Tag Archives: fentanyl

Teddy’s journey: pain and anxiety come to the fore

The past week has been a tough one for Teddy and for Jill.

When Teddy first came home from the hospital, he seemed to be adjusting quickly.  He’s always been an independent boy and so he has rejected any support such as a strap or harness when taken out for toileting.

However, this week, Teddy became noticeably withdrawn.  For much of the time, he was restless and would whimper frequently.  We were sure he was in pain.  Because he was so out of sorts, we also felt that he was suffering from anxiety.

When I saw Teddy on Monday, Jill was stressed and Teddy was clearly not himself.  We introduced a hot water bottle (or ‘hottie’ as they are known here) on his back which seemed to provide relief and comfort.  I also gave Jill a CD from the Through a Dog’s Ear range.  This music is designed specifically for dogs to help calm and treat anxiety.  These seemed to assist Teddy in the short term to relax and rest.

But Teddy needed better pain management…

Teddy and his 'hottie'

Teddy and his ‘hottie’

Jill took Teddy back to his vet several times this week to discuss pain relief.  She freely admits, “I didn’t feel that I was being listened to as the owner.  I knew Teddy better than anyone.  Persistence, in my case, finally paid off.”

We seemed to agree on Monday that he was taken off his pain medication too quickly – he was taking only Previcox at the time –  and his body had been left vulnerable.  A Fentanyl patch was re-introduced on Monday and replaced again on Thursday.  Jill also started Teddy on Tramadol on Thursday and Teddy received a ketamine injection, too.

Meanwhile, I could tell that Teddy’s back muscles were stiff; his top line did not seem normal, and he was clearly distressed at being handled along the withers and the back.  Thankfully, since Teddy was too uncomfortable for deep massage, I was able to use the low level laser along his spine and muscles to help with blood flow and pain relief.  I know I want to passively stretch Teddy’s spine but we agreed to wait until Teddy was more comfortable before attempting this.  I was able to do passive range of motion stretching on Teddy’s legs.

Armed with this information Jill took Teddy for acupuncture on Tuesday and an osteopathic adjustment on Friday.  Both his acupuncture vet and his osteopath agreed that Teddy was in pain and that support with traditional veterinary medicines were needed.  The osteopath used gentle traction on Teddy’s back since she found his spine has become compressed.

With his pain properly managed, we can do more to help Teddy’s muscles, tendons and ligaments to adjust to his new gait.  And then true rehabilitation and exercise can begin including a greater focus on core muscle strength.

During this stressful week, Jill took to the Internet for help with Teddy’s condition.  She found a wonderful site – Tripawds Blogs – for owners of amputee dogs.  Owners soon responded with news that helped to assure Jill she had made the right decision for Teddy and gave her information to help her discuss pain management with her vet.

Owners who have been through similar adjustments with their dogs said:

  • Amputees go through an initial ‘good’ period after coming home, only to suffer because they do too much, too soon
  • The muscles of the body are under incredible strain because the body’s mechanics have changed rapidly
  • In Teddy’s case, his amputation was not preceded by a period of pain or dysfunction in the front leg – so his body had no time to adjust (such as would be the case for an osteosarcoma patient, for example)
  • Pain management medication is critical; the switch from Fentanyl to Tramadol was recommended
  • Teddy’s size is a big advantage – he’s a lot smaller than, say, a Labrador with the same conditions
  • Every dog is different and it takes a little time to find the right balance of therapies

Jill says, “In hindsight, we really took things too quickly and allowed Teddy to move around the garden area with enthusiasm.  I wish I had thought of this sooner and we may have avoided him seizing up so badly.  The Tripawds site has been a fabulous resource for me  knowing that there are others who have been through this before us.

I do feel that vets should listen to owners when it comes to understanding their animal.  And if you are not happy with your vet, you need to find someone who you are more comfortable with.  The vet can’t have all the answers when they are not with the dog as often as the owner is.  This proves that vets are not the final word in recovery – and I’m grateful that complementary practitioners are part of Teddy’s healthcare team”

It’s a new week – and we are all hopeful that Teddy is back on track to recovery.  He’s booked for massage and acupuncture this week.

Kathleen Crisley, specialist in dog massage, rehabilitation and nutrition/food therapy, Canine Catering Ltd, Christchurch, New Zealand

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Teddy’s journey – the bandages come off

Teddy has had two consultations this week to assist his recovery.

On Monday (a day after discharge), Teddy was at home resting near the log burner and constrained in either his crate or a playpen area that Jill had set up for him.  His pack mates – sister Verdi (shown in the background) and his mother, Maggie were a little confused by the new situation.  Verdi was showing some signs of dominance – growling at Teddy.

Teddy sleeping with compression bandage

Teddy’s amputation incision was covered in a compression bandage to help with swelling

Jill was using an ice pack on the incision area four times per day to help with swelling and pain relief (Teddy was also receiving pain relief through a Fentanyl patch which delivers pain medication through the skin and also Previcox, a non-steroidal anti-inflammatory drug.)

On this day, I performed an acupressure sequence on Teddy to help his body recover from the anesthesia.  We also measured Teddy for his Walkabout Harness.

Teddy received a replacement Fentanyl patch on Tuesday.

I returned on Friday to see Teddy – with his bandages removed.  This is the first time I’ve been able to view his incision up close.

Teddy's incision

Teddy on the massage table, ready for a light treatment

Teddy was very tired on Friday and favoring his right side by sleeping mostly on his left.  This is not surprising since the comfort of the compression bandage and padding on his surgery site had been removed.

We will treat Teddy conservatively and manage his comfort in the early stages of his recovery.  Consequently, I only worked on Teddy in the above, resting position.  I gently massaged over his hips and back and he received cold laser therapy over his hips and his left forepaw (which has some arthritis).

Teddy was deeply asleep after his session – a sure sign that he needed the time out and that rest is the best thing for him.

Teddy has always been a receptive dog for massage and I expect him to be even more so post-amputation.

Kathleen Crisley, specialist in dog massage, rehabilitation and nutrition/food therapy, Canine Catering Ltd, Christchurch, New Zealand