Caring for a Three Legged Dog or Cat
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Charlie had his right rear leg amputated today. He is a 7 mth old cavapoo who sustained an injury, had surgery to save the limb - which didn't work. I know everyone has different experiences with pain, but here is my question. I was going to bring Charlie home today (the vet said I could) but then we got into a little disagreement about pain meds. She wanted him to stay on gabapentin 100 mg twice daily and take a non-steroidal anti-inflammatory med (which he had been taking since his first surgery). She said he had a block (anesthesia) for the amputation and that would help. I'm not familiar with animals but I know some about pain management in humans so I pushed back a bit. The block will wear off, this I know. Then we'd be stuck with no meds that are designed for acute post-op pain. For his first surgery, he stayed overnight so the vet folks could monitor him (and medicate him as needed). But this time (different vet office) they were going to send him home just with gabapentin and a NSAID. Of course I want him to come home today, but I don't want to have a puppy screaming in pain with no meds available. We agreed that he would stay overnight at the hospital.
This is a very emotional time and I understand that I am being quite reactive. But the way I see it, Charlie has been through so much. I want to advocate for Charlie in a reasonable way. Have others found the need for stronger pain meds during the acute phase of post-surgical recovery? Or did the NSAIDS and gabapentin cover the pain? TY Cheryl
I swear there was a recent forum or blog post detailing best practices for pain management after amputation surgery... But I'm not finding it
I am no expert on pain management (I adopted my tripawd post-amp so I never went through recovery), but I think your instincts are right. I sure someone who is knowledgeable about this will come along with more concrete recommendations soon.
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YOU ARE NOT ALONE! We've got your back!
Good for uou for advocating for good pain manage for Charlie! And I'm glad they are keeping him overnight to monitor him....that's pretty much the standard when it comes to amputation
You are right, the heavy Hospital meds, the nerve block, the anesthesia will wear off and be out of his system shortly. That's when it's crucial to have good pain management .
If it helps give you some reassurance, Gabapentin is what we see used most often to keep the pain under control after amputation surgery. That, as well as an anti-inflammatory. The trick is to make sure Charlie gets the right dose amount and the right frequency. Most dogs stay on the Gabapentin for anywhere from ten to fourteen days, sometimes a bit longer. Just depends on the individual dog and the pace with which they are healing.much does Charlie weigh?
The other med we see ised in conjunction with Gabapentin sometimes is Amantadine. Those two seem to compliment each other. Gabapentin can be given as much as three times a day to stay ahead of the pain.....sometimes only every twelve hours but that's when the Amantadine can be used inbetween.of coirse, all thos depends on the dose amount.
Of course, not a Vet and not giving Vet advice. So when we know how much Charlie weighs we can share what we see most often here
STAY CONNECTED. We are right by your side to help you navigate through recovery.
We understand the emotions involved in getting to this point better than anyone can. Stay strong, stay focused on the prize! Charlie will get through this and we'll be able to reclaim being his feisty self but without pain soon!
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!
Charlie weighs 15 pounds; he is 7 months old. The poor guy has been dealing with pins sticking out of his leg for at least one week prior to this amputation surgery. He was given gabapentin 100 mg twice daily after the first surgery, although I think the main intent of that was to slow him down. It didn't of course.
Also Charlie hates the collar. He hardly moves when he is wearing it, just stays in one place wide eyed without breathing much - I think he inadvertently bangs into things which must cause further pain. I am home with him so was able to take the collar off and just sit with him for long periods of time after the first surgery. That seemed to help. Also after reading posts here, I purchased an amputation garment so that will hopefully minimize the need for the collar.
I am familiar with gabapentin and amantadine, having used those when I was prescribing pain meds for human people. I worked in pain management (prescribing meds for seven years in the past). Which was part of my frustration with the vet folks. I found myself experiencing "mansplaining" only instead of a man talking down to me it was young women. I spoke about pain management several times and even sent a text identifying my concerns (before the amputation surgery). What I got in return was the standard "we will keep him comfortable" response. Okay but tell me how gabapentin will work for acute post-operative pain. Maybe it does in animals. But tell me how (the physiology, the research) and then I'll be more comfortable!
I am old enough to remember a time when we believed that infants did not experience pain - something about having an undeveloped nervous system I think it was. What we found out was babies in pain typically don't cry - they don't move! It hurts to cry.
I know it's easier for me to be angry rather than sad. But I am also frustrated that I am still arguing about pain management with the vet. This takes me back to my days of prescribing and the many discussions (read arguments) I had with human surgeons who were reluctant to prescribe pain meds to people with a history of substance abuse. All people experiencing acute post-operative pain need pain meds. It doesn't matter if they have a history of substance abuse or green hair or have a hobby of skydiving. We can figure it out and work with the individual to have a very controlled med regimen that is for acute post-operative pain. Oops, sorry, I digress. But I am a bit stunned that I find myself back here.
TY also to the group for recommending carpets or yoga mats to put over slippery floors. I did that and am purchasing food bowls that are elevated off the ground. These pieces of information are so helpful - I feel like I am doing something to help Charlie. So TY.
Hi Cheryl. We went through something similar with our dog, Ava. She’s 11 and 55lbs so different size here, but I can relate to the confusion and concerns you have. Our vet put Ava on 200mg of Gabapentin 1-2 times per day post operation. We were like, “wait what?? That’s it??” She would cry and shriek almost every night for the first few days. We were so convinced that this was due to extreme pain that we brought her back to the hospital in the middle of the night on day one. They did a bunch of physical tests around her incision, and Ava did not react at all. The vets (and we) concluded that it was likely 1. Phantom nerve pain and 2. Anxiety (rightfully so she was like “what the hell happened to me”). We decided to up the Gabapentin to 300mg which was extremely helpful. Apparently it’s a nerve blocker so great for the phantom nerve pain they’ll experience. We were also given trazadone for the anxiety which we used for maybe 3-5 days total until she was much calmer.
Our vet explained to us very beautifully that in the beginning they don’t want to over medicate your pup so much so that they can’t tell where the pain is coming from if they needed to. It’s much healthier to add medication as needed than to overload them. If they’re completely medicated with intense pain killers and something actually ends up being wrong with the would/surgery site, they need your dog to be able to communicate that to you. I respected this philosophy very much. Hope that’s helpful.
Cheryl, you are an incredible, knowledgeable advocate for Charlie. With your background, he is very lucky to have you looking out for his needs. Finding the right mix of medication once recovery begins at home can be challenging. It's not cookie-cutter, and often needs fine-tuning. It's so important to have a vet who is willing to do that for him.
I'm wondering if perhaps your vet wasn't giving you more information on the meds is because most folks don't want the level of detail that you are seeking (good for you!), and they're of course, super busy, short staffed, etc. But you still deserve to get your questions answered.
So, there's a reason why we have the phrase "pain management " linked to our articles here. It's because this is a HUGE deal for Tripawds going through surgery recovery, and late rin life.
We interviewed Dr. Robin Downing, who helped found the International Veterinary Academy of pain management . You'll find our series of videos and articles with her helpful. She knows her stuff and she's not afraid to tell it like it is. Here's what she says about a situation like this:
Also see what Dr. Petty, a colleague of Dr. Downing's has to say:
I think this is the post that @mischief is referring to:
Best (and Worst) Pet Amputation Pain Drugs (Updated 2022)
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