What we wish we would have known…..
I started this blog in hopes of helping owners who are trying to make a decision about amputating your beloved dog’s leg due to osteosarcoma. Goli, our incredible (don’t we all think our dogs are amazing!) rescued shepherd mix is a little more than one week post amputation and there are many things I wish we would have known before we made the decision to amputate and do metranomic chemotherapy. Don’t get me wrong, given our situation, we would still choose amputation, but there were so many things that we did not know, (and were not told), that knowing beforehand would have helped a lot. (I did read the book, “When Your Dog Has Cancer” and searched and searched the Internet before hand, but there was so much I didn’t KNOW TO ASK!).
- The first big thing we found out, as we were paying and receiving post amputation discharge instructions, was that our Vet expected our big heavy undercoated Anatolian Shepherd outside dog to be kept indoors and monitored for 14 days. Again, don’t get me wrong, had we known before, we would still have amputated, but we would have known to arrange for one of us to be able to take vacation time at least for the first week (my husband and I obviously both work). It’s cold and rainy around here, and sweet Goli (my precious G–man) was so hot and uncomfortable in our heated house (he was panting so hard and so anxious, I couldn’t tell at first whether he was just hurting, frightened, or hot, or some combination of the three). Turning off the furnace and opening windows helped and his breathing slowed down some. Of course the rest of us (including our short-haired beagle) were freezing, but walking around in coats and sweaters and using down lap throws to be able to sit on the couch is doable.
- The next BIG thing was the post amputation pain and balancing on 3 legs. On this subject we were actually misled. We were at first told at the Vet’s that, “Dogs are so happy to be free of the bone pain once they recover from the anesthesia, that they come hopping out to go home wagging their tail.” When I incredulously asked, “You mean he will be completely pain free and can balance and walk on three legs immediately?,” I was told, “Yes, of course, he will have been given pain meds before the anesthesia is reversed, and he will easily walk on 3 legs – he has already been balancing on just 3 legs because of the limping and not using the affected leg.”
- So, here is an actual story. As is typical, Goli was fine one day and limping the next. After 2 months of anti inflammatories and pain meds, x-rays showed the bone lesions, and we received the gut-wrenching diagnosis. (We chose not to do a bone biopsy before surgery to confirm because of the pain that causes, and the treatment for the only other things that cause holes in bone like Goli’s is also amputation. We would get the biopsy from the amputated leg. We were told that there was a less than 5% risk of it being anything but cancer.) Though G–man limped when he was walking, he still ran after cats and cars, but he never whimpered or cried out – that is until after the amputation.
We chose to have the amputation done at our vet’s office rather than the oncology vet’s office because it was half the price, and we knew our vet. What we did not know was that our vet did not staff his office to be able to keep dogs overnight, and so, if they could not be sent home immediately after they woke up, they have to be transferred to an emergency veterinarian facility. Make sure you ask about the surgical facility’s capacity for overnight stays. Emergency veterinarians are very, very expensive. Goli was in terrible pain post surgically despite a Fentanyl patch and IV pain meds, and he thus, could not/would not walk. We had to transport him to an emergency facility; he screamed as he was moved to and from our car, and cried non-stop the whole trip. He stayed there a day and a half but was not pain free despite IV pain medication because of the surgery for 5 days more – again despite a Fentanyl path, anti inflammatories, and twice the normal dose of pain meds. The oncology vet finally suggested we use Gabapentin (for the possibility of phantom limb pain) along with the pain meds and 2 days later we achieved pain control (though now he was so lethargic he did not move anymore – but that’s a story for another day….. When we asked our Vet why we were not told the surgery could be so painful, he said, “All dogs are different.” AND, getting no sleep for 4 days because your dog is crying essentially non-stop is very stressful on everyone, needless to say. But, I digress….. Given the $90 Fentanyl patch and other medications that were not included in the original estimate and the emergency vet stay, surgery from our vet ended up costing the same as the oncologist’s surgical fee would have been (and the oncologist vet’s fees included a 2-day post-op stay!)
- The final thing I want to add to this first post is about balancing and walking on 3 legs at first. We were told to use a towel sling under his body to help him out of the car, get down stairs, etc., but not to use it very long or he would get dependent on the sling. Goli never needed a sling. Though he hopped from one solid object to another to lean against at first, he never fell, nor did he slip on our tile kitchen floor. We do have a wheel chair ramp at our house which kept him from having to navigate stairs at first, and we used a garden wagon, for a while, as a step down so he didn’t have so far to jump from the car to the ground (we have a high 4-wheel drive utility vehicle). We also elevated his feeding and water bowl because bending over to ground level to eat or drink caused muscle spasms in the amputated shoulder. Now that we have achieved pain control, he easily jumps into and out of the car without tipping over. Apparently he has become an excellent tripawder without much trouble at all! And, oh yes, the tail has started to wag every once in a while again…..
I think a lot of people will find this post helpful. I asked a lot of questions on the forum before Tate’s amp but there were still things I didn’t know. You just can’t think of everything.
I’m sorry your vet misled you. I heard the “free of pain” so many times but Tate wasn’t in pain either – he appeared perfectly normal, only the slightest limp and that only rarely. So when he was was depths of recovery, I really questioned our decision. At least I knew to expect “two weeks of hell” and it was hell and it went on longer that two weeks. But Tate had a hemipelvectomy.
Thanks for posting this, lots of good advice.
You are most welcome – I’m glad you think the post will be helpful. That’s the reason I decided to do it. (This is a first time blog for me.)
Thank you for mentioning the “longer than 2 weeks of hell.” When we know what could happen, we can prepare for it – physically and psychologically. If it doesn’t happen, we are all the more grateful.
It was the shock of being unprepared for the “depths of recovery” that made the first week so hard. AND also the number of pills we had to find a way to get him to take. The minute he would bite down on a pill hidden in chicken etc., he could swallow all the chicken yet spit the entire pill out. Forcing his mouth open and cramming pills down his throat was just too stressful for everyone. Thank heaven’s my husband thought of chunky peanut butter. It masks the smell of the medications and Goli swallows, swallows, swallows, but does not try to chew it.
Another thing that confused me about pain in dogs was a statement the vet said – “Dogs are stoic because as a pack animal they can not let the pack leader know they are in pain. Your dog is definitely in pain even though he doesn’t show it. Bone cancer is the most painful cancer.” I couldn’t tell if Goli hurt before the amputation, but I certainly know post amputation. Dogs moan, whine, cry and scream out in pain.
Thanks for sharing this. It will be helpful in preparing people for what is needed with amputaiton. I think we can sometimes gloss over the bad stuff, not deliberately but because when we come out the other side and have our beautiful dogs enjoying life again we sometimes forget the pain and difficult parts (a bit like child birth!).
Our Magnum spent a total of 5 nights in hospital – 1 before the op and 4 nights afterwards. I thought that was normal so when I read about dogs coming home the same day or afterwards I wondered if our specialist had been too cautious (and a little too interested in the money!). But, I am so relieved that the specialist recommended those 4 nights in hospital. Magnum had the best possible 24hr care and was kept free of pain with an epidural initially and then morphine in those first few days. Yes, it cost a small fortune but she was quite comfortable on Tramadol when we brought her home.
On the pain part, I think bone cancer is more like a constant, chronic pain whereas the pain after amputation is more acute, hence the more vocal response. At least, that’s what I observed with Magnum. Her eyes were very dull with pain during the week before her amputation but she didn’t make a sound. Post amputation she did whine a bit but fortunately we never had any of the screaming from phantom pain.
And yes, I can relate to the pill problems. That was very stressful!
Thanks again for sharing this.
Karen (Spirit Magnum’s mom)
Wow, 4 nights in the hospital post surgically! That sure would have helped – Goli and his pawrents.
Illness is a family system experience, not just an identified patient event. So many nights of poor pain control and without sleep was hard on everyone -another vote for prior warning of the possibility!
Your explanation of chronic (low grade constant) pain verses acute severe pain makes more sense to me than anything the two vets said. Thank you!
A dog screaming in pain is unlike anything I had ever heard before. With Gabapentin being so cheap and apparently effective, my vote would be to order it prophylactically.
Mattie (Goli’s mom)
This post really is helpful, thank you for taking time to share Goli’s experience, for better and worse. The wider range of experiences that are shared within the community, the more people can be prepared.
The pain management thing is such a difficult step in the experience. Not all vets are up on the latest pain management protocols (did you know that vets who were trained prior to the mid-1980s were taught that animals don’t feel pain, and not giving pain meds was GOOD for them?!). So, if a dog isn’t given the right combo of pain meds before surgery, after surgery can be hellish because those pain receptors are all wound up and it takes a heck of a lot of managing it to bring them back to acceptable levels. It’s a tough situation, for sure. When choosing a vet for surgery, it’s so important to ask about their pain management training and protocols (we didn’t know this before my amp but learned it long afterward…pain management is something that’s only been advanced in the last few years really).
I’m so glad to hear that things are good again for all of you. We look forward to hearing more about Goli. Thanks for blogging, you’re doing great!
Thank you so much Jerry for the information on vet training in regards to pain management. This is certainly an important question that needs to be explored pre amputation!!
Our vet used a Fentanyl patch post surgically, but it takes 12 hours before the full analgesic effect of the patch kicks in. As you said, Goli’s pain receptors were by then already too traumatized.
Yes, things are much better. We are 9 days post amputation and Goli went for a short walk 2 times today. Having gotten 2 full nights of sleep in a row has brought the old Goli spark back. We have used the Gabapentin only at night and Tramadol during the day for the past two days. The Gabapentin makes him sleepy and in the morning he wakes wagging his tail. There have been only a couple of whimpers as he gets up from lying down, but I think that might be because the stictches are pulling as he stretches to get up.
Mattie
Thanks for the negative side of the story. and positive outcome. I was told the towel sling too. Keetah hated it and moved too fast on 3 for me to keep up to her to balance her weight. in the end after two weeks post amp she strained her front leg, same side as back leg amp. She was an outdoor great Pyrenees in Manitoba Canada, so you can imagine that she was used to the cold snow and temperatures. NOT HOUSE broken was my frustrating challenge. Now she is in the attached garage, 3 weeks post amp, not heated, but I do have a heater in there. I would like it warmer for her, but she is comfortable on her mattress covered with a quilt. she’s no longer panting or messing on the blankets on the floor. she is using the pile of shavings I have on one side of the garage floor. works great for soft stool and urine. blankets block off the big garage door so no draft can come in under it. Its always good to get second third vet opinion. saves expense and tears. I am so sorry you went through all that. As pet owners its normal for us to loose sleep due to our own anxiety too. I put a t shirt on keetah to cover the amp at first. she did ok for two weeks and even with a cone on her head she managed to slide off her tail end. take care of the dog and yourself. stay strong!