FAQ's About Amputation

 

My dog has bone cancer, why bother?

Amputation provides permanent, definitive pain relief. It does not cure the cancer, except in extremely rare cases. The first way to attack this disease is to address the pain. In many cases amputation actually prolongs life, because without it, the pain will eventually become unbearable and lead to a very difficult and final decision.

This disease is aggressive and ruthless. The pain of bone cancer is probably the worst pain ever. Many dogs are stoic, and don't show how much pain they really have. Others will stop doing their favorite things, develop a limp, sleep more or show a change in appetite. The pain from bone cancer will whittle away at your dog's spirit, while the cancer whittles away at the bone. There is a risk of fracture through the cancerous bone which is excruciatingly painful. The quality of your dog's life will slowly decline due to pain.

Pain medications are very commonly used and may help for a while. Pain medications alone are just temporary until the pain becomes too strong or you decide on an alternate plan. There are several options for pain medications which should be discussed with your veterinarian. Amputation alone can bring back "quality of life".

Fighting cancer is not about "how much time" will my dog have, it is about "how much quality time will my dog enjoy".

How do I know if my dog is a candidate for amputation?

Amputation is a major surgery. Your dog must be healthy enough to undergo any major surgery, not just an amputation. Ask your vet to assess the surgical risk, and set aside the cancer diagnosis for a minute. Consider your dog's overall health. Does your dog have a heart, liver or kidney condition or neurologic problems? Does your dog have arthritis in his joints or spine? Is your dog overweight? If the answer to these questions is YES, then your dog may be at higher risk for complications during or after surgery. Discuss your dog's health issues with your vet. First you must decide if your dog is a good candidate for any surgery. No surgery is without risk, but the overall risk versus benefit picture is what you are looking at.

If your dog is overweight, start a diet now. If your dog has arthritis issues, consider consulting with an orthopedist if you can. Don't assume your dog is arthritic because of age or breed. Dogs carry approximately 2/3 of their weight on their rear legs. A dog with severe arthritis of the unaffected hip or knee may have some difficulty after surgery. Each case is different. Some dogs are not bearing weight on the cancer leg, and are getting around fine. Tying the affected limb up to assess gait is not a fair or accurate way to determine if your dog will do well on three legs.

Breed, size, age and weight alone are not reasons to avoid amputation. Many older, large and giant dogs have successfully undergone amputation.

What blood tests and xrays should be done before surgery?

If possible, blood tests to evaluate kidney and liver function, a urine test and a complete blood count should be done before surgery. A chest xray should be done as well, to determine if the cancer has spread to the lungs.

What if the cancer has spread to the lungs? Is amputation still possible?

It depends on your dog's overall health, the size, number and the location of the metastases and how much pain your dog is experiencing. Amputation is for pain relief, and despite official statistics, it is possible for a dog to experience quality time for a while, even when the cancer has spread to the lungs.

Can my vet do the amputation? What do I need to know?

Many primary care veterinarians are quite comfortable with amputation surgery. Others might refer to a general surgeon or orthopedist. The most important thing is that you have an excellent relationship with your vet. There is no room in the management of this disease for pessimism. "Putting the dog down" is not the only way to manage this disease. Find a vet you can talk to and work with. Questions to Ask the Vet about Surgery.

What does the amputation site look like?

Look at pictures ahead of time. There will be a large incision and there may be some bruising which is normal. Sometimes there is a dressing over the wound. When you first see your dog, you will be emotional. Be happy to see your dog, he will be happy to see you. Remember, dogs don't have psychological issues with amputation...humans do.

After a few days, the bruising will start to fade. The stitches or sutures usually come out 10-14 days after surgery, at which time most dogs are back to normal activity.

How can I prepare for the amputation? How long is the recovery period?

The average recovery time is approximately between 10 and 14 days. Most dogs are up and moving about the day of surgery or the next day, depending on the dog. The pain relief is so obvious that some dogs will literally be running around, even though they will require supervised rest to allow proper healing. Some dogs experience side effects to pain medications, but most recover without incident. You may need to use a sling or harness to help your dog get around, and negotiate stairs. Some dogs do well with ramps. Some dogs develop bruising or drainage from the wound. Many dogs are completely back to a normal activity level by the time the sutures or staples are removed.

Won't my dog be embarrassed? I don't want my dog to lose his dignity.

Dogs don't see things the way we do. They know something is different, and they adapt. They shift their weight, balance their tails and move on. They learn how to climb stairs, relieve themselves, chase tennis balls, swim, jump on the couch and everything else they did before the amputation. They don't lay around wondering about their appearance. Your dog may not be as fast, and may need some help jumping into the car, but he will still be the same dog you have always loved. Allowing your dog to live a quality life, no matter how short or long, without pain, is a very dignified thing to do.

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Questions for the Vet about amputation

 

  • Have a list of your medications and supplements and review them with the surgeon. Which ones should be stopped, and how far in advance? Some anti-inflammatories and herbs have blood-thinning properties and should be stopped several days before. If your surgeon is not your regular vet, check with your regular vet first.
  • Ask the surgeon which medications should be stopped, how far in advance, and why. If the surgeon recommends stopping all medications, including pain medicines, ask what you should do for pain management until the day of surgery.
  • Is there 24 hour coverage for post op patients at the vet hospital? If so, who watches them? How often are they checked? Can the surgeon or covering doctor be reached at any time if necessary? (If not, you may want to strongly consider bringing your dog home the same day of surgery). If you can't do that and there is no one there overnight, can you hire a vet tech to watch him until the next morning?
  • If your hospital doesn't offer 24 hr emergency care, where is the nearest facility?
  • What pain medications will be given after the surgery? Pain Management morphine? fentanyl? torbugesic? codeine? tramadol? What are the side effects? How long will the dog be on these medicines? When was the last dose before discharge?
  • When can you restart supplements (if you stopped them pre-op)?
  • Will there be a bandage? If so, when should it be changed? If not, what should you cover the wound with, if anything? Is it okay to use a T-shirt or boxer shorts to protect the wound?
  • Should you apply ice over the surgical site? If so, when can you start and for how long at a time?
  • How much wound drainage is "normal"? When will the drainage start? What parameters should you use to call the doctor?
  • How much swelling should you expect at the surgical site? Are antibiotics being prescribed? When was the last dose before discharge, and when is the next dose due? Can it be given without food? Will the pain medicines affect the antibiotic or vice-versa?
  • How much activity is allowed? On the first day home?, second day? etc.


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Pre & Post Op Information

 

Pre Amputation

  • Decide on where your dog will stay when resting and prepare the place ahead of time if possible. If you will be using an x-pen, set it up ahead of time and put some favorite toys and things inside. If you have time, start feeding your dog in it. Keep the x-pen open so your dog can explore.
  • Think about whether or not you need baby gates. If so, put them in place ahead of time so your dog can get used to them.
  • Use old blankets or quilts that can be easily washed.
  • Slippery floors will need to be covered with non-slip rugs or runners. Rubber matting or treading is also an alternative.
  • If your dog is used to sleeping on your bed, decide how you will handle that after surgery, and whether or not the mattress will go on the floor so your dog can still be next to you. If you do, you may want to keep a leash on your dog in case your dog decides to try and get up.
  • Make some changes before surgery if you can so that your dog is not overwhelmed with changes at home. Your dog will have enough changes to deal with.
  • If your dog is not used to walking on a leash or going potty on a leash, start as soon as possible. Use treats for every success.
  • If you have stairs to negotiate, start using a harness or sling now to help your dog up and down. Use treats whenever possible. If you will need a ramp, consider planning for it now and get your dog used to it if you have time. (see below)
  • Write any questions you might have so you can discuss them with the vet, and write down the answers.
  • Paint the nails on the limb that is to be amputated.It will be a good reminder for the technicians and vet as to which leg is afflicted, especially if there is no visible swelling on the limb.
While your Dog is in the Hospital

  • Take the time to relax and have a nice dinner.
  • Spend time with friends or family.
  • If you have another dog or other pet/s, spend time with them as well. Your other pet will appreciate some quality time and it will help you focus on something positive.
  • Walk around your home and make sure things are not moved around and that the furniture is still in same place.
  • Make sure nothing is on the floor that your dog might slip on. Use rubber matting to keep throw rugs in place, or consider using yoga mats, interlocking non-skid foam rubber pads or washable carpet runners.
  • Consider starting a journal to keep track of your dog's progress.
Post Amputation

  • If you have stairs inside or outside that your dog must use, consider how you are going to handle this. Use a harness to help your dog up and down the stairs: you can use a regular walking harness or purchase a special one. ruffwear.com has really nice ones and they can be used for swimming as well.
  • You can also slide a sling, towel or canvas tote bag under your dog's belly or chest to help your dog with walking.
  • Stand on the side of the amputation so that you can be the counterweight when you help your dog walk.
  • Use a short leash (12 or 18 inches) so your dog can't get ahead of you. Even if your dog wants to go fast, he/she shouldn't because their weight distribution will be off and he/she may fall taking you along.
  • Down may be harder than up because of gravity... most of your dog's weight will be redistributed to the rear if a front amp and to the front if a rear amp, but going up stairs will be difficult either way because your dog will literally try to hop from step to step.
  • Use treats if you have to so you can control your dog's pace. Put some on the stairs on your way up so your dog is encouraged to take each stair and gets rewarded for doing it. Pieces of cheddar cheese will work very well if your dog likes cheese.
  • Consider getting a ramp or building one if you have deck stairs leading to the yard. Be prepared to walk your dog on leash for potty breaks in the beginning. There are many good choices for ramps online, dogramp.com is just one of them.
Post-operative suggestions for your dog

  • Try to remain as calm as possible and think positive thoughts. Your dog has just been through major surgery and has no idea what has happened. They will be able to pick up your feelings, so try to be strong.
  • If your dog has a dressing on there may not be leakage from the wound initially, but have some extra towels or those blue absorbent towels from the drug store on hand-they work very well.
  • Find out what pain meds and antibiotics your dog received before you brought him/her home and what time the next doses are due. Keep a written schedule of when the meds are to be given and check them off when you have given them.
  • If you have supplements and other meds that need to be given during the day, get a pill box from the drug store and organize the meds.
  • Have favorite toys readily available.
  • Have special food and treats available. Your dog may not be hungry so go for the good stuff if you have to: whatever your dog likes best.
  • Make sure your dog is drinking water and keeping it down. Offer the water often, your dog may not be able to get up and go to the water bowl right away. Offer the bowl to your dog even when your dog is laying down. Any vomiting should be reported to your vet.
  • Remember that pain medications can cause drowsiness, nausea and confusion in some dogs. Do not hesitate to call your vet for advice if your dog is behaving erratically.
  • Get specific instructions if you come home with a duragesic (Fentanyl) patch. It has to be handled carefully when removed, use a rubber glove and flush it down the toilet.
  • Consider using boxer shorts for rear amputation dogs if they seem bothered by the stitches, they go on backwards: the "slit" can be used for the tail.
Post amputation suggestions for other dogs or pets in the house:

  • Recognize that your dog will be getting lots of extra attention, so plan on some fun stuff for your other dog(s) or pets during your dog's recovery. Maybe a visit to the park, a play date with a friend, special car rides or trips to Dairy Queen, a new toy, a sleepover at Grandma's, whatever works.
  • Try to keep their routine as normal as possible and take into consideration their sleeping arrangements if they are used to sleeping with your dog.
Post amputation suggestions for humans:

  • Find out how to reach vet after hours or where the emergency vet is if you need them. Keep those numbers handy.
  • Supply of good wine or beer or whatever you prefer.
  • Several good videos that you like to watch or a good book you have been wanting to read.
  • Lavender candles (very soothing) or other fragrance you enjoy.
  • Soft music to help all of you relax (classical music seems to be especially soothing to most dogs)
  • Email your BCD friends so we know you are all okay.
  • Be prepared for mood swings, in all of you. This is emotionally exhausting so be patient and remind everyone how much you love each other and that together you are a force to be reckoned with.
Potty problems:

  • Keep in mind that your dog has had major surgery and they might need assistance to go out for potty breaks. They may not be able to tell you when they have to go, so try to stick to their schedule as closely as possible.
  • Pain medications and anesthesia can cause changes in bowel habits. It is not unusual for dogs not to go potty for one or two days. They should urinate within 24 hours of being home if they don't stay overnight at the hospital, sooner if they have been there for a day or so.
  • Check with the vet or tech when was the last time your dog peed or pooped.
  • If your male dog had a rear amp and that was the leg he used to lift, he may be confused. Most dogs adjust fairly quickly though.
  • When they poop on their own for the first time after surgery, you will be elated ! Bet you never thought you would be so happy to see dog poop, but it will bring a HUGE smile to your face !
  • Some pain medications can cause diarrhea or loose stools as well. Keep track of the BMs and report to your vet if there are changes.
Behavior changes you may notice in your dog

  • For some dogs (not all) the amputation brings on transient confusion while they regain their balance and try to figure out what happened. Be patient and try not to let your dog see how frustrated you are (because you will be frustrated).
  • Your dog may refuse his/her regular food and may not want to take supplements or pills the way he/she used to. You may have to come up with alternatives to get your dog to eat and take his/her medicine.
  • Most dogs can be excited and energetic immediately after surgery, but may eventually develop post-operative depression within a few days. Sometimes it can last for approximately 2 weeks. During this time your dog may not be interested in old games or get excited about things. He/she may seem unusually tired and there may be a change in appetite. Check with your vet about changes in behavior than concern you.
  • Remember that you will be giving your dog lots of extra attention. You will find yourself watching every move, worrying about every move and trying to prevent anything from happening. Dogs are quick to learn how powerful all this attention is and sometimes that behavior can be self-rewarding.
Physical changes you may notice in your dog

  • Seromas and bruises are expected to occur at the surgery site. A seroma is a collection of fluid that accumulates from the surgery itself, residual fluids used to wash the wound during surgery and drainage from the healing process. It is usually yellowish or blood-tinged. If you see it report to your vet for advice.
  • Check the wound often, note any redness, puffiness around stitches or staples and the characteristics of the drainage. Take pictures of it. Report any changes to your vet.
  • This will sound weird, sniff the wound. A clean wound with clean drainage will have a clean smell... if there is any sign of infection in the seroma the smell will change. You will be able to tell the difference. As your dog becomes more mobile, there may be more drainage when they are upright than when they are laying down, so at times it may seem like there is more drainage.
  • Consider taking your dog's temperature once a day if you can do so comfortably without any distress to you or your. Normal canine temperature is between 101F and 103F. Keep a temperature chart so you can report any changes to your vet. Lower temperatures can also be a sign of infection, and infection can occur without fever.
  • If your dog has had a rear amputation, the wound may rest on the floor when he/she is sitting. This can cause trauma to the surgery site. It is very difficult to keep a dressing on a rear amp for a male dog because of their anatomy. Try to keep the stump from resting on the floor or carpet. Use towels or blue absorbent sheets.
  • If they choose to lay on the affected side, it's okay... If it is too sensitive or painful they will shift their weight.
  • If you don't have a dressing and there is leakage, you can use maxi-pads and sensitive skin tape to cover the wound temporarily if you have to. Skin that has been shaved, stretched & manipulated can be very sensitive, so use tape sparingly as it hurts when you pull it off, no matter how gentle you are.
  • Front amp wounds may not spend that much time directly on the floor, so there is less direct trauma.
  • The other muscles groups get overused after amputation, so there may be some soreness and tenderness in those muscle groups. Your dog may be reluctant to walk if the muscles are sore. Warm compresses to the other muscles may be soothing, and gentle massage may help. Gently rubbing the muscles on either side of your dog's back or rubbing the chest can be very relaxing for both dog and human.


Most important of all, don't forget the dog !!!

This may sound weird, but we spend so much time focusing on the wound, the pills, the drainage, what the vet said, should we call the vet, the bodily functions, the diet, the supplements that we may forget about the dog.

Spend quality time with your dog, even if you are doing nothing. Talk gently to him, stop fussing for a minute and just enjoy him/her for who he/she is. They have been through a lot but they don't know they are sick, they just know something is different.

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Post op bruising & seromas

 

With amputation surgery there is alot of manipulation of tissues, muscles, ligaments, skin, etc. There is a normal amount of bleeding that is washed out during the surgery, but the tissues themselves suffer bruising inside, and that shows up under the skin.

Sometimes, with the shift in weight, as the dog becomes more mobile, the bruising shifts. The surgery itself is somewhat traumatic so there will be bruising which is normal. Initially it will be bright red, then purplish/blue then eventually greenish and then it will fade away. The bruising looks worse than it really is.

The important thing is to check the wound for drainage, and if you see any, note the color and smell (yes, smell) of the drainage. Take daily pictures of the wound. Some dogs will develop a seroma, which is a fluid collection under the skin that usually drains through the incision as it is healing.

The fluid can look bloody or watery tinged with blood, but should not be just blood. This can get quite big so be prepared and consult with your veterinarian. If the wound is healed above the seroma, there is no place for the fluid to drain, and swelling under the stitches will develop. Consult with your veterinarian since this condition usually requires drainage.

There are times where the seroma can become infected, which is why smelling the wound every day is important. It is hard to describe what a clean wound smells like, but you will know if the smell changes to an infection, usually the color of the drainage changes as well if the infection is significant.

Changes in the wound, loosening of the stitches or staples, drainage from the wound or change in smell or color of the drainage should all prompt a consultation with your veterinarian.

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