Tuesday, July 22, 2014

To Amputate Or Not To Amputate: Heidi's Story

by  Krista Magnifico, DVM

As a veterinarian there are so many talks that you discuss so many times that you feel as if it might just be a whole lot easier to video tape the discussion, push play when the next appropriate patient presents, and pop back in the exam room to discuss the final details of the treatment plan.

Wouldn't it be so simple? 

You bring your pet in, I diagnose the problem, tell you how to fix it, and then we schedule it the following day.

No wasting time, no idle insignificant chit chat, no silly feelings about your pet "not wanting to go through any procedures," or ridiculous excuses about “sparing them from the hardships of recovery,” etc. etc.

It can be frustrating to feel as if I need to repeat the same thing over and over. 

And yet, I’ll do it tomorrow, and the day after, and the day after,.Its my job. To tell you what disease, condition, ailment, need, etc., that your pet has and how I suggest it be treated.

How do I keep myself from feeling like a broken record? Well, I employ my clients to serve as future character witnesses, provide their own personal experiences, and pass it forward.

Here is one story I find myself repeating often. It is about bone tumors.

In large breed older dogs that present to me with swelling, lameness and intense pain at the site I will place a bet that your dog has a bone tumor. The diagnosis is usually pretty easy. OK, well, I should back track a bit and clarify.

In the earliest stages of bone cancer it can be difficult to pin the diagnosis exactly. Because your pet knows before the x-ray does that there is a problem.

The typical presentation of a bone tumor is a progressive limb lameness that persists.

On the first trip to the vet we corroborate your suspicion; The leg hurts and the pet is limping.

The normal course of events after that first trip is to prescribe an NSAID, (a non-steroidal anti-inflammatory) and monitor for response to treatment and resolution of clinical signs, (they stop limping). These work very well on pain and inflammation associated with osteoarthritis (OA). Most older dogs, just like most older people, have some joint pain because their joints get sore after years of wear and tear.  A response to treatment is a quick, cheap, easy way to help confirm a diagnosis. If we are right, and if it is just OA, then the medications lessen the inflammation which in turn will help alleviate the pain. If we are wrong then the owner will call back in a few days/weeks and report that the lameness is worse, or no different.

Trip number two is for a re-check and x-rays.

Depending on the degree of bone destruction we may or may not have visible evidence on the x-ray.

 (One little tip here from a weathered vet; take the x-ray of the whole foot..shoulder /hip to toes. It makes you look like a bone head when you miss the big lytic (destruction of bone) lesion in the foot because you cut the film short).

If there is a lytic lesion on the bone it is most likely a bone tumor, and the most common bone tumor is an osteosarcoma.

Osteosarcomas are incredibly painful aggressive tumors. They essentially eat away at the bone until it crumbles. They also spread fast! Those little microscopic cancer cells will hijack a ride through the bodies internal highway system (blood stream or lymphatics) and land in remote areas where they then lay down roots and begin to eat away at another part of the body.

After you and I have gotten to this point the waters get muddy and the navigational gear gets all screwy.

The dance of the decisions, the debating, the doubt, the second guessing, hesitation and indecision begins.

Here’s where I'd like to take the command and remove you from the bridge. What I really want to say, “OK, I got the wheel. I am steering the ship. Here's what you need to know: The estimate for surgery is $800 - $1000, average lifespan after surgery 6 months. But, trust me, your pet will be happier because they will no longer be in pain."

At which time you say, “OK, thanks doc, see you tomorrow for surgery.”

Now, I understand there is a lot to discuss. But remember I have had this discussion about 300 times before you, so in truth, I’m not looking forward to number 301.

Here are the arguments and points of discussion that pet parents have:

Number One:
“I don’t want to put my dog through that.” OK, I’m going to put on my best “be nice” face. Your dog is in an immense amount of pain. That pain is manageable only for a short period of time. At some point we will be putting your dog down because they refuse to move, or eat, or do anything because they are in so much pain. SO, if you are telling me this I will remind you that not taking that leg off is not wanting your pet to be pain free. Be honest. I think that most people use this excuse because they don’t want to put their wallet through the procedure.

Number Two:
“He will be unhappy with three legs. I can’t do that to him.” My response; Your dog is already three legged. They are just three legged with one additional painful rotting limb stuck to them. Another important point to remember is that at some point the cancer will eat away so much of the bone that it will fracture, or crumble.

Number Three:
“The recovery will be too much on him.” Like the current excruciating minute to minute with no chance of relief in sight is better?

Now, I understand that I am not being subtle. 

Here’s why. I cannot stand seeing an animal in pain if there is anything that can be done about it. So get over your phobias, and cosmetic disfigurement, and get that damned leg off!

Here is a story of a patient of mine. Her name is Heidi.

Heidi was an older mixed breed dog who presented with the above scenario.

Her dad is one of the most devoted genuine guys around. He is direct, honest, and not at all uncomfortable making you uncomfortable when it comes to his pets. I like him all the way around. We are kismet. I get him. I don’t mince words, and he doesn't tolerate it to begin with.

When Heidi first came to see me she was lame, exceptionally lame. 

She was in pain all the time. He knew he had to do something and he was leaning towards putting her down. When he said this I started to pull out all of the tricks of my medical bag.

There was arm wrestling, and some somewhat questionable, unethical promises. I also pulled out the “past experience” card. He was so stubbornly stuck on not being able to put her through surgery that I doubled down and confided to him:

"If Heidi was my dog I would take her leg off.”

Now I’m going to be really honest. I hate when vets do this. It is coercion in my opinion. We should never ever use this as a way to persuade. While I’m being so honest I will also admit that I do say this. For my friends I feel OK saying it.

Before I convince you to take a bad terminal leg off, do your due diligence. 

A pet that is a candidate for amputation should have a full bloodwork and urinalysis done. They should also have a full 3 view set of chest x-rays. If everything is clear and normal I recommend amputation.

If there is evidence of metastasis to the chest than the prognosis is poor and the floor is opened up again for discussion and debate.

I have some distinct advantages to being so sure footed here. I have years and years of cases to use as my precedence. I have never had one owner tell me that they regretted amputating a leg after they did it. Every single pet a week later was a thousand times happier than they were the day before their surgery.

Taking pain away from a pet is giving them back their life.
"Within 24 hours of her amputation, Heidi was remarkable.  I brought her home, using a towel sling to carry her into the house.  What did she do immediately after I released pressure on her towel sling? She took off on her own accord across the house to go to her water bowl and then down the hall to her bed.  We were moved beyond words by her strength and resilience."  ~Heidi's dad

About a year later Heidi passed away at the clinic with her dad and I. 

She was unable to hold herself up anymore. Before her surgery her hips were weak and arthritic and the additional stress and strain her body had to carry with the loss of her front leg made the hip stress more pronounced. Her dad bought a special harness for her with a handle to help her get up and provide an extra point of stability. The harness was also the way that her dad could help carry some of her weight and keep her from slipping or falling.


Krista Magnifico, DVM owns a small animal hospital in northern Maryland, where she practices everyday. She wants to make quality veterinary care available to everyone, everywhere at any time; trying to save the world 1 wet nose @ a time.  Her blog is a diary of he day-to-day life & the animals and people she meets. 

Dr. Krista is also the founder of pawbly.com, free pet advice and assistance.

To contact her, you may leave a comment on her blog, email her or catch her on Twitter or Facebook.

Articles by Dr. Magnifico:
Don't Make This Mistake: Ruby's Death To Heat Stroke 
Parvo: Cora's Story 
Jake's Laryngeal Paralysis
The Tip Of The Iceberg: The Unexpected Dental Dilemma
The Ear Ache That Wasn't Going Away: Tottsie's Story
Cody's Eyelid Tumor
Ruger's Mysterious Illness
The Day The Heart Stood Still: Timber's Story 
Different Definition Of Comfort Food: Levi's Story 
Savannah's Pancreatitis  
Histiocytoma: Rio's Mysterious Bump
Von Willebrand's Disease: Greta's Story 
Alice's Heart Murmur  
Jekyll Loses His Tail Mo-Jo 
Pale Gums Are An Emergency: Bailey's Story

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!


  1. Just want to give a big shout out to Dr. Krista, she is so right! If anyone wants proof that dogs and cats can do great on 3 legs, one visit to the Tripawds.com community is all it takes. Whether you're fortunate to have your pet around for years afterward or just a few months, that time together is precious and icing on the cake when it's spent without the horrible pain of bone cancer. Thank you Dr. Krista! We need more vets like you.

    1. I've met a few in my life and they were as if they had all their legs. Running, playing ... of course, I met those on our hikes; there might be some, such as at the end of Heidi's story who do have problems having the remaining legs carrying all the load if there are other problems going on.

      With Jasmine, for example, it would had been a tough call, since she had both knees operated on, was getting sore muscles quite often and had arthritis just about everywhere. I think it also makes a difference whether it s front or hind leg. Since the front carries majority of the load, I would be more concerned about losing a front leg than a hind one.

      To eliminate pain and prolong life, though, it is the best solution.