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Friday, November 22, 2013

Another Bulldog Tail Issue

Lynda sent me this email....

I was googling about options for my (child's) dog's tail and came across your blog post on the tail surgery. I have an amazing 2 month old English bulldog who has had a few tail infections over the past year.  It seems to be getting more regular and worse.  I took him to the vet to get x-rays this week but they said his tail is too hard for them to do the surgery in-house so we should wait on the x-rays until I see a specialist and try to clean it and treat it aggressively first. I thought I would be ok with waiting and trying the culture and more antibiotics but I am having a very hard time cleaning his tail and more so keeping it dry. He is obviously uncomfortable and the smell is taking over the house.

I saw that you went to NC State and that you are in Georgia now. I went to UGA, got my dog in Athens, and my first dog spent a lot of time at NCState vet school with Addison's disease and muscular distrophy.  I will do anything for my dogs.

I heard that there are multiple options for Geno's tail, but don't know who to trust or listen to. I heard they could seal up the folds with surgery without removing any part of the tail, I heard they could remove part of the tail to make the space less crowded and easier to keep clean and then I've researched the full amputation (which seems dangerous and risky). Can you tell me what options there are, (though they may not actually be options for us if he isn't a good candidate)? Is there anyone you would recommend that is a specialist in this specific area here in the Raleigh/Durham area?

I cried when I thought he was going to get x-rays so I can only imagine how I will be with surgery. But bottom line I want him to be happy and comfortable. Thank you in advance for any help and guidance.

Lynda was referring to a post I made earlier this year (click here).  This is certainly not a simple situation, but here is my reply to her.

I'm curious as to why they would take x-rays for a skin infection.  Were they worried about infection in the bone?

Doing an amputation of a bulldog's tail is certainly NOT easy, and if they don't feel comfortable with it I wouldn't want them to try it.  I also have some surgeries that I won't do because of lack of proper skill or abilities.  However, a skilled general practitioner should be able to do it, and it isn't necessarily something that can only be done by a specialist.  It all depends on the vets at that clinic or in the area.

One of the problems we see with infections in skin folds is the recurrent nature.  This can happen in deep folds around the face, tail, vulva, and just about anywhere else.  Yes, you can typically cure the infection for a time with appropriate antibiotics, topical medications, and cleansing.  But often these infections have yeast and not just bacteria, so you have to use multiple methods.  And because the reason for the infection is at least in part the deep folds themselves, it's likely to keep coming back until you fix that particular problem.  Many times you'll also find an underlying allergy disorder which needs to be addressed.  Even so, most sources I've seen agree that the best long-term management involves eliminating the deep fold itself, which requires surgery.  Facial fold removal, vulvoplasty, and even tail amputation are not uncommon surgeries for severe skin fold infections.

In my experience, the really deep folds around the tail in a bulldog make amputation the best option.  In order to remove the skin of the fold you have to cut so deep and extensively that you're just about amputating the tail anyway.  Personally, I find it easier to remove the stub of the tail (which they don't need) than to try to get the skin off the bone and then close the defect over the stub.  I would also question the idea of a partial amputation on a bulldog.  The problem isn't so much the tail itself, but the very deep skin folds around it.  Yes, you could remove the outer part of the tail, leaving the deeper bones and skin.  But is that really resolving the issue?  Is that taking enough of the fold away to keep the problem at bay?  If you remove ALL of the tail and skin fold, then you simply don't have that problem at any other point in the future.  The few cases in which I've recommended amputation have been so bad that a partial surgery wouldn't have fixed the problem.

If done properly and with a skilled surgeon, tail amputation is not a highly risky surgery.  You're not in danger of affecting the nerves or muscles of the rectum in most cases, and any bleeding or pain can be controlled.  I've done many partial and full tail amputations for various reasons, including everything from short bulldog tails to long, whip-like tails.  I've never had any serious complications and once they are healed the patients have always been better off than before the surgery.

As far as recommended referral practices, there is one in Cary that one of my former surgery professors, Dr. Gary Spodnick, left the vet school to help found. It's Veterinary Specialty Hospital of the Carolinas (, and they have multiple locations in the Triangle. I don't have much personal experience with them as I haven't lived or practiced in that area in over seven years, but I think they would be considered high quality.  Although if you're in that area the vet school is always a great option.

If you still have questions about the best option, I think it would be worthwhile to spend the money to get a couple of opinions.  Talk to your own vet about your concerns, as they know the case better than another doctor and may have very good reasons as to their recommendations.  If you're not quite satisfied, find a high-quality vet in your area and go for a second opinion.  If both doctors agree (which happens commonly), you'll have more assurance in your decision.  It may also be a good idea to consult with a veterinary dermatologist, looking for non-surgical options first.

Hope that helps!