A Leg To Stand On

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[Punch (brindle male, right front lower limb gangrene) and Zuka (Boerboel female, severe compound fracture of lower right hind leg), two of my Botswana amputations. Both of these pictures were taken at less than 24 hours after surgery — although Punch was pretty sulky about the leash, Zuka wasn’t shy about giving us a smile!]

Limb amputations are a relatively common surgery both in my current practice and during my volunteer trips. There are many reasons why a vet may wish to remove a leg; the presence of a tumor, a break which cannot be fixed for whatever reason physical or financial, nerve damage, severe soft tissue damage, infection…the list goes on. But amputations are one of my favorite surgeries to participate in for the simple reason of just how successful they can be at restoring life and removing pain. Read on for a glimpse into the life of just a couple of the amputation cases I’ve been privileged enough to work with.

Botswana. A brindle village dog of indeterminate lineage, stands just above my knee but weighs maybe fifteen kilos, sleek and slight, narrow nose, bright eyes, flopping ears. One forelimb wrapped in a bulky bandage. He came to our little outpost of a clinic without a clear history but when I start to cut the Vetrap and gauze from his right foreleg and the stench begins to rise I think we probably don’t need one. Skin falls away with the bandage material and sloughs in great weeping patches underneath my fingers; I’m beyond grateful I decided to wear one of our precious pairs of latex gloves when the first sickly-sweet whiff of rot reached my nose. The dog whines once, softly. What remains of his leg is swollen, cold to the touch, green-gray and crackly from the gas trapped under the skin. Whatever it once was, it’s gangrene now. My vet’s mouth twists. There are only two possible options here, and not much time left to decide on which. We present the owner with the options: euthanasia or amputation. There is no third option; even with the oral antibiotics and anti-inflammatories we coax down his throat in meatballs of canned food each hour provides the climbing bacterial infection with a better foothold in his slender body. I sit in his kennel after the surgeries for the day are done, watch him staring dully at the wall. I know our pain control can’t be taking it all away.

In the end the owner consents to amputation, and one of my vets steps up to be the one to take the leg. The surgery is nerve-wracking, I think for both of us — I nervously crack jokes and take photographs and give microdoses of the strongest anesthetic agent we have access to, and bless him my vet cracks jokes and laughs right back with me — I don’t think I ever asked him how it felt, if he had the same squirming terror in his guts that I did, but I look back and I wonder. When it’s over and the leg is nothing but deadmeat in the garbage can and a neat line of sutures forms a backwards C over his shoulder, we both breathe a little easier. The dog recovers in our bathroom at the cottage, floating on a morphine sea. We recover on our front porch with Hansa and Windhoek, chutney-flavored chips. We all sleep uncertainly that night.

The next morning, fourteen hours after the end of the surgery, just over half a day — the dog struggles out of our arms as we’re carrying him to the clinic and lands on three legs, takes a cautious bounce forwards. More wary of the leash around his neck than the missing right forelimb he pulls against us, sits awkwardly, overbalances and catches himself. When we offer a cookie bribe he scoots forward faster than I ever expected and snorfs the treats down before I can pull away, looking decidedly triumphant. It takes him roughly another six hours to figure out how to lay down and get up properly. By the end of the day I almost can’t catch him to get him in a kennel. By the end of the week another amputation has joined him and they race each other against the fenceline, a blur of legs so that if I didn’t know there were only six there I’d never have guessed. His owner thanks us over and over. When I go to feed at night he presses up against my legs, tail wagging slowly as he begs for his kibble. If he mourns the missing limb, if he feels the loss, I’ll never know — but I watch him walk, run, jump, bounce, wagging tail and lolling tongue and bright eyes and I know: this was the right decision.

 

Canada. She’s a younger dog, barely past her first birthday. A working breed, a little taller than most I know, a little more broad. A tricolor with delicate, feminine features, she pants up at me from her padded kennel when I first meet her, salivating from opiate-induced nausea as we try to keep the grinding pain of a shattered hindlimb at bay. Her x-rays are still up on the computer. Just looking at them makes me uncomfortable; there’s a deep and visceral revulsion at the sight of bone looking so wrong, my mind firmly putting its foot down, that is not what that is supposed to look like. Under the splint we’ve applied in hopes of making her a little more comfortable there’s torn skin, and under that I know there’s pale splinters of tibia and fibula meeting the outside world the way they were never meant to do. An IV line runs warmed saline and antibiotics into her vein. She flaps her tail when I go to stroke her ears but as soon as my hand slips back to adjust the blanket her lip curls, a soft warning whine-growl that I imagine in English would sound like don’t touch. 

It could be fixable. It’s just possible that surgical steel and wire could bring those fragments together and that a young body, a strong body, could lay down the framework for new bone. The recovery would be long and painful. The cost enormous. Success is not guaranteed. The owner opts for amputation with a grimace on his face like it’s giving up, like it’s settling for second best. He’s struggled with the decision, still struggles with it. We do our best to reassure him; tell him how well she’ll do, how happy she’ll be. I don’t know if he believes us. I tell her the same thing that night as I carefully carry her outside to pee. I know she can’t understand me but it makes me feel better, anyway, especially as she tries to take a cautious step on her own and cries out as her splinted toes make contact with the frozen ground, as she stumbles trying to fling herself away from her own body, curling into an impossibly tight circle to snarl at the leg before I can grab her and sweep her up off her feet. She doesn’t understand. She stares at herself and then at me with a look of hopeless betrayal; there is pain and she does not understand it. I bite my lip. Tomorrow, I tell her, entirely for my own benefit. Tomorrow will be better.

The surgery goes as smoothly as can be expected. An epidural keeps the worst of the pain away and a dedicated technician tends to her every need under anesthesia while two pairs of skilled hands lift the splintered wreck of her leg away and leave only smooth sutures in its wake. She recovers wrapped in heated blankets with extra sedation at hand to smooth the confusion of recovery, stroked and patted and loved by every tech, vet, assistant, and receptionist who passes by her kennel. The next morning when we go to take her out we keep a blanket sling around her hindquarters, support her weight, hold our breath as she takes a cautious step forwards. Her hip drops, a step with a leg that’s just not there anymore and I know — I know I’m anthropomorphizing but just for a moment I think I see her eyes open wide with the realization that there’s no grind of bone on bone, no sudden spark of pain. That the break is gone along with the leg.

When her owner arrives to pick her up a few hours later, she hops her way cautiously to the door. When it opens and she catches a glimpse of him, standing at the counter a few feet away, her whole demeanor changes. She darts forward almost quick enough to pull the leash from my hands, tail wagging almost hard enough to send her off balance as she bolts to his side and stands on her one remaining hind leg to plant both front paws on his thigh, panting adoringly up at his face. He kneels, holds her chest, strokes her ears and her cheeks and runs his hands down her sides and she doesn’t even blink as he passes over the shaved hip, fingers stopping just shy of the sutures. When he closes his eyes, she licks his face.

They walk together to the door, step by step. I hold it open for him and he turns as he steps through into the wintery air, his dog already pulling for the truck with as much leverage as her remaining three legs can give her. He smiles.

This was the right decision.

Author

81 comments

  1. Hi Rose,
    I really enjoyed these two stories. I have seen in the past dogs who have lost a leg and I always marvel at how well they do.

    Hope everything is going well with you in your vet “teching” and web “siteing”. Obviously these are not words but they get the message across.

    Reply

  2. Great article. My two tripod cats survived and thrived thanks to amputations. Any advice on preventing injury to the remaining limbs due to arthritis or over use?

    Reply

    1. That’s an awesome question, Donna! Generally speaking we suggest preventative care more than anything else; high-quality joint supplements with glucosamine and chondroitin in appropriate levels (green-lipped mussel is also becoming more popular) along with maintaining a healthy to slightly slim weight! Regular wellness exams to identify any signs of injury or damage can help to catch small issues before they become big problems as well. Keep a close eye on the foot opposite the missing limb to ensure that toenails aren’t being worn unevenly or damaged. If and when arthritis does develop, there are tons of options for pain control which can be tailored to your kitty’s needs to keep them happy and pain-free. Hope that helps! 🙂

      Reply

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