Taking it ALL off - amputations in vet medicine
Last week’s client came crying (justifiably) over her dog’s bone cancer (the too-common osteosarcoma, in this case). After the requisite diagnostic biopsy, her previous vet had told her there was nothing to do unless she elected in favor of amputation and chemotherapy. Unsatisfied with this ultimatum, she’d come looking for a second opinion.
This owner was miserable over the ordeal but loath to submit to amputation and chemo based on her personal biases and beliefs (more on this later this week). Nonetheless, she wanted her dog to feel better immediately. As frequently happens in these cases, she couldn’t stand to watch him suffer like this but couldn’t yet let him go.
“Righteous” was doing poorly with the pain medications (standard-dose Rimadyl) prescribed. No wonder: This was a 150-pound Rottweiler with too much fat on his frame and joint disease in full swing despite his mere six years of age. (Excess weight has a way of accelerating joint degeneration.) The painful tumor on his right hind leg (at the knee) had rendered this leg a cumbersome and excruciating burden. To make matters worse, the biopsy sites were not healing well.
In the end, this was the plan we agreed upon:
1-Emergency weight loss using Slentrol, an obesity drug indicated for rapid weight loss.
2-Booties for support and slip-protection on the three limbs he was able to use.
3-A sling for assistance and regular bouts of forced mobility (the owner was young and strong).
4-A stepped-up pain protocol to manage his evident discomfort (we added high doses of Tramadol for the present time and a Fentanyl patch every three days, to boot.
5-An immediate referral to a surgeon for amputation.
6-Culture and sensitivity of the non-healing sites for appropriate antibiotic therapy in the interim.
In short, I did nothing his own vet wouldn’t have done at this point. The only positive note I added to the pro-treatment speal was the acceptance of this client’s choice to decline chemo and still do right by Righteous. (Though I did try to convince her otherwise, as lengthier lifespans statistically result from the use of chemotherapy along with amputations.)
Now, you may think a three-legged 150 pound Rottweiler an abomination—not to mention a gravity-defying impossibility—but we had little choice. This guy was already three-legging it—with difficulty, but it nonetheless pointed to his capacity to withstand this surgical approach.
Predictably, his owner declined chemo and proceeded to opt for amputation, heartened by the fact that he’d be in much less pain, but aware that the spread of the cancer was inevitable. She’d ultimately been swayed not by me, not by the surgeon and not by Righteous’ pain, but by what she’d read on Tripawds.com. Three cheers for them!
Though Righteous suffered a day of rough recovery on an opiate drip, much as my Sophie did after her neck surgery, the following day he was far brighter than he’d been in weeks.
This is why we do amputations. Because though we know they’ll suffer for a short period of time, their improvement after surgery is dramatic—in almost all cases. If ever I had a case where amputation was a scary option, this large, overweight, osteoarthritic dog was it. And even he recovered with aplomb.
Success stories like this make me want to cry with relief and an abundance of sentimentality. Watching him walk out of the specialist’s place, the owner couldn’t stop hugging me. How sweet is that!—and how gratifying.
Though Righteous won’t likely be with us long (six months?), his owner knows that the next step is likely to be euthanasia. This tumor likes to go to the lungs, eventually. And at that time his owner understands that she’ll need to be prepared. In the meantime, though, he’s almost pain-free and well-loved. The only thing better would be no cancer at all.
Each owner must choose his own path on this question. Ten years ago I elected otherwise for my own Boxer dog with osteosarcoma. Given my financial circumstances, Agatha’s severe hind limb osteoarthritis and the dearth of drugs like Rimadyl, Metacam and Previcox on the market, I felt certain this was the right choice. But today? I’d like to think I would’ve gone with it. Who knows?
Regardless, it’s our job to present the evidence and hold the client’s hand, not so much to cajole and convince. Sometimes, however, I can’t resist. After all, I’m only human.