Bumblefoot hole can't clear pus

[deacons]

I have a 2.5 year old Golden Laced Wyandotte who has a stubborn bumblefoot issue going on. I've successfully dealt with bumblefoot before, but all the things I thought I knew how to do aren't working. We're about 2-weeks in, here's what I've tried so far:
1. Soaked in epsom salts, removed black scab (and with it, a large "kernel"), cleaned with Betadine, packed with neosporin, vetwrapped. After the initial removal of the kernel, it left behind a decent sized hole, but I really thought I had taken out everything that needed to come out.
2. Changed bandaged every 1-2 days, soaked again in epsom salts, sprayed with a lot of Vetricyn gel, re vet-wrapped, and sent her on her way. She was with the flock doing normal chicken things and roosting at night.

About a week in, she had painful looking abrasions in between her toes and up her "ankle."

At that point, I got worried that infection was spreading. The day after I saw these abrasions, when I did the bandage change, the second I uncovered it, it was obvious the foot was full of infection. There was a milky white "scab" on the footpad, and when I poked it, liquid white pus shot out. I'd always heard chickens don't have liquid pus (?) so this seemed very bad indeed.

That morning, I got a vet involved- he's more of an old-school country vet type but is willing to see chickens, so off we went. He was not particularly concerned about the abrasions- he thought these were probably because the foot swelled, pulling the bandages too tight, and she probably was sitting oddly on the roost to relieve the pressure. I think I buy this explanation. Both areas are responding well to 2x daily application of alternating povidone iodine gel and Vetericyn gel.

He did give Baytril tabs which I am giving her 2x day.

But here's the one thing that seemed frustrating about the vet visit- he left all the white cottage cheesy pus in the hole in teh footpad, saying he didn't think it would be productive for him to dig around in there. It seems to me like all that stuff has to come out, right? I am able to poke around at it a little with tweezers and pull some out with qtips, but it is still very obviously filled with white cottage cheese stuff.

We're 5 days into a 10-day course of antiobiotics. I am soaking the foot in epsom salts 1x daily, changing bandages 1-2 daily (doing my best to clean out the gunk close to the surface, repacking with povidone iodine or vetericyn). She is staying in a sick crate packed deep with straw and not moving around much or roosting at night.

She's laying (!), eating, drinking, pooping. A little anxious about being isolated. I feel bad for her so have let her loose in teh garage (dry and relatively clean) a few times with a couple of other chickens so she gets some movement and company.

My biggest question is what to do about the cottage cheesy pus. Bring her back to the vet and ask him to clean it out? Let a new scab form and see if it creates a plug that I can pull out all at once and essentially start the healing over? I do not have the proper tools or knowledge of foot anatomy to do much aggressive digging in there- I am fine clearing out surface stuff with tweezers/qtips, but it keeps filling back in. Advice?

 

[enola]

Packing the wound with gauze wetted by sterile water and removing it each day is just what we did with my son in law when he had a staph infection in the area just above his knee. We pulled out the old, repacked with the new and it healed from the inside out.

At first it was kind of gross, but we got used to it.

 

[deacons]

And just read somewhere that epsom salts and Baytril don't go together. This was on a forum, I wonder if anyone can confirm that or point to any research? I'd really kick myself if I realized I'd been negating the Baytril doing any good- she is NOT happy about taking it!!

 

[lewlew]

First off, let me just say that I have no chickens yet, so obviously I am certainly not, in any way shape or form, qualified to give you any advice. However, I work at a jail and have had to deal with staph (MRSA) infections throughout the inmate population and also on myself as staph is very contagious. We treat the staph with antibiotics, obviously, and wound care. But I was just thinking, one thing I did when I have had a staph infection (looks like a boil) in addition to the antibiotics, I used black drawing salve (ichthammol ointment) it helped "draw" out the puss and infection. Now, please don't use this unless the vet says it would be safe but I wonder if any of the more experienced members here know if ichthammol ointment would safe for poultry. If its safe, it seems like it might help to pull the some infection out.

 

[deacons]

@lewlew , thanks for weighing in. I know a lot of people who use ichthammol on horses with stubborn foot abcesses, but I'm not sure about using it on a wound that's already open.

That's what's frustrating about this open wound on my chicken's foot, I'm keeping it open, but still seeing white cheesy pus in it daily even while keeping it really clean and open. The vet indicated the povidone iodine treatment would also have some drawing properties and was ok to use on something that's open, so I've been using that under a piece of sterile gauze wrapped in vet wrap.

I've got a couple of days of antibiotics left and will give the vet a call if things haven't changed.

 

[microchick]

I'm wondering if she is on the correct antibiotic to clear the infection? Simple solution for that is to ask the vet to do a C&S (culture and sensitivity) on the wound and pin point exactly which bug she has working there and which anitbiotic will irradicate it. Some times they can get early results in 24 hours and a final in 72.

I did a lot of time as a wound nurse in one posting. Depending on how deep the wound is, would she tollerate doing a wet to dry dressing on the hole? Would she allow you to stuff a small wad of gauze dampen ed in sterile water/saline into the wound and then bandaged over with more gauze and vetwrap? The purpose would be to debride the wound. The gauze in the wound will dry in about 24 hours and you gently pull it out removing drainage and dead tissue with the gauze packing, flush the wound with betadine and repeat. The wound would be able to granulate new tissue.

I hope you get things sorted out with your girl. It sounds as though you are on the right track with her.

 

[deacons]

Thanks @microchick . The vet did mention the possibility of doing a culture to better target the antibiotic, but he quickly said "but that's pretty expensive." I think he felt bad about what he was charging me to look at a chicken, and suggested a couple of things (another one was a prescription strength antibiotic ointment) and then said, "we probably don't need to do that." But honestly, I'd rather just do it right and get this over with rather than extend the time it takes. That's the funny thing about where I live, people are always trying to save you money but I think sometimes it's at the expense of doing things right!

I do think that she'd let me do what you describe with the gauze/dressing. She's fairly easy to handle. The one thing that makes me nervous about what you described is making sure that I extract all the gauze- is there a concern that pieces would get stuck inside if it tears apart while removing it? What would happen then?

 

[microchick]

No, you shouldn't have any problem with extracting the gauze.

For instance, I imagine that with a wound the size of a regular Bumblefoot wound on one of my hens, I would take a small 1x1 gauze square and cut it in half. I would dampen it with sterile saline so it was damp, not soggy wet and I would use a small forcep to grasp the end of the 1/2 x 1 in piece of gauze and gently work it into the wound so that the end is outside the wound, then I would wrap her foot in gauze followed by vetwrap. When you remove the packing (basically that is what you are doing, packing the wound) you would just grasp the end of the gauze sticking out of the wound and pull it out. It will come out in one piece. Flushing the wound with betadine will remove anything such as gauze fibers that were left behind. If 1/2 by 1 is too large, just trim it to fit.

The packing with clean the wound out and promote healing from the inside out.

I would go with the C&S at this point no matter the cost. No point dosing the poor girl with 18 different antibiotics trying to hit on the right one.

 

[deacons]

Thanks for the advice! I will put in a call to the vet today or tomorrow and see what he thinks about where to go from here.

Quick confirmation though- people generally agree that the pus needs to be taken out, right? It's not just going to clear out itself.

 

[microchick]

If it is thin, it will drain by itself, if it is thick in consistency, the wet to dry packing will remove it for you. Leaving pus in any wound isn't a good idea. Ever had an abcessed tooth? The pressure is horrible as is the pain. Drain the abcess, the pain eases. Pus is an accumulation of dead white blood cells and bacteria. Never good to leave it laying around a wound.