Thursday, November 14, 2013

Donner. God gave pets four legs so they would have a few spares.

Every blog that I write is a little bit of personal experience, a sprinkling of veterinary medicine and a story about a patient. I am writing a few blogs on amputation because I still feel in almost all cases that I have to coerce pet parents to consider it as a palliative treatment option.

I would like to start today's story about amputation with my dear departed cat Donner.
Donner at about 12 years old.
He was a gentle giant. At 15 pounds he was always a big cat. But he was quiet, reserved, affectionate, and always seeking attention from anyone he could. He loved to be carried. He would climb on your shoulders and drape himself around you like a shawl. I spent most of my adult life carrying him throughout the house, yard, and everywhere in between. He never understood why I would repeatedly put him down. But a 15 pound scarf is hell on your back.

The consequence of all pets that are bigger than nature designed them to be is joint disease and osteoarthritis. He suffered from terrible elbow arthritis from the time he was about 10. He couldn't jump, barely broke into a jog, and sought the thickest cushion in the house. His right elbow was significantly thicker, harder to bend, and more painful than the left.

At about age 12 he also developed a swelling in his left wrist. It grew from a swollen area on the top part of his wrist to a round hairless sci-fi looking tumor. But even with this swollen red wrist he was much happier to walk on the left front leg than the painful arthritic right.

It became obvious that I had to make a decision about what to do with his wrist. I debated about putting him under anesthesia. He was an older cat, and I felt pretty certain that the mass was cancerous. I also knew that I would not be able to remove enough tissue to get clean margins, without removing the ligaments, tendons, and muscles that he needed to use his foot.

I finally surgically removed the mass when I realized that if I didn't it was going to rupture. You see skin can only stretch so far, and then it tears. The underlying tissue be exposed, and because the mass is composed of tumor cells it will bleed endlessly. A bleeding tumor is ripe for introduction of infection, self traumatization and impossible to manage with a bandage.   With great trepidation about Donner's ability to walk if I removed the leg I decided to first remove the mass, submit it for a biopsy, and then make a decision from there.

I removed the soft tissue mass when he was about 14. It came back from the pathologist as a spindle cell fibrosarcoma. These tumors originate from the connective tissue, are locally invasive, difficult to remove completely, but have a low incidence of metastasis.

Sure enough, as the publications predicted, it came back about four months later. But this time I decided to wait before I did anything else.

I hedged my bets that the regrowth was from the same tumor that I had just taken off, that the pathologists had gotten the diagnosis correct, and that it wouldn't metastasize.

Donner would have a terrible time trying to get up and being able to walk around if I took his better leg off.

Donner at about age 16.
I watched that tumor regrow over about a year and a half. It was an ugly, ghastly thing. But through that whole time Donner remained favoring that leg and walked around as well as he ever had.

On the day that I noticed he limped more on the left than the right I brought him in for an x-ray.

I was shocked! That tumor had eaten almost the entire distal (towards the foot) radius and ulna. There was almost no bone left to support his weight, to allow him to walk, and yet there he was still walking on it.

I asked a boarded surgeon to remove his leg the next week. I also prayed that he would be able to get up and figure out how to walk on three legs, with one of those being his painful arthritic front foot.

Donner did very well through his surgery. He woke up calm and comfortable and was kept on narcotics to ease his pain for the next three days.

At day four I took him out of his cage and brought him back to his favorite spot in our cat room.

He just lay on the floor puzzled. His right front foot couldn't bend well enough to get it up under him. And his back legs splayed out froggie style behind him. He was weak, tired, and frustrated.

I spent the next week gently picking him up, placing his feet underneath him and teaching him how walk again.I also spent that entire week beating myself up.

Oh, how I tormented my decisions.

Here's why Donner's case is so different from many of the normal amputations that we do is.

Donner was walking on his tumor leg. He was comfortable on it, so he never really learned how to walk without it. Most pets with tumors that need amputation of a limb for are ALREADY three legged when we see them. They avoid using that leg at any and all costs because placing any weight on that limb is excruciatingly painful.

It took Donner a few weeks to get used to his lost leg. And for the last few years of his life I carried him everywhere, which he loved. He always had the best spot on the couch, was always by my side, and like every other animal, never ever felt sorry for himself.

In the end I carried my dear Donner for 20 years.

My shoulders ache for his purr, and my heart will always miss my big cat. But I was so lucky to have known him.

If you have any pet questions or concerns you can find me at Pawbly, or on Twitter @FreePetAdvice.

Related Posts; Heidi's Story.

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