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post-amputation pain
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16 August 2017 - 7:08 am
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Hello,

My dog Kira had her front leg amputated on Friday 4th August. Her recovery was going really well until about a week after the amputation, when she suddenly started getting strong painful muscle/nerve twinges at the bottom of the wound. The vet put her on gabapentin (in addition to the Tramadol and Metacam she was already on) on Sunday 13th, but the twinges have just gotten worse since then. Now they are happening every 2 hours and can last 30mins-1 hour. She gets them every time I try to take her outside to the toilet, but also when she is just laying in her bed sleeping. They are extremely painful and when she has a particularly bad episode (2-3 times per day) she comes to me and leans her whole weight into me so she's effectively in my arms. At first I thought this was phantom pain, and hoped the gabapentin would help with it, but it hasn't made any difference. Yesterday (15th) the vet increased the gapabentin dose from 300 to 500mg 3 times a day, put her back on antibiotics (as the time that she finished them matched the start of the pain) and changed her metacam to cimalgex. She's also still on Tramadol twice a day. That made no difference (in fact I think it's getting worse) so I took her back into the vets today and they are keeping her in for two nights so that they can give her stronger pain meds. 

Before taking her to the vets I really thought that this sounded like a nerve problem (neuroma from reading other posts) but the vet said that neuromas don't form within such a short time space after the operation. He thinks that it is because she has mild arthritis in her spine (neck and tail base) but I don't understand why it would take 1 week for the pain to occur suddenly, and for her to twitch from the bottom of the wound near her chest if it was related to her spine. He isn't checking for anything else at the moment, just increasing the meds and hoping the pain goes away by itself. If it is the arthritis in her spine, I guess the pain won't truly go away and I think I will have to have her put down because it is so severe and frequent. That's why I was hoping it was a neuroma and could potentially be fixed.

Sorry for the rambling post - any advice/opinions on this would be hugely appreciated!

Vicky

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16 August 2017 - 7:11 am
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Sorry I just read Jerry's post after writing my question - Kira is a 26kg cross breed (possible german shepherd cross) whose leg was amputated for bone cancer. 

Virginia
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16 August 2017 - 7:51 am
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Just going to chime in until our Volunteer Vet sees this.   Also want to strongly encourage you to take her for a second opinion from an Orthopedic Surgeon who did NOT do the surgery!  Kira needs to be checked for "something" else!!!

There are two dogs who had something "similar" that came to mind.  One is named OLLY ( or OLLIE) I think.   Bottom  line was that a second surgery had to be done at the incision area as it was an exposed nerve...or something definitely nerve related, that was causing this awful pain intermittently.  

Is this the ORTHOPEDIC surgeon who did the surgery??  Even if it means going to another Orthopedic Surgeon for a seond look, I would definitely pursue thst asap.  For it to happen with sspecific movements sounds like an exposed nerve...or even a staple sticking him.Hard for me to belieq this kind of lain presenting itself like it is, has anything to do with arthritis!

Completely unprofessional opinion, but it seems like throwing more pain meds....and that's a lot kf Gabapentin  for a dog his size....is NOT the solution.  

Your frustration, as well as your exhaustion, must be off the charts!  Seeing Kira in pain and not being avle to stop itnis just awful!  PLEASE know that this CAN be figured out....it just may mean you need to get her to another Surgeon.  I'll try and find OLLIE's thread.  Once the cause was figured out, he was a different dog!!! 🙂

Hang on, okay?  Kira can get past this!   And you certainly are NOT rambling!!!   I'd be completely hysterically  bonkers by now!!!

Love and hugs!

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

  • PS...CAN ANY OF THISE WHO KNOW HOW TO DO SEARCHES FIND OLLIE'S STORY!   I think we also had a dog named Charlie with the same initially  undiscovered nerve thing.

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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16 August 2017 - 8:08 am
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Hi Sally,

Thank you! Yes definitely feeling very upset about her being in pain - she's hurting so much more now than when she had the tumour! I've just left a message with the referral specialist who advised me to have the amputation done. The vet I've been discussing this all with is the head surgeon at the practice where they did the operation. I saw Ollie's thread and the other dog - the video of the other dog looked just like what Kira is going through as it's a front leg amputation. I read that that dog had an abnormal bundle of nerves adhered to an artery. I asked the vet twice whether he could check for that today but he dismissed it. Hopefully I'll hear back from the referral vet later today, but if there is no change after I get her home again I'm going to push for them to open her up again and check for nerve issues. Otherwise I really don't know what to do - neither of us can cope with how she is at the moment and I feel cruel leaving her like that.

Virginia
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16 August 2017 - 8:29 am
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Glad you found th threads I was referring to!!   That's where your answer may be!   You've found the thread,so you'll know better than I,  but I think in one case it was a "second opinion Surgeon" who found it.

Youre doing EVERYTHING you can and yiu are a powerful advocate for Kira!!!   I think you jave great "instincts" as far as what is going on with Kira and what just  doesn't make sense! 

Update when you can.   We're all cheering for Kira!!!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

The Rainbow Bridge

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16 August 2017 - 9:20 am
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This makes me mad

 I asked the vet twice whether he could check for that today but he dismissed it.

Nobody should ever be dismissed by their vet. When that happens, it's time to find a new one who will listen to your concerns and recommend steps to address them. If yours is not, find a new clinic to work with.

I'm sorry Kira is  hurting so much. This does sound a lot like Ollie's case, I'm glad you found that. Not saying it is what's going on, but it's a place for a good vet to begin exploring. It's such a rare situation that I can see why your vet wouldn't think it's possible, but I'm also mad that your concerns were dismissed the way they were. Grrr.

What is their point for keeping her overnight and observing her? Have they presented you with a plan for next steps based on what they find? Have they recommended an evaluation by a physio therapist yet? 

You are not being cruel, you are doing everything that you can right now. She is getting pain management, that's good, but the cause needs to be addressed too. Hang in there OK? We have  members in the UK if you want to chat with them in real time, like Clare, mom to Meg. She has quite a story to tell you about being dismissed by vets.

P.S. if you're up right now I'm in the Tripawds Chat room for a bit.

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16 August 2017 - 9:20 pm
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I would try to do a video of the way she's reacting when the pain hits, that way the vet can see it.  He can't dismiss it if he sees it.  When Ollie was first going through everything, the way they were describing it was nothing compared to when we saw the video!  Once we saw the video, we all agreed that it appeared to be nerve pain or something really not normal.  Luckily they had the video to show the vet who was able to do further investigation into what was going on.  But if your vet continues to blow you off, then yes, you may need to find someone else, which is never easy.  You have to be an advocate for Kira - you are her voice.

Donna

Donna, Glenn & Murphy  http://murphyh......pawds.com/

Murphy had his right front leg amputated due to histiocytic sarcoma at 7 years old.  He survived 4 years, 2 months & 1 week, only to be taken by hemangiosarcoma at 11 1/2 years 6/12/17  

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17 August 2017 - 8:27 am
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It sounds like nerve pain and spinal pain does not usually present like that.  I wonder if he blocked the nerves before they were cut?  Gabapentin works best when given before the amputation but may still be helpful at 600 mg three times daily.  Amantadine can also help and I would consider adding diazepam as a muscle relaxant.  Our neurologist prefers this drug to the old methocarbamol.  Recent info shows that Tramadol is not the greatest pain reliever for dogs so higher doses might be needed (ask your vet first).

If all else fails a second surgery on the nerves or MRI may be needed.

Pam

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17 August 2017 - 9:54 am
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Hi Vicky,

This must be so stressful for you. Can you take Kira to another surgeon? Being dismissed by a Vet is never ok!

Tiffany's dog Daisy also had this issue. They ended up going in for an MRI and then performing another surgery. The doctor talked about publishing a paper on it so people would know of this possible complication. Here is what she wrote: 

So Daisy went in for an MRI this morning. The surgeon called this morning to let us know they didn't find anything so while Daisy was still sedated she was going to go back in and explore. Similar to what you had mentioned Sally about the dog Charlie, she found an abnormal bundle of nerves adhered to the back of an artery that was cut during amputation. They said they had a difficult time with anesthesia as Daisy's heart rate was up around 150 and she was hypertensive. As soon as she removed the inflamed bundle of nerves her blood pressure dropped and her heart rate went down to 80. They were hopeful that indicated they had identified the source of pain. She told us she was sending the tissue sample away for biopsy. They will be keeping Daisy until Monday or Tuesday so they can manage her pain. They inserted a catheter so they can infuse pain med directly to the site.  The surgeon told us today she is considering publishing her case to help inform others. I will admit, I have been an emotional wreck today- hopeful tears of happiness and also tears of sadness for the horrific pain she endured for 2 weeks. They are encouraging us to visit her daily starting tomorrow so we are looking forward to seeing her again (hoping I can keep it together- I've learned from this site the importance of positive energy!). Once home, we will be back to 2 more weeks of rest until staple removal but at least she's already got the walking on 3 legs down!

This is the link to the discussion, you can see videos of her episodes as well. 

http://tripawds.....-for-meds/

Sending you loads of strength and positive vibes. 

Mascha & Schlomo

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17 August 2017 - 12:38 pm
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Thank you everyone for your responses - you are all keeping me sane(ish)!

To update, the vets have had Kira since yesterday lunchtime and they are keeping her until tomorrow. They put her on strong pain medication to begin with, including this morning, and want to let that get out of her system and see how she does on oral medication before I take her back home. They said that they haven't seen any of the twinges that I saw, and while I want to be hopeful, I feel like the strong medication is probably masking her pain (or they aren't checking on her as obsessively as I do at home as she is very quiet even when in pain). They have taken her off gabapentin as it didn't seem to make much difference and are going to put her on diazepam instead. I still have gabapentin at home so I will probably put her back on that if she can go on both as I've heard so many good things about it from other people's posts. 

In the mean time, I rang the specialist referral oncologist who I saw originally (I couldn't afford for them to do the amputation but they did the pre-checks). They said that it sounded like a neuroma to them, and suggested an ultrasound (or MRI to be more accurate, but I can't afford that if she needs to have a second operation). If there is a lump of nerves, then they would need to do a second amputation.

Pam, thank you for responding to my post, I will ask the vet whether they did block the nerves tomorrow. I'll ask about Amantadine and I'm really pleased that you agree about the diazepam. I just worry that all the pain meds will just mask an underlying problem. 

Donna, thank you for your advice with the video, I took one with me on my phone and the first thing I did when I got there was show him it. That was before he started talking about arthritis and said no to my neuroma suggestion.

So I think my current plan is going to be to ask if they can do an ultrasound tomorrow 'just to rule it out/put my mind at rest' and give her a couple of days on the new meds. If that doesn't help, I'll be taking her back to the specialist and hoping I can afford whatever they suggest. I have £500 left of my insurance until it renews in October, so we are stretching things a bit thin! The specialist also agreed to talk to the vet so if I get any pushback on the ultrasound I can bring her in! 

Pam do you think that there is a good chance that an ultrasound will be accurate enough to find the neuroma? Or should I be saving the money and looking into MRI instead?

Thanks again everyone for your support!

Vicky

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17 August 2017 - 10:58 pm
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It depends on the skill of the ultrasonographer and how deep in the tissue it may be.  But an ultrasound could also pick up fluid pockets and muscle swelling and is not that pricey so I would go ahead with it.

Pam

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18 August 2017 - 8:55 am
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Thanks for your reply again Pam! 

The vet told me that Kira was ready for collection this morning and they had not seen any sign of the twitching over the 2 nights that she was there. I drove her home (20 mins car ride) and as soon as I got her inside she started twitching again. She was twitching continuously for over an hour, and while her response wasn't as strong as before, I could see that she was in pain.

I rang the specialist and she couldn't fit me in until Monday, but I booked a provisional appointment with her. Then I rang back the vet and explained the situation. They don't think that their ultrasound is precise enough to check for a neuroma, so they said that the only thing they could do would be to open her back up. At first I thought I should wait until Monday, but she was in so much discomfort that eventually the vet agreed to take her back in and put her back on the stronger meds. Their plan was to keep her until Monday and then I take her to the specialist, but now I'm thinking I may as well skip the ultrasound and go straight for opening her back up because they've already given her so many pain killers and nothing has worked, so going back in seems like the only option to me. If they go back in and don't find anything, then maybe they shouldn't wake her up again as there is nothing else they can do. 

I'm trying to post a video here but I can't get it off my phone at the moment, will keep trying

The Rainbow Bridge

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18 August 2017 - 9:31 am
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tazziedog said
It sounds like nerve pain and spinal pain does not usually present like that.

 Recent info shows that Tramadol is not the greatest pain reliever for dogs so higher doses might be needed (ask your vet first).

We learn SO MUCH from you Pam, thank you for clarifying the difference between nerve and spinal pain.

Also, can you point me to any of the recent info you've come across? It's not surprising that Tramadol isn't as effective as it seems, we see many Tripawds here whose pain isn't alleviated with it. Thanks again.

It's better to hop on three legs than to limp on four.™
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The Rainbow Bridge

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18 August 2017 - 9:35 am
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Vicky I'm just now catching up. I hope that if you do go forward with surgery they can pinpoint this issue. I'm so sorry, this is really a tough situation.

I'm trying to post a video here but I can't get it off my phone at the moment, will keep trying

First you must upload to YouTube or Instagram (not Facebook), then share the link here. If you'd like help I'm in the Tripawds Chat room for a bit.

Sending lots of love and pawsitivity to you and Kira.

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19 August 2017 - 1:07 am
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Hi everyone,

I finally managed to get a smaller video off my phone and onto youtube. This is the URL: 

I'm not sure if that's the right way to share it here. It is just a mild episode because if it is a strong one she's in my arms and I can't video it. This episode started as soon as I got home and continued for an hour before I took her back to the vet. It has been happening on and off every 2 hours every day for a week. I showed the video to the vets and they didn't seem concerned by it - am I massively over-reacting about this? Is this just normal after an amputation?? And apparently the vets have never seen it happen while she's been there for two nights.

I feel like I'm either going crazy or I've turned into a hypochondriac and there's nothing wrong with her. I would be very happy to hear if I am overly worried about this!

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