Good news everyone. Bender is coming home today after a long stay in the animal hospital.
As mentioned in my previous post, Bender experienced uncontrolled nerve pain pre/post amputation. This pain was not managed with oral medications or hydromorphone injections (injection would last two hours and should last 6 ). As a last ditch effort to break the pain cycle, Bender was placed on a 72 hour constant rate infusion of ketamine and opioids. Bender appears to be doing much better and is no longer screaming in pain.
I hope the oral medications (Amantadine, Pregabalin and Amitriptyline) can control the pain going forward.
I will keep everyone updated on his progress.
Until I can take some post amputation pictures, here are a few more with all four legs.
Bender initially presented with lameness in his left forelimb and underwent x-rays to determine the cause. The first round of x-rays showed no sign of cancer but indicated elbow dysplasia and arthritis. He was prescribed Meticam for the inflammation and started on Cartrophen, Glucosamine HCI and fish oils right away.
The lameness progressed and another round of x-rays were ordered 3 weeks later. Unfortunately, the radiographs showed signs of bone loss around the elbow. Bender was prescribed antibiotics for possible septic arthritis, blood test to rule out fungal infection and scheduled for a soft tissue biopsy.
Within 2 weeks the biopsy and new x-rays were taken. Both indicated cancer and advanced histopathic stains were ordered. 7 days later the stains came back positive for histiocytic sarcoma (changed to Myxosarcoma post amputation). He started Gabapentin (300 mg x 2 per day), Amantadine (100mg x 1 per day) , and Tramadol right away. I also layered in Curcumin for potential protective effects and to counter the skin dryness caused by Meticam.
Our vet scheduled an amputation at the teaching hospital (only one in Canada) right away. Within the two week waiting period, Bender’s lameness progressed and the limb began to atrophy. He also started to exhibit severe pain in the form of screaming and inability to get comfortable. The day before the amputation Bender was flat out screaming in pain and required heavy sedation.
The amputation included his front left forelimb and shoulder. The surgery was uneventful and he returned home 5 days later. The first few nights were amazing, we were dealing with a new dog that was free of pain. This quickly turned into a nightmare as he regressed into severe pain uncontrolled by any oral medications. We admitted him to the teaching hospital for better pain control and further testing. Everything checked out clean and they were unable to nail down a cause for the pain. The surgeon was leaning toward wind up pain resulting from fast disease progression and location around the elbow (involving nerves and bone) pre-amputation. This resulted in extreme nerve sensitivity and pain.
In a last ditch effort to control the pain, Bender is undergoing a 48-72 hour constant rate infusion of Ketamine & Opioids. They are also assessing the feasibility of a secondary nerve block (very hard to do because of the location).
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