Excessive Bruising And Swelling After Surgery

[Guest LindsaySF]

Sophie had a lump removed from her thigh on Thursday. (Old thread here). It was histiopericytoma, but they got clean margins.

 

Now for the bad news... She has had A LOT of bruising and swelling since the surgery. We think Greyhound post-operative bleeding syndrome. We started Amicar on Saturday.

 

 

Here she is on Saturday, which prompted the vet visit and request of Amicar. The bruising on the leg with the incision got better, but then it started spreading up her stomach. Her bloodwork was fine. Platelets and hematocrit were on the low end of normal.

 

 

 

 

 

She was finally more mobile on Saturday afternoon, able to stand and walk on her own. (Thursday and Friday were tough, she weighs 75 lbs...) You can see how swollen her leg was.

 

 

 

 

 

This photo is from early this afternoon. As she is more mobile, able to walk in the yard, and laying in different positions in her ex-pen, the blood and fluid is moving around. Her other hind leg is getting more swollen and the blood and fluid on her tummy moves to her chest and armpits and forms a pocket there. The leg with the incision is less swollen.

 

 

 

 

 

I brought her back to the vet today to repeat the bloodwork because the bruising was continuing up her chest, the other leg was swollen, and her gums seemed pale to me. Pale gums = panicking Lindsay. Thankfully her bloodwork was better today. Platelets and hematocrit in the middle of the normal range, better than Saturday, so it appears the Amicar is working. Her continued bruising was filed under the category of "It will get worse before it gets better". Her gums looked a little pinker as she moved around too.

 

 

The vet suggested buying a Thundershirt, hoping the compression would encourage resorption of the fluid. We'll see if it works!

 

 

 

 

 

 

Does anyone else here have experience with this type of bleeding after surgery? How long did it take for the bruising to go away? I have 5 days of Amicar, will that be enough? Will the bruising get worse? Is there anything else I can do? Thanks in advance.

 

 

 

 

~Lindsay~

[4My2Greys]

I've had no experience, but wanted you to know my thoughts are with the both of you for her speedy recovery.

[mychip1]

My thoughts are with you.

 

As someone who had a horrible post surgical situation with a hound, all I can say is watch her like a hawk. If she begins to get lathargic or "distant" get her to an evet immediately. Also, I know you are watching for pale gums, but also be on the lookout for areas where skin is exposed like ears and gums going the other way...i.e. too dark.

[tbhounds]

I have had the same experience with my Shannon a few years ago. She had a mast cell tumor and her popliteal lymph node was excised by a board certified surgeon - it bled like a bugger and she developed extensive bruising.

I did not use Amicar (remember this was a few years ago). The bruising resolved after about a week. Now to compare, Shannon just had a unilateral thyroidectomy (thyroid carcinoma) performed by a greyt resident surgeon at Ohio State. She was started on Amicar the next morning (remember the gh bleeding syndrome doesn't present in Ghs for 25-36 hours post sx). Shannon had zero post operative bleeding and ZERO bruising. Amicar works by strengthing the clot-- something also to remember these guys will have normal clotting factors.

Amicar is inexpensive- and there really isn't a valid reason not to use it. 500mgs by mouth 3 times a day for 5 days is Dr Coutos standard protocol.

Edited May 1, 2012 by tbhounds

[Charlies_Dad]

Poor Sophie but I am glad they got clean margins!

[Guest LindsaySF]

As someone who had a horrible post surgical situation with a hound, all I can say is watch her like a hawk. If she begins to get lathargic or "distant" get her to an evet immediately.

I guess this is where I'm having trouble. It's really hard to tell if something is "off" with Sophie, because she's a weird dog already, and on all sorts of medications for her seizures. (KBr, Pheno, Zonisamide, Keppra). She's kinda lethargic and distant from time to time anyway. Add in the Tramadol for pain, and she was really out of it the first few days. We've cut back the Tramadol to every 12 hours, to prevent sedation. She'll go hours and hours where she sleeps and doesn't move, then all of a sudden she'll wake up and be ravenous (Pheno makes her hungry, and it "hits her" suddenly).

 

She has been very quiet since the surgery, but I guess that is to be expected? She does lift her head and perk up when I talk to her, and when she wants to potty she can get up and walk fine, so I guess those are good signs. She has been a bit of a picky eater, but is still eating. I've honestly been a nervous wreck since Thursday (and I didn't sleep one wink all Thursday night).

 

 

Also, I know you are watching for pale gums, but also be on the lookout for areas where skin is exposed like ears and gums going the other way...i.e. too dark.

The area between her thighs is very dark, but I figured it was just bruising that hadn't spread around to other areas yet. Is that what you mean? Or are you talking extremities?

 

 

 

Tbhounds, so you think by Thursday I should see some/most of this bruising resolve? I guess I'm getting worried because she's still in the "getting worse" stage where the bruising is spreading. Maybe it's unrealistic of me, but I expected more improvement by now. Today is day 4 post-surgery. I am, however, happy that she is mobile again. The first 2 days were torture on my poor back!

 

 

 

~Lindsay~

Edited May 1, 2012 by LindsaySF

[tbhounds]

I think you most likely have seen the worst of the bruising-,it should start to resolve. Just like when you see when your own bruises start to resolve- may turn colors first before dissipating.

I'm sure she's quite because she's been through the ringer lately.

[3greytjoys]

Wow, Lindsay! I'm relieved you started treating Sophie with Amicar (Aminocaproic Acid). Sophie's bleeding is quite severe. Could any of her other medications be complicating her excessive bleeding issues? I would try to send these pics to OSU for their input. Normally, I wouldn't recommend that, but I do in her case.

 

Please see following treatment section (blue text) for Aminocaproic Acid dose range: https://greyhound.os...ancer/index.cfm

 

Viewer caution: Photos of excessive bleeding cases post op.

https://greyhound.os...eders/index.cfm

 

We have 3 excessive bleeder hounds. They can begin excessive bleeding on the operating table (and/or within 3-4+ days post op.). One of our hounds began spontaneous bleeding a couple of weeks ago (not even a post op.). That hound was nearly clear of excessive subcutaneous blood within 5 days of Aminocaproic Acid treatment. None of our own hounds have been as severe as Sophie's "post op." while at home. One hound bled very badly during a surgery (before we started using Aminocaproic Acid) but vet was finally able to stop her surgical bleeding. Now, all our hounds (excessive bleeders or not) get liquid form A.A. for every surgery. (There are a few hounds who shouldn't get A.A. but a vet can read drug cautions.)

 

As Robin mentioned, I agree about watching Sophie like a hawk and getting her back to vet if she worsens or doesn't improve soon. (We saw a bad situation after a full amputation of a hound's leg, but that was withOUT any Aminocaproic Acid.)

 

Please remember to ask your vet if any of Sophie's medication mixes could be compounding her problem by causing additional internal bleeding.

 

Prayers for Sophie's rapid recovery.

[MaryJane]

Is she getting hydrated? Reason I ask is that the hematocrit could possibly be falsely elevated if she was dehyrated giving the illusion that her blood volume was OK (cells versus plasma).

 

You might want to get another hematocrit.

[3greytjoys]

Lindsay, I sent you an email. If you haven't seen it yet, please check your email account/s.

 

I hope Sophie is improving today...

Edited May 1, 2012 by 3greytjoys

[Guest sirsmom]

I saw a lot of bruising with ALS (ligament surgery) and it scared me! It took about 3 weeks before it wasn't horrible. I would just keep watching her and keep her potty breaks short for awhile.

[Guest LindsaySF]

Thanks for all the posts! I don't think Sophie is dehydrated (when I don't think she's drinking enough I syringe some into her cheek ) and her urine is normal in color. But I guess it's possible? The vet was pleased with the improvement in her bloodwork.

 

I have some good news. I carried Sophie upstairs to my bedroom last night (she's walking but not doing stairs) because I wanted to sleep in my own bed, that darn recliner downstairs wasn't cutting it. When I woke up in the morning she was roaching!

 

 

 

 

Her leg swelling has improved greatly. I guess the elevation did the trick. I had been putting her legs on pillows and massaging them, but roaching was better I guess!

 

 

 

The bruising has continued to travel up her chest, and now to her front legs. But she no longer has blood "pockets" under the skin that move when she moves. I guess that's an improvement?

 

 

 

 

 

 

~Lindsay~

[Guest freightsmom]

Poor baby and you as well; sending get well wishes to all. Freight recently had to have a toe amputated for a malignant growth and the surgeon put him on Amicar the day before surgery and 5 days afterwards. I was pleasantly surprised that I did not have to ask for the Amicar, he knew about bleeding and greyhounds and requested it be started even before the surgery.

[Guest LindsaySF]

Sophie was able to climb the stairs last night to go to bed. I think the bruising on her front legs is a little lighter today. The bruising between her hind legs, and on her stomach, seems about the same.

 

Today is Sophie's 6th birthday! Unfortunately she celebrated it by having a seizure this morning. She was okay during the day, if a little tired. She was a picky eater tonight, so we had pizza...

 

I emailed OSU some photos last night using their consultation request form. Hopefully they respond in a day or two with advice.

 

 

 

~Lindsay~

[3greytjoys]

Happy 6th birthday, Sophie!!!

 

Great news that she's improving today!!!

 

I'm glad you consulted OSU about her extreme excessive bleeding, particularly coupled with her seizures. Will be interesting to learn if they are satisfied with 5 days of Amicar, or if they recommend any treatment beyond that.

 

Please give Sophie extra birthday kisses on her "kissy spot" on her head.

[sweetdogs]

That sounds like she's on her way! It totally must have been the roaching. Sorry about the seizure but it's better it happened now rather than last week. And yay for pizza!

[tbhounds]

Glad she's improving-- good the hear the bruising is starting to resolve. Thank goodness for Amicar and for Dr Couto who found its usefullness with the hounds.

[FiveRoooooers]

Sounding better and better, Linds. Sophie just wanted to be in her own bed, too. Love that she roached! Happy Birthday, Sophie

[Guest LindsaySF]

This was her in the yard today. Her hind legs are less swollen, though her stomach is still bruised and she gets a blood-filled "boob" on her chest when standing.

 

 

 

 

The bruising looks worse when she's laying on her side, as it all appears on the side of her body facing up. But she looks slightly better today compared to yesterday.

 

 

 

 

 

 

Tomorrow morning is the last dose of Amicar. I'm a little worried about that. Hoping to hear from OSU, or I'll check in with Sophie's vet.

 

 

 

 

~Lindsay~

[tbhounds]

Have you had her on the Amicar for 5 days already?

She does look better.

[Guest LindsaySF]

Yes, we started the Amicar on Saturday night. Tomorrow morning is the last dose. 15 tablets total.

[tbhounds]

Yes, we started the Amicar on Saturday night. Tomorrow morning is the last dose. 15 tablets total.

Geez, time flys. She should be fine.

[Guest LindsaySF]

Yes the time has gone by very fast. Lack of sleep might have something to do with the days blurring together. I wish the bruising was a little better resolved before the Amicar runs out though...

[Remolacha]

Happy Birthday Sophie maybe it's just the pictures, but I think she is looking better!

[sweetdogs]

I wish the bruising was a little better resolved before the Amicar runs out though...

 

I'm guessing it just has to disappate & be re-absorbed/excreted. As long as it isn't getting worse, the amicar has done it's job.