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10 January 2018 - 11:40 am
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hi all,

our 12.5 year old Labrador retriever, Raven had her right front leg amputated on Tuesday, January 2nd.  Our recovery has been pretty smooth.  She is eating, drinking, potty, hopping by herself.  Beginning on Monday, our prescription for Gabapentin ran out and our vet has suggested not refilling it and leaving her on Tramadol and pervicox for the second week.  Since we have had her off of Gabapentin she has starting having “episodes”.  After she goes out to potty she comes back inside.  The episode begins by her being restless.  Up, down, up down, sit up, lay down, roll over to the other side, moving head from one position to another.  Then there is sometimes obsessive licking of her pillow.  Eventually it leads to her incision site starting to twitch.  The twitching continues to get worse until finally she is contracting almost all her muscles, then relaxing.  This goes on for about 20 minutes, then she relaxes and sleeps for a few hours.  She also does low level groaning throughout the twitching.  It usually happens after she has been up and hopping.  So I guess my questions are 

1.  Does this sound like phantom pain ?  

2.  How long after amputation does phantom pain continue.

3.  Could this be a side effect of the Gabapentin?  Could it be withdrawal?  

We have contacted our vet again (saw him on Monday, but that was less than 24 hours after her last dosage).  We have also texted him a video of her “episode”.  Just wanted to get some opinions/ advice while we wait.  I hate watching our baby go through these episodes.  We are doing so well post amputation and we just want to continue her road to recovery as smoothly as possible.  

Here and Now

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10 January 2018 - 12:08 pm
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Restlessness and panting are common side effects of tramadol. Sudden outbursts and yelping may indicate phantom limb pain. Check out the many pain management articles, podcasts and videos for more help identifying often overlooked pain symptoms and treating pain. Click any of the highlighted phantom pain links for more help with that.

Livermore, CA
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10 January 2018 - 2:18 pm
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I have not dealt with phantom pain personally but what most people report here is a sudden onset of pain with yelping or crying that lasts for a few seconds.  Raven sounds like her issues are come on gradually?

Does it always happen after she has been active- like a potty break? How close or far away from a dose of tramadol are the episodes?

Most of what you describe sounds to me like signs of pain.  Tramadol may not be enough for her right now, many dogs are on both pain meds for two weeks or so.

Admin guy is right that tram can cause agitation- but it sounds more like pain to me.

How long was she on the gabapentin? Suddenly stopping the gaba can cause withdrawl symptoms depending on the dose and how long she was taking it. 

Karen and the Spirit Pug Girls

Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.

1999 to 2010

 

              Maggie's Story                  Amputation and Chemo

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10 January 2018 - 2:49 pm
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Thank you for comments.  Now that you have described phantom pain , I do not think that is what Raven is going through.  It is definitely not sudden or quick.  

Yes, it almost always is after she has been moving.  Right now, she gets up about 3 or 4 times a day to go to the restroom outside.  She seems to do really well with movement and she loves laying outside in the sunshine.  But as soon as she gets back to her bed in the house, the "episode" starts.  It lasts for about 20 minutes and then she relaxes and rests for hours.  It is the only time that she exhibits any type of pain behavior.  When she is awake & just laying on her bed, she is tail wagging, alert, and wanting to be part of family activities.  She seems very comfortable and almost back to her normal self.  

She has been on tramadol since December 4th (before & after her bone biopsy (Dec. 6), her mass biopsy (Dec. 20th) and now her amputation (Jan 2).  We added gabapentin on December 18 before her 2nd operation.  She is also taking previcox & caphalexin post amputation.  At the recommendation of our vet, we discontinued gabapentin cold turkey.  Now i'm worried that wasn't such a great idea.  

What are signs of withdrawal & if they are present, how long do they usually last?  This has been such a roller coaster, but we are so proud of how well Raven has championed through the past month of surgeries & amputation.  Her recovery from amputation has been smooth sailing until this bump in the road which is somewhat discouraging since we have done so well up until the past few days.  We thought the hard part was behind us.  However, we will keep on keeping on until Raven is strong again!  

Livermore, CA
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10 January 2018 - 4:40 pm
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Another thing you might try is some gentle massage after she comes in and lays down, here are some blog posts on massage.  Or maybe some heat to relax her muscles. 

You could also take her to a certified rehab vet for evaluation.  I suppose it could muscle spasms- but you would need to get to the bottom of what is causing them.  Could be her new gait...

Just some other ideas if you think it is not a pain response. If it is nerve related the gaba might help with it, and may be why you didn't see it initially after amputation.

As far as the gaba- my quad pug Tani was on it to help with her arthritis so I did some research when my vet suggested adding it.  Because Tani had a seizure disorder I was concerned about what would happen if she didn't do well on it and we had to stop it.  From what I remember the withdrawal signs included pain and seizures.  I also remember reading that the dose given for pain management is usually much lower than when it is used to control seizures and I read that some vets don't feel that tapering is needed when gaba is used for pain.

That being said- I always try to taper any pain med, it helps me determine if my dog is ready for the reduction.  To me any med that acts on the nervous system needs to be tapered- but that is my non-vet opinion.

You should talk with your vet about what you are seeing with Raven and your concerns. I didn't see anything like the episodes you are describing with my Tri-pug Maggie after her amp and I haven't heard it a lot here.  Maggie was not on gaba though, and Tani was on gaba until she passed, I never took her off of it.

Karen and the Spirit Pug Girls

Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.

1999 to 2010

 

              Maggie's Story                  Amputation and Chemo

Hudson, WI
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11 January 2018 - 11:41 am
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I can't speak to phantom pain because our boy hasn't experienced it.  I can; however, speak to the benefit of massage as Karen suggested.  Our boy is 25 days post surgery of his left front leg and I massage twice a day and I started this right from day one.  The muscles have to adjust and compensate for the shift in weight and balance.  This is very taxing on the muscles, and I found massaging his muscles to be both therapeutic and relaxing for both of us.  I continue with his massages and know first hand how beneficial they are.

As Karen also suggested, consult with your vet.  Bubba was on both Tramadol and Gaba for about a week and a half.  I consulted with my vet and upon his physical observation, we decided that we would just keep his pain meds on hand and give as needed.  He continued on his anti-inflammatory and it seemed enough.  I watched him like a hawk for any signs of pain or discomfort and to my relief there was none.  He too, like your Raven, was on pain meds prior to surgery, but didn't experience the withdrawals that could happen. 

The best advise would be to work with your vet to collaborate the best course of treatment for your Raven.  

Lots of hugs

Bubba and Family

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11 January 2018 - 1:42 pm
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Otis is only a few days post amp (Jan 8) but he has been on gabapentin, rimadyl, and tramadol for almost 3 weeks pre amp. He's added cephalexin to the mix since the surgery. Our vet also told us to just let the gabapentin run out (which would take us to about a week post amp) and the rimadyl (a week post amp as well), but to keep him on the tramadol for almost 3 full weeks. 

It's interesting to me because I always thought for humans and dogs that these types of meds should be tapered. For what it's worth, Otis seems to be hopping and moving great, but I have noticed that after coming inside, he licks his bed and towels a lot and it does take him a long time to get comfortable which includes some circling, repositioning, the licking, some whining, and the like. Let us know what your vet says! Sending good vibes to Raven!

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12 January 2018 - 1:03 pm
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Hi all, 

Thank you for your words of encouragement.  They are so, so comforting during these restless days.  So a summary of where we're at:

We got her back on full dosages of gaba & tramadol (3 times a day).  This has seemed to help a little bit.  She seems more relaxed & while the episodes still occur, she doesn't seem to be in as much pain as she was before.  It is still gut wrenching to sit & watch her suffer.  (In my mind that is what is happening).  

A few days went by with full medication, but I still wanted to see the vet again. This morning we visited the vet again, they have decided that Raven might just be experiencing "sensations" of the amputation area.  Her muscles & nerves might be "firing" and they are in the process of recovery.  Our vet described it as when you get the feeling back after your leg has gone to sleep.  She feels "funny", but not necessarily pain driven.  They think this because of the low & consistent groaning.  They think that if she was in pain it would be more yelping in nature & quicker movements.  Today she got her staples removed & she jumped so fast because of a little pinch,  I let out a little yelp.  The vet said she would be moving more like that if she was really in pain.  She also has some liquid build up, but they did not want to drain it because they said it wasn't enough to worry about.  We got sent home with instructions to taper the tramadol dosage to twice a day & leave the gaba at 3 times a day.  I am hoping that we can have a somewhat peaceful weekend. They are actually very pleased with her progress, so I guess I should be too........ 

I have such a hard time accepting this news.  I don't know why?  Maybe because I watch her for most of the day in her uncomfortable state & hear the constant groaning.  The amputation site also looks a little "scary" when it is doing it's contracting.  

Also, this afternoon her incision has started oozing again.  It did this the first couple of days, but then dried up.  This afternoon it has started again.  Is this normal?  Should we put her bandage back on?  We are 9 days post op.  

Again, thank you for the comfort.  This journey has been such a roller coaster, but it is so helpful to know there are people that have walked this path.heart

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28 January 2018 - 9:06 pm
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This. My Chy is 5 days post op and what you describe is exactly what she's going through. These "episodes" start with her being extremely agitated; up, down, up down, reposition, on the bed, off the bed. Then her leg will start to twitch, and I mean full on muscle contractions. It is so bizarre and difficult to watch because I don't know what to do to help her. Eventually it subsides and she's able to relax and go to sleep. It's so comforting to know that this is most likely her nerves healing, and sending signals. I usually massage her back and muscles which seems to help a little.

For what its worth, this can't be from Gabapentin. Chy has never been on it, only Tramadol, Rimadyl, and Fentanyl. Now that you're further along in the recovery process, has this subsided? 

Virginia
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28 January 2018 - 9:32 pm
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And try gentle massaging AROUND the incision, obviously not directly on it.   Otherwise Chy is doing "okay" considering she just had mzjor surgw five days ago?  

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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28 January 2018 - 10:46 pm
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I'll give that a try; I try not to get too massage too much on her "stump" just because I know things are still healing. Otherwise she's doing well. Eating, drinking, getting around, and is still herself. These episodes are just brutal -- I know they must be driving her crazy because of how agitated she gets.

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29 January 2018 - 10:53 am
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I’m so sorry to hear you are going through this.  To be honest, this was the scariest part of the recovery process for us.  Days 6 - 11 were terrible for us and very scary because of these episodes.  Then magically on Saturday she just stopped having episodes.  After that we went pain med free!  Raven still has an occasional phantom pain Yelp but never “contracts” anymore.  The best medicine we found to calm her down was just loving on her. We also put a heating pad on a low level and also massaged the area around it.  She found all of those things somewhat comforting.  Unfortunately, I feel like the only advice I can give is that you have to wait it out.  It will get better.   * Hugs *

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29 January 2018 - 11:50 am
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That's good to know, and it definitely has been the most unnerving part of this process. Aside from these episodes I feel like we've had a pretty uneventful recovery, and I feel really lucky for her sake that it hasn't been difficult. We'll continue with the extra loves; they seem to help the most to get her through. I have still yet to hear her yelp (thank goodness!), but these are definitely uncomfortable by the way her face and lips tense.

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