Ozzie, the 7-year-old Cockapoo, is a familiar patient at our Wells branch. He is a sensitive soul who we see regularly for various minor health issues. Despite this, he is always remarkably good-natured at the practice, loving the attention and wagging his tail as he comes in. However, nothing has put this happy demeanour to the test more than Ozzie’s problems with his nails – a saga that started nearly two years ago.

It all began with a sore paw after a walk, which didn’t settle with pain relief at home. When we saw him, one toe was swollen, with some bloody discharge around the claw. We suspected a nail bed infection, affecting the tissue deep within the toe from which the nail grows, so Ozzie was sent home with additional pain relief and antibiotics.

His toe initially improved, but the problem soon returned and was worse than before. Ozzie was agitated and wouldn’t stop licking the toe, while the nail had started to separate but was too painful to remove. We took a swab from around the nail base, restarted antibiotics and continued his pain relief, using a boot to stop him licking as he didn’t cope well with a buster collar.

The swab confirmed a nasty infection, although thankfully Ozzie was responding to treatment. Nail bed infections can be difficult to treat and often require long courses of antibiotics, so we continued his medication while monitoring his progress.

Improvement wasn’t without its challenges. Ozzie struggled with restricted exercise, his fragile nail would bleed if damaged, and some of his medication disagreed with his sensitive stomach. More importantly, after several weeks of treatment his toe still wasn’t right, so we decided to investigate further.

Under sedation, we removed the loose nail and cleaned away the dead tissue and debris. The nail bed was very inflamed, but X-rays revealed that the bones of the toe were also affected. The changes suggested osteomyelitis, meaning the infection had possibly spread to the bone itself. However, similar changes can sometimes indicate an underlying cancerous process, so we also took a biopsy of the inflamed tissue.

We warned Ozzie’s owner that osteomyelitis in a toe can be difficult to treat, with amputation sometimes becoming necessary, and that there was also a small chance the problem could be cancerous.

Thankfully, the results confirmed osteomyelitis, with no cancerous cells seen. Fungal culture was negative and the bacteria present were sensitive to the antibiotics we were using. Ozzie’s antibiotic treatment was therefore intensified to tackle the bone infection.

After another month or so of treatment, Ozzie had really been through the mill. He had spent much of his time wearing either a buster collar or a boot, had put on weight because of his reduced exercise and was downright miserable. Happily, his toe was finally better and the nail was beginning to grow again. Four months after the problem first started, Ozzie was back to normal and we thought we could put the episode behind us.

Unfortunately, as the affected nail grew back, it continued to cause occasional problems. It sometimes grew abnormally, causing irritation, and would occasionally fall off on its own. With no sign of ongoing infection, we felt this was likely a consequence of the previous damage to the nail bed and that this nail might never be completely normal.

Then, over the following months, Ozzie developed similar problems with two other nails. He would suddenly start licking, and we would find that a nail had begun to break away at its base. These episodes required sedation to remove the damaged nails, although this time there was no obvious infection.

We became concerned that there might be a problem with Ozzie’s general nail health. Certain conditions, including immune-mediated diseases, can cause recurrent nail problems. However, definitive diagnosis can require histopathology on an amputated toe – a procedure we weren’t particularly keen to perform on Ozzie.

Instead, after discussion among the vet team, we introduced measures at home to support his nail health. These included nutritional supplements, regular antibacterial bathing and a topical steroid spray to reduce local inflammation or immune reaction, with other medical treatments available if needed.

Ozzie responded well to his new nail management regime and, at his next booster, his nails generally looked really healthy, although we knew the original problem nail would never be normal. When we tried reducing the frequency of his foot bathing and sprays, that nail became troublesome again, suggesting his ongoing management was helping to keep things under control.

It’s been a long journey for Ozzie, and we know he may have more nail problems in the future. But he has faced it all with that same happy demeanour, and his owner has worked incredibly hard to get him through it. Needless to say, we all hope we don’t have to see him again too soon – even though we’ll miss that wagging tail!