It was July 4th when the Facebook post came across: a sad photo of a young black and white dog with a severely mangled rear foot. Dallas Animal Services needed a rescue group to take this poor guy ASAP for care. Mazie’s couldn’t take him due to lack of fosters. (Hint, hint: we NEED fosters, registered and ready for cases like this! Goto maziesmission.org to fill out an application. We pay the bills, you provide the love and care.) Sorry for the sidebar. I spent the rest of the holiday wondering if another rescue group pulled him, or did he have to be euthanized because of his condition?
About a week later, I saw an appointment on the books for a dog named Fletcher, to examine injured rear foot. I wondered if it was the same guy. Sure enough, it was! Fletcher was rescued by the always amazing: Dallas Pets Alive!
My job at Mazie’s was to evaluate the foot to see if it could be saved.
First off, Fletcher is a dashingly handsome, SUPER cool and upbeat dog. He has such a sweet, friendly personality, that it was really hard to believe that he had been surrendered to the shelter, not once: but 3 times in his short life (he’s less than a year old).
This is an awesome dog y’all.
Anyhoo, Fletcher just wagged away and gave us kisses while I removed his bandage to reveal his horror story of a foot. X-rays from the shelter indicated that all of his metatarsals (basically “foot bones”) on the affected foot were broken. Couple that with the fact that his foot had swollen to boxing glove proportions. Add to that the grey-green pus hanging out under the bandage. This whole picture leads to a non-salvagable foot. It’s hard enough just to get one fractured toe to heal (generally they never heal right) trying to save 4 of them is just not gonna happen, not to mention the months of painful wound care. Totally not worth it. This guy needed an amputation sooner rather than later.
My boss had run off to the Bahamas to get married, so the job of doing this surgery fell upon me. In my old life in private practice, I didn’t do much surgery. I had done a couple amputations, but they were front limb, not rear. Dr. Shults assured me that front limbs were way harder than rears, this would be a piece of cake. “You got this” she said.
I got out my trusty surgery book and got to studying. I quickly bogged down in fancy anatomy terminology that I hadn’t thought of in about 24 years. Currently, my rear limb anatomic vernacular consists mostly of “thigh muscles” and joints. Suddenly, I’m reading about dissecting away the semimembranosous muscle from the semitendinosus and finding the pectineus, etc. We’re talking paragraphs of muscles to identify and transect.
I started to sweat a little.
I was relieved when I realized I was looking at the surgery technique for amputation at the hip joint. Apparently that’s way harder (and actually harder for the dog) than the mid-thigh amputation that I was advised to do.
The mid-thigh amputation section of the book was just one big paragraph. Much less intimidating.
That night I had a Collin County Veterinary Medical Association Meeting. As luck would have it, not only was the shelter veterinarian (who made sure Fletcher escaped the gallows and got released to a rescue for care) at the meeting, but a very well respected local surgeon. I found myself in a circle of these plus two other vets who loaded me with advice on performing Fletcher’s surgery. One of the vets even came over to Mazie’s the next day to assist (many thanks to Dr. Haixia Kong from Allen Veterinary Center).
Everything went really well with the surgery. One of the vets I spoke to at the VMA meeting told me “You will have your book, open, sitting next to you. You will be carefully identifying and excising each muscle by name, when you will reach a moment where you will say %$C# this, and just start hacking stuff away.” Actually, multiple surgeons told me this, and sure enough, I reached that point (obviously taking time to correctly tie off vessels and nerves).
The hairiest part of a mid-thigh amputation is the actual cutting of the bone. Fancy clinics and surgeons have actual power tools to do this. Our fundraising has not reached this level of fanciness (YET! Donations always welcome!) so we have a thing called a “Giggly wire”. I don’t know if that’s how it’s spelled, but I’m going to choose to spell it that way because it’s funny. It’s a wire, with another wire wrapped around it,, that somehow gives it cutting properties. Our friend, Abbie (from the official poop removal company of Mazie’s Mission: Poo B Gone) had popped in for a visit (and subsequently stayed to spectate the surgery) and informed us that people use those wires to cut PVC pipe in sprinkler lines*. Somehow that brought me comfort to know that the Giggly wire was invented to do more than just hack bones in half. *Our Gigli wire is an actual medical device, that was properly sterilized. I don’t want you thinking we’re doing surgery with equipment from Home Depot.
Cutting a femur in half (well, really I’m transecting the bone in the proximal 1/3, but “cutting in half” is just easier than, what, 1/3?), is kind of an odd experience. I’m no hunter, butcher, or murderer, so it’s not something I do on a regular basis. First you have to basically cut away all the meat from the bone, then someone has to go under the surgery drape and hold the leg so it doesn’t just fly off when you cut it. The actual act of sawing with the wire is not easy. You have to put your muscles into it. Sawing back and forth until you get a purchase, then continuing the motion to get through. The wire gets dull, then gets stuck and you have to un-stick it to keep going. It’s kind of a slow, gory process.
We have such an amazing team at Mazie’s. By this point, the whole staff had gathered to watch, and before I knew it, I had a cheering section egging me on. At one point, someone got their phone and started playing “Eye of the Tiger”. A mighty hurrah erupted from the crowd when I finally got through the femur. I admit, if felt pretty good.
Once the bone is cut, the rest of the surgery just consists of sewing together the transected muscles, so that the remaining hip has plenty of cushioning. That’s why the mid femoral amputation is the preferred method, it essentially gives them something to sit on (removal at the hip joint removes all the him muscles, so no cushion).
A word about prosthetics. I really wished I didn’t have to take off Fletcher’s whole leg because of a foot injury. If his foot hadn’t been rotting off for the last week, I would have loved to look into that option (it’s not commonly done, I didn’t know what’s involved or who to contact.) Unfortunately, time was an issue: he was in pain and infected, he needed surgery ASAP. Furthermore, an amputation is a whole lot cheaper than a prosthetic (We do have a dog in the Mazie’s system named Nubs, born without back feet (or they were chewed off by her mom, we’re not sure), who was fitted for prosthetics this week for around $3500). I’m not sure what the amputation cost the rescue, but it was likely less than $700.
Back to our story: pre-op, another cool thing happened. Pain control is important to us at Mazie’s and we’re a little limited on options due to cost of the medications. I had read about using certain cheap and readily available drugs in a constant rate infusion (via IV) to give prolonged pain control in surgical patients. The problem with CRI’s is that they require math to do correctly.
Math isn’t my strong suit. Thus, I started to stress: God knows I don’t want to successfully amputate Fletcher’s leg, only to overdose him on pain meds. However, I know this amazing veterinary anesthesiologist over at Animal Imaging in Irving. Her name is Dr. Carrie Davis, and she’s a total Rock Star. I texted her in desperation, and not only did she give me the correct recipe, for the exact and successful administration of the CRI, but she offered to walk me through how to do an epidural (I actually had another friend, a licensed veterinary technician lined up, to physically show me how to do one). However, alas, we lacked the proper equipment to do the epidural (another thing your donations can help us get!)
Here are some gratuitous before and after photos of his incision:
Well, this was supposed to be a quick blog, with a bunch of pictures, so in typical fashion, I totally failed to keep this at the ideal cellphone worthy 300 words or less. Fletcher’s story is definitely a tale worth telling, of the dedication, collaboration, and ingenuity we use at Mazie’s to provide the best possible care to our precious rescue patients.
Special thanks to Dallas Pets Alive! for their continued support of Mazie’s Mission and the wonderful work they do to care for animals in need. For those of you wondering, we are not a free clinic. We provide deeply discounted services to animals in the rescue system. We survive on the fees we charge our member rescue groups, and donations, which make up the difference between what we charge and what regular vets charge. We do not see privately owned pets.
Fletcher is up for adoption, check him out here!
Mazie’s Mission has a brand-spanking new website! Please check us out!
Fletcher’s last recheck visit to Mazie’s. Looking great!