Abscess on paw - still under skin

[miraramsay2012]

My cat has a hidden abscess on the top of his paw. There is no opening or wound, just a swollen lump that is obviously fluid-filled (the vet can tell when she feels it). He has been limping for 5 days, and doesn't seem to be getting any better. 

Day #1 - saw the vet, did xrays, concluded it was a sprain (no lump yet, just limping), started Onsior 

Day #2 - Onsior again

Day #3 - Onsior again

Day #4 - developed a fever, slept most of the day/night

Day #5 - saw the vet again, now diagnosed an abscess, gave an injection of Ampicillin and a 14 day course of Clavamox (which he starts tomorrow), also gave us a bottle of Torbutrol which I have not given him yet

I have a couple of questions.

1. We talked about lancing the abscess, but she recommended against it because she thinks antibiotics will take care of it, and doesn't want to risk creating an opening for more bacteria. Should I have insisted on lancing it? Do abscesses ever go away with just antibiotics?

2. She prescribed Clavamox at twice the recommended dose (125mg twice a day for my 9 lb cat is HIGH). Should I give him this super-dose, and why?

I really want to just take him to another vet, because of these concerns. But I've already spent over $400 on tests and medications, so I'm not sure if it's warranted or if I should just do what this first vet is saying to do. 

Help

 

[red top rescue]

I'm totally on board with your vet.  That sounds exactly like the right treatment, what I would recommend.  After you get him loaded with the Clavamox, you can cut the dose back, but it is best to start with a loading dose and it's usually very well tolerated.  Clavamox is a very safe antibiotic, has been around for years, and if your cat is not allergic to penicillin (which I guess he isn't because he already had ampicillin and had no allergic reaction).  The Onsior was for pain but it is in the NSAID family and cats are highly sensitive to NSAIDS.  Onsior can only be given a maximum of three days, so your vet gave you the Torbutol to manage his pain.  Give it to him.

https://www.vetinfo.com/cat-pain-relief-torbutrol.html

http://us.onsior.com/en/

He probably won't have to be on for the entire two weeks because once the Clavamox wipes out the infection, he won't be in so much pain.  When he stops limping and being sensitive to touch, you can cut the pain med back gradually (don't just cut him off suddenly, just cut back the amount of each dose very gradually)/  If you have ever had an infected cat bite, you would know how extremely painful they are, but the pain goes away as the antibiotic starts to wipe out the infection. 

I agree that there is no reason to lance the abscess and it would just create a wound where other germs could enter.  In nature, untreated, the abscess gets huge and is extremely painful and inflamed but it stops the cat from getting blood poisoning by actually encapsulating all the germs in a thick walled pocket.  Eventually it ruptures and all the pus drains outside the body, and then the abscess heals from inside out.  If you treat it with antibiotics, it wont get big and rupture.  The body will reabsorb it after the bacteria die, and the abscess will lose its heat and swelling and will disappear.  Lancing and draining is the old fashioned treatment, but vets have learned that it isn't necessary and it's much better to just give the antibiotics for a sufficient time and it will go away.  Two weeks is the right amount of time to give Clavamox for an abscess, and 125 mg. twice a day is not excessive.  If you were treating him for an upper respiratory infection, he might get 62.5 mg twice a day, but at 9 lbs., I would always use 125 mg. for an abscess.  Better a little too much than not quite enough in this case.  You want to make sure to kill any and all bacteria that might be in bone and tendon from a bite, and thus you do give a high dose.  I have treated any number of abscesses with Clavamox and they have all healed perfectly.

If you want to see what kind of mess Clavamox cleared up, look at the photos by my signature in GREY BOY's album.  That wasn't a bite wound, it was way worse, and wo weeks of 125 mg. clavamox (administered in food, since he was a feral) did the job. 

The only thing I might add to the mix is some probiotics, because the antibiotics can also kill some of the intestinal flora, so it's best to replace those daily to help his digestion continue on an even keel.

When treating a badly bitten feral that I can't handle, I particular like the clavamox pills because you can crush them with a mortar and pestle and then dissolve them in liquid (I use condensed goats milk) and they have hardly any taste, mix it in with food, and the ferals gobble it right down, which is good because I can't touch them to ill them.  I prefer not pilling my own cats too, and the liquid Clavamox tastes yukky, while the crushed and dissolved Clavamox doesn't seem to bother them at all mixed in with wet food.

I think you have a great vet, one who cares about your cat, chooses the best drug for the job, cares enough to prescribe a pain medication you can use to help him through this time, and avoids charging you extra money to anesthetize the cat and lance the abscess.  Stick with this vet, follow the instructions, and your cat should be fine.  Let us know progress reports, okay?

 

[miraramsay2012]

Thank you for the detailed reply.

About an hour after I first posted, I checked on him and saw that the abscessed ruptured. I was shocked, because it appeared so far under the skin I thought it would be reabsorbed. My cat is grooming the area, which is now flat with a small hole. He is putting weight on the foot now, so I think that when it popped, he must have felt a great deal of relief from the pressure. I phoned the vet's hotline and reached a vet tech, she said it would be fine to cleanse the area with diluted hydrogen peroxide, so I did that.

I'm hoping with the ampicillin injection and now with the Clavamox, it will not become re-infected. I know it's also important to keep the area open so it can drain - what are some ways to do that, without actually putting in a surgical drain? 

 

[red top rescue]

The cat will probably lick it himself which will keep it from scabbing over until it is drained.  Then he will stop and it will close up.  Since he is on the antibiotic, you don't really have to worry about it closing up and swelling again.  Nature is actually very clever that way.  However, if you have any triple antibiotic ointment, you can but some of that over the opening if that makes you feel better about it.  He will lick it off, of course, and the licking will keep the wound open and draining until the infection is gone.  If it had not ruptured, it would have been reabsorbed by the body from the inside out as it healed anyhow.  I'm pretty sure that he's going to be very fine very soon.  As you said, just the release of the pressure makes the pain less.  When I was on Clavamox (human version is called Augmentin) for my cat bite, the infection and rednessand swelling were all gone by day 3.  I still took it for the entire 2 weeks because that's the way to avoid super germs from developing.  I have a scar there still, but nothing else.

 

[Geoffrey]

I am an human doctor, not a vet and any medical advice that I give about the cat should be checked with your vet.  

There is a medical axiom that is very useful: "Where there is pus, let it out " and your cat has put this into practice!   Make sure that the wound remains open, your cat should do this instinctively by licking the wound.  Don't worry about getting another infection; this is most unlikely and if the abscess is allowed to drain the condition should cure itself.   Make sure the hydrogen peroxide is dilute: 3% should be fine.  higher concentrations can burn!

As for antibiotics, the clavulox probably contributed to the abscess  rupturing.  It probably will not now need to be taken for 2 weeks but check with your vet as this antibiotic can cause nausea in humans.

With best wishes,

Geoffrey

 

[miraramsay2012]

Update:

It is day three of antibiotics, and the swelling has completely subsided - the wound is just two small punctures (pretty sure it is a bite wound that caused it) on a hairless area about the size of a quarter. He grooms the area often, and I apply coconut oil once a day, which encourages him to lick it because he loves the taste (even before his injury he occasionally had a few drops of it as a treat!)

He has had stomach upset with Clavamox in the past, but this time I see no sign of it - he has a great appetite. Aside from being momentarily mad at me for pilling him twice a day, he is a happy cat and back to playing and cuddling all day. 

 

[red top rescue]

Why don't you try crushing the clavamox pill and mixing it with something very yummy?  If works for my guys.  When treating a badly bitten feral that I can't handle, I particular like the clavamox pills because you can crush them with a mortar and pestle and then dissolve them in liquid (I use condensed goats milk) and they have hardly any taste, mix it in with food, and the ferals gobble it right down, which is good because I can't touch them to ill them.  I prefer not pilling my own cats too, and the liquid Clavamox tastes yukky, while the crushed and dissolved Clavamox doesn't seem to bother them at all mixed in with wet food.