Caring for a Three Legged Dog or Cat
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Hello. We have a new tripawd dog named Blue. He's an 8-year-old catahoula cur mix who is 6 days post-op from a left hind leg amputation due to suspected osteosarcoma in the proximal tibia (pathology is still pending).
He has a 'stump' in that the hip joint and part of the proximal femur were retained. We had what I would assume is a 'normal' recovery so far. We brought him home on the day of surgery and had a tough couple of days and nights, but by Post-op-day (POD) 3 he was starting to get around very well, got his potty routine figured out outside, and he was really doing GREAT hopping around and we went on a couple of short walks down the cul-de-sac and back.
Then, yesterday (the day after removing his fentanly patch) on post-op day 5, he started having regular episodes of muscle spasms and hyperflexion of the stump with SEVERE pain (like writhing and screaming kind of pain) that probably last for about 10 seconds (even though it seems like they last forever). Once they subside and he can get the stump to relax, he goes right back to being comfortable. They are happening about every 3-4 hours and tend to occur at rest, even while sleeping (twice last night at 11pm and 3:30am).
His medication regimen since discharge was:
Gabapentin: 300mg every 8 hours
Trazodone: 200mg every 8 hours
Rimadyl: 75mg every 12 hours
Fentanyl patch (removed on POD4, the day before these episodes started)
Other than these 'episodes' he is honestly doing great on this regimen and has no panting or whining anymore (like he did the first 2 days, especially the last hour before his next dose of gabapentin/tramadol).
He also has a small seroma on the medial stump, but it is non-tender.
We talked to the surgeon (have had a hard time getting real communication from them), and they thought we could try to add amantadine to his regimen. In searching the forum, it seems like this has been used by others to help control pain.
I guess I have 3 questions:
1. Are these episodes of phantom limb pain?
2. Is amantadine going to help?
3. I know this is probably dog-specific but...how long might this last?
He's just doing so well other than these episodes!! 
Online
Hi Cassidy and Blue. Your post has been approved.
It does sound like he is having Phantom limb pain based on your description. It happens out of the blue and it's almost like an electric shock that goes off. It's the nerve reacting to the signals that the brain is sending out to a leg that is no longer there. Yes, even though it last the way less than a minute it is horrible to observe.
Gabapentin is definitely what is prescribed for this so you need to talk to your vet about increasing it. How much does blue weigh?
Just a guess, but it's the dose is probably too low. So increasing that and adding the amantidine
Should help. As you know, the trazodone is a sedative and does nothing for pain. So, unless he's being way too active and needs to be sedated, you can talk to the vet about eliminating that.
Talk to your vet about icing the area or alternating with warm compresses.
For whatever it's worth, we do see this fairly often and, with proper pain management it dissipates fairly quickly. It sounds like overall blue is doing very well in recovery. Let us know how the adjustment and pain meds works, okay? Hang in there! Recovery doesn't last forever!
Hugs
Sally and Alumni Happy Hannah and Merry Myrtle and Frankie 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!
Thank you!
To answer your question, he weighed about 75 pounds pre-surgery. I will also ask about increasing the gabapentin and see what the vet says.
Hello and welcome.
For clarification is he on Trazadone or Tramadol?
Are you giving the pain and anti inflam meds at the same time? Sometimes it helps to spread them out so coverage is better. Of course discuss with your vet.
When my Pug Maggie lost her back leg to mast cell cancer we were told that she was only allowed short, leashed potty breaks for the first two weeks post op Perhaps Blue was doing a little too much in the first few days?
I have another Tripawd now who lost her back leg at 7 months old to a car accident. Elly was 10 months old when I adopted her so well past surgery. She still had puppy energy and would zoom around the house and jump on and off furniture, she would walk forever it I let her. A few months after I got her she started having what I was guessing were either muscle spasms or phantom pain episodes. She never yelped but she would jump up (from sleeping sometimes) and look at her back end like something was attacking her. I realized that her hip muscles were in spasm, as I started tracking the episodes I saw that they only happened after long or very active days. Once I got her stronger and learned how much activity was right for her the episodes stopped.
Blue's does sound a bit more like phantom pain based on your description. Be sure you let your vet know all the symptoms you are seeing. Maybe more rest and an adjustment in pain meds can bring relief. He sounds like he is doing well otherwise.
Karen and the Spirit Pug Girls and Boy
Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.
1999 to 2010
It's Trazodone, for sedation. We have a message in to them to see if we can taper the trazodone and up the gabapentin. I just got the Rx for amantadine and they're having us take that once a day and can increase to twice-a-day if needed. We'll see how tonight goes!
We also haven't had any direction from the vet on how to work on his med tapers. My wife and I are both in medicine and I do orthopedic surgery, so in my mind...
1. we should be off of narcotics first (check)
2. then taper the trazodone for sedation (maybe 1 week postop?)
3. then Rimadyl as an anti-inflammatory second (maybe start to taper after 3-4 weeks once incision is healed and doing well?)
4. then Gabapentin? (but honestly I figured this might take a while d/t the nerve trauma he had from surgery)...
But what do I know...that's just what we always did for hoomans!
Hi Cassidy and Blue, welcome.
Thank you for joining us, sorry you had to!
You've gotten spot-on insight from Sally and Karen. And it does sound like your vet is prescribing really good pain management (many people have a hard time getting Amantadine added into the mix). It should help, although it could make him extra sedated especially if the Gabapentin dosage is increased. I agree, it's pretty low for a situation like this, and a dog his size...400 mg would be about typical. It helps to get Gaba prescribed in 100mg doses so you can easily go up or down with the dose.
Regarding your tapering ...
In my "I'm not a vet" experience, Traz doesn't need to go on that long if he is a pretty mellow dog. Although as a Catahoula I suspect he might not be? Just a generalization. But most dogs only need it for a couple of days while they're first home from surgery.
Most vets do recommend leaving the anti-inflammatory as a regular daily medication after surgery, if there are no health conditions that could cause side effects (like liver issues). We've had vet ortho surgeons tell us that aside from weight control, a good NSAID given on a long term basis (with regular labs) is very helpful for reducing inflammation from compensatory movement, and later, reducing the effects of OA that Tripawds are more prone to experience.
Gabapentin tapering varies by dog, as does phantom pain . So that may take some time to move him away from. One really great way to get guidance in that department is with a canine rehab therapist. Yep, they're out there for dogs too! We believe it's so helpful for any new amputee, even young ones, that Tripawds Foundation reimburses for the first rehab visit ! Many rehabbers are excellent pain specialists too, and can help pinpoint and treat issues like what Blue is experiencing.
Be sure to check out our recent Tripawd Talk with Dr. Tamara Grubb, president of the International Veterinary Association of pain management . She gives really great input about before and after surgery pain control. Follow that up with our interview with Dr. Esquivel. about Rehab Therapy, and you'll be extra knowledgeable about how to help Blue live his best life on 3!
Keep us posted on how he's doing. It's really good to have you here, with a perspective like yours from the human orthopedic medicine side of things. And it's an honor, thank you for putting your trust in our community.
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