At one time or another, all of us have benefited from the expertise of fellow member Dr. Pam Wiltzius, DVM, a veterinarian from Puyallup, Washington.
Dr. Wiltzius joined us in August, 2008, when her beloved 165-pound Mastiff, Tazzie, was diagnosed with osteosarcoma. Since then, she has generously shared so much of her time and perspective with us, and we really can't thank her enough.
Tazzie's story has always served as an inspawration to us, and we always point new members to it. Tazzie proved that if a big gal like her could live a good life on three legs, there's hope for other dogs too. Recently we were digging through older Discussion Forum posts, and came across one of Dr. Wiltzius' first posts about Tazzie.
"Unfortunately, Tazzie had a limp 2 weeks ago. I am a veterinarian, so I took Tazzie in for xrays the next day and confirmed a lytic lesion in her right front leg near the carpus (wrist joint) which is almost always osteosarcoma. Like all of you, I struggled with the decision to amputate her leg. She is only 6 years old, but has already had both of her knees repaired and she is a very big dog (165 pounds)."
We would like to share Dr. Wiltzius' early experience with Tazzie's diagnosis below, because she has some terrific advice about how she approaches pain management
, amputation surgery and follow up care. We hope you find it as valuable as we do. And if you have amputation questions of your own for Dr. Wiltzius, be sure to post them in our Ask A Vet Discussion Forum topic.
Tazzie coming home: One Vet's Amputation Surgery & Recovery Tips
28 August 2008
My name is Pam and my husband and I share our house with 3 dogs; Tazzie (Mastiff), Loki (Dogue de Bordeaux), and Kona (Pitbull). Unfortunately, Tazzie had a limp 2 weeks ago. I am a veterinarian, so I took Tazzie in for xrays the next day and confirmed a lytic lesion in her right front leg near the carpus (wrist joint) which is almost always osteosarcoma. Like all of you, I struggled with the decision to amputate her leg. She is only 6 years old, but has already had both of her knees repaired and she is a very big dog (165 pounds).
I found your excellent website and have been following the stories of all the dogs, especially Titan and Butch. Dogs really are so amazing and resilient! After a week of furthur testing (chest rads, abdominal ultrasound, bloodwork) we scheduled the amputation. Even though I have performed many of these myself, I just couldn't do my own dog so I had the surgeon who repaired her knees do it for me.
Tazzie had her amputation Tuesday 8/26 and is doing very well! I am planning on taking her home on Friday since we have a long weekend.
I thought I could pass on some tips for any dogs that may need amputation in the future, since there is lots of new info out there. I know that different vets have different opinions but this is what has worked for me.
First of all, I would always use what is called a CRI (continuous rate infusion) of morphine, lidocaine, and ketamine (MLK) during the amputation. These drugs help prevent a lot of the pain felt after an amputation and allow you to use less gas anesthesia during the procedure. The drip is continued postop until the dog is comfortable. Tazzie's surgery lasted 3 hours and she needed the drip for 12 hours postop until she was comfy. I have to admit that I slept on the kennel floor with her all night long just to make sure she was ok.Smile
I started her on 3 drugs the day before surgery. One is a Fentanyl patch applied to one of her back legs. This is a narcotic that lasts 3-5 days and will be removed Friday. The other drugs are gabapentin and amantadine. These are drugs used in human medicine and both are inexpensive and very safe (main sided effect is sleepiness from gabapentin). Gabapentin is used to prevent nerve root pain and thereoretically can help with "phantom pain". We can't ask our dogs about that but I think that it does exist! Gabapentin is continued for 2-4 weeks after surgery depending on the dog. Amantadine helps prevent what is called pain "wind up". Once the pain receptors are annoyed it takes more pain meds to calm them down. This drug blocks that response and can be used for 1-2 weeks postop. Lots of dogs with chronic arthritis also take this drug for flare-ups when the Rimadyl or other NSAIDs they are taking stop working.
Tazzie will also take Tramadol as needed for pain after she comes home. I will continue her glucosamine supplement (Dasequin) and add fish oil. She can't take an NSAID due to high liver enzymes but that is a great choice for other dogs. She eats Innova (Evo is also a great food but her liver can't handle it) which I supplement with veggies and chicken or turkey.
Her first chemo is 9/15. I will do Carboplatin because it has the fewest side effects and has been linked to more long-term survival rates (although median survival age is the same with all chemo drugs). I should get the biopsy results next week. On large/giant dogs with Tazzie's symptoms and radiographs I don't usually put them through a painful bone biopsy first since we don't have fungal disease in our neck of the woods (Seattle). I just send in a sample after the leg is off.
Well I know that this is a long, technical, and maybe boring post but maybe it will help someone make their decision regarding amputation. I think that almost all dogs are good candidates for this procedure regardless of size as long as they aren't severly arthritic or neurologic, and it sure beats the severe pain of bone cancer!
I will keep you updated and try to send a picture through Jerry as I am technologically challenged when it comes to computers.
Pam (and Tazzie!)
1 September 2008
Hello, I just wanted to give everyone a quick update on Tazzie. She is really doing well on 3 legs! I am very surprised that it is day 6 and she can go out by herself to pee and finally had a bowel movement yesterday. She is back to eating dry kibble (if I hand-feed her) and her pain seems well controlled.
My other 2 dogs are treating her very well and so far we have had no mishaps like fighting for food or attention. Her incision is a little puffy but so far no seroma
! I am keeping a body bandage and tshirt on her just to be safe, until her staples come out.
I still have to figure out the harness I bought. Has anyone tried this with a giant breed dog? I plan on using it to help get her to her chemo appt on September 15th but it just doesn't seem like it will support her huge body!
I sent a postop picture to Jerry and I had done another post answering some of your questions but I don't see it here. If he can't find it I will repeat it later.
Good luck to all,
Pam and Tazzie
7 September 2008
I just thought I'd post an update on Tazzie. She is still getting around very well, and is eating and drinking like a champ. She has been trying to figure out how to get back on the couches and bed but can't quite get there yet with just the 1 front leg. My husband moved our kingsized mattress on the floor and we all sleep there so she won't feel left out!
She has developed a firm cellulitis over her incision area.
I sent some pix to Jerry in case anyone is interested. It is not painful or red, and not soft like a seroma
. I think that the deeper tissues like muscles and fat are healing at different rates so it feels lumpy.
Also, she developed a bad bladder infection and had a flare-up of hepatitis post-op when she was still in the hospital so we had to change her antibiotic. Her incison was a little infected then and I think that also has contributed to her problems now. I sent blood to the lab today to see if her liver enzymes have returned to normal. She was actually jaundiced for a day or two (kind of scaryFrown).
I am planning on removing her staples on Tuesday Sept 9th and then the next step is chemo. For now she wears her Led Zeppelin tshirts and feels like a rock star!