A Small Thing Helps a Big Dog

June 29, 2008

By Eric Davis, DVM

HSVMA Rural Area Veterinary Services (HSVMA-RAVS) is most challenged when working in isolated communities, but that doesn't mean the team of dedicated professionals isn't prepared for a new kind of challenge.

It was through our collective experience and advice from specialists in the veterinary profession that we were recently able to use a humane, cutting-edge way to help a big dog in a small town.

The best option

Our team met Socks, a shepherd-mix resident of the tiny settlement of Mandaree, North Dakota, who needed relief from the pain associated with an untreated injury.

Since his guardian was without access to veterinary care, Socks went several weeks without treatment for his injured shoulder, causing the shattered joint to swell beyond healing and the pain to become more unbearable. Socks couldn't bear weight on his front leg, and since it couldn't be fixed, the leg had to be amputated.

Sometimes amputation is the best choice for old, unhealed fractures, infected joints and gangrenous legs—all of which we see a lot in the field. However, removing an entire forelimb or hindlimb poses significant problems.

Devising a plan

Although HSVMA staff and volunteer veterinarians are skilled in the procedure—which requires large blood vessels and nerves to be severed—we had to consider aggressive pain management techniques, as post-operative discomfort from amputation can be quite severe.

Socks
Socks sporting his T-shirt and special pain-control device.
Windi Wojdak/HSVMA

In general, pain can be controlled using a variety of techniques, including oral and systemic usage of drugs such as morphine. Epidural analgesia, which involves admistering painkilling drugs directly into the spinal canal, can work very well for hind leg amputations.

However, in Socks’ case, his entire left front leg had to be removed. The HSVMA staff had to choose a simple, yet effective technique to prevent him from experiencing pain.

In the last few years, some of the most prestigious veterinary teaching hospitals have been using catheters, which are placed in the surgical area before the muscles and skin are sutured back together, to control surgical pain. Tiny perforations in the tube allow drugs that anesthetize local nerves to seep out into the tissues, effectively preventing the patient from feeling anything at the amputation site.

Exceeding expectations

Sock’s amputation went very well and a catheter was placed at the site for pain management. A pump,which is a balloon-like device attached to the dog’s collar, was then attached to the catheter that would very slowly inject analgesics directly into the catheter, thereby relieving discomfort.

As Socks recovered from anesthesia, it was evident that his pain management plan was working well. Within a few hours of surgery, he was looking more comfortable than he had been during his pre-operative examination.

He never whined or showed any evidence of pain. By the next day, he was walking around the clinic on three legs, investigating everything in a typical happy dog fashion.

Socks got a large T-shirt with one sleeve tied off to protect the incision and stayed with the team for four more days.

Nobody gets attention like a three-legged dog or a three-legged cat, especially one in a T-shirt with a balloon pump on his collar! The pump made him look like a St. Bernard with his flask of brandy, ready to rescue skiers in the Alps.

However, it was ultimately his personality that made everyone want to take turns taking him for walks or sitting next to him.

At no time did Socks show any signs of discomfort or even disability—he had already learned how to walk on three legs. By the time the catheter was removed, the surgery site was healing well, and Socks only needed some long-term antibiotics and oral analgesics, which his owner could administer.

Socks went home and joined a long line of animals who got special care from the HSVMA-RAVS staff and volunteers—not to mention one who benefited from cutting-edge treatment.

Dr. Eric Davis developed the HSVMA Rural Area Veterinary Services (HSVMA-RAVS) program in 1995 and has served as mentor and inspiration to hundreds of young veterinary professionals over the years. He continues his hard work in the field and is currently a consultant for the program.