Cheddar’s post-amputation recovery

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Hey all! Thanks for everyone’s kind comments and engagement with our last post โค๏ธ we feel so thankful for this supportive and loving community ๐Ÿ™‚ Today’s post will be about Cheddar’s experience following his amputation, and the Tripawds community certainly played a huge part in our preparing for that too, so we’re hoping this post can be our way of giving back and helping others who may be going through similar experiences!

Warning: This post contains graphic pictures of surgical incisions and blood.

We know it might be gross, but we believe that it will be more helpful for people to see what we saw and compare any similar things they’re seeing if they can see the full extent of what happened in our journey, so we’ve decided to not hold back on the pictures.

The night before

Cheddar’s amputation was scheduled for June 10, 2020. We knew that he probably would not be able to be in water for 4-6 weeks after a major surgery like this (because it messes with stitches healing up), so we gave him a bath the night before his surgery.

The amputation

The day of the amputation went relatively smoothly.ย  We dropped Cheddar off in the morning and were told to pick him up the next day — he would have an overnight stay at the hospital. The surgery itself was only about 90 minutes long, and the orthopedic surgeon called us after it was over in the middle of the day and let us know it had gone smoothly. Even though we hadn’t had Cheddar for that long yet at this point, it still felt weird to have him not at home that night!

Post-amp day 1

We went to pick Cheddar up right after about noon.

This is what his incision looked like on that first day (the stitches were the self-dissolving kind, so it looked less scary than we were expecting after seeing some other post-amp dogs on the internet while we were researching beforehand):

Day 1 incision

We were sent home with some additional Gabapentin and Carprofen (Cheddar was already on Gabapentin and Carprofen for several weeks before his amputation for the pain from his tumor and also following his incisional biopsy), as well as a Fentanyl patch which we were to remove after 72 hours, and a prescription for Prazocin that we had to get filled at our local pharmacy — Prazocin isn’t typically used for dogs so the vet didn’t stock it, but Cheddar was having trouble controlling the muscles used for urinating, so he was leaking pee a bit, and the Prazocin was supposed to help with that. They also gave us a sling to help him walk around with. He also got a double cone, because he was demonstrably flexible enough to get around just one (throwback to that time he chewed his biopsy stitches…):

Cheddar on his bed with two cones

We were actually surprised that he seemed to be on his feet and getting along with assistance from the sling for short distances (admittedly, somewhat stumble-y). As usual, he was very eager to go outside and sniff around. The vet explained that he would probably get tired very quickly as he was recovering, even though he was on his feet, but he would slowly get stronger as his muscles in his remaining legs grew to compensate for his newly missing limb. The first day, we walked up to the corner of the block by our house and back, a total distance of ~ 600ft. We were probably lifting at least 70% of his weight.

Also on the first night, Cheddar got up on his own and hopped onto his bed! It was just like 3 steps, but still we were very surprised. We know that every dog is different with recovery time so we felt very blessed that he seemed to be recovering so quickly.

Short-term recovery

We’ve compiled a playlist of Cheddar walking in his first week here — one video is 1 day. The first video is the day we brought him home from the amputation (you can see the fentanyl patch on his lower back!) it’s really amazing to see his progress just over a couple days:

On day 2, Cheddar was getting up on his own and getting around the house in short spurts without assistance. He was also able to eat out of his Kong. He was still leaking a bit of pee, but the Prozacin seemed to be helping compared to the previous day. He also seemed to be doing ok peeing and pooping, but we tried to support him when he was squatting so that he wouldn’t fall over (his balance still needed a bit of work). You can see a little of him losing his balance while squatting to poop at the end of the Day 6 video in the playlist above.

By day 3, we were starting to see bruising around his incision:

Cheddar's Day 3 incision showing bruising

We also started to walk him without the sling on the third day.

On day 4, we made it to the park near our house! Cheddar was sooo happy to be able to lie in the grass again!

We also gave him a boot to wear on his back foot — about a month before his amputation, Cheddar had broken a nail on his left foot and the quick had started bleeding. We’d made him wear a boot whenever he went outside for about 2 weeks after that to let his nail grow back and it was ok after that, but it started bleeding again now (maybe because of additional weight being on it?) — so we gave him a boot again. It might also have helped him get better traction as he was learning to walk on 3 legs again, and we noticed he was more bouncy on walks.

On day 5, Cheddar ran up the hill on his own!! This was no small feat for a rear leg amputee since it requires more strength/power to be generated from the single back leg, so we were super proud.

By day 6/7, the bruising around his incision had mostly healed up. But we found that the stitches near the bottom of his stitches (the end closest to his butt) had split open, making a hole!! Furthermore, it was oozing a little bit, which was worrying… where-ever he would sit down, he would leave a little crusty spot (ew D:) We made some time to go back to the surgeon for a checkup the following day.

Cheddar's incision with split stitches

On day 8, we went to the vet in the morning to get the hole in Cheddar’s stitches checked up. The vet told us that it looked ok, because although the outside had split open, it seemed that the inside had healed up for the most part. Apparently it is common for that spot to split open in stitches, because that part of the skin gets stretched a lot when a dog sits. But to be on the safe side, they gave us some Mupirocin antibiotic ointment to apply.

That afternoon (it’s always onto the next exciting(?) thing with Cheddar), Cheddar started passing blood clots and having bloody pee! ๐Ÿ˜ฑ He also had an accident in the house, seemed to be very down, and seemed to be straining to pee while outside. We were quite worried — it seemed to match the symptoms of a UTI, so we made another appointment (with our regular local vet this time) the following day to get him checked out.

Cheddar's bloody pee

Cheddar's blood clot

The local vet took a sample to run tests on, but a couple of days later the test came back negative for UTI bacteria. They did did say that sometimes blood clots can happen after surgery and get passed through the urine. It might also be that the Prozacin had had a harsh effect on Cheddar’s urinary tract. Luckily, it was pretty unlikely to be cancer metastasis or the like because we would have seen the nodules in previous x-rays. The vet told us to see if it got better in a week or so and to call her again if it hadn’t. The bloody pee went away after about 3-4 days on its own (to our relief), but we still don’t really know what its cause was!

Longer-term recovery

We are still working on longer term recovery these days, 2-3 months after amputation, like building more strength in Cheddar’s back leg and making him more confident in climbing stairs (he was always very scared of stairs, even before his amputation), improving his balance (if he were a cow, he would be a cow-tipper’s dream), and working on improving our own massage technique and flexibility stretching exercises with him.

Compared to the first week or so, Cheddar can now go a lot farther on walks (though he still gets tired quickly, and we stop for breaks often), and he has also stopped wearing his boot again (his nail has not started bleeding again again thankfully). He still has strong days and weak days, and there are definitely some times when he goes a little too hard (he loves running around outside when he’s excited) and he is sore the following day. We also got some cheap rugs and mats from Costco to go over our hardwood floors to help him with traction in the house (he was slipping quite a lot more after becoming a tripawd).

Woah, this post has gotten so long! After the last episode of blood in pee, there were luckily no more major surprises in Cheddar’s post-amputation recovery, so I think we’ll wrap up here for now. We definitely feel very lucky that Cheddar happened to recover relatively quickly and without major complications, but recognize that every dog is different and have different recovery stories. We just wanted to share ours in case it helps someone who happens to read about it, but we definitely don’t want to give off the impression that every dog will have a recovery exactly like this!

Until next time! ๐Ÿง€๐Ÿถ


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Cheddar’s pre-amputation journey

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Today we’d like to talk more about the brief time we had Cheddar before his amputation, and to share our experience learning about his cancer diagnosis and evaluating care options leading up to his amputation.

A little about us before we begin Cheddar’s tale: we are Winnie and Alex, a couple in our 20s living in San Francisco. We adopted Cheddar at the end of April 2020 since we thought that having the shelter in place order would mean we would have more time at home to take care of a pet. Little did we know, we were in for wayyy more than we bargained for!

Warning: This post contains graphic pictures of surgical incisions and blood.

We know it might be gross, but we believe that it will be more helpful for people to see what we saw and compare any similar things theyโ€™re seeing if they can see the full extent of what happened in our journey, so weโ€™ve decided to not hold back on the pictures.

Getting the diagnosis

The reason we brought Cheddar to our local vet the first time was that he had a limp while he was walking and was finding it difficult to get up the stairs to get into our house. We wanted to know if there was anything we could do to make things easier for him. Here’s an example of him limping:

Our local vet inspected him and said that we would probably need to get x-rays done to really determine what was wrong. She also suggested that if surgery might be an option, we should get those x-rays done at the orthopedic specialist so that we wouldn’t need to double up (since specialists can be very particular about using their own x-rays rather than those taken from a regular vet clinic).ย  Actually at this time, the vet suggested that the issue might be hip dysplasia, and cancer was not a realistic thought because of Cheddar’s supposed age of 3 (this number was given to us by the rescue we adopted him from, but as would become clear, Cheddar is definitely much older than 3). Taking our local vet’s advice, we got in touch with an orthopedic specialist in our area and took Cheddar in for an initial consult.

The first thing the orthopedic specialist did was inspect him externally and stretch his legs out in different positions. I’ve never heard him yowl so loudly as when they moved out his legs! He must have been in terrible pain. The vet also was concerned by his right ankle joint, which was enlarged. She suggested x-raying that joint in addition to the hips (given that we were there for supposed hip dysplasia). She said that there might be additional actions to take depending on the result of those xrays, so we ended up letting them take Cheddar for the whole day. We knew things were not good when they called back in the midday and said that they would need to run a few additional tests — the xray for the ankle joint had come back looking extremely concerning, and they had performed a fine needle aspiration in the joint to extract some of the joint fluid out, and it had come out bloody and dark (definitely not normal — it should have been clear).ย  At the end of the day, we were shown the x-rays.

Cheddar's cancerous ankle joint xray

This was the primary tumor in his right rear ankle joint. As you can see, there is a ‘cloudiness’ across several bones and jagged edges along the bone. The periosteum (surface of the bone) has almost completely disappeared in some parts. It definitely was not normal, and was highly indicative of cancer. The fine needle aspiration sample came back negative for infection-related bacteria as well.

We also found evidence of Cheddar’s real age from his hip x-rays (his hips looked great, by the way) — the spine showed some compression and spondylosis in the lower vertebrae (age-related wear on bones) which indicated that he was definitely much older than 3, making cancer a more plausible diagnosis.

Furthermore, we were given the impression that our choices were somewhat limited — the orthopedic surgeon was hesitant to perform an amputation due to the arthritis in Cheddar’s spine, and was concerned that he wouldn’t be able to get around well on just 3 legs because he had yelped in pain when she was inspecting his spine.

Deciding what to do

We came home and mulled over our choices for a couple of days. We should say at this point that it had been about a week or two since we adopted Cheddar, and also that Cheddar is actually our first dog — we felt completely overwhelmed and weren’t sure at all if we could really take care of him well. There were a lot of tears and a lot of stress. We had to discuss whether we would give him back to the shelter — we really didn’t want to, given what we had learned. We weren’t sure about his chances of getting adopted again, or what kind of treatment the rescue could afford (it was likely that he would simply be put on palliative/hospice care). Also, none of this was Cheddar’s fault — he is truly a really good dog with a great personality and really no behavioral issues; he had just drawn an unlucky lot with his health conditions ๐Ÿ™

We opted to follow up by getting more information about the cancer. From the fine needle aspiration, we weren’t able to tell what kind of cancer it actually was. In fact, the radiologist looking at the x-rays had suggested that it was unlikely to be osteosarcoma given that multiple bones in the joint were affected. So, our first course of measure was an incisional biopsy — the orthopedic specialist would cut open the joint and remove a sample of cells to be sent and inspected in a lab. As part of this procedure, Cheddar would also get a set of chest x-rays done to see if the cancer had already metastasized to his lungs or not — if it had, it might not make sense to do the biopsy at all, since it would suggest that the cancer had progressed very far already. Luckily, the x-rays came back clear and the biopsy was done.

A couple of days later, the diagnosis came back from the biopsy — Cheddar was confirmed to have osteosarcoma ๐Ÿ™ We knew that this was a very aggressive cancer, and wanted to talk to an oncologist to find out more about our options. The orthopedic specialist referred us to an oncology specialist and we arranged to meet.

The morning that we were supposed to meet with the oncology specialist, Cheddar got around his e-collar and bit open his biopsy stitches!!!

torn stitches

This turned out actually to perhaps be a stroke of luck — we made arrangements to stop by the orthopedic specialist’s office before we went to the oncologist. When we stopped by the orthopedic specialist, she mentioned that she would like to inspect Cheddar a little more — they had found that while running chest x-rays before his biopsy that Cheddar HATED being restrained, to the point where he was yelping as if he were in pain. The orthopedic specialist then wondered whether the spine issue that she had been concerned about before (making her hesitant to perform an amputation) was actually a non-issue, and what she had previously perceived as a yelp of pain was actually just Cheddar protesting being restrained… I will say that this aligned with our experience with Cheddar at home, where we observed that he seemed to be getting along just fine on our walks often not using his right leg at all (it would be in the air and he would bunny hop often).

In the end, the orthopedic specialist said that if the oncologist would recommend an amputation, she would be happy to perform one. In other words, if Cheddar hadn’t torn open his stitches that morning, it’s possible that amputation would never have even been an option on the table!

The meeting with the oncologist was pretty standard. She inspected Cheddar and gave us a run down of options. If we did nothing, he would probably have to be euthanized within a couple of months when the bone in his ankle became weak enough to break. We could also do radiation therapy, which would alleviate the pain, but it would likely only give him a few additional months. Or we could amputate the leg and follow up with chemotherapy, which is basically considered the gold standard for this type of canine cancer in the legs.

When we were discussing our options with each other, we came to the conclusion that neither of us wanted the traumatic experience of suddenly being with Cheddar one day and then seeing him break his leg randomly, and having to put him down that same day. The chances were that Cheddar would probably die of cancer eventually if we went down the amputation + chemo path, but at least we would know what to expect and we would see his decline rather than just waiting, not knowing when his leg would break and we would have to go to the emergency vet. The oncologist seemed to think that Cheddar could get around as a tripawd just fine, so we were comforted by that. We were also in the fortunate state of knowing that we could afford his medical procedures financially, and we wanted to do right by this dog who clearly had the will to keep going and live.

So we agreed to go through with amputation and chemotherapy to give Cheddar the best chance to live longer ๐Ÿ™‚

I’ll conclude this post here since it is already pretty long. I hope this detailed recall was somehow helpful for anyone going through a cancer diagnosis for their pet. If I learned anything from it, it’s to press hard forย all the options, ask lots of questions, do research, and also don’t necessarily take the first answer as a given — in Cheddar’s story, at first we thought it was hip dysplasia, then perhaps an aggressive infection, then probably not osteosarcoma,ย then finally osteosarcoma. We were told “amputation isn’t recommended”, then “amputation would likely work well”. It was a roller coaster of a journey getting to the decision to turn Cheddar into a tripawd! Next time I’ll talk more about the amputation procedure itself and what recovery looked like for Cheddar.

Hello!

Cheddar smiling and lying on grass

Hi! This is Cheddar, a hind leg amputee and tripawd as of June 2020! We want to record and share Cheddar’s journey so that our experience may help some other dog owner going through tough times as we have ๐Ÿ™‚ we’ll be updating this with more info about what has come before and continuing to update as new things come to light!

A brief backstory: Cheddar was rescued on the outskirts of Bakersfield in early 2020, apparently abandoned by his previous owner. He found his way up to San Francisco with help from the amazing PilotsNPaws program and was adopted by his current family (us!) in April 2020.

We noticed right away that Cheddar had a bad limp and apparently atrophied muscle in his right rear leg. The ankle joint also appeared to be larger on that leg compared to his left hind leg. We were told it was from an old injury, old bone that had fused together. But the limp concerned us, and we scheduled several vet visits within days of adopting him.

It eventually became clear with subsequent xrays and tests that the situation in his right rear ankle was osteosarcoma (bone cancer). Heartbroken but wanting to give this amazing dog another chance given his unlucky past, we decided to opt for amputation followed by a chemotherapy treatment. Cheddar became a tripawd on 6/11/2020!

Other fun facts about Cheddar: he is deaf, he’ll eat almost anything (he even likes veggies! The only thing we’ve found he dislikes is lettuce…), and he is a huge lovable derp with a tenacity for living ๐Ÿ™‚ we hope someone here finds learning about his story useful!

For more day to day updates about Cheddar’s life, feel free to follow him on Instagram at @cheddar.thegoudaboy