Getting Legless – by Michael Watts MRCVS

To us wordsmiths the English language is a beautiful thing, a kaleidoscope that changes subtly all the time to suit the needs of the moment. I am prepared to believe Chaucer wrote great literature, but after so many centuries a dunce like me cannot make sense of what the Wife of Bath and her fellow travellers were banging on about on the road to Canterbury. Shakespeare is easier and a handy source of apposite quotes. Dickens never quite works for me but at least he writes in something resembling English as she is spoke today.

The language adapts, it cuts its cloth to suit its measure. Sometime imperceptibly in the past year or two I gradually became aware of   television reporters and radio news anchors talking and life-changing and life-limiting illness and injuries. That works for me.

Too often in the greyhound game we fall back on the familiar euphemism ”career-ending injury” a conversation stopper after which further discussion is generally superfluous. At least it is an improvement on the column heading “Scratched from All Engagements (Dead)” which was a regular feature of the horse racing page of a certain Dublin paper in my youth. Cutting quickly to the chase, let us turn our attention to one of the most life-changing procedures a greyhound might have to undergo if his luck doesn’t hold, the amputation of a limb

The operation is not rocket science. The object of the exercise is to remove all the damaged or diseased tissue leaving the dog with a nice short discreet stump on which he will never bear weight. The injured leg is generally amputated by cutting through the relevant bones rather than by cutting through a joint as the cut end of a bone generally heals quicker than an intact bone covered in cartilage.

In human patients as much of the injured limb as possible is saved with a view to fitting the patient with a prosthesis later. I am aware that a professional colleague of mine and a star of the small screen to boot, fits artificial limbs to dogs but many of his treatments are pioneering rather than mainstream. The average first-opinion veterinary practitioner has neither the knowledge not the equipment to carry out procedures of that type and many I suspect would not wish to go that road for ethical reasons. Enough said.

Every picture tells a story, but sometimes not the whole story. When your attention is caught by the bobbing gait of a three-legged greyhound crossing the street or taking his constitutional in the park you see his journey’s end, but not the road that lead him there. The most common indication for amputation of a leg in a dog is probably severe injury to the limb.

If there are multiple broken bones for example, and the bones themselves are comminuted, or broken into many pieces, it may prove technically impossible to stabilise the fractures with pins or plates, or with a cast because the pieces are so small and there are so many of them.

Amputation may be a valid treatment of last resort in such cases for those dogs who have a sporting chance of a decent quality of life afterwards. Devastating multiple injuries, where not only are bones broken, but the associated joints, muscles, tendons and ligaments damaged and the skin lacerated so that infection is inevitable are something that in veterinary practice is much more likely to be seen in a pet dog that has sustained external trauma, typically during a road traffic accident, than a greyhound who suffers a stress fracture to his hock or wrist during a race.

Piecing together the fractured central tarsal bone of a greyhound is no picnic, especially if the misfortunate dog in question has gained such momentum before disaster struck that he runs on for fifty yards before he can successfully get the brakes on, but at least the blood supply to the broken bones may be reasonably intact and the fracture site itself safely protected from infection by the intact skin. Once in a very blue moon you might see a compound fracture, that is to say, one where the skin has become torn and the broken bones exposed to the four winds, in a green puppy who inadvertently catches his foot in the hare rail, but such distressing injuries are thankfully rare.

Another potential indication for limb amputation in dogs is bone cancer. Tumours of the limb bones are common in dogs in general and in greyhounds in particular. One turned up by my favourite internet search engine suggested that 22% of deaths in pet retired greyhounds in the U.K. could be attributed to one particular bone tumour called osteosarcoma.

Research into the pedigrees of Irish Wolfhounds with osteosarcoma shows that the condition is much more prevalent I some families than others, suggesting strongly that there is some sort of inherited basis to the disease. Studies of this kind are relatively easy to do in Wolfhounds, where there is a small gene pool. The same sort of data for greyhounds is not available to date, but given the frequency with which it occurs in this breed in comparison to others, the smart money says there is likely to be a genetic predisposition to the condition in greyhounds too.

Bone tumours in dogs are almost invariably primary, that is to say the tumour starts in the bone, rather than developing elsewhere in the body and spreading to the sites in the bones where it has been identified. Bitter experience of many vets over many years is that osteosarcomas do not respond well to medical treatments like chemotherapy or radiation therapy, at least not when these are used as the sole approach to the problem. On the face of it amputation of the affected limb looks like an option worth exploring.

Osteosarcoma is an intensely painful condition and commonly used approaches to pain control may do little more than take the edge off the suffering of affected dogs. Furthermore limb bones eaten away by tumours may become seriously weakened and break without warning in response to quite minor stress or trauma causing great distress to the affected dog. Amputation certainly removes the source of pain and eliminates the possibility of pathological fractures occurring.

On the other hand, the amputation of an entire limb is radical invasive painful surgery and affected dogs would need to have a decent chance of a reasonably long reprieve during which they enjoyed a reasonable quality of life to justify going down that road. Osteosarcomata are characteristically aggressive rapidly-growing tumours which spread quickly to other organs, typically the lungs. Removing the primary tumour when it has already spread to more remote sites is akin to shutting the stable door after the horse has bolted. To put an affected dog through such a big painful operation when the existence of secondary tumours means there is no chance of survival beyond the short term shows poor judgement in my opinion.

Before amputation should even be considered for an osteosarcoma case, chest x-rays are essential to try to ensure that the tumour has not spread. Alas, radiography is a blunt instrument in this context and there may be small secondary tumours in the lungs which are too small for the technology to detect, yet ultimately lethal. In practice dogs with osteosarcoma treated by amputation of the affected limb alone typically live for three or four months after their surgery.

Those in which amputation is teamed up with chemotherapy or radiation therapy or both, therapies which themselves are often associated with unpleasant and life-limiting side effects, have a life expectancy in the region of eight to twelve months. Doctors proverbially differ, and patients die, and the same is undoubtedly true of vets. Striking a personal note for a minute, in some thirteen years of owning retired race dogs as pets, I have lost three friends to osteosarcoma.

For one old lady the first sign of trouble was a pathological fracture shattering her foreleg. In another, respiratory problems lead to her having a chest x-ray which revealed secondary tumours before the primary had been identified. My choice was a heart breaking one: all three were euthanased without treatment once an incontrovertible diagnosis of osteosarcoma had been made. St. Peter may haul me over the coals for this at the Pearly Gates but, much as I miss every one of them, I still think I made the right move.

There are other indications for amputation of a leg in a greyhound but they are much less common. In no particular order they might include traumatic amputation, where the affected dog’s leg has by some misadventure already been severed and it only remains for the attending veterinary surgeon to stop any bleeding, administer pain relief and in due course tidy up the stump. I recall the somewhat surreal case of a beautiful lurcher dog who let out into the garden for toilet purpose before being shut in for the night, somehow became entangled in a clothesline and returned to his now hysterical owners on the back doorstep minus a hind foot. You could not do it if you tried.

Irredeemable paralysis of a leg, for example following a brachial plexus avulsion, which left the affected limb trailing helplessly and developing pressure sores might be a good indication for amputation when all less drastic remedies have been tried and failed, but it is not the sort of case that crops up very often.

Amputation might be more urgently required in the case of a dog with gangrene in one leg, where the lower portion of the limb has died ad is decomposing while still attached to the remainder of the body. This can happen following and accident which impairs the circulation of the blood to the lower leg but perhaps more commonly follows the incorrect or injudicious application of a dressing or cast to the limb. The old time Greek physicians’ creed was to do good or to do no harm but sometimes in trying to achieve the first of these precepts things do not go according to plan.

From time to time pups might be born with significant deformities to one leg to justify amputation. I have in mind the brood bitch of a lady client which was sent out to be whelped down and returned with a well-bred litter of six which included a fawn dog with a tiny wizened unbendable foreleg carried in permanent flexion, Clearly not destined to race and hard to get reared on a one for one basis, I lost sight of her and do not know what life held in store for her.

Those are some of the medical reasons for considering the amputation of the leg of a greyhound, but they are not the only considerations. Before launching into a bit of life-changing surgery like this some consideration has to be given to the age of the patient. Intuitively you imagine that young dogs may adapt more readily to the loss of a leg and at least they have the chance of a long life in front of them if the procedure is successful. Older dogs are more likely than youngsters to have other co-existing health problems which might militate against success..

There might be little pint in amputating one leg for example if the patient has pre-existing arthritis in the opposite one. Kidney disease in the elderly potentially makes anaesthesia more hazardous while obesity, with an abnormal load to be carried on three legs in future rather than the standard four, may need addressed before surgery if time permits.

Then there is temperament. If the patient is timid and skulks at the back of his kennel, snapping at strangers through fear, he may not be the ideal candidate for surgery. Likewise the aggressive predatory greyhound who dreams all day of chasing cats and coursing small dogs needs the most careful placement in a pet home.

Finally there is the matter of money. Most decision making in the veterinary treatment of greyhounds is determined at least in part by the economics of the situation. While the more successful and better bred among their ranks may have some value at stud, for most amputees the future is life as a pet. If no pet home can be found for him after surgery, you have to think twice before proceeding with the operation. There are alas always more greyhounds looking for forever homes than there are good homes for them.

Someday every dog leaving the racing strength will find a berth somewhere but we are not quite there yet. There is another aspect of the money thing that I have to mention. From time to time I see greyhounds coming through rescue and rehoming organisations who have had amputations as a less expensive alternative to a complex orthopaedic procedure.

Personally I feel that most dogs with serious leg injuries are better with four legs than three and that all reasonable steps to salvage the damaged limb should be attempted as far as possible But I would say that, wouldn’t I?