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Socks sporting his T-shirt and special pain-control device. © Windi Wojdak/The HSUS |
By Eric Davis, DVM
HSVMA Field Services is most challenged when working in isolated communities, but that doesn't mean the team of dedicated professionals isn't prepared for new challenges.
It was through our collective experience and advice from specialists in the veterinary profession that we were recently able to use a humane, cutting-edge way to help a big dog in a small town.
We helped Socks, a shepherd-mix resident of the tiny settlement of Mandaree, North Dakota, get relief from pain due to an untreated, weeks-old shattered joint by performing a pain-free amputation using a tiny catheter.
Since his guardian was without access to veterinary care, Socks went several weeks without treatment for his injured shoulder, causing the shattered joint to swell beyond healing and the pain to become more unbearable. Socks couldn't bear weight on his front leg. Since it couldn't be fixed, his leg had to be amputated.
Sometimes amputation is the best choice for old, unhealed fractures, infected joints and gangrenous legs, of which we see a lot in the field. Removing an entire fore- or hind limb poses significant problems. HSVMA Field Services staff and volunteer veterinarians are skilled in the procedures, which require large blood vessels and nerves to be severed. Aggressive pain management techniques need to be used because post-operative discomfort can be severe.
Pain can be controlled using a variety of techniques, including oral and systemic analgesics such as morphine. Epidural analgesia involves putting pain-killing drugs right into the spinal canal, and works very well for hind leg amputations. However, Socks’ entire left front leg had to be removed. The HSVMA staff chose a simple, but ingenious technique to prevent him from experiencing pain.
In the last few years, some of the most prestigious veterinary teaching hospitals have been using catheters to control surgical pain. The catheters (sterile plastic tubes) are placed in the surgical area before the muscles and skin are sutured back together. Tiny holes in the tube allow drugs that anesthetize local nerves to seep out in to the tissues, effectively preventing the patient from feeling anything at the amputation site.
Sock’s amputation went well and the surgeons placed a catheter at the close of the incision. They then attached a pump containing local anesthetic fluid to the catheter. This pump is basically a balloon attached to the dog’s collar that would very slowly inject medications through the catheter. As Socks recovered from anesthesia, it was evident that the plan was working well. Within a few hours of surgery, he was looking more comfortable than he had been during his preoperative examination. He never whined or showed any evidence of pain. By the next day, he was walking around the clinic on three legs, investigating everything in a typical happy-dog fashion.
Socks got a large T-shirt with one sleeve tied off to protect the incision, and stayed with the team for four more days. Nobody gets attention like a three-legged dog or a three-legged cat, especially one in a T-shirt with a balloon pump on his collar! The pump made him look a little like a St. Bernard with his flask of brandy, ready to rescue skiers in the Alps. His personality made everyone want to take turns taking him for walks or sitting next to him.
At no time did Socks show any signs of discomfort or, really, disability. He had already learned how to walk on three legs. By the time the catheter was removed, the surgery site was healing well, and Socks only needed some long-term antibiotics and oral analgesics, which his owner could administer.
Socks went home and joined a long line of animals who got special care from our staff and volunteers—and who benefited from cutting-edge treatment.
Eric Davis, DVM, is HSVMA director of field veterinary services.
HSVMA is a program of The HSUS.
