5 days post amputation - we can’t get her up

[Sundrop]

Our girl had a severe humerus break on Monday night and long story short, we are awaiting biopsy results, but it is suspected osteosarcoma. We were given the option to amputate or euthanize since the bone could not be surgically repaired.

Surgery was Tuesday afternoon, we brought her home Wednesday afternoon. She is on 600mg Gabapentin every 8 hours and was already on Rimadyl once per day. That is all the pain meds (which seems light for an operation like this). She is also on Amicar and an antibiotic. We are religious about her med schedule.

She has been going outside to pee regularly since she is drinking a lot. She is eating okay and had already pooped 3x - so we are really pleased with that.

This morning she went out around 9am, peed and pooped, and since then we are unable to get her up to go out. She was whining and crying around 3pm, which is a sign she needs to go out, but she kept refusing to get up. She ended up peeing in bed. 

Now at 9pm, she is in the same position she has been in since this afternoon and will not get up. We figure it is pain, but she isn’t acting any differently, other than not getting up. We will call the vet first thing in the morning, but until then, we don’t know what is best.
 

Should we pick her up and take her out, or just leave her alone? 

[ramonaghan]

Definitely give the vet a call in the morning, but try discontinuing the gabapentin in the meantime. It made Sweep very wobbly and dazed, and its efficacy for pain management is debated. She did much better without it.

I'd just let her stay put for now. She might be having some phantom pains too. How does the incision look? 

[Time4ANap]

I will second that the Gabapentin may be causing the issue. LaVida has been on Gabapentin for pain and her back legs became so wobbly that she had trouble getting up, and trouble walking without being completely wobbly. We had to discontinue the Gabapentin and just leave her on the Rimadyl. Definitely give your vet a call as your dog will likely still need some pain control to replace the gabapentin. 

Edited June 19, 2023 by Time4ANap
typo

[Sundrop]

Thank you both! 

Her incision looks great, no oozing or smells and pretty minimal swelling. Redness has even gone down and though she has some “spread” bruising on her belly, I know that is to be expected. 

She ended up going out on her own after we let the other two go out downstairs where she could see them. Our boy started barking excitedly outside and she was too interested to stay put. She peed a river and went right back to bed and slept like a baby. My husband is sleeping downstairs with her and I am letting him sleep a bit more this morning because he is exhausted, but I think she might’ve slept thru the night for the first time!

I had knee replacement a few years ago and the pain was so awful. I was a younger patient, which apparently makes the pain worse (go figure) - but Gabapentin and Rimadyl just do not seem sufficient for such a radical surgery. My family vet opens soon and I will call her and follow up with the surgeon. 

 

[gracegirl]

The pain she has now is nothing compared to what she experienced from the osteosarcoma and subsequent break. Was she on any pain meds before this happened? After my girl’s amp she was only on pain meds for a few days per the surgeon. She did need them a bit longer but not every dog does. It’s remarkable how quickly they recover from a surgery like this. She might also be experiencing a longer recovery from the anesthesia. 
 

I would call your regular vet and change her pain medication. See how she does then. I feel like recovery from an amp is two steps forward, one step back. The first week is hell. Then it starts getting better. Hang in there. 

Edited June 19, 2023 by gracegirl

[zimsmom]

Maybe ask for Tramadol.  

[greysmom]

Not Tramadol.  It can cause the same issues as the Gaba, and is questionable in treating pain both for humans and dogs.  The best opioid pain reliever we've used has been codiene sulfate.

Gabapentin *will* be useful to you down the road, but see if your vet will give you a smaller mg capsule so you can customize her dosage better.  It's really helpful for phantom pains, and nerve pain in general.

She probably will be able to get up and out for potties now, and you've found a good trick to use to motivate her.  I usually try and keep them on a pretty strict pottying schedule just because greyhounds seem better adjusted to being on a schedule, but she may have other ideas.  You might get some puppy pads to have on hand to put on top of her bed when she's having issues getting up to go.

But it sounds like she's doing well over all!!  Good luck!!

[Sundrop]

Thanks, everyone! 

Our family vet was surprised at the high dosage on the Gabapentin and said she's probably sedated & loopy from it. She recommended bumping her down to 300mg every 8-12 hours. My husband was too nervous to let her go 12 hours because she is crying out quite a bit. Our vet didn't recommend opioids, other than potentially a Fentanyl patch if the surgeon's office has them (our vet doesn't use them anymore). She was hesitant about that also, and I'm not too keen given we've used opioids in the past with other hounds and none really reacted well to them. I also sent an email to her surgeon to see if he agreed or had any other suggestions, but I doubt I'll hear from him today as he is the emergency surgeon at the practice and is normally busy all day. 

We got her out again this morning with the other two as we did last night - but this afternoon she wasn't budging. I'm hoping she will be okay and we can continue to ween her off the Gabapentin, though seeing her cry out is so tough.

 

Edited June 19, 2023 by Sundrop

[FiveRoooooers]

Sweet girl. Is she still eating and drinking ok?

[racindog]

When Ivy came home from having her leg amputated she also was NOT prescribed anything for pain. I was surprised and inquired but was assured that she did not need anything more than aspirin if I wanted to give her a little of that.  In fact she did not appear to be bothered by anything and jumped into our bed the first night home.  I was standing there looking at her and looking at the bed where we always slept trying to figure what to do and she knew it and just jumped in with no trouble  before I knew what was happening. 4 days later she was jogging with me again-and leading as usual- and felt like a million.  I think maybe its like one of the posters above pointed out -the pain from the surgery is nothing compared to osteo pain. My Ivy truly felt great very shortly after her amputation with no rx meds. She was on Fresh Factors because that stuff is magic and I keep all my dogs on that always. It also helped her to sail through weeks of chemo without so much as 1 sick day.

[macoduck]

Racindog, I'm surprised your vet okayed aspirin. I'd have been worried that it would cause bleeding at the surgical site.

[ramonaghan]

How's your girl doing, @Sundrop?

[racindog]

20 hours ago, macoduck said:

Racindog, I'm surprised your vet okayed aspirin. I'd have been worried that it would cause bleeding at the surgical site.

At first I was to but aspirin is really not as bad as its reputation w/ dogs I don't think. I adopted a broodie  STRAIGHT OFF THE FARM when she was 11 years old.  The man that transported her knew Aggie (Aggie Desperado) well and told me, emphasized to me, that I should be sure and give her her aspirin-one a day!  Well that was a bit much even for me but I could not argue with her health being so good so I followed suit but I did reduce it down to the 81 mg typical daily dose instead of the 325 mg regular size.  They knew her they loved her she was very healthy and it was important to them that she got that aspirin everyday and made sure I knew about it so I trusted them.   She did very well and lived to be almost 15 years old at which point old age caught up with her and she wanted to leave on her own terms which she did.  She advocated for senior greyhounds while she was here and looked almost more like a stock dog than a greyhound and she was a AAA racer despite being short in stature. People knew her from her successful career. I think she ran a lot at Lincoln Park.   Shout out to you Aggie! Sending love!  Never forgotten.

Edited June 21, 2023 by racindog

[macoduck]

Racindog, even Dr Couto has okayed aspirin, although I don't think it was for anything post-op.

[Sundrop]

Hi all! Kira is progressing, got her stitches out and began chemo last week. Took her in yesterday for her 1-week post-chemo bloodwork and all looks good. No infections, yay!

What is killing us now is her nerve/phantom pain. Our oncologist added Amantadine into her pain medication line-up (Gabapentin, 300mg 3x per day; Amantadine, 100mg 2x per day; Carprofen, 100mg 1x per day). For the past two weeks, she has been yelping/crying and jumping up. I understand the nerve pain, as I had total knee replacement at 42 when my nerves were firing like crazy! That is why they added Amantadine & upped her Gabapentin back to 3x per day. The issue is - it seems to be getting worse. She has had hours where she is yelping, crying out and jumping up constantly - every few minutes. Sometimes, it's every couple of hours.

Her incision is healed nicely except for one spot that is scabbing up and bleeding a little. Vet looked at it yesterday and said it was fine, no infection, healing nicely. 

We are trying not to overreact and cause her more stress at being coddled, but it's painful to watch. We are taking turns sleeping downstairs with her because she does this overnight also and sleep isn't great. 

Any ideas on how we can help? We're trying to desensitize the area, though she doesn't seem to have any sensitivity on the incision at all. 

[greysmom]

Sometimes more isn't helpful.  That's a lot of gabapentin.  And sometimes it can have the opposite effect from what you want.  She's past the point where she needs it for pain relief, so I would have a discussion with her onco about trying to gradually reduce the amount of gaba she's getting.  

Our dog by this point wasn't on any regular pain meds, or any meds at all except supplements.  If he had a pain flare or a bad day, we had codeine sulfate, and some 50 or 100 caps of gaba to give as needed.

If she'll let you ice the area that may help.

[cleptogrey]

Amantadine enhances the other pain meds. that was part of emily's osteo pain management cocktail.  it's a long haul, but just remember dog are far more stoic than us humans and we need to encourage that.  Just keep the love and special treats a comin-