you think the Veterinarian should know about the Old English Bulldog?
Customer: yesterday, she was unable to bear weight on her right leg, which was significantly swollen and exquisitely tender. she had xrays of the spine, neck, and leg which were unremarkable, except for mild arthritis (no change in joint spaces). her labwork was unremarkable, including a normal wbc. the joint was tapped, and on initial results had no bacteria. she was started on a course of antibiotics, an increased dose of rimadyl, and pain medication
Submitted: 3 months ago.Category: Dog Veterinary
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Answered in 14 minutes by:
7/27/2017
Dog Veterinarian: Dr. Emily, Dog Veterinarian replied 3 months ago
Dr. Emily
Dr. Emily, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 945
Experience: Associate veterinarian at a small animal clinic
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My name is***** and I would like to assist with your concern today. I've read over your background information. So originally the swelling of the left leg improved with the antibiotics and anti-inflammatory, correct?

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Customer reply replied 3 months ago
it did. She had some residual limping, which was attributed to the mild arthritis findings noted on the xrays at that time. She has never favored the right leg until yesterday.
Dog Veterinarian: Dr. Emily, Dog Veterinarian replied 3 months ago

Is it throughout the leg or is the swelling focus on one area?

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Customer reply replied 3 months ago
yesterday her whole leg was swollen, warm, and exquisitely tender. Yesterday evening, after IV Rimadyl and the tap, the swelling had improved, and appeared to be more of a defined collection in the area at/below her elbow. Today, the swelling is again more generalized.
Dog Veterinarian: Dr. Emily, Dog Veterinarian replied 3 months ago

Although with leg swelling we focus on an issue specifically with the leg, there are other conditions that can cause what we call "peripheral edema." Bulldogs are actually predisposed to this as well. Some of the causes include heart disease, kidney disease, tick borne diseases, altered eletrolytes as well as infection. Do you know if the blood work your vet did included assessing the kidney values as well as doing a 4dx test for tick borne disease?

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Customer reply replied 3 months ago
All of her labwork (CBC, BMP, liver funcntion) was normal. Testing for tick-bourne diseases was not done yesterday, but was done 6 months ago and was negative. We also liver in Manhattan, she receives regular Frontline, and has had no ticks.
Dog Veterinarian: Dr. Emily, Dog Veterinarian replied 3 months ago

Ok, that is all good to know. Thank you for the further information.

The next steps to looking into this are more advanced diagnostics. Assessing heart function is the number 1 priority. Although an xray was taken of the limbs, they were normal so we need to focus attention elsewhere. An xray of the chest is a good start but an ultrasound of the heart is the best. Decreased cardiac function causes swelling of the limbs that dissipates with appropriate medical intervention. The same is true in the case of decreased lymphatic flow. In decreased lymph flow, the blood work and xrays tend to be normal. There is a special xray that can be done to assess lymph flow, although most need to be done at a specialist. Lymph flow can change due to a mass blocking the flow in the area of the lymph nodes of the limb but also due to a mass in the chest.

Due to the unusual nature of the on and off swelling and it switching legs, no stones can be left unturned. Submitting fungal and bacterial cultures should be done of the joint tap but also of a tissue biopsy of affected tissues.

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Customer reply replied 3 months ago
But, would lymphadema and/or peripheral edema 2/2 impaired cardiac function present with such acute pain and warmth of the affected limb? (also had a low grade fever). Also, yesterday when the overall swelling had improved somewhat, it was concentrated to a much smaller area at the elbow, which looked more like a collection/abcess. This seems inconsistent with an underlying cardiac/lymph issue, no?
Dog Veterinarian: Dr. Emily, Dog Veterinarian replied 3 months ago

Not necessarily as medications were given. Antibiotics and anti-inflammatories reduce swelling in all areas, including lymph obstructions. You are correct that cardiac function would likely cause the area to not improve so quickly, it is still on the list of differentials due to the repeated nature of the swelling and it shifting to the other leg. If the area was an abscess, this would not shift from one limb to another. An abscess also should have been detected when the vet sampled the area. They readily produced discharged when sampled. Abscesses typically do not shrink down in size within a day, especially without antibiotic therapy.

Swelling of the limbs in a sudden onset is painful regardless of the underlying cause. Chronic swelling is less painful because it develops slowing over time allowing the body to adjust. Fever can be secondary to infection but also occurs in situations of stress and inflammation. If the initial swelling was due to infection from something like a spider bite (which causes sudden, painful and aggressive swelling and resolves with medication), it would be odd for it to switch to the other leg unless it is coincidental and is another, separate bite.

Initially therapy should consistent of antibiotics and anti-inflammatories but since this is a second occurrence, I would recommend looking further into possible causes because if this time it resolves again, there is no guarantee it won't return or worsen in the future.

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Dog Veterinarian: Dr. Emily, Dog Veterinarian replied 3 months ago

Do you have any questions about the above information?

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Dog Veterinarian: Dr. Emily, Dog Veterinarian replied 3 months ago

Hello, just wanted to check in and see how things were going today.

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