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Post-op pain management for tumor removal with skin flap
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Colorado Springs, Co
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5 June 2017 - 3:02 pm
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Zuzu will be going in on the 14th for her tumor removal surgery.(soft tissue sarcoma, right hind leg just above the knee) The doc will be using a skin flap for closure. How long should she be on pain meds for? The doc said she usually only sends home nsaids and antibiotics, but I think we're gonna need pain meds too. I know this is out of the norm but any advice is appreciated!

11 year old Australian Shepherd with soft tissue sarcoma.
http://princess.....ipawds.com

London, UK
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6 June 2017 - 9:20 am
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How long are they planning to keep Zuzu in? Or is she coming home the same day? Meg had skin flap surgery on her elbow, but she stayed in hospital for a couple of weeks after (it was a complicated situation, not because of the skin flap itself), so I'm not now sure exactly how they managed her pain in the days after surgery. When she came home she was on Metacam, antibiotics and (I think) Tramadol, as needed. The absolutely critical concern is obviously infection prevention, both at the site of the skin flap and in the area where they source the tissue. Do you know where they are planning to take it from? 

One tip that might be handy, when Meg did come home, I photographed the skin flap every day, so I could see how the healing was progressing, and check it hadn't changed colour etc. I found it reassuring to be able to compare, and not rely on my memory.

All best wishes for the surgery , and do please keep us posted. We'll be thinking of you.

Meg, Clare and Elsie Pie xxx

Meg, Mutt, aged around 8, adopted 31/12/2009. Sudden explosive right elbow fracture 06/12 (caused by IOHC), diagnosed with End Stage Arthritis 03/15, Total Elbow Replacement 08/15, problems with healing leading to skin graft & skin flap surgery, Chronic Infection leading to implant breakdown. Became a Tripawd 9th March 2016. 
Lives with Elsie Pie, & Mum, Clare, watched over by Angel Billie
My life as a MEG-A-STAR 


Colorado Springs, Co
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6 June 2017 - 9:50 am
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Thanks Clare, Meg and Elsie Pie,
They'll be taking from her abdomen and flipping it around to the knee. She'll be coming home day of surgery, and I know she'll have some drains for about 5 days.
That's a great idea about taking a daily picture so you can easily notice any changes, I'll have to remember to do that.
I felt so prepared for amp recovery and now that plans have changed I'm feeling rather unprepared and unsure about recovery. I just want to do what's best for our girl and part of me feels like I'm failing her because I'm not prepared enough. I guess there's always gonna be something to worry about.

11 year old Australian Shepherd with soft tissue sarcoma.
http://princess.....ipawds.com

London, UK
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6 June 2017 - 10:12 am
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Aw, Ashley! (it is Ashley, yes?) You will be absolutely fine and we will be here for you. The basics are not so different from amp recovery (except she gets to keep the leg! YAY!!! smiley) You will need to keep her calm and quiet and make sure she gets plenty of rest. I would also remove or block off any furniture she may jump onto/off, as you won't want her moving the flap site too much. Absolutely key is to ensure that she cannot lick the skin flap, or the area they took it from, as this could introduce an infection. We used an inflatable buster collar, which worked well on a relatively small dog with a front leg surgery. You may need something more substantial on the rear leg of a larger dog. And if you have any other dogs or cats, you may need to keep Zuzu separate for a while just to make sure no one else can lick at the site.

Make sure you stock up on lots of treats (for both of you!). I found liver paté invaluable for smuggling meds to Meg inside blobs. Might be handy to have some in.

You are NOT failing Zuzu, she is a super lucky girl to have such a dedicated and committed Mum, who is planning and preparing so thoroughly. Her surgery is still eight days away! You have plenty of time to get ready and you are asking all the right questions.

Have a hug!

Meg, Clare and Elsie Pie xxx

Meg, Mutt, aged around 8, adopted 31/12/2009. Sudden explosive right elbow fracture 06/12 (caused by IOHC), diagnosed with End Stage Arthritis 03/15, Total Elbow Replacement 08/15, problems with healing leading to skin graft & skin flap surgery, Chronic Infection leading to implant breakdown. Became a Tripawd 9th March 2016. 
Lives with Elsie Pie, & Mum, Clare, watched over by Angel Billie
My life as a MEG-A-STAR 


Colorado Springs, Co
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6 June 2017 - 11:16 am
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Yes, its Ashley. Sometimes my wife Noelle comes on, but usually I'm the one posting in the forums.

I know she'll have some drains so the giant cone o' shame is necessary. I've read that the inflatable ones don't do so well with rear sites as they can still reach them pretty easily. She'll also be sporting some boxer shorts, though I imagine that won't be until after the drains come out.

I'm really not concerned about her activity level-shes very calm for an Aussie and I'll be with her 24/7 to make sure she's not trying to jump on couches or anything. We are going to be staying with our neighbor(we live on the 3rd floor-24 steps to ground level) so that Zuzu will have an easier time with going potty. Only 5 steps to deal with when we first bring her home and any time we need to go to the vet(not sure how to handle that yet-dont want to stress on her abdomen by lifting/carrying her but not sure what else we can do), but otherwise its only about 5 feet from the door to "grass"(weeds and dirt mostly). She will be staying with another dog, but I don't think Sally (the dachshund) will be of any concern, they get along fine-mostly just sniff then ignore each other.

Part of me is glad we have time to prepare but the other part wants it to just be done and over with so we can move onto recovery. The more time my mind has to think the more I worry about her, it doesn't help that in the past week or so we've started seeing some signs of pain.

This surgery, even though I know the technical aspects(thanks dvm360) is scarier to me than amp surgery. I think mostly because it's so hard to find anyone else with experience in this. I'm glad our girl gets to keep her leg (for now) and that everything with this surgery seems to be falling into place-it feels like a sign that this is the right course of action for us and for Zuzu.
Thank you for the reassuring words, the support from everyone here has been amazing. I love reading all the different stories and adventures, it sucks that our pets being in pain have brought us here, but I'm so glad we have a place to come to be together and help each other. I have recommended this community to several different people in the short time I've been a member.

*hugs*
Ashley and a sleepy Zuzu

11 year old Australian Shepherd with soft tissue sarcoma.
http://princess.....ipawds.com

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6 June 2017 - 11:39 am
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In general if you are cutting through muscle or bone additional pain medication is warranted.  New research shows that Tramadol may not be that effective for all dogs for pain control although it may reduce the neurologic perception of pain and may work in combo with other drugs.  We often use an MLK (morphine) drip for painful surgeries and give additional pain injections before going home or place a fentanyl pain patch prior to surgery.

There is a new local anesthetic called Nocita that is an exciting addition for pain control because it blocks pain receptors for a full 72 hours after surgery so you may see more vets using this option.

Pam

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6 June 2017 - 12:06 pm
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Thanks Pam, I was hoping for your input!
I know they said they would be giving her pain meds before/during surgery but I don't remember her specifying what exactly. It also shows post-op pain medication on her estimate breakdown but again doesn't say what specifically.
I know all dogs are different but how long should she be on pain meds for?
If she has an injection before coming home does she still need oral meds?
If tramadol is suspected as not being as effective is there something else you recommend we ask for?

Thanks so much!
Ashley

11 year old Australian Shepherd with soft tissue sarcoma.
http://princess.....ipawds.com

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7 June 2017 - 12:00 pm
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I would do an NSAID for 10-14 days and if they give her a Fentanyl patch you shoul dnot need Tramadol.  If the surgery involves bone I would ask for an MLK drip.

Pam

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7 June 2017 - 12:12 pm
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tazziedog said
I would do an NSAID for 10-14 days and if they give her a Fentanyl patch you shoul dnot need Tramadol.  If the surgery involves bone I would ask for an MLK drip.

Pam  

Thank you!

11 year old Australian Shepherd with soft tissue sarcoma.
http://princess.....ipawds.com

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