Taking It Off ... Taking It All Off: When is Amputation (Extraction, Enucleation, Splenectomizing, etc.) the Right Choice?
I know you think I belabor this point too much (those of you who know me well), but getting rid of random anatomical parts is something I’m good at. And I’m by no means alone. Extracting stuff (think ovaries, uteruses, testicles) is something we vets are well-equipped to effect.
I started thinking about this topic yesterday morning when my mother sent me a link to a Huffington Post inspiration piece, where a prosthetically-pawed dog was featured in all of his meticulously rehabbed splendor. He may have lost all four paws to frostbite, but it didn’t diminish his will to act the normal dog — not once he was outfitted with his bionic booties.
Too cool, right? That’s what was going through my mind as I blithely Tweeted it. Unfortunately the next patient proved to be one for which no prosthetic would be on the menu. Not on her budget.
Though a surgical procedure would definitively repair this cat’s dislocated and fractured radius after a devastating dog attack, her owner’s inability to shoulder the specialist’s $1,500 - $2,000 estimate left her looking for alternatives — amputation, even.
Thankfully, a "free" consultation with a veterinary surgeon over dinner (it cost me exactly two bowls of home-made elk chili with tomatillo salsa and a couple of cans of Guinness) produced an alternative besides amputation:
A Schroeder-Thomas splint could probably do it, he concluded. This kind of splinting technique sort of works like putting a leg in traction, effectively pulling the ends of the limb apart so that the bones get back into as-close-to-normal alignment so they can heal properly — or as close to properly as possible without applying screws and plates to hold them in place.
Problem is that (a) the splint would have to be applied perfectly, (b) I haven’t placed one of these splints in well over five years, and (c) it still wouldn’t be cheap; not with the anesthesia, the X-rays, the splint itself, and the need to repeat this procedure at least three times. My guess is at least $200 every two weeks for three sessions — that is, if we’re lucky and all goes well for what will almost certainly be a cat with a permanent limp, even if things go perfectly.
So what if it doesn’t go well? We’re back to square one: amputation. Which will cost $500 or so … leading to a grand total of $1,100 and six weeks of splinted stress Pretty close to the low end of the original surgeon’s estimate.
Which left me sort of squirming as I picked at my chips and salsa. "You know if it was my cat and I didn’t have either the money or a surgeon at my beck and call, I’d take the leg off." (I didn’t actually say "at my beck and call" but it sounds good here.) To which he agreed that it wouldn’t be the worst decision for this owner, given the 50-50 chance of reasonable success with the splint approach. And let’s not forget the almost-inevitable limp and probability of future arthritis.
While I will offer the owner all the choices and let her come to her own decision, I can’t help thinking the stress of it all isn’t worth it.
Now for the obvious observation: If this were a human in a developing world setting with limited resources at our disposal we’d never — ever — bring up amputation as a stress-reliever.
Sure, humans need a leg more than pets do, but you know where I’m going with this. Animals don’t have the cognitive ability to emotionally fret over whether they’ve just lost a lung or an eye, a tooth or a toe. All they can manage is the in-the-moment stress of it all. Which is why sometimes it’s best to get it over with fast so they can get back to being animals as quickly as possible.
But sometimes I do think we take it too far. Sometimes it’s true that we don’t try hard enough to spare a cat a limb; or save a tooth; or an injured tail. We’re good at taking off claws and ears and ovaries and testicles and eyes. Veterinarians can be knife-happy that way. Because, historically, expediency has been the issue. And "stress relief" (AKA "let’s not put her through it") is often how we couch it.
But maybe, just maybe, we’ve been going about it all wrong. Could it be that I’m taking the defeatist approach with this cat’s splint because I relish the definitiveness of amputation? Because I’m culturally predisposed toward removing things?
I actually believe that’s probably true. But that doesn’t mean I’m changing my mind. I’d still want the leg off, if I were this client. So maybe it’s a good thing I’m not.
Dr. Patty Khuly