Caring for a Three Legged Dog or Cat
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My 10.5 year old amstaff Sonny is two weeks post-op from a front leg amputation due to osteosarcoma and it's been tough. He is currently on gabapentin, rimadyl, amantadine and proin. It seems like I am constantly fighting adverse effects like drooling, drowsiness, nausea, panting at rest. He still seems kind of depressed and not his usual happy self. The palliative docs seem to think he needs to continue the pain meds. I feel guilty for putting him through this. It seems the recovery is going much slower than the oncologist and oncologic surgeons said it would and that I am constantly putting out fires. Does anyone have any advice or have any ideas? I don't really know what to do and don't have support.
18 October 2009
Hi Brian, welcome to you and Sonny. Your future posts will not have to wait for approval. Sorry it took so long to get this first post approved, I was having trouble with my internet connection.
First off- don't feel guilty (although most all of us went through this phase!). You made a good decision based on the information you had and are doing your best for Sonny. It's important for you to be strong and positive around Sonny so he knows everything will be OK.
Proin for incontinence? Can he get around by himself at all? Is he eating, drinking and eliminating?
Much of what you describe sounds like pain signs but can also be from a med combination. Have you discussed changing the dosing or timing with the vet? It's not uncommon for pups to need pain meds for two or three weeks and some older pups need something long term. Maybe he doesn't need all three now, or maybe you can taper some of the doses down. Of course don't change anything without consulting the vet.
At 10.5 years old he's not ancient, but we often see here that the more mature pups take a bit longer to get their sea legs.
It seems the recovery is going much slower than the oncologist and oncologic surgeons said it would and that I am constantly putting out fires.
Not all dogs heal and recover at the same rate. My little Pug Maggie spent weeks in her bed after surgery- I was sure I had made a terrible mistake. All the input I got from the vets was 'dogs do fine on three legs' so I thought I had the only dog that wasn't going to cope. Once she accepted her new normal she hopped happily through life for almost 4 years.
Is there anyone around that Sonny likes that could visit? When my dad came to visit Maggie would really perk up. Oh- back to being strong for Sonny...I know it's hard when you are so worried and exhausted but really try to stay upbeat. I think Mag's recovery was so long partly because I was do down around her- we feed off each other!
Karen and the Spirit Pug Girls and Boy
Thank you for the kind words. Yes, proin for his long history of leaking. I will speak with his palliative care doctors to see what we can do to adjust his meds. Good idea! I will have friends come visit with him. It's just so hard now. It really feels like I am constantly putting out a new fire every day and right now he seems worse than before the amputation. He starts chemo on Monday. Thank you again for your support.
Hi Brian, sorry you had to join our club. Yes, do talk to the vets about adjusting the medications. All dogs are different in their response to pain management and it does sound like they are giving him a good combination to control the surgical pain. It's just a matter of tweaking it to his physiology. He is still doing better than any human would at this point in time.
Don't beat yourself up. I know it's hard not to but EVERYONE feels regret and sadness after surgery. Your guy WILL get there in his own time. Try your best to be patient and know that he will get his sparkle back soon. We call this learning how to Be More Dog . He's not looking back, he's just taking things day by day.
Look at him with new eyes but keep them on the future because in time you'll see your old pup again. Look for improvements even if they seem small. What are some achievements he's made lately? How his his mobility? Can he stand longer than he was a few days ago? Is he eating more than he did a week ago? Are you seen any positive changes? If yes, write them down by keeping a journal so you can look back even a few days later and notice the improvements. If not, what do you think is not getting better as far as appetite and mobility? Those are the two big areas where he'll start to shine first.
You can do this!
Thank you so much for the kind words Jerry. Today has been a tough day. The physical therapist came over and he was manipulated a bit more than usual and since then he has been in pain. Licking himself a ton, tail under his body, wincing and yelping a bit periodically. I just gave him some extra dilaudid. I am hoping he settles. Reading your post was helpful because overall he is doing much better with eating, walking, engaging with me, wagging his tail. He even greeted me at the door yesterday wagging his tail which was the greatest gift ever. It's just hard. The rollercoaster of it all and wanting him to just be ok. I am so sorry that he has to go through this. Thank you again for the post.
Brian you are so welcome. Please let the PT know about his pain signals if they continue. I hope he's feeling better.
Yes it IS hard to go through this! We get it. Try to focus on the big picture. Even with cancer he can go on to live a good life, it's just a matter of getting the pain under control and finding out the cause so it can go away.
We don't hear much about dogs getting dilaudid as pain control Can I ask where you are located?
Oh that's interesting they chose dilaudid for his pain relief, it's a new one to me. The licking...it's not just around his incision area? I do know that some drugs can cause an itchy allergic reaction (it happens to me when I've taken a certain antibiotic, and some narcotics/opioids can have an itchy side effect). Or, it could be completely unrelated to the meds or even the surgery. I would let your vet know before the irritation gets worse.
When you say "palliative care vets" do you mean you are not doing chemotherapy so you are choosing to manage his cancer with pain control and comfort care? That's OK of course, I'm just curious. Palliative care is a term used to describe "comfort care" and hospice, meaning no chemotherapy or other surgical cancer therapies because an animal is closer to end-of-life stages.
Good question. He had his first round of chemo today so I am definitely trying to prolong his life as much as possible, while balancing chemotherapy. I owe it to him to keep him alive for as long as he wants to live. He is my best friend and I love him more than anything in this world. He has given me more than I could ever give him.
I have palliative care vets and nurses helping with his pain management and overall quality of life. Generally and from my understanding, osteosarcoma is a terminal diagnosis. Despite my best efforts and as hard as it is for me to admit - dogs usually will die from osteosarcoma even with amputation and chemo. Because of this, I have chosen to have palliative care on board every step of the way to assist with pain management , adverse effects of chemo, physical therapy and any other issue that comes up. Ultimately, they will also help me know when the time is right and Sonny has decided he can no longer go on. I see them as insuring he is not suffering and is comfortable every step of the way. I can say as a human doctor that the greatest gripe of palliative care doctors is people wait too long to include them in the management of patients because they think it means you've given up etc. I imagine that is the same frustration that veterinary palliative care docs have.
They prescribed dilaudid because he vomited after tylenol with codeine. We now know that it was the amantadine so he is back on tylenol with codeine for now. His overall med regimen now is: gabapentin, tylenol with codeine, rimadyl and proin. He also has anti-nausea and anti-diarrhea if that comes up from the chemo.
This has really been such a tough process for the both of us, but I am trying to remain as strong as possible for him and get him the best care even if it means a 5.5 hour drive at a top academic center for his amputation. The hardest part for me is the guilt I have because he has suffered from the surgery and adverse effects of meds etc and I wonder if I have done right by him.
Anyways, I really appreciate all your support. It means so much to me. This is one of the hardest times we've ever gone through.
I'm so sorry you are going through this. I can totally relate as my 12.5 yo golden also had same surgery and diagnosis only 10 days ago. It's so much harder than the surgeons and oncologists tell you. I 100% agree with you. They do not prepare you adequately. Thank goodness for this group!! As others have said, every dog reacts differently to meds. My golden is totally zonked on 300mg of gabapentin. I have gotten 100mg tabs from my vet and she is better on 200, though still sleeps a lot, which isn't so bad. It's a very slow process so take all the time you need. I'm so sorry because I know how hard it is and I know my Isabelle is also terminal but i'm trying to weigh what is too much for her quality of life. How is the chemo going? I haven't decided on that yet! Thinking good thoughts for you both.
Thank you Elizabeth. I am sorry you are going through this as well. He is doing well with chemo so far but it's still early. For me, the decision came down to median survival - although we can't predict anything. Amputation without chemo has a median survival of about 4 months while w chemo it has 12 months. I just want to give him as much time as possible where he can be a happy boy again.
Totally agree - the vets do not really convey how difficult the recovery can be in some ways.
Glad to hear your golden is making progress. Sonny was also zonked on the high dose of gabapentin and we decreased it. Please keep in touch. We are all here for eachother
Thanks Brian. I just reached out to oncology to try and set up the chemo appointments. I'll be curious to hear how it goes with you and Sonny and chemo: side effects, what regimen etc. We are scheduled for an oncology appointment in about a week. Hang in there and best to you both.
For me, the decision came down to median survival - although we can't predict anything. Amputation without chemo has a median survival of about 4 months while w chemo it has 12 months. I just want to give him as much time as possible where he can be a happy boy again.
Yes, you are correct. These are the stats given to folks who have a dog with osteosarcoma. It's depressing. But, I can tell you that around here, the cancer timeline goes in all sorts of directions. We see some dogs live way past prognosis, with or without chemo, and some don't get that extra time at all. You never know what will happen, so you put one foot and one paw in front of the other and take each day as it comes. I think you have a really good attitude that will allow you to do just that.
I hope Sonny had a better day today and tomorrow is even better. Keep us posted.
22 February 2013
Just want to add my support to uou and Sonny. Just catching up in time to say I'm glad you are seeing "some" reasons to celebrate. Every "-little" improvement is a HUGE improvement during recovery!
You've already gotten great support and advice, so I can only say ditto!
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 all for the very kind words and support. It means more than you could possibly imagine.
Sonny has been doing well and I think we hit the sweet spot with pain meds and utilizing treatment options such as the assisi loop.
He still seems to sleep way more than usual. I am wondering if that's from the gabapentin + codeine. I am excited to hopefully wean him off of some of these pain meds soon.