Caring for a Three Legged Dog or Cat

Our whole second floor is carpet, and our first floor is good for him.  We went to Home Depot the night before he came home and bought the cheapest carpet they sold in 12' rolls.  We bought a 12'x16' piece for our family room where he spends most of his time, and we bought a number of 2'x12' pieces for all of our hallways and his favorite pathways. 

Before removing the fentanyl patch I talked to the Tufts surgeon and he was confident going from 75mcg/hr fentanyl plus gabapentin, to just gabapentin would be no problem.  I thought it sounded extreme when he first said it, which is why I called and asked again.  I swear Milo was having withdrawal symptoms later that night.  After talking to my local vet, we added back Tramadol at a low level.  We popped by for a casual visit on Saturday so we could use her scale and so she could see how Milo was doing (small town stuff -- we also had to talk town politics.)  She told me then that we could increase his tramadol by 2 or 3 times if he seemed to have problems, and also recommended acupuncture down the line if he had aches and pains.  I'll also be asking the Tufts team about rehab and physical therapy.  I've identified two solid candidates so far.

So based on comments here, and other reading, and our local vets advice on Saturday, I gave him an extra Tramadol at dinner tonight.  He has gotten up a few times on his own to change spots and go sit by someone who will pet him.  He's maybe a wee bit better, although he skipped dinner for the first time since who knows when -- a month?  Long before the diagnosis.  Right now my husband and I are sitting on the front porch and he's right next to us and just gave me a bright-eyed look before rolling over (no whining.)  

Thank you everyone for the feedback.  I'll talk to his Tufts team tomorrow and get their advice on meds, and in the meantime, I think he's more comfortable with the extra and still well within safe doses.  (safe is 300mg/day at his size according to his local vet and the onco, and I've given him 150mg so far today, with 50 more planned at bedtime.)  

Why oh why do they do this stuff on Sundays?!?! 

Jenifer & Milo

Most important thing to report.... the Tufts onco came in today and told me about a website I should visit.... https://www.tripawds.com!  A surgeon or orthopedic or someone who deals with more amputations than her was giving her advice to share with me.  I told them this was already my go to!  Thank you to this whole community and know that research hospitals are recommending you, too!

Once again, goods, bads, and no ideas.

The onco approved the 100mg 2x a day Tramadol, and suggested that on Monday night we even go all the way to 150mg and see how he handled it.  Milo slept like a baby!  It made him too drowsy and lethargic in general, but to try at night and have him not move a muscle while sleeping for most of the night was the time to try it.  We backed back to 100mg 2x a day.  Plus the gabapentin still.

Milo was thrilled to be at Tufts, even though his last visit there he walked in on 4 legs and came out on 3.  Excited to ride in the car.  Hurried to the door at Tufts, then decided to hit the grass for a poop, then back to the door (not short walks!)  He had to greet everyone in the waiting room.  I struggled to control him because of the slippery floor and not wanting to knock him on his keester trying to get him away from other dogs.  He was certainly high energy which was a huge positive, so I'll forgive his lack of manners.

Tufts is in the midst of a major rehab and using trailers and wooden walkways outside.  I bet Milo logged more miles today than he has total since the surgery, and he was fine with it.  And he wanted to stick his nose in every room with people and dogs.  We found a long hallway with no distractions and got him walking at a higher clip of speed, and his gait seemed fine.

The ortho who checked him out said his back right leg is stiff (front left amputation), but has full range of motion.  He thinks Milo may have quit moving due to pain on Sat and Sun, and then tightened up so that when he would stand it would hurt.  Sort of like a spiral.  Sort of like my elderly mother who I am always nagging to get out of her chair and move -- use it or lose it!

Just now after dinner, he had a great bounce to his step and is laying in the front yard, head up, and watching the world.  

Lots and lots of good!

And some bad.  He has a fever.  It's not clear why.  His wound looks great and the sutures came out, and only a wee bit of pink. They tested for various tick borne diseases which are common place in Mass.  Just his usual ongoing low level anaplasmosis reading.  He was 103.5 when first checked, then after visiting the ortho and returning, and getting his sutures taken out and returning, he was at 103.8.  But he was down to 103.2 at dinner tonight.  We started him on Clavamox after the 103.2 number, i.e., it quit climbing on it's own.  Plus, we don't have AC and it's nasty today.

And some really bad news.  The full biopsy report came back today.  He has Giant Cell Osteosarcoma, which is a very rare form and is super-aggressive.  There is a "mitotic index" which grades the rate at which cells are replicating.  Over 10-20 is considered high and aggressive.  Milo clocked in at 40+.       

And the "no idea", likely bad but unclear.  He might have lymph node involvement which means we'd be kicked out of the clinical trial.  when they took his leg, they took the common lymph nodes at his shoulder and armpit, and both of those were clear.  That's good.  But the full biopsy report says there was a metastatic lymph node.  It's not clear which node, where, at what level.  The pathologist who did the report is on vacation, so they will have another pathologist revisit it tomorrow.  Because lymph nodes tend to become involved based on proximity to the cancer, and the nodes at the shoulder and armpit were clear, this may not kick him out, but it might.

Good:  high energy today.  Bad:  rare super-aggressive form of OSA.  No idea:  may or may not be kicked from the study.

Peace,

Jenifer & Milo