Pain Management – Dealing with Vets

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Fang - The hunter
Fang – The hunter

This amputation is my first really major run-in with the vet. Sure we’ve gone there for shots (though rarely, and now that I know the rabies vaccination can give your kitties tumors, I’m probably never doing that again either!), and to get my doggy put to sleep two years ago (old age, throat collapse), but not for major surgery. I sort of expected that all vets would be equal and know what to do – wrong.

One thing I’ve learned is that you really have to take your cat’s medical care into your own hands and make sure that your vet is really doing what’s best for your baby. I am so appreciative that the people at Tripawds Forums know about what to expect and what to require as far as an amputation goes, because I was going into this blind. They offered these articles, which I highly recommend, about what to expect from the vet, and what to ask them about:

How to Choose a Veterinarian for Amputation Surgery

Dr. Kay’s 12 Things to Expect from Your Vet

I was also suggested by a few people (both at home and on forums) to go out and get a second opinion, which I would also highly recommend. I called the Vet School nearby, and a surgeon there was kind enough to say that he would consult with me via email regarding my cat’s amputation. Unfortunately, he didn’t email me back. However, I was lucky enough to be able to chat briefly with a vet on Tripawds Forums and it did make me feel a lot better. I wish the guy from the vet school would get back to me, but, I’m glad that I at least tried. Getting a second opinion helps to (1) make you feel better that you’re doing the right thing, and (2) figure out what the gaps might be in your current vet’s care and assess whether or not those gaps are okay.

For example, I love my vet – she has a relationship-based way of providing medical care and she is always willing to answer my questions by email during her off-hours. That’s a huge deal. She is also willing to let ME decide what we should do with Fang – she doesn’t presume that she can choose what’s best. She is also really flexible, and obviously feels like my comfort level is very important. The hospital she works at is open all night, with trained staff and at least 1 doctor there at all times. The surgery is done with two assistants in addition to the surgeon (my vet), and one of those assistants is trained well enough that they could actually perform the amputation themselves. All of these things make me feel much better about the amputation – and I would never have known if I didn’t ask (and if I didn’t know to ask – thanks guys).

However, there are some issues with pain management, and these are issues that you really really need to discuss with your vet.

Pain Management

People I’ve talked to about amputation (who have gone through it with their pets themselves) have been kind enough to tell me that vets have extremely different approaches when it comes to pain management. Apparently theories have changed over the years, so vets trained in the recent-ish past may not do as much to PREVENT pain as they do to treat the pain once it occurs. This is an issue, because there are things that can be done to prevent some of the pain from ever occuring.

The most important things seem to be: (1) administering Gabapentin before the surgery (2) using nerve blocks during the surgery, and (3) using a morphine drip during and after the surgery. Talking to your vet about these things is important. For example, my vet does not use Gabapentin, but was willing to try it because I asked. My vet does not use a morphine drip – they use a fentanyl patch which is a a pain patch put on his foot that releases fentanyl for about 4-5 days, that way he has it when he goes home too. I still don’t know if this is better or not, but I wouldn’t have known to even ask. My vet generally does not send home oral medication in addition to the fentanyl patch, but is willing to give me a liquid one as well just in case I need it.

After talking with her I feel much better about the surgery, and feel like I did something to help his recovery be better than it would have been otherwise. I also, through this conversation, found out that my vet is really flexible and willing to do things the way that I would like them to be done. She has been an excellent mediary between myself (no medical experience) and the medical world. I really appreciate that.

But remember that no vet is perfect. Phantom limb pain occurs in lots of cats (and dogs), but my vet had never heard of it. This was the most worrying thing for me, and one of the biggest reasons that I was seeking a second opinion. I am still unsettled about this issue, but feel like the additional pain prevention will also help to prevent the phantom limb pain. My vet believes that arthritis is not often an issue with three-legged cats, but forum members who’ve got three legged cats have recommended that I start Fang on a joint supplement. I love my vet, and I feel confident in her, but there are differences in medical opinion out there, and it’s your job as loving owner to find them.

My point is that the reality of the situation is that you need to ask and find out what is really going on at your vet’s office. You need to be sure that your vet is the right one for the surgery, and that their facility is the right one for the surgery. YOU need to do the homework and be an advocate for your pet because you cannot, cannot, cannot assume that the first vet you went to is going to be the best one for your kitty.


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Setting Sugery Day

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Surgery day is set for this Saturday, 11/3/12 (my birthday, as it were). I am agonizing over it. Half of me thinks it’s too soon and I want to put it off, and the other half worries that I’m waiting too long and by the time Saturday comes Fang’s tumor will have started to hurt him. I guess all I can do is hope for the best.

The good thing about it being on my birthday is that I’ll have people to talk to to keep me from going absolutely nuts. Maybe.

A Second Visit to the Vet, and Shopping

I had to take Fang to vet again today – I hate taking him to the vet! Even for minor blood work and X-Rays! His crying from the cat carrier makes me want to cry!

I’m going to be a terrible parent one day.

Anyway, we went to the vet for the pre-surgery checks to make sure that (1) he’s healthy enough for surgery, and (2) he doesn’t look like cancer has spread to his lungs. The blood-work comes back tomorrow, but I am happy to report that his lungs apparently look normal, and so does the rest of him. That’s the first bit of good news in a long while.

Fang's chest X-Ray, Side
Fang’s chest X-Ray, Side

 

Fang's chest X-Ray, Under
Fang’s chest X-Ray, Under

The Vet also gave us some Gabapentin to administer at home before the surgery to lessen the likelihood of phantom limb pain, which is really good. So, $500 later we are feeling better about Fang’s health all around.

Shopping Makes You Feel Better

In other news, now that we’ve pretty much made our decision to amputate (although I still have my roller-coaster moments – mostly when I watch videos of three-leggers and imagine Fang that way), I’ve been able to find a little piece of mind by getting the house ready for Fang’s recuperation time. I went to the store and bought:

(1) Gerber Onesies. (Hind sight: Lots of people say they need these, but I didn’t. Fang was totally uninterested in the staples.) Fang hates cones – they make him depressed. I’m sure onesies are no fun either, but I’m thinking their better than cones, and they’ll keep him away from his wounds. At the moment he’s too pissed at me to let me try one on him (I bought size 0 ones, and also size 0-3 months – it was hard to gauge at the store), so we’ll see which one’s fit better tomorrow. Then I’m going to sew up the left armhole, and cut the right armhole bigger on each one. Yep. He’s going to love it.

(2) A Soft Bed. Fang is an outdoor kitty, and I don’t have any cat beds around the house for him to lounge in. But, for the recoup time he will need to have one so I found the very softest one I could find and brought it home! I’m going to put it in the bed with us tonight so it smells more like us, because I just put him in it and he jumped right out. Not interested. Then again, he’s pissy right now anyway.

(3) A Big RubberMaid Container.  (Hind sight: didn’t use it. He was fine with the regular litter box) Supposedly kitties have a hard time getting over the rims of regular sized litter boxes after the surgery, so one of the wonderful people who shared their three-legged cat stories with me told me that this worked well for her as a replacement litter-box until kitty got more accustomed to walking and balancing. It’s about the same size as a litter box, just with lower edges.

(4) Corn Litter. Fang is an outdoor cat, and he’s never used the litter box – he just waits at the door like a dog. Obviously that’s not going to work out for the first couple of weeks, so I figured maybe this natural litter would bother him less because it smells more… well, natural. I’m going to mix some dirt in as well, per suggestions.

(5) New Toys. Fang has toys – and those are living creatures that squeak and die at his pleasure. However, while he is recuperating inside I will have to somehow hold his attention and keep him from getting bored and depressed. I bought some toy’s that squeak when you hit them, and some feathery sticks… you know, the regular stuff. I’m not sure how interested he’ll be with things that don’t bleed, but hey, it’s the best I can do.

(6) Baby-Stopping Door Blocker Things. (Hind sight: buy two of these. He jumped over one on day 1) These have real names, but I’m too lazy to go to the other room to read them. You know what I’m talking about though – those fences that go in the doorway that are meant to stop kids from going into rooms where they’re not supposed to go. I’m hoping these will keep my other cats at bay while Fang recuperates in the bedroom. It will also allow him to see the other cats when he wants to, and flee into the depths of the room when he doesn’t.

(7) Liquids he will want to drink. I keep hearing that the pain medications make kitties constipated, and they don’t always drink enough water to fix that issue. Therefore, it is best to buy stuff that they’ll want to drink because it’s yummy. So, I bought some cat-milk (milk designed to be digestible for cats without lactose), low-sodium organic chicken broth (Hind sight: He totally didn’t drink this), tuna in water (so he can drink the tuna-y water), natural cat food from the refrigerated section of the supermarket that has a lot of juice in it, canned cat food, and baby food (Hind sight: Only buy baby food with NO ONION POWDER in it. Onion powder makes them dehydrated. Your best bet is to get baby food with only meat, or only meat and broth as ingredients).

I probably need some other things, but it feels much better to actually have something to DO to make this better for him, rather than just sit and cry and worry. So, bring on the shopping!

Arguments For and Against Amputation

Fang before surgery with the tumor lump showing on his left side
Fang before surgery with the tumor lump showing on his left side

Here is Fang, and his lump (you can see on the right side of his body … well, his left and our right… you get it). You can feel the lump a lot better than you can see it. This picture was taken yesterday. He is still fine, with no pain, but his habits have changed. He now sleeps on the bed with us, which is absolutely unheard of. He is NOT a bed cat…. Well, he is now. I think that he senses that something weird is going on with his body, even if it’s not bothering him. Or he just knows that I am sick with depression and anxiety. Probably it’s a mixture of both.

So, in making this decision (about whether to amputate or put my baby boy to sleep), I have been doing a ton of web research. It has both made me feel worse and better – I should say, is has made me much more realistic. Either way, I very much suggest watching videos of tri-pod cats, and finding online communities of people who have gone through this extremely difficult time. I am focusing on front-leg amputation stories, as it seems that the front and back leg are very different things to lose. Back-leg amputees seem to have a much better time of it… but hey, we can’t choose these things.

Where Do I Find Information?

(1) YouTube it. There are way more three legged cats out there than you realize – I was shocked. Some of the videos will make you sad, and some will make you happy. Either way, you’ll be much more knowledgeable.

(2)  So, for online communities, I highly recommend TriPawds forums. Note that these are mostly three-legged dog owners, rather than cats, but they have been through the process, have tons of information available for reading, and really know their stuff about managing pain, and just the entire process. Not only that, but they are extremely, extremely supportive. I think I have answers about my first frantic post about Fang within 20 minutes. Since then I’ve had a pretty steady flow of posts and answers. They’ve been wonderful and they’ve made me feel much better – and much less alone.

(2) “Advice for Three Legged Cats“. This was an article/blog written by a tri-pod owner, but the comment section became sort of a forum for tri-pod kitty people. I posted on there and had tons of cat amputation stories and support right away.

(3) Use a completely unrelated forum that you already visit. There are more three-legged cat people out there than I would have thought. I posted on my BackyardChickens forum because I was so distraught and needed to talk to someone who had a three-legged cat – I was just grasping for straws. Surprisingly, I got a ton of responses from three-leg kitty owners explaining their stories, and h0w their kitties have managed. You never know.

The point is.. don’t suffer alone. There are lots of people that have been through the same agonizing question – they can’t give you the right answer (only you can do that), but they can tell you a bit about their choice and how it played out for them. I don’t think there is a “right” answer, to be honest with you… but it helps to see what’s happened to other kitties.

Arguments For and Against Amputation

You’re going to notice that no one wins this self-debate. These are the things that people have told me, or that are going through my mind, and the counterpoints that also go through my mind. I don’t think there’s a right choice – but this is where my constant nagging mind has gotten me.

For Euthanization: Amputation is a catastrophic loss – it is not natural for a cat to try to live with three legs. It will be a very difficult and arduous life, even if it is not painful. The cat will not be able to do the things he used to do – he will not be able to climb like he once did, or walk as quickly – and he will have no idea why. If he wakes up one day without an arm, that would be an extremely scary, confusing, and frustrating experience for him. He would also be in pain for a while during recuperation. There is no guarantee that he will adapt very well – especially if he is a bit older. There is no guarantee that he will not suffer from phantom-limb pain, which occurs fairly often in cats and dogs, and which many vets still do not necessarily recognize or do anything to prevent during or before surgery unless you expressly do the research and ask them, and even then it might occur. There is no guarantee that he will not suffer from arthritis in his remaining limbs, and that might make it more difficult. Moreover, the difficulty is that you cannot guarantee that his quality of life will be good, and there isn’t really even a gauge for how good quality of life is. And, if he quality of life is bleak, would you want to put him through that? Should you put him through that? Is it moral to put him through that? If he was euthanized, he would never even know it. He would die after a relatively happy and pain-free life. That is the best end that a life can have, is it not? And, dogs do well after amputation but dogs are different animals – they lead a different lifestyle. They don’t climb very much, and they really care about the affection that human’s offer them 0 human affection makes them HAPPY. Cat’s often don’t need human affection as much as dogs do – they are a bit solitary, not pack-like. So, really, there is a limit to how much YOU, the owner, can do to make the cat happy after his loss.. and will that be enough?

For Amputation: Amputation is a catastrophic loss… for humans. Of course the loss of a limb will make life harder for anything – that’s sort of a given, but cat’s don’t think of their limbs the way that we do. In my opinion, he will not miss his missing arm – he well not wish that it could come back, and he will not mourn over the loss. As much as we project human emotions onto out pets, these just aren’t feelings that I think a cat can have. Now, cats absolutely have feelings, but I think that they are more basic and less past-future driven. I don’t think the cat will look back at what he had before versus what he has now. I don’t think that he can be angry with the world over his loss. I think that he can be frustrated at the sudden un-explained difficulty in doing the things he did so easily before, but as cats figure out how to do things a new way, they lose those feelings. I am still at a loss about how much amputee kitties can do – some people put “helper” items such as stools all over the house to help their kitties up and down, while others do absolutely nothing different to their house, and the cats are reported to do just fine. Some people don’t let their cat’s out after the amputation because they cannot protect themselves, while others let them roam free without issue. I think that there is a big difference in how owners approach the issue, and it reflects on how they feel their cat approaches the issue. And, of course, all we have is what people say, so it’s difficult to sift through. That’s why more experiences are better. After hearing and reading many stories about front leg amputees, I believe that they do not actually have such a difficult time getting around. I don’t think that it’s like normal, either, but I think it’s not too burdensome. That’s what I’ve gathered. The pain during recuperation cannot be avoided without euthanization – that is a personal choice that everyone must make, and it is a difficult one. Similarly, phantom pain may affect your kitty – and there’s not really much you can do. I don’t have a good answer for it. Then again, you can’t ever guarantee anything – I mean, at this point the cat is looking at either an amputation or death so obviously they’ve come to a point in their lives where they ran into some terribly bad luck. It happens to all cats and humans, and eventually we die of it, or suffer severe loss. So, there not being a guarantee is just another part of life.

As you can see, there’s not really a “right” answer here. For me, the things that really resonate are these two points:

(1) Fang trusts me, and I feel guilty for doing anything bad to him, but I have to do something and they’re both rather bad so there’s nothing I can do about it. So, just throw it off of your plate. There’s too much other stuff on it right now.

(2) If he was out in the wild and something chewed off his leg, or it was messed up in a trap, etc (these are true stories, believe me, I’ve heard them) he would still crawl back home. He wouldn’t just lie there and die. He would crawl back home and try to make things work with this new disability. So, if it comes down to it, and it was HIS choice – well I think he would choose to live. And I think that really matters.

First Vet Visit and The Decision

On Monday 10/22/12 I noticed a very large bone-hard lump on my 10 year old cat’s shoulder. I took him to the vet the next day and, after x-rays, they said that he has a bone tumor. They were surprised because apparently this typically occurs in large dogs, not cats, and so there aren’t a lot of previous cases to go by. Later in the evening they called to tell me that after an expert examined the X-ray, they believe that it might be a benign tumor since his bone has not been destroyed – it is just growing. He is not in any pain at all, and he has no limp (which would likely be the case if it was cancerous). However, they say that even if it’s benign it will continue to grow rapidly and will break his leg and cause extreme pain. We could do a biopsy, but its a painful surgery and even if it is benign, the amputation would still be required.

Fang's Arm X-Ray and Tumor
Fang’s Arm X-Ray and Tumor

So, I am faced with this horrible decision that I must make quickly, as this thing is growing very rapidly. I don’t know if I should amputate, or put him to sleep.

I keep reading that cats do very well with three legs, and I was feeling much better – but then I looked at videos. It seems like cats that lose a hind-leg do fantastically, but the videos seem to show me that when they lose a front leg, walking around seems to be very difficult. Some of them seem to almost have to crawl all the time. I am back to being a wreck. I don’t know what to do.

Part of the issue is my cat’s personality. He is already a skiddish – he likes to cuddle but hates strangers and quick movements. I have no idea if that will worsen after the surgery, but I kind of feel like it. Also, he is an outdoor cat. He has spent 90% of his life hunting outside and hates to be cooped up indoors. But, with a front leg amputation, will it be possible for him to really run around outside like he used to? It doesnt seem like it from the videos…. I think he might hate his life if I forced him to be inside forever.

I feel so guilty. I take him to the vet and they put him to sleep and then he wakes up with no arm? That’s horrifying, isn’t it?

I don’t know what’s best, and I don’t know what to choose. I feel like I’m condemning him no matter what I do.