Species: dog
Breed: Australian Sheperd
Sex: f, neutered
Weight: 23.5 kg
Birth date: 2015-04-02 00:00:00
Primary diagnosis: Myxoma left carpus
Situation: Pre-surgery
Medical history: Since 2 months the owners have noticed that Emily has a swelling cranial to the left carpus. She otherwise shows no lameness and no dolence in this area. The increase in circumference is increasing quite rapidly. On 15.06.24 the mass was punctured by the PTA and a cyst was suspected. Three biospies were taken 3 weeks ago, the conclusion was, it is a myxoma with suspected synovial origin. One of the byopsie sites has become infected. She has been given Combiclav (amoxicilline and clavlucanic acid) against this infection until today (23.07). A CT was also carried out (report: Soft tissue cystic mass over the left carpus consistent with suspected soft tissue sarcoma (in particular myxoma, less likely myxosarcoma), No aggressive features on adjacent structures; Splenomegaly may be compatible with a benign process (extramedullary haematopoiesis, benign hyperplasia) vs.less likely to be malignant.,This lesion may also be induced by general anaesthesia (passive congestion); Bone lesions involving the radiointermediate bones of both carpals: benign and probably incidental (failure of the growth plate to close, subchondral cyst, etc.); Discrete osteoarthritis of the elbow and fragmentation of the coronoid process). Now the dog has been presented to our clinic to remove the mass (24.07.2024). After removal only a partial wound closure was possible. After two days (26.07) closure was still not possible, two new "pre-tension" sutures were made. 5 days after surgery wound revision was performed again, one new suture and release cuts were made. On the 02.08 the dog was released (under therapy with Carprofen, Sucralfat, Omeprazol and Amoxicillin / Clavulanic acid), she then came back on 06.08 to do a skin graft the following day. Bandage change was done on 10.08, 12.08 and 14.08. On the 12.08 they took a bacteriological sample during the badage change, which came back positive for Enterobacter cloacae complex on the 14.08 -> Emily was put in isolation so I couldn't film her anymore. On 16.08 a last wound revison and bandage change were done and Emily could go home. (The dog also had cystitis in mid-June, which was treated with Combiclav and Canidryl. Since then she still shows polydypsia, but no other symptoms. -> written in anamnesis at presentation. At our clinic a urine sample for culture was taken on the 09.08 but came back negative.)
Medication: 23.07: Cylanic (Amoxicillin & Clavulanic acid) 10.6 & 2.7 mg/kg (250 & 62.5 mg) PO BID, Carprofen 2 mg/kg SID, Omeprazol 1 mg/kg BID. 24.07: Cylanic & Carprofen & Omeprazol same as 23.07, (all not given before observation 1), Paracetamol 15 mg/kg IV TID (given while filming observation 2), Burpenorphin 0.01 mg/kg IV TID if needed. 25.07: Cylanic & Omeprazol & Paracetamol same as 24.07, Carprofen 4 mg/kg IV SID, Buprenorphine 0.015 mg/kg IV TID, Cerenia 1 mg/kg IV SID (started after observation 3). 26.07 (nothing given before filming observation 4): Cylanic & Carprofen & Omeprazol & Paracetamol & Cerenia same as 25.07, Methadon 0.2 mg/kg IV q4h. 28.07: Cylanic 12.5 mg/kg PO BID, Carprofen 4 mg/kg PO SID, Omeprazol 1 mg/kg PO BID, Cerenia 1 mg/kg PO SID, Paracetamol 15 mg/kg PO TID, Buprenorphin 0.015 mg/kg SC/Sublingual TID. 29.07 (nothing given before filming observation 5): Cylanic & Carprofen & Omeprazol & Paracetamol same as on 28.07, Maropitant 1 mg/kg IV SID, Buprenorphin 0.01 mg/kg IV TID (Methadon 0.2 mg/kg IV given 1x at 09). 30.07 (nothing given before filming observation 6): Cylanic 12.5 mg/kg PO BID, Carprofen 4 mg/kg IV SID, Omeprazol 1 mg/kg IV BID, Paracetamol 15 mg/kg IV TID, Maropitant 1 mg/kg IV SID, Buprenorphin 0.01 mg/kg IV TID. 31.07 (nothing given before filming observation 7): Cylanic & Omeprazol & Carprofen & Paracetamol same as 30.07. 06.08: Carprofen 3.2 mg/kg PO SID, Omeprazol 0.9 mg/kg PO BID, Sucralfat 45 mg/kg (5 ml) PO BID-TID, Cylanic 10.6 & 2.7 mg/kg (250 & 62.5 mg) PO BID. 07.08 before surgery: Carprofen & Omeprazol & Sucralfat & Cylanic same as on 06.08 (nothing given before observation 9). 07.08 after surgery: same as before surgery + Trazodon 5 mg/kg PO TID & Paracetamol 10 mg/kg IV TID, Ondansetron 0.3 mg/kg IV TID, Maropitant 1 mg/kg IV SID, Buprenorphin 0.02 mg IV TID. 08.08: Buprenorphin & Ondansetron & Omeprazol & Carprofen & Sucralfat & Trazodon same as on 07.08, Ampicillin 30 mg/kg IV (nothing given before observation 12). 09.08: Buprenorphine 0.02 mg/kg IV TID,Ondansetron 0.3 mg/kg IV TID, Ampicillin 30 mg/kg IV TID, Omeprazol 1 mg/kg IV BID, Carprofen 4 mg/kg IV SID, Sucralfat 45 mg/kg (5 ml) PO BID, Trazodon 4.5 mg/kg PO TID (only Sucralfat given before observation 13). 12.08: Ondansetron 0.3 mg/kg PO TID, Cylanic 11.5 mg/kg & 2.9 mg/kg PO BID, Omeprazol 1 mg/kg PO BID, Carprofen 4.6 mg/kg PO SID, Sucralfat (5 ml) PO BID, Phenylpropanolamin 1.4 mg/kg (0.6 ml) PO BID (only Sucralfat given before observation 14). 13.08: Ondansetron & Cylanic & Omeprazol & Carprofen & Sucralfat & Phenylpropanolamin same as on 12.08 (only Sucralfat given before observation 15). 14.08: Cylanic & Omeprazol & Carprofen & Sucralfat & Phenylpropanolamin same as on 12.08 & 13.08 (after the bacteriologic result Cylanic was changed to Marbofloxacin).
Anesthesia: Intervention on 24.07.2024: Myxoma excision over left tarsus. Premedication: Dexmedetomidin 0.015 mg/kg PO, Methadon 0.2 mg/kg IV. Induction: Propofol 4 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: Local anaesthesia RUMM Block Ropivacain 1.8 mg/kg (8.5 ml). Antibiotics: Ampicillin / Sulbactam 30 mg/kg IV. Wake up phase: Dexmedetomidin 0.002 mg/kg IV, Bolus Carprofen 2 mg/kg IV, Bolus Paracetamol 15 mg/kg IV. Intervention duration: 80 min. Anaesthesia duration: 395 min. Intervention on 07.08.2024: Mesh Graft from left thoracic wall to left carpus. Premedication: Methadon 0.2 mg/kg IM, Dexmedetomidin 0.007 mg/kg IM. Induction: Ketamin 1 mg/kg IV, Propofol 2 mg/kg IV. Maintenance: FiO2, Isofluran. Analgesia: IV Infusion Ketamin 0.6 mg/kg/h, IV Infusion Fentanyl 0.005 mg/kg/h, local anaesthesia splash block on the wound Ropivacain 2 mg/kg (8 ml). Antibiotics: Ampicillin / Sulbactam 30 mg/kg IV. Wake up phase: postoperative sedation Dexmedetomidin 0.001 mg/kg IV, Bolus Buprenorphin 0.015 mg/kg IV. Intervention duration: 70 min. Anaesthesia duration: 200 min. Complications: regurgitation during surgery (discovered after surgery when the head was decovered).
Pain type: acute, inflammatory, somatic
Pain origin: Over the tarsus, front legs
Pain duration: More than 7 days
Estimated pain severity: 25