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Tibia fracture and possible osteomyelitis in dog

This is about a female, free-roaming Indian dog (not a pet staying in a house), about 6-7 months old. She used to be taken care of by a family who have road side stalls. Normally they give him fish and biscuits. She never eats rice.
On October 12, 2011 the tibia of her left leg was fractured (broken into two, open fracture, bones visible through a hole on the inner surface of leg). She was discovered two days later, on October 14, 2011. She also had puncture wounds on the right leg, near her vagina. (Sometimes when a dog shrieks in fear and pain after some accident, other dogs attack her.) The same day, i.e. October 14, 2011, her leg was set in a traction device called Thomas splint which keeps the leg stretched and immobilised. A metal ring goes through the limb and is fixed to the uppermost part of the leg where it meets the body.

I gave him Arnica 1M in split dose (from a solution of 3 drops of Arnica in 200ml of water) thrice a day for three days.

This relieved her pain. She drank plenty of water and chose to eat biscuits soaked in water while completely refusing fish or meat.
A homeopath prescribed her Opium 3o three times a day to be followed by Calendula 1M alternated with Symphytum 30 in split doses. I was told to continue with the Calendula and Symphytum. Initially, for three days I gave her antibiotic Cefixime 100mg b.d. The open wound at the fracture site healed well, though it oozed a reddish or brownish liquid a lot. The leg became considerably swollen, red and hot too. On October 18, 2011 the vet changed her splint and said that she had a large haematoma. As pressure was applied to her leg, blood squirted out. Around a couple of days of later, a lump developed on the inner face of her leg not far from the site of open fracture (which had healed considerably). It burst and there was a lot of bleeding. This left quite a deep wound which is gradually healing with dressing. However, the leg is swollen a lot (specially between the joints above and below the point of fracture) and blood mixed with pus comes out of the haematoma wound and the puncture wounds to the side of the vagina on the other leg always.

In the region where the leg joins the body, she had developed a pressure sore due to constant friction with the ring of the Thomas splint which had become soiled as urine seeped through it. This sometimes happens with female dogs when proper care isn't taken. There was also a sweet smell of pus from the pressure sore. The homeopath advised Silicea 30 for her together with Calendula 1M and Symphytum 30 that she is already taking with a gap of 2h after each one. I couldn't understand whether it would it be right to give her three remedies together and from October 26 night to Oct 27 I gave her Silicea 30 5-6 times in split dose ( from a solution of 3 drops in 200ml water). However, this didn't reduce the swelling or the oozing of blood and pus from the haematoma wound or the puncture wounds near the vagina.
On October 27, the splint was removed as the pressure sore was getting worse and the also too much pressure worse. Fresh X-rays showed the onset of callous tissue formation. The doctor was worried about the swelling of the leg and said it might indicate osteomyelitis thought it wasn't clear from the X-ray image. Her leg has been placed now in a Robert Jones bandage for immobilisation and it will be great if the bandage can be retained for another 7-10 days. None of the wounds are visible now and I am unable to ascertain the state of her infection.
She doesn't have much appetite, drinks water, eats soaked biscuits and chicken but doesn't seem to like chicken stew. Homeopath had given her two doses of Syphillinum 200 around October 21, 22 due to her aversion to meat or fish. It worked wonders and after that she started eating chicken. She usually passes stool in the morning which is neither too hard nor too soft, is long,yellowish brown. Her urine is clear. She is calm and sleeps almost all day when she is by herself. Will you please by advising what remedies should be given? Our homeopath has prescribed Silicea 200, Calendula 1M and Symphytum 30 at 2h interval but I haven't started this regime yet. Kindly advise.
 
  bhondor on 2011-10-28
This is just a forum. Assume posts are not from medical professionals.
This is not an easy case for me, I am not a vet and I do not treat animals very often. My experience and skill is with people.

So we have swelling and heat is that right? What does the swelling look like? What aggravates the problem? What makes it better?

It does look like Apis could help her if I had to choose a remedy on the basis of what you have given. Apis 30c would be my preference giving daily, and as a liquid dose not as dry pellets.
 
brisbanehomoeopath 8 years ago
The swelling is soft, mainly between the two joints above and below the fracture site. It also axtends beyond these joints. If I place my finger on her leg, an imprint of the finger forms. Vet said this is due to infection. The place is warmer than the rest of the body but not too hot. If the area around the haematoma wound is slightly massaged so as to draw the 'fluid' from the leg towards the hole, then more blood and pus come out. But this is a slow process. All this is what I observed till yesterday, now it is completely wrapped up.
The other puncture wound on the side of her vagina on the other leg is always draining blood and pus. I forgot to mention that this is not the original wound. It has healed and another hole had opened on the soft skin beside the vagina, on the leg and while this second one healed, another new hole had formed.
The homeopath I consult is also a human doctor and gives medicines according to the description I can provide him.
 
bhondor 8 years ago
I forgot to mention that she also eats only a little at a time
 
bhondor 8 years ago
Apis for the swelling, or the other remedy could be Bovista which has this kind of swelling as well. Apis has the heat, but heat would be normal for infection.

There is a rubric, with only one remedy in it

Swelling, edematous: joints, fractures, after - bovista.

Bovista is characterised by a softer swelling than Apis, where the imprint of your finger will be left behind. Apis is much harder. So I would suggest Bovista 30c, given as daily for 3-5 days.
 
brisbanehomoeopath 8 years ago
Thank you. Due to the difference in time zones, I am a bit late in replying. Yesterday, I had given her Calendula 1M and Symphytum 30 alternatly in the morning. I didn't know which one to give and so did as our homeopath had advised. In the evening I got Silicea 200 and since then I have given her Silicea 200 thrice, within 15 hours approximately.
Yesterday, I cut open her bandage completely and discovered to my surprise that the swelling is almost gone. The thick bandage had become wet and the hole on the leg through which blood and pus was draining had closed. However, a new hole has formed. I think, I found a small bony particle on the cotton. I can feel a hard bony structure where the bone had broken. Fresh dark blood is coming out from the new hole.I have applied powdered Ferrum phos on the hole and it seems to have arrested the bleeding temporarily.

The dog is keeping her leg raised while walking though while lying down, if her leg is moved in certain ways, she feels pain. My homeopath today asked me to continue only Silicea 200 and said Symphytum or Calendula might be given sometimes in between, but it is not necessary.

The puncture wound beside her vagina, on the other leg is still oozing blood pus. She has very little appetite, she didn't pass any stool yesterday. Today, her stool was yellowish brown, tending towards softer side and she strained to pass more stool without success.

Now in this altered scenario, it would be great if you could share your views on her remedy selection. Thank you again for all your effort in helping your unknown four legged patient. Good day
 
bhondor 8 years ago
It is impossible to tell what is going on, 4 remedies at once, high potencies and medium potencies, repeated dosing without assessment. There is no way to tell what is her symptoms, what are proving symptoms - it is a mess. I don't really feel comfortable getting involved in such a case.

If your homoeopath is happy to muddle through it I would stay with them.
 
brisbanehomoeopath 8 years ago
I am very sorry , brisbanehomeopath. I shouldn't have troubled you with an emergency case where I couldn't afford to wait for your opinion. I sought your views because I was confused why so many remedies were being used after reading about correct homeopathic practice in many of your posts and writings by others elsewhere. However, I do not yet know anyone in Kolkata who is willing to treat animals on these lines. I am sorry again.
 
bhondor 8 years ago
It's not your fault, but what has been done has been done. The homoeopath prescribing needs to take responsibility. The only way I could get involved is if all remedies were stopped and the patient observed for about a week to see what is really happening. Right now it is confusing, with no way to tell what remedy even helped her. How do you continue now not even knowing what remedy was working? It is a messy way to practice homoeopathy and makes long term management very difficult. I cannot judge what happened, what will happen, and couldn't tell you what to do next. There is nothing to work from, or perhaps too many things.

After a period of time without remedies, then the case could be reassessed to see what needs to be done. If one of the remedies already used was correct, there might be no need to do anything more. That would be the best case scenario here.
[message edited by brisbanehomoeopath on Sun, 30 Oct 2011 02:47:16 GMT]
 
brisbanehomoeopath 8 years ago
Thank you, I have already stopped all remedies from today. There are 3 issues at present with her:
1. The wound on her leg is still oozing blood and I think it has some amount of pus in it. Application of pressure stops the bleeding temporarily. The wound near her vagina on the opposite leg is oozing too.
2. She has almost no appetite, sleeps all day and has become weak.
3. An odd thing to me was the fact that her original wounds healed (both on the leg at the fractur site and by her vagina) and new openings formed which too closed only to open new holes.

Can I give her Calcium, vitamin and iron supplements or should I rather try to feed her nutritious food only?
 
bhondor 8 years ago
I forgot to mention that I'll try to keep her off all homeopathic remedies for a week. Will you please tell me your opinion on any calcium, vitamin or iron supplements?
 
bhondor 8 years ago
She should not be weak with low appetite and sleeping all the time, if those remedies were helping her. Her vital energy should be stronger, but it appears to be weaker.

Something is wrong here - the original wounds vanished only to be replaced by new ones? That sounds to me like suppression has taken place - and with the weakening of her general strength, that seems to be confirmed.

Try to give me a detailed description of her general state, not her local (wound) symptoms. How does she look, how does she act, what is she doing, how is she reacting to things?
 
brisbanehomoeopath 8 years ago
First let me give you a picture of her environment. We have a population of indigenous dogs who are free and in cities, live on the streets. In older days, families used to love their community dogs but now things have become bad as people try to be 'civilised' like big cities of rich nations. The puppy I am talking about now was brought from somewhere by a poor family who own a small food stall on a busy road. She is about 6-7 months old. When she was younger, I saw that she used to be tied by their food shack. They fed her well and loved her. Our Indian dogs are strong and can digest various kinds of food. Naturally, her human guardians gave her cooked human food which might have consisted of fish cooked with turmeric, salt, oil etc. On Sundays, they brought chicken for her. She had a pot belly when she was around little and I was told that there were worms in her stool. A homeopath had given her Cina 6 then (June), which cured her. She wasn't naughty, liked to sleep but jumped around when someone she loved cme to her. She is smart but not hyperactive. She had also been dewormed with Fenbendazole around August end for the purpose of giving her anti-rabies vaccine (which hasn't been done yet, because she fell ill).
I didn't know her much then and won't be able to give you a more proper idea. I have sometimes seen local kids playing with her. She enjoyed these activities.

Around the end of September, she had her first oestrous cycle and probably she had mated. Their season last for approximately 10 days. I can't confirm whether she is pregnant. For most of the first two weeks of October, her guardian family didn't set up their food stall and she must have had to go around in search of food. Probably because of this, she had an accident and was missing for a day or two.. Finally she was seen coming back to the stall limping, to the food stall on October 13. I have already told you the events since October 14 in my first post.

On October 26, I brought her home with me. Before that she had been on the road with her splint, was kept in the campus of a nearby office.

A thing which struck me is that although she was tied up for long periods, even more than 12h at the garage in the office, she never peed or passed stool. Only when she was taken out did she do her business but that too, not immediately.

Now, at my home, she is sleeping always. From yesterday, I noticed that she has a feeling of not being well. She isn't at all playful, lies down always. licks her wounds whenever she is awake. However, she quite often slowly comes to the room where I am and quietly lies close by. She is quiet but growls at our other dog (who doesn't say anything) and at her reflection in the mirror thinking of it to be another dog. But she is smart. She passes stool only once a day and now on alternate days it seems. Doesn't lie in the balcony like our other dog (our home is in an apartment and the balcony is covered). Her gums have become paler.
She is slim, small, her eyes seem to have an expression which might be interpreted as a feling of knowing her suffering. But this is subjective. She is black and white.
 
bhondor 8 years ago
Ok putting the story aside, which doesn't help us choose a remedy, the state we have is:

Sleepy (848 remedies)
Desires to lay down (211 remedies)
Desires to be quiet (87 remedies)
Suffering expression (90 remedies)
Appetite wanting (503 remedies)
Weakness (1498 remedies)

Using a repertory, there are 18 remedies that score for all those symptoms, although some of them are so general they are probably useless for deciding on a remedy.

I would suggest giving her Opium 200, but it must be given as a split dose, and she must be given 3 doses, each one about 12 hours apart if possible.

INSTRUCTONS FOR SPLIT DOSING

Firstly, you need to create a separate dosing bottle. Get a bottle with a dropper, 15-30mls in size, and fill it with a mixture of water and alcohol (5 parts to 1 part). Dissolve 2 granules or 2 drops of the medicine you bought from the pharmacy into this mixture. Your doses will be made from this bottle.

Hit the bottle firmly against the palm of your hand, or another elastic surface like a book. It should be a firm hit not a tap. 2 hits is enough to begin with, and should not be increased unless it is clear that it is needed. The water in this bottle will 'remember' the number of times you have hit it, so that subsequent doses will be stronger (necessary to overcoming the resistance of your disease).

Place 1 drop directly into her mouth.


This is one dose. Repeat doses would be started from the 2 hits on the bottle.

Each step of this process can be adjusted to reduced aggravation or to increase the effect of the medicine. In order to be able to do this, it is important to measure each step (count the hits, the drops, measure the water etc).
 
brisbanehomoeopath 8 years ago
Dear Doctor,
I have opium 30 with me and won't get Opium 200 before tomorrow. Can I give her Opium 30?
There is a lot of bleeding from both her wounds, mainly from the wound on her leg.
 
bhondor 8 years ago
You can try it, I suspect it may not be strong enough for this situation but if it is the right remedy there should be some reaction. Do 3 doses close together - every 2 hours. Make sure you hit the bottle twice before each dose.
 
brisbanehomoeopath 8 years ago
I noticed another thing:
I had tied up her leg for a few hours to arrest the bleeding. However, it didn't help, blood and pus had oozed out. Moreover, if i lightly massage the are around the hole near the fracture, blood pus is coming out. Pressing her paw also caused blood pus to ooze. Is opium still suitable?
 
bhondor 8 years ago

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