Samson, a 125-pound Great Pyrenees, is on his way to the vet with his family. Of course, he has no idea where they are going, but he obeys their call, and jumps into the car, despite the pain in his leg. Always excited to go riding with the family, wherever the destination. We will never know if he senses that something is different about this trip. His family is sad and expressionless. They pet him, but absently.
They know where they are going and why. They feel that everything about this trip is a betrayal of Samson’s love and trust. They know he will not return home, get back in the car, or even leave the vet clinic. They are heartbroken but believe that there is no choice for Samson.
This all began three days prior. Samson was playing in the yard with the children when a family friend arrived at the house. Attention was diverted and Samson walked out an open gate. Being a jumbo puppy, he could react only one way when a dog appeared across the street. As he bounded to greet the stranger, he was struck by a fast-moving car. The family heard the screeching tires, and Samson’s painful cries. They ran out to see him struggling to get to his feet and took him straight to an emergency clinic.
X-rays defined the orthopedic damage. His right femur was shattered and he had a pelvic fracture on the same side. Both fractures required surgery, they were told. It also was said that this would be a very expensive repair, requiring a surgical specialist. The alternative, they were told, was amputation.
On one level, this was all true. If it had been just one fracture, maybe, but two. They just weren’t in a financial position to handle two. Amputation just seemed to them a cruel thing to do, especially to so large a dog.
In the fog of distress and sadness, the focus was upon the requirement for surgery, and the inability to do it. It seemed, to them that the equation was simple. The inability to properly repair equaled incompatibility with life. It was time to let him go.
Readers of this column know that amputation is in many cases a very reasonable step to take. In cases of cancer, it can permanently alleviate pain, and possibly lead to a cure. With certain types of injury, amputation is an effective remedy. I (Henri Bianucci) can still say that I have never amputated a limb and had a client who, subsequently, regretted the decision. However, I still consider it a method of last resort, and many pet owners find it unacceptable in any situation.
Fortunately, Samson’s veterinarian had been around the block a time or two. He had seen enough to know that not all dogs “read the book,” and that one veterinarian’s definition of “require” may differ from another’s. He convinced the owners to at least consult with a specialist and see if there was another option somewhere between amputation and reconstructive surgery. That’s where mine and Samson’s paths crossed.
I evaluated him and found that his other three limbs were in great condition. The emergency vet was technically correct. Both fractures “required” repair to eliminate pain, and predictably restore normal anatomic form and mechanical function. But, the pain will subside with time, rest and some creative slings. Ultimately, this was the route chosen for Samson. At his last recheck, eight weeks after the incident, his fractures had healed, and he was operating at about 80 percent of normal on the leg.
Medicine has come a long way, without a doubt. But, in some ways we have developed a dependence upon medical technology and intervention, to the exclusion of basic approaches. Because we can fix something, we begin to think that is the only way it can be repaired. Then, when someone can’t afford it, they are faced with choices like amputation or euthanasia, when a conservative approach may have yielded a perfectly acceptable outcome.
When forced to choose between the unaffordable and choices from which there is no return, such as amputation or euthanasia, be sure you and your veterinarian explore the middle ground. Mother Nature has been in the business of healing bones, joints and a variety of other problems that we now define as “requiring” intervention. Conservative approaches may not yield the best possible outcome, but they may allow you to keep your pet and nothing is much better than that.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to firstname.lastname@example.org.