First and foremost, Gambino (aka “Tony”, aka “Gambit”) is recovering beautifully. He went off fluids and onto oral medications (as opposed to injectable) yesterday. He’s starting to get the hang of this new three legged walking thing.
If you’re just tuning in and want to know what the heck I’m talking about, start here.
Next, a word about amputations in pets. The moment you mention the word amputation to a client, almost always, a look of horror comes across the owners face, followed by “I can’t put him through that”. This is when I switch into a vague panic mode: I have to convince these people that amputation is ok in this circumstance, and it may save their pets life.
We don’t recommend amputation lightly or often. However, situations arise: trauma (like Gambino), and cancer are probably the most common reasons for limb amputations in pets. Some cancers can be totally cured with amputations. (Heavy emphasis on the “some”. With highly malignant and aggressive cancers like Osteosarcomas, amputation may slow things down and give the dog pain relief, but for a limited time only.)
The thing is, that in a healthy dog or even cat, with the right circumstances, amputation recipients learn to handle their disability beautifully. I find it down right inspirational, really. After a short period of adjustment, pets seem to think: “Hm, well that’s weird, I’m missing a leg. Well, life goes on and I’d best get on with it.” Generally ,they adjust, learn, and live happy pet lives to the best of their ability. Animals don’t linger on the negative like humans do, they just focus on the positive and move on. There is so much we humans can learn from that.
So on with Gambino’s surgery. In our practice, generally the docs do surgery alone with a technician to monitor anesthesia. This time Dr. Cook and I got to do it together as a team and it worked great. The pup was premeditated with a sedative called acepromazine and a narcotic called hydromorphone. The purpose is to just relax him (nervous, hyped up dogs don’t do as well under anesthesia) and get pain control on board early. (research shows that the more you do to control pain before it happens, the better the effect of the medications and recovery of the pet after. ) We induced anesthesia with propofol (The Michael Jackson drug, very safe when you actually MONITOR the patient receiving the drug, unlike MJ’s doctor’s technique of giving it and walking away.) Next he was intubated (breathing tube in the trachea to deliver anesthetic gas and oxygen) and placed on inhaled anesthetic.
We also started him on a Ketamine constant rate infusion (CRI). We hate CRI’s because they require math and all vets hate math. However, Dr. .Brewer found a handy dandy website that does all the math for us. So, Ketamine (Inexplicably and illegally abused on the human side as a hallucinogen, is used to induce anesthesia in veterinary patients. It’s super safe, and at low, low doses, given by infusion, provides excellent pain control).
After that, our super wonderful technicians hook him up to a plethora of beeping monitors (we monitor blood pressure, heart rate, respiratory rate, oxygen saturation, CO2, and temperature), then shave and sterile prep the surgery site.
Gambino gets transferred to the surgery suite next, where we position him, reconnect all the monitors and get him sterilely draped up in preparation to operate. Dr. Cook and I, in our super sexy surgery attire then proceed with operation Rotten Limb Removal.
Sidebar: I just started watching The Walking Dead. Over Christmas break my husband and I may or may not have let the kids play too many video games in order to binge watch seasons 6 and 7. I’m now watching season 1 on my own (hubs has seen it). Season 1, episode 2 features a scene where the live humans smear zombie guts all over themselves to deceive the zombies into thinking they’re dead too. Let me just tell you, you could smell Gambino’s leg from about 5 feet away. It was bad, giving me a whole new respect for the dead-zombie smell of TWD.
Back to the surgery. The whole thing took about two and a half hours. The amazing thing about front limb amputation, that set the audience of enthralled pre vet students to semi revulsed squealing, is that the arm is basically just strapped to the body by a bunch of muscles. You incise the muscles off the shoulder, tie off those big blood vessels, cut the nerves (after application of local anesthetic) and the arm just pops right off. No sawing required.
Prior to closure, I injected what I could with that Nocita long acting local anesthesia product. Then doctor Cook and I each started at a different end of the incision and started sewing all the muscles and skin back together.
He was handling the anesthesia beautifully, so I quickly neutered him, then after a second dose of hydromorphone, we took him to recovery.
He’s spending the weekend at North Texas Emergency Pet Clinic with our technician, Lauren and their wonderful, generous, kind staff.
He’s doing so well, that I suspect he will goto his new home next week.
Talk to you soon, and if you’re of that persuasion: Go Cowboys!
Here are some pictures, there is one intra op picture that might be a little bloody for some, so don’t look if you’re squeamish!