Caring for a Three Legged Dog or Cat

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Tripawds Three Legged Dog and Cat Forums Ask a Vet: For Amputation Questions…19 week old puppy with carpal joint…

19 week old puppy with carpal joint ligament damage - wait to fuse joints or amputate?

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oopcdayc

Member Since:
21 May 2015

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21 May 2015 - 9:23 am

I was wondering if someone would be willing to consult on a course of treatment for my 19 week old Brittany puppy. After nearly 2 months of care with a local veterinary surgeon, we do not feel like we have good answers to our questions about what is best for his future - waiting for him to finish growing to determine if he's a candidate for surgery, or to proceed with amputating one of his front feet.

On 4/1/15, my then 12-week old Brittany, named Jake, was attacked by our neighbor's dog through a chain link fence. After being stabilized by our regular veterinarian, we transported Jake to the an emergency vet hospital, where Jake was seen by two doctors - an emergency vet and surgeon. That evening, we were given three options to heal very serious open wounds on one of his front feet - vacuum-assisted wound closure, wet-bandages or amputation. After consulting with our regular vet the following morning and the chief of staff at the emergency hospital, we decided to use the VAC treatment. After 8 days in the ICU, Jake's wounds were closed via suture and he was able to return home with a splint and bandage.

At first his bandage was changed daily, and slowly we worked our way up to 2x/week changes. After follow-up x-rays, it was determined that Jake's broken foot bones were beginning to heal on their own, albeit crooked. Bones combined, some were attached to the wrong ones, etc. The surgeon presented two options for treatment - wait to see how he healed on his own and Jake wasn't in pain, leave him be, or go in to rebreak and pin the bones so they grew correctly. After consulting with our regular vet again, we decided to give Jake some time to heal on his own and moved from the splint to a soft bandage to allow Jake to put more weight on his injured foot. We scheduled his next visit a week out. When we came in for his next visit, the surgeon informed us that the pain that Jake was presenting in stress tests of his foot was most likely not from his broken bones, but instead from possible tendon/ligament damage to his carpal joint. He said that he was hyper extended and that the injury most likely was due to the initial attack, but since they were so concerned with first healing his wounds, then his broken bones, and that the soft tissue damage was so extensive that they did not know his ligaments were damaged. At that time, the surgeon said that we would instead need to do another series of x-rays and look into fusing one or two of his carpal joints. We scheduled out next appointment for x-rays on 5/19.

Two days later, we received a call from the surgeon that he had not considered that Jake was only 4 months old and that we could most likely not fuse joints until his was full-grown. He asked for a week to consult with other surgeons. When we brought Jake in on 5/19 for what we thought were the x-rays to determine which joints may need damage, we did not get a clear answer from the hospital on what procedures Jake would be undergoing. We also did not have the opportunity to speak with surgeon about Jake's care. He left us a voicemail stating that after consulting with other vets, they unanimously agree that we cannot consider fusing his joints until he reaches skeletal maturity, and that he does not even want to x-ray the joints until then because Jake's situation could change.

Because the hospital is so busy tending to other patients, we are having a difficult time scheduling any conversations with the surgeon and have many questions about whether it it is best for us to wait and see if Jake is a candidate for joint fusion, or if it will be better for him long-term to consider amputation. We are concerned about keeping Jake splinted and on limited activity for the next 8 months of his life, for him to then have to go through a potential series of additional surgeries or end up at amputation later in life. We are starting to wonder if amputating now while he is still young would allow his body to better develop to support himself on just three limbs. Although Jake is in great spirits, on no pain meds and using his splinted leg just fine, we don't want to waste his first year of life cooped up in a cage with just 2 10-minute walks a day, and then subject him to countless future surgeries if it won't provide him with a better quality of life than just becoming a tri-pawd.

Any guidance would be so very appreciated. I would be happy to provide any additional information if you have questions.

Tripawds

On The Road

Member Since:
24 September 2009

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21 May 2015 - 7:08 pm

Hi and welcome, your future posts won't need approval so post away.

I'm sorry you're in this tough spot with Jake, I know it's got to be difficult.

Our fairy vet mother may not see this for a while so just wanted to let you know that we can't actually offer any consulting here, but what we recommend in tough situations like this is to contact another specialist if you're not happy with the ones you're already working with. Having a good relationship with your vet is so important when something major like this happens, so if you're not happy, definitely want to move on. Have you consulted with a certified rehab vet? What about a veterinary teaching hospital? These other two options can offer you different insights that might help you figure out a game plan.

Rehab vets have told us that generally, very young dogs will bounce back quickly from the surgery aspect of amputation, but finding their balance and coordination is tougher than for an adult dog, who has already learned proprioception (awareness of one's body in space). Young dogs will be more uncoordinated on 3, and benefit from additional rehab therapy. This is another reason why your vets might want to wait.

To find a certified rehab vet, see the Canine Rehab Institute Directory, and to contact a veterinary teaching hospital near you, check out this Tripawds News blog post.

I hope this helps. How is Jake getting around otherwise?

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

tazziedog

Member Since:
22 August 2008

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21 May 2015 - 7:11 pm

Do you have a vet school nearby? This sounds like a difficult case and I would either get a second opinion from a different board-certified surgeon or go to a vet school. At his young age it seems like amputation might be the best option but it is hard to say without examining the dog.

Pam

oopcdayc

Member Since:
21 May 2015

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22 May 2015 - 9:34 am

Thank you for your responses, Jerry and Pam!

I actually reached out to the university veterinary school yesterday and am working on getting an appointment with their orthopedic clinician as soon as possible. They fortunately wrote back right away and took a look at his most recent radiographs. It sounds like they would like to do some more radiographs and palpate his foot soon. I appreciate that they're given some urgent attention. Our regular vet knows the clinician there well and was going to reach out to him to let him know Jake was his patient. We'll have to take off work and drive 2 hours to get there... but would definitely appreciate another opinion on our situation.

I also really appreciate the lead on the certified rehab vets - I didn't know this even existed. I've found a doctor listed in the directory that is not too far from my home, so I'll reach out to them as well.

If you are aware of any other pets that have gone through the joint fusion or any other puppies that have had similar experiences with amputation, I would also greatly appreciate any points of views from their families on the experience.

Thanks again. This website has been so helpful to my husband and I. We no longer feel like we're alone in all of this.

PS - I'm also seeking resources on anyone who's had to work with homeowner's insurance to seek reimbursement for veterinary care... so any and all help would be so appreciated.

Tripawds

On The Road

Member Since:
24 September 2009

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25 May 2015 - 2:22 pm

Oh good I'm glad the information was useful! I forgot to show you Spree's rehab and conditioning story, you'll find it inspawrational..

Not sure about the homeowner's insurance but it would make sense that an incident like this would be covered by your neighbor's policy, assuming they have one. So sorry you are dealing with this. Ugh.

Keep us posted on the appointment. Which school are you contacting? Just curious.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

oopcdayc

Member Since:
21 May 2015

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26 May 2015 - 4:10 pm

Thanks Jerry!

Our neighbor's insurance company is not being very helpful. They said they won't review the claim further until his treatment is complete. I don't know if his treatment will ever be completed! It's looking like we are going to have to get a lawyer involved. Would love to hear from any others who have had to navigate the insurance companies or legal proceedings.

Our appointment is June 3 at the University of Missouri - Columbia's veterinary hospital. The date can't get here soon enough!

Thanks again for your support.

Tripawds

On The Road

Member Since:
24 September 2009

Offline

26 May 2015 - 9:09 pm

Oh we love Mizzou! Awesome folks there, I hope you have great results. We have one member here who lives in the area and has worked with the Mizzou team, you might want to PM Marla, Daisy and Biscuit, and connect with her at some point.

Sorry about getting the lawyer involved but I can't blame ya. Unfortunately I have no insight there but maybe someone does. Consider posting in "Anything Goes" and you might get some tips.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

kazann

Member Since:
27 July 2014

Offline

26 May 2015 - 10:27 pm

In Canada insurance legislation is provincial and in Alberta for example a dog’s owner is responsible for injuries his or her dog inflicts on another person or animal. So this means victims can seek damage compensation for medical costs, loss of income due to injury or destruction of property (dogs are considered to be their owners’ properties).

Perhaps you could phone your own house insurance company and ask them about the legislation where you live and how to approach this situation. It's likely you'll need to use a lawyer if the neighbour and their insurance company are not cooperating.

Kerren

oopcdayc

Member Since:
21 May 2015

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14 July 2015 - 12:52 pm

Hi all, just popping in for a quick update. We went to the Mizzou clinic on 6/3. They took a look at our pup's wrist and said they could not see any ligament damage and actually recommended that we take the splint off and try to teach him how to walk on the leg again. There were signs of osteoporosis since he had been splinted for 8 weeks.

We have slowly increased his activity from 5 minute walks up to 20 minutes and are starting to introduce off-leash time. He had his 5 week check-up yesterday and now we're keeping an eye on his growth plates. There is some concern that on of his growth plates may be prematurely closing, causing some bowing of his leg as he is growing, which could require some additional surgery, but that the fractures in his foot have healed enough that he can walk on his foot.

For now, it looks like our little guy will remain a quadpaw, but there's always the change will have to explore amputation in the future if he has problems with his joints, etc.

Thank you for your support and for providing such great resources on this site. It has been a great comfort to know we are not alone in this adventure!

Biscuit and Spirit Daisy

Columbia, MO

Member Since:
10 December 2011

Offline

14 July 2015 - 1:06 pm

Hi! I'm glad to hear that Jake will most likely get to keep his leg. That would be the most favorable outcome. If you go to any of the dog parks or trails you might see me and my little terrier mix tripawd Biscuit. Be sure to say "hi" if you see us! This is my little man. He is a right rear tripawd.