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Caring for a Three Legged Dog or Cat

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How to know is it time for amputation? Chemo or amputaton first?
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Forum Posts: 6
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14 May 2015 - 11:33 am
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 Hi everybody,

First of all I want to give you honor for founding and maintaing this site. I found more helpful info on Tripawds.com then on all other sites together. You gave me hope that there is way to fight with cancer…

My 8 years old Dogo Argentino started to limp few months ago. On 1.st May she stoped using right hind leg, she raised it fully, she was very depresive and reduced food intake for 2 days

1) On 2nd May we went to our regular vet, made X-ray and verdict was – most probabaly osteosarcoma. He also did X-ray of chest, no signes om metastasis. Sugestion was to do amputation as soon as possible, without chemo. He offered to do biopsy, but warned that taking sample for biopsy could spread malicius cells arround.

2) On 4th May we went t[Image Can Not Be Found]o Serbian Faculty of Veterinary Medicine, showed X-rays to one of oncology proffesors. His oppinion was that she have osteosarcoma and prognosis was that she have 3 months. He advised me not to do surgery or chemo since she is big dog in breed meaning (she isnt obese, arround 35kg, 55cm, perfect ratio for her breed), just to go home, enjoy time with her until she refuse food and then to bring her for euthanasia.

In meanwhile she started to use her leg, just small limp time to time, she was (and she is right now) very cheerful and her apetite was back

3) On 6th may we went to other vet for third opinion. He made new x-rays of leg, chest, and hips, same result – no signs on chest, and visible change on leg, diagnosed as Osteosarcoma. He also found small change (I think osteoporosis) on other hip, which could make problems after eventual amputation. We did blood tests, and results showed that she is good candidate for surgery and chemo, all vital functions was good. His advice was 4-6 rounds of chemo therapy (price of chemotherapy in Serbia is way cheaper then in USA or EU, one round of Carboplatin treatment is arround 100$) and after that to follow situation and eventualy to do amputation. He also warned me that she will recover much faster if we do amputation first and then chemo, but concidering all facts (change on other hip, fact that she is activly using affected leg, good mood, apetite…) his advice was to do chemo and then amputation if needed. He also was against biopsy.

4) On 11th May we went to next vet to get forth opinion. X-Ray of chests and leg, diagnosed as Fiberosarcoma, Chondersarcoma or very small chance of bone cyst. His advise was to first do biopsy, then choose treatment according to result. 

 

I’m realy confused, since I got 4 different advices frmo 4 different vets…I hoped that I could get some advices from you, which will help me to bring final ferdict…

Facts are:

– Dogo argentino, 8 years, 55cm, 35kg, not obese

– limping last 6 months, raised her hind leg for few days, after that started to use it with small limps time to time.

– visible change on hind leg, ferum bone, sugested to be: Osteosarcoma (most probable), fiberosarcoma, chonderosarcoma or bone cyst. No visible change on chest. Visible change on left hip, diagnosed as Oseporosis.

– blood tests: out of normal range – fact – result – (normal range)

WBC-leukociti 5.1 (6.0-12.0×103 /mm3)

ALP 229 (10.6-100.7 U/L)

Creatinin 107.7 (35.4-106.1  μmol/L)

CK 597.9 (14-120 U/L)

– very good mood and apetite.

Questions:

1) Should I do biopsy first?

2) Should I do chemo or amputation first?

3) When is apropriete time for amputation? How to know that dog is in pain?

Thank you for your time and advices!

Very best regards

p.s. Sorry for spelling mistakes, I hope that I understandebly represented situation.

The Rainbow Bridge



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14 May 2015 - 12:38 pm
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Hi Milos, welcome and thank you for the kind words, it means so much to know you are finding help here. What is your dog’s name? I looked up the Dogo Argentino breed, they are beautiful Mastiffs! At 77 pounds, she is definitely not a big dog, we’ve had many much larger dogs here do fine on three legs, some as large as 75kg! You obviously care so much about her by taking her to four different vets.

Vets do things slightly differently all over the world, and what your vets recommended is probably normal for your region, but not as much for vets here. I can only tell you about what the typical course of action is here in the U.S. when it comes to osteosarcoma, which is the type of cancer we dealt with in our Jerry. The options most vets here will give are:

  1. If it is almost 100% certain that the tumor is osteosarcoma, and the dog is a good candidate for surgery (no major medical issues), amputate immediately. Osteo is very, very painful. Dogs hide their pain well and by the time they limp it is terrible pain.
  2. After amputation, follow up with 4 to 6 rounds of chemotherapy. This is not a requirement but statistics show that dogs survive longer with it. Chemo doesn’t guarantee they will live longer but it gives your dog better odds if it’s within your budget. Chemo costs are based on the dog’s weight.
  3. After chemotherapy, follow up with metronomics , an at-home chemotherapy regimen. Again, not a requirement, and some like us chose this method over traditional IV chemo, but it does help with those odds.

Bone biopsies are typically only recommended if there is doubt that the tumor is osteo. They are very painful for the dog and carry a risk of fracturing the bone when they take the sample. Bone biopsies are not recommended if amputation will be required anyways. The biopsy can always be done once that leg is off, saving your dog from an extra surgery, and you from the additional expense. You might want to read up on Mac’s story. Their vet also thought he had chondrosarcoma, and it turns out he has osteo.

Your dog sounds like she is in good shape and can tolerate amputation. If all of the vets agree that she can live life on three legs, at the very least by doing the amputation you are helping her be free of that pain for whatever time she has less.

I think that I’ve addressed your questions but don’t hesitate to ask any others. We are here to help.

P.S. your English translation is wonderful!

It's better to hop on three legs than to limp on four.™
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Forum Posts: 6
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14 May 2015 - 2:17 pm
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Hi Jerry,

Thank you for promt and very detailed answer! It will help me very much to make final decision.

Her Name is Jenny.

I’ll post my decision as soon as i make it, tomorrow or on Saturday.

 

Once again thank you for all

 

Keep in touch, best regards

 

Jenny and Milos

Maryland
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14 May 2015 - 2:34 pm
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You’re to be congratulated for doing such a thorough job getting different opinions. It sounds like you are being a terrific advocate for you dog. What is her name? We’ve all been in your shoes at some point, so I hope we can help you through this difficult time. It is a lot of information to digest and of course we all want to make the right decision for our dogs. I’m sure it does not help when you get such conflicting advice.

I think it is important to keep in mind that for osteosarcoma (OSA), amputation is not curative. It is only pallative. You will not cure the cancer by amputating, but you will relieve the pain of OSA. It is terrific that she is eating well and has a good mood right now. But the pain of OSA is unrelenting and it will start to affect her comfort and quality of life even if right now she seems fine. Unfortunately, by the time OSA is found, there are probably ‘micro-metasis’ to the lungs—too small to be seen on X-rays. The reason to do chemo along with amputation is to kill those cancer cells that have already spread around her body. I just wanted to point that out since you’ve been given so many different options by the different vets.

Of course amputation is not an easy decision and it isn’t an easy path. But 35 kg is not very big. Our dog is a Great Pyrenees mix and she was 100 lbs (45 kg) pre-amp. There are even bigger dogs here that have done really well as tripawds. So I would not agree with the advice that she is too big for amputation.

To try answer your questions….

1) The risks of a biopsy are real, and it seems that there is not much disagreement overall among the vets that she most likely has OSA. I think we’d all like to believe in that tiny chance that it isn’t OSA, but I think the presentation is usually so obvious that you have to weigh the risks against the small chance that a biopsy will tell you it isn’t OSA.

2) Given that amputation is not meant to cure the cancer but only relieve the pain, I’m not sure why you would do chemo first and then amputation. Amputation will at least rid her of the pain. And it will rid her of the source of the cancer cells. Yes, it might cause problems w/ her other hip. There are definitely consequences from amputation and they shouldn’t be taken lightly. But I think you have to weigh those risks against the benefits (pain relief etc) of removing the diseased leg. 

3) Reading a dog’s pain signals is not always easy but there are some classic signs—panting, ears pinned back, not wanting to interact with you, lack of appetite. Each dog probably is a little different in how they show pain. For us, Ellie’s main signal was that she wouldn’t want to interact——like the pain was making her retreat into herself. Dogs are also very stoic, especially a dog like a mastiff. So the signs could be very subtle—a little hesitation before wanting to go for a walk, a little slower pace etc.

As to the right time for amputation—I think that once the diagnosis of OSA is made, if your intent is to amputate for pain relief then unless there are special circumstances,  there is no reason to wait. Waiting only prolongs the pain. And the sooner the pain is gone, the sooner you can start chemo (if you want to do chemo), the sooner chemo will be over and the sooner you can start enjoying whatever time you have left with her. None of us ever get all the time we want but (for us) having that time be pain free was the most important thing.

Denise, Bill and Ellie

Active 10+ Pyr mix suddenly came up lame with ACL tear in left rear leg. Scheduled for a TPLO but final pre-op x-rays indicated a small suspicious area, possibly OSA, which could have caused the ACL tear. Surgeon opened the knee for TPLO but found soft bone. Biopsy came back positive for OSA. Became a Tripawd 9/18/14. Carbo6 with Cerenia and Fluids. Pain free and living in the moment. Crossed the Bridge on 7/12/15 after probable spread of cancer to her cervical spine. A whole lifetime of memories squeezed into 10 months. Here's her story: Eloise

Michigan
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14 May 2015 - 5:12 pm
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Hi Milos ~

I will share Murphy’s story, hopefully it will help you.  Murphy is smaller than your dog, at just 50 lbs (I think he was about 26 kg before his surgery).  When he was almost 7 years old he started limping on his right front leg.  We thought that he strained a muscle or something because our dogs run like crazy when we open the door to let them out (there might be a squirrel to chase!).  This was in October.  After about a week or two I took him to the vet to have it checked out.  It was hard to tell if the pain was at his elbow or his shoulder – there was no swelling, and he didn’t cry when we squeezed anywhere.  So our vet put him on pain pills and sent us to a radiology center for x-rays.  The pain medicine helped right away and Murphy was able to walk on his leg, so when I took him for his x-rays they didn’t sedate him, they just did very quick s-rays and said everything looked fine.  Of course I believed them.  When Murphy finished his medication, he started limping again, but even worse than before.  He would yelp and didn’t want to go outside, which is not normal, he loves going outside, he didn’t even want to eat or drink.  So I took him back to our vet..this was about a month after the first visit.  I also took with me the copy of the x-rays from the radiology center.  They were a little bit blurry because Murphy hadn’t been sedated, but my vet thought he saw something near his elbow.  He gave him more pain medicine and said he would give it more time, because maybe it was just a strain.  In January he ran out of medication again and the pain was even worse.  He would just lay under the kitchen table, he wouldn’t eat or go out.  Once a day my husband could get him outside and he would yelp.  We decided to take him to the university hospital for an orthopedic specialist, but it took a few weeks to get an appointment.  He got a refill on his medications again, and again was fine – he could walk on his leg as long as he was medicated.  In February we finally went to the orthopedic doctor.  He did a very thorough exam and Murphy was so good!  He watched him walk and took more x-rays.  Then they told me they saw a tumor.  They couldn’t believe that even with medication that Murphy could walk.  They did a biopsy that day to see if it might be an infection, but it turned out inconclusive.  In April, 5 1/2 months after this whole mess started, Murphy had his right front leg amputated.  Almost 3 weeks later we found out that it was histiocytic sarcoma, which is highly aggressive.  The first 2 weeks were difficult,  but we have not regretted it at all! 

Murphy did go through 6 doses of chemo after surgery.  The specialists told us that if we were lucky, we would get 12-18 months with Murphy.  That was just over 2 years ago, and he’s still doing great!  He runs all over the place, jumping on the furniture, chasing squirrels, digging in the yard, barking and just loving life.  He has no pain, and that’s what matters.  He’s such a happy boy!

The surgery is going to take the pain away from your sweet baby.  The chemo will shrink any cancer cells and hopefully prevent any recurrence.  If she’s already limping and at times not eating, then she’s telling you that she’s in pain.

 

Donna

Donna, Glenn & Murphy 

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  
Read about Murphy's Life on Three Legs

Donna.png

Rio de Janeiro, Brazil
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14 May 2015 - 9:26 pm
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Hello, Milos and Jenny.  This community is becoming more and more international.  

Our saga here was exactly the same as Murphy’s: months of limping and pain medicine until finally the diagnosis came for Osteosarcoma.  In a few days we will celebrate 1 year from Johnnie’s surgery and he is doing very well.  He is a large Golden Retriever, weighing today 40kg (90 lbs) and he did very well.

Answering your questions, from my perspective and experience:

Your questions:

1) Should I do biopsy first?  

NO, NO, NO.  We ended up doing a biopsy, and this meant more suffering for the dog, for nothing.  Better to have the surgery and have the tissue examined in order to determine what type of cancer and what stage.

2) Should I do chemo or amputation first?  

If Jenny is a good candidate for amputation, do the surgery first.  Then, the carboplatin, aiming for six rounds, with a 3-week interval.  

3) When is apropriete time for amputation? How to know that dog is in pain?  

You should amputate as soon as possible, to get your dog free of pain and be able to start the chemotherapy.  If your dog is limping, your dog is in pain.

Good luck with your decision!

Our awesome Golden Boy was diagnosed for OSA in April 2014 in the proximal humerus, front-leg amp on 05/20/2014. Finished chemo (Carbo6) on 07/10/2014. Ongoing treatment: acupuncture + K-9 Immunity Plus ( 3chews) and home-cooked no-grain diet.   Stopped Apocaps because of liver issues.   Liver issues: controlling altered enzymes with SAM-e and Milk Thistle.  October 17:  started having seizures.  Taking fenobarbital for seizures.  April 18: started prednisone.

Martinsburg, WV
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15 May 2015 - 12:13 pm
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Hi Milos and Jenny!!!

I just wanted to welcome you both to the community and let you know that you have found a wealth of knowledge in the members here.  My Leland (108lb Dobie boy) had his hind leg amputated although his amputation didn’t come because of cancer but an infection and failed TPLO procedure to fix his knee.  I just wanted to echo that large breed dogs do alright as Tripawds typically.  I do want to stress that since Jenny will be a hind leg amp, if that’s the route you go, to be mindful and protect that remaining knee.  Not sure if your area sees a lot of cranial cruciate ligament ruptures but it’s pretty common here in the states.  If you have stairs that Jenny will need to navigate you might consider helping her (even after full recovery) with a belly sling or towel…going up stairs is more challenging for hind leg amps than front leg amps.  Also, if Jenny is very active you don’t want her taking flying leaps off things (beds, steps, etc) as she could blow out the remaining knee.

Anyway welcome and your English was quite good.  I understood you completely…smiley.

Please keep us posted on Jenny’s journey and if able we’d love to see a picture of your precious girl!

Sahana and her Angel Leland

Leland

November 17, 2009 - June 30, 2014

May you finally be healthy and running free at the Rainbow Bridge. Until we meet again my sweet boy!

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16 May 2015 - 1:36 pm
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I wanted to add that rather than biopsy, the oncologist I’m using recommends an ultrasound guided FNA (fine needle aspirate).  They successfully did one on my boy prior to his amp, as there was some disagreement about what kind of cancer it was, and one of the options did not require amputation. Turned out he did have OS, and he had the amp the next day.

I wish you and your boy good luck, he is lucky to have you.

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20 May 2015 - 3:05 pm
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Hi Everybody,

First I want to thank you all for support and usefull tips, you helped me much to make final decision.

Jenny is new member of tripawds crew! We did amputation 12 hours ago and came home 3 hours ago. I’ll try to represent current situation, please give us some advices:

– she is mobile, trying to stand up every 10 minutes. Should we allow her?

– she did 3 pee pees and 1 poop

– she is very very very thirsty, but our vet said that we limit water intake. Should we listen to him? She is trying to find water in every place in the house and in the yard.

– We got some cramy-like caned food, we are giving few bites every half an hour

– she looks litle bit confused

– she has dificulties to make confortable position. How can we help her?

– Time to time she whines like she is in pain, but very quietly

– she doesnt have any bandage, just plain stiches with some spray over. There are few drops of light red bloodlike liquid every half an hour. is it normal?

– She is trying to lick stiches. Should we wear some t-shirt on her to stop her doing that?

Thats all in this momment, I’ll keep you informed about changes…

Very best regards

 

Jenny and Milos

Virginia




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20 May 2015 - 3:45 pm
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Oh my gosh!! Just catchingnup on all that’s going in with your and Jenny!

First, my English may be okay, ut my typing is horrible! I apologize if it is hard to figure out what I’m saying!

Okay…pee and poop already…that is great!!!

Here in the U.S. al.ost all dogs spend the first night in the hospital pretty heavily sedated. The fact that Jenny is home already is somewhat unusual, but not unheard of.

She MUST stay as quiet as possible and only go out to pee. And by all means…and I’m no vet….but she should be able to have her water! Maybe he’s afraid she’ll get nauseous this soon after surgery. I don’t know why he woukd say that. But you certainly don’t want her to get dehydrated.

I hope she is on really good pain meds. What is she taking and how often? This is major surgery and whining and being restless are not unusual at all. She needs to be confined if at all possible. My Happy Hannah was very restless and would not sit down but for a few minutes the first 19 hours she was home. And this was AFTER spending the first night in the hospiatl pretty well zonked out on drugs! She did not sleep one wink the first night she came home.

The pain meds can make them a little crazy and confused sometimes, but it is very important to keep her pain managed really well right now. Plis, in a druggy state she’s trying to figure out mobility issues.

Most dogs do not have bandages. Did the vet send you home with a cone to put around her head somshe won’t lick her stitches? Yes, a tee shirt may be helpfu, but check into getting a “soft” cone to put on her if she seems like she’ll be trying to get to those stiches.

For now, do everything possible to keep her quiet and just be by her side reassuring her. Glad she’s eating and drinking water and peeing and pooping! All really good signs!

Keep an eye on any fluids coming out of the incision and watch for a seroma . Check with your vet, but if it’s just a small amount, is not smelly and is light in color it shouldn’t be anything at this point to worry about.

Stay connected snd keepmus losted. These first several days and nights can be really rough!! Hang in there! You are doing great!!

Hugs to all!

Sally and Alumni Happy Hannah and Merry Myrtle too!

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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20 May 2015 - 7:24 pm
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Hi guys! Glad to hear she came through surgery! I’ll try to answer your questions:

– she is mobile, trying to stand up every 10 minutes. Should we allow her?

She sounds like she could be restless. Is she panting too? If so that could mean she needs different pain management . Either more or less of what she’s on. What pain pills is she taking? While you don’t want her moving around too much, you also don’t want to stress her out by forcing her to do things she doesn’t want to do. It’s a fine line, I know.  Try to encourage her to rest.

– she is very very very thirsty, but our vet said that we limit water intake. Should we listen to him? She is trying to find water in every place in the house and in the yard.

I’m curious why the vet suggested that? It’s new advice to me. My gut instinct is if she’s thirsty to let her drink but I’d want to know why your vet recommended that.

– she looks litle bit confused

– she has dificulties to make confortable position. How can we help her?

Again, this sounds like pain to me. Here are some articles about pain symptoms.

– Time to time she whines like she is in pain, but very quietly

Please talk to your vet about pain medication. Gabapentin and Tramadol are two common ones that dogs receive. Sometimes tramadol can make them a little crazy but not always.

– she doesnt have any bandage, just plain stiches with some spray over. There are few drops of light red bloodlike liquid every half an hour. is it normal?

 

It sounds like a seroma . Click on the link for info. Not harmless but just read about seromas to make sure that’s what you’re dealing with.

– She is trying to lick stiches. Should we wear some t-shirt on her to stop her doing that?

Absolutely. Do you have a cone? The more days beyond surgery, the more that incision will itch. You don’t want her to scratch those stitches or it could cause infection.

I hope this helps. Ask any questions you want, that’s why we are here. Hang in there!

It's better to hop on three legs than to limp on four.™
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Norene, TN
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21 May 2015 - 11:37 am
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Just looking for an update on Jenny. I hope she’s doing great!

As I was reading through the threads, I’d like to reiterate the water issue. When Harmony first came home she drank a lot of water. The anesthesia makes them really, really thirsty as does the pain meds. I don’t understand why your vet said to limit her water. To me I would think that one thing alone would make her restless and whine.

Just my 2 cents.

Welcome to the community! Please, please keep us updated!

pam

Harmony became a Tripawd on 10/21/14 (MCT). She left us way too soon on 11/1/14.

"We miss you so much; our love, our heart, our Harmony."

- Pam, Ron and Melody, Meesha, Doublestuff and Mariah Carey

Martinsburg, WV
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21 May 2015 - 12:21 pm
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Yeah…I’m confused on why Jenny’s vet would recommend limiting water intake.  Perhaps the vet meant not to let Jenny gorge herself on water but to let her drink some, remove it if she’s gorging herself, and then give it back…way-confused.  I know if my current pup Lucian gorges himself with water he sometimes ends up throwing it back up and if that happened with Jenny she may be throwing up medication.  But I can’t see denying her water completely for long periods of time.

And a suggestion that our Leland’s surgeon gave us was wetting a dish towel, microwaving it for like 50-60 seconds, and then applying it to the incision until it cools.  The surgeon indicated this would help the skin in healing plus it would feel pretty good too.  I know how I like a warm heating pad when my back aches.

And like others have mentioned stay on top of Jenny’s pain management .  Dogs a like people in that not everyone does well on the same pain medication.  It may take some tweaking the dosage and/or combination of medication to find what works best for Jenny.

Hang in there!!!  You have the Tripawd community supporting you both!!!

Sahana and her Angel Leland 

Leland

November 17, 2009 - June 30, 2014

May you finally be healthy and running free at the Rainbow Bridge. Until we meet again my sweet boy!

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21 May 2015 - 12:44 pm
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Hi everybody,

I missundestood my vet yesterday, but I got better explanation from him on time. He said that I should limit water to 1 cup (2dl) per hour, to avoid nausea. Regarding pain medicants today she got Trodon, and for tomorrow it will be Rimadyl.

She had ups and downs today. Early in the morning she made one more poop, few peep pees, but then she went in her special place in the yard and been there for more than 4 hours without moving. I took her to vet, he gave her more pain medicants, antibiotics, vitamins… He will come in visit in the morning (now it is 21:00).

I made few photos of Jenny and stiches, how can I upload it here?

Jenny and Milos

Virginia




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21 May 2015 - 7:21 pm
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Rest is good. She should just be resting and taking pee and poop breaks.

Is she on. Rimadyl AND Tramadol now, plus antibiotics? Here in the U.S. dogs are on all three for about two weeks.

Glad she rested today. Hope you are getting rest too!

How to upload pictures….others will explain that. Can’t wait to see pictures of Jenny! Give her a kiss for us!

Hang in there! Recovery is no picnic for a week or two! We are here for you!

Hugs!

Sally and Alumni Happy Hannah and Merry Myrtle too!

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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