Happy Tail in a Dog. Why Tail Amputation is Sometimes The Answer. Surgery Photos and Cost of Care Included.

Meet Max.

Max is a typical Lab, effervescent, energetic, and incorrigible. He has two speeds; On, as in Full-On, and sleeping. He is so energetic that he is crated during the day. I know lots of clients who think that their dogs have "outgrown" the crate, but, I think that having pets crated when you are not at home supervising them is a great way to insure a pet who rests and has down time. Mind you this takes training and acclimating, ideally starting as a puppy, AND, carting also helps us in the veterinary medical assistance in that we can prescribe cage rest so that pets are forced to relax and rest. It is especially important for the little dogs with bad backs. These pups need to rest, really sleep and rest. No access to anything. Please don't try to convince your vet that your dog will not jump pn and pff the couch when you leave. They are dogs, they are as sweet and innocent and as incapable of a good decision as a toddler is. Crate rest is an important life long training and healing tool. Max is a crated dog. He is also a happily to be crated dog. So he wags in his crate. He also wags out his crate. If Max has his eyes open he wags.

Max also lives inside. Outdoor dogs, wolves, all creatures in the great outdoors don't suffer from happy tail. They don't have walls to inhibit their happiness. And lets also be honest outside wild animals don't wag much. they have busy schedules to keep them busy and focused. Happy, well, happy is an emotion built on luxury.

When Max came to us he also came with a long, many year history of wagging his tail into beaten burger consistency submission,, that still never stopped the wagging.

A dog with a beaten, sore, painful paw (the other extremity) that we talk about on pets will carry that foot and not use it all to walk on. The nerves that feed the toes and foot are abundant and extremely sensitive. The tail, well it is primarily a bone rod with a paltry bit of leather like skin covering it. No fat, no thick skin like the sole of the foot, nope, just a somewhat flexible whip that swings aberrantly on a whim or a wish.

These are surgery photos from Max's tail amputation. We shave the entire tail from about 6 inches above the expected incision site to the end. We also tie it up so I can aseptically (keep the surgical area sterile) wrap it out. 

Draping the tail so that only a small area stays in the surgical field.

First cut is one of the most important. Every surgeon will tell you that they do A LOT of pre-planning and always keep a few back-ups plans in their back pockets. Once you start you have to be able to figure out every single possible scenario to get out with a happy ending, and what the pet parents were expecting.

Max's previous visit was to start antibiotics, attempt to wrap and protect the tail and discuss options for eradication of the condition we could never seem to manage long term. Max's dad, like all of us would be, was pretty frustrated that the tail never seemed to heal for long. A line of blood lashes lined the hallways. The tail would be found bleeding every night they came home from work. Max and the family never got a break.

Here is the conversation that I had with Max's dad when the subject of amputating the tail came up;
1. This might not be the end. A tail will always wag if the happy soul at the other end of it tells it to. Did you know that even pets with complete spinal paralysis can still (sometimes) wag? Yep,, a happy dog will tell you even through paralysis of all of its legs!
2. We have to keep the tail incision site, no matter how short that tail is, protected for weeks. That takes a huge amount of dedication and oversight on Max's family. An e-collar at all times, frequent post op visits, and protecting that tail are hugely important. If he is allowed access to his tail we will have to redo the surgery.
3. If the surgical area gets infected, traumatized (by him chewing, laying, or banging it on anything) I have to remove more tail. The tail is docked by removing segments of the tail bone, which is essentially pieces of vertebrae. You only have so many pieces and then you risk jeopardizing the spinal cord that innervates and commands Max's ability to pee and poop voluntarily.

Max is still under general anesthesia. His surgery is done, but, now we need to bandage the area before he wakes up and starts wagging again.

I've tried lots of splints, covers, and protective options on tails. The problems are always the same;

a. the tail tapers so that a big wag will cause the bandage to just fly off.

b. The tail, the incision and all healing tissue will respond better if it can breathe, so, the plastic cone enclosures I used to use left the tail stump wet, sweaty and delayed in healing,, air,, we all need air!

c. How to protect an incision and end of tail in 360 degrees and also allow air? 

My latest answer has been a spoon splint. It is the blue spoon shaped item to the right if the end of his tail above.

Bandages are the balance of protection, comfort, and durability. It is an art form that takes practice.

 This is Max (note; still smiling!).

He came to visit about 3 days post op so I could check his incision. As much as it is imperative that the incision site, and new end of his tail, stay protected post-operatively, it is also really important to check the incision frequently. Bandaging protects the healing tissue, but, it also hides a problem should there be one. Max also has an e-collar on 24/7 so he can't lick or chew the end of his tail. A dog, or any and every, post op patient will try to lick, bite, or chew at a painful area. So how do we know what is detrimental chewing curiosity, and, what is an indication of a hidden under the bandage problem? well,, we check the incision frequently, and, we pay attention to our patient. Not eating, or not eating well, pain, or signs of reluctance to do normal activities are all signs of a potential problem. Listen to your patients. They will tell you there is an issue, if there is an issue..

The incision is a little red, but holding well, and Max didn't mind us changing, cleaning, or re-bandaging the tail.

I also replaced the bandage in front of his parents (they are EMT's), so they can replace it at home if needed. We send home extra banding supplies,, JIC.

I want pet parents to see the surgical site at every visit. Everyone should know what it looks like at every visit. How else can they also monitor progress and know what normal and abnormal is? I keep parents involved in all aspects of their pets care. It helps them feel empowered, involved and invested. 

Max approves!

Bandage changes happen every 3-7 days. As long as the tail is wagging comfortably, being held at a normal height and angle and showing no signs of wetness, blood, or a bad smell we change it in the clinic with parents present. I expect it will need to be bandaged for about 6 weeks.

For more on Max read his Pawbly.com story here;

The cost of Max's care;

Pre-op exam; $50

Pre-op blood work, full panel $170

antibiotics for infected end of tail $30

surgical cleaner for end of tail $15

Surgery costs;

surgical package; iv catheter, fluids, pump, anesthesia, instrument pack; $250

tail amputation $200

post op pain NSAID $16

splint application $50

additional suture $60

refill antibiotics $30

e-collar $16

Max's story is posted with his families permission. I thank them for allowing me to share his story, photos, and process.

If you have any veterinary questions please ask me for free at Pawbly.com

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Golden Retriever Uveitis, Max's Rare Bird.

This is Max

There are a few diseases that I only get to see once in every blue moon. They are those elusive veterinary diseases listed in the tiny paragraphs at the end of the chapter of your text book. A veterinary student, like an ornithologist, focuses on the “common birds” learning about their specific traits knowing full well that we will see them, and therefore, we need to recognize and feel comfortable and confident in treating them, but secretly we are hoping to encounter those “less commonly seen birds.” We hope and pray that somewhere along our travels we will finally get to see that magical mysterious rare bird that lives at the end of the vet school books. 

When Max walked in last Tuesday (2/18/14) I finally got the chance to log his disease in my record book.

Max as his full on welcoming self

Max as he looked on his initial exam on 2/18/14. 

Max walked into the clinic with his mom and brother on a Tuesday night. A shy, smiling face, with a timid wag, but a welcome expression. He is the typical Golden Retriever, quiet, sweet, gentle, un-foreboding, and willing to meet a new friend if you are quiet, calm, and unassuming. Even with his gentle expression he sat at his parents feet almost unable to open his eyes.

For a veterinarian observation of your patient before they enter the exam room, when they are calmest and least likely to feel, or act like a patient, is the best time to gather your information. Free from the influences of their parents perception, the hidden masked epinephrine hidden clues, and the biased thoughts of the veterinarian that preceded you. Just watch without anyone knowing you are, let your eyes read the small subtle clues and remember that you can diagnose a patient about 90% of the time with just your senses and an open educated mind.

I was fairly certain of Max’s dilemma, disease, and treatment needs just by secretly watching him in the reception area. 

When we entered the exam room his mom gave me Max’s history. He was a middle aged, happy, healthy boy. He had a previous eye ulcer that had healed well almost a year ago, but this morning he was quiet, panting, and squinting his eyes. He had no history of trauma, illness, or exposure to toxins that might have injured his eyes. He just sat and squinted his eyes as if the brightness of the pearly gates were shining upon him beckoning him to come home.

After a thorough exam revealed no abnormalities to any other body system I took a good long look in his eyes. When you have a patient who will not open their eyes it is usually because they are painful to do so. A few drops of a short acting anesthetic in each eye will relieve their pain for just long enough for you to be able to check the eyes. Of particular concern were; his ocular pressures because glaucoma (increase in intra-ocular, or inside the globe of your eye) can be very painful and present with a patient who squints because when your eye hurts you keep it closed. These were checked with the Tonopen (a device to check the pressures in the eye) and were normal after checking both eyes several times.  I was also concerned about damage to the corneas (normal on examination) and the appearance of the sclera which can indicate blood pressure and disease. Max’s eye exam was quick. He was very reluctant to be a patient eye patient and I had to gather the information I needed quickly. It took four people to hold Max, his head, and each eye open. When you need excessive force there is something wrong and you need to re-think both your strategy and your end goal. Excessive force will lead you to a bigger problem then you started with. We needed four people to keep an eye open for about four minutes. The results were more normal than abnormal but there was no denying a painful, irritated eye, and a tiny hint of “flare” in the anterior chamber.

My poor puppy Jekyll, always the one who has to be the demo dog.
Jekyll demonstrating the Tonopen use.
Such a good boy!

“Flare” is seen when tiny pieces of protein float inside the eye. The eye is separated into a front (anterior) and back (posterior) chamber by the lens.  It can be seen with a slit lamp that sends a narrow beam of light into the anterior chamber. A normal anterior chamber is clear and allows the light to pass clearly and smoothly to the lens. When there is abnormal stuff in the anterior chamber the light gets murky and irregular.

So, Max had a diagnosis. Max had uveitis, or inflammation of the anterior chamber. I presumed the rest of his diagnosis. He is my elusive (third case in ten years) Golden Retriever Uveitis. 

Lesson Learned; Always go immediately to your vet if your dog or cat is squinting. Squinting indicates pain! Eye problems can become huge disasters that could jeopardize your pets vision very quickly. But, the flip side is that in many cases eye problems can be cured very quickly too, ONCE the problem is DIAGNOSED AND a TREATMENT PLAN is started.

This is Max at his follow up appointment on February 23, 2014

Golden Retrievers can get a specific type of uveitis called "pigmentary uveitis." In this disease Golden Retrievers disperse pigment in their anterior chamber. 

Cross section of the eye

 "The iris becomes darker and thickened and clumps of pigment can be seen on both the lens capsule and corneal endothelium (inside layer of the clear corneal covering of the eye.) Aqueous flare, posterior synechia, cataract, and glaucoma may also occur. Any relation between the presence of uveal cysts, pigmentary uveitis, and glaucoma is unproven." From Slatter's Ophthalmology Text.

I spoke to Max's mom about the treatment plan and my concerns about Max's eyes.

I put max on a topical steroid with very specific instructions to monitor his eyes very closely. I also discussed my concerns with both Max's eyes and the drug I was recommending for his treatment. I wanted her to use the lowest effective dose of the eye ointment and to begin tapering the medication as soon as possible. If she had any questions or concerns about his eyes I wanted her to stop treating them and return immediately. Steroids, whether taken orally or put in your eye are both absorbed systemically and can cause both short term and long term detrimental side effects. 

Max returned five days later. His eyes were wide open, comfortable and he was smiling from ear to ear. He was clearly much more comfortable and much happier. His mom had started to taper his eye steroid and was going to remain vigilant on any future flare ups or recurrence of his eye issues.

We will monitor him closely for glaucoma, uveitis recurrence, and hope that we never see either again..I will remain ever observant for the other tiny paragraph birds in the hopes that I spy another "snowy owl" among the millions of starlings...

If you have a pet related question, or just an adorable pet photo to share you can find me on Pawbly.com, or at the clinic, Jarrettsville Vet, or even on Twitter @FreePetAdvice.

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