Quality of life for hind leg amputation?

[Liung]

Opinions on quality of life for a rabbit after amputating a hind leg?

My little old man Lahi very suddenly developed a huge growth on his right hind foot toe last week.



I immediately called the vet to make an appointment, and that was today. In the week since, the growth has swollen and the ulceration on top has spread. A second one also appeared on his knee.





I’ve just left him at the hospital, they’re going to biopsy the one on his knee and get histopathology results to see what it is. Based on the rapid appearance and growth patterns, they’re expecting it to be malignant.

If the results are benign, they want to amputate the toe. If the results are malignant, and further testing shows it hasn’t spread further, they’ll want to amputate the entire leg.

And I just... I don’t know if I can do that to him??? I’ve always said that I prioritize their quality of life over longevity. It would be selfish to force them to continue living just so I could keep them a little longer, if they aren’t happy. Lahi is 13 years old, his body has been throwing problem after problem at him for YEARS now. We’ve always been able to successfully treat whatever it is, and have him recovered and bouncing happily around again.

So he’s 13, I don’t have any idea how long he might live provided nothing else happens to him. He’s actually REALLY healthy for his age; he’s got a small heart murmur, slight cataracts, mildly creaky joints, greying nose, some missing teeth, and that’s pretty much it for signs of old age. The vet even commented today, his missing teeth seem to not be affecting him at all, he’s got good muscle tone, nice fat stores around his chest... I would fully expect him to crack 15 years old IF nothing else happened.

So let’s say it’s malignant. Let’s say it hasn’t spread. Let’s say I approve the amputation. That’s a MAJOR surgery, with a huge recovery. That’s tremendous amounts of pain and distress. And once it’s over, and he’s healed, that’s all the pain and problems associated with any amputation. And that’s extra stress and weight on his remaining hind limb, when his joints are already creaky. And that’s a major loss of normal movement and ability. In animal welfare we say that the ability to perform highly motivated behaviours is extremely important for good welfare... what kind of life is it for him if he can’t run and jump properly? Can’t climb and zoom around? Their condo is built with ramps and tunnels and even if I remake it so it’s safer for him... he LOVES being up high, Lahi and Delilah both get really distressed when I take the ramps away and don’t let them access the higher shelves. I took the ramps away when Delilah had a surgery and then had to give them back because her agitation over not having the ramps was more likely to hurt her than climbing the ramps would.

But then let’s say I don’t decide to let them amputate. Let’s say that I decide that, at 13, it’s not worth the amount of pain and suffering and loss of ability just for the chance that he gets another couple years. Quality over quantity, right? And there’s nothing to say that he wouldn’t immediately get hit by some new medical disaster.

But that means palliative care while the malignant cancer slowly kills him. The vet talked to me last year about chemo and radiation—my initial stance was that I would put him through that under no circumstances whatsoever, I’ve seen humans go through that and it was horrific, I don’t care if there’s a chance of beating the cancer, the long-term intense suffering required to get that chance is not humane to inflict on an innocent, non-consenting animal. The DVM assured me that the veterinary community feels the same, and that animal chemo and radiation is intended to be palliative, not therapeutic. The goal is only to slow down the cancer and maximize quality of life, not cure the cancer. So that’s good, right??

But a slow death by cancer isn’t any better. And rabbits are notoriously good at hiding pain and distress. And can I trust myself to make the right call and let him go when he’s reached a point of suffering and distress? Can I trust that I won’t try and delude myself into keeping him with me a little longer??

I don’t know what to do [emoji26] all I want is my little boy to be happy for as long as he can.

 

[Liung]

Some pictures of my handsome little man because <3

 

[SableSteel]

Honestly, the quality of life for a rabbit missing a hind leg isn't great. Unlike many other animals, they put most their weight on their hind legs and use them for mobility. They also don't have paw pads - the amount of extra weight all on one foot will likely wear away at the fur at the fur on the hock and lead to sore hocks along with any joint issues. The fact that he's a small breed probably helps (at least there's less weight) but the fact that he is 13 probably does not. If it was a front leg I would try it. If I were in your position, maybe see if they can just amputate the toe whether it's benign or not and hope for the best? I'm not a vet though, and yours seem to know what they are doing. Although at his age any procedure requiring anesthesia is likely to be risky.
Good luck

 

[CinM]

Im so sorry you’re going through that. I have a rescue that only has one working back foot and does perfectly fine getting around (even does little kicks). She does struggle a little balancing to bathe herself so something else to think about and that’s with the non working one to help balance herself on. She had a sore hock so now is in a carpeted room with thick blankets and memory foam mats everywhere to help relieve the pressure of the working foot. My opinion would be just the toe yes and the whole foot no based on how mine gets around.

 

[Liung]

Lahi has achieved his goal of stumping the foremost experts on rabbit health. The histopathology results came back as “?????????? It looks like a hepatoid carcinoma but that appears in the perianal glands of dogs, we don’t think rabbits CAN get hepatoid carcinomas???????”

So the OVC cancer centre, people who are specifically specialized in identifying rabbit tumours, are just completely baffled by him. Good job Lahi.

The good news is that even though they weren’t trying for tumour margins, the biopsy on his knee tumour came back with completely clean margins. So should it turn out that it’s benign, his knee is done and won’t need more work. They’re going to do chest X-rays on Tuesday and if he hasn’t got masses in his body they’ll go straight to amputating the toe and sending that for histopathology too to see if they can get a more clear result that makes sense.

 

[Liung]

Honestly, the quality of life for a rabbit missing a hind leg isn't great. Unlike many other animals, they put most their weight on their hind legs and use them for mobility. They also don't have paw pads - the amount of extra weight all on one foot will likely wear away at the fur at the fur on the hock and lead to sore hocks along with any joint issues. The fact that he's a small breed probably helps (at least there's less weight) but the fact that he is 13 probably does not. If it was a front leg I would try it. If I were in your position, maybe see if they can just amputate the toe whether it's benign or not and hope for the best? I'm not a vet though, and yours seem to know what they are doing. Although at his age any procedure requiring anesthesia is likely to be risky.
Good luck

I’m lucky enough to live in Guelph, the home of the Ontario Veterinary College. All vets in Ontario are certified here, most are trained here, and vets from all over send samples to the OVC Animal Health Laboratory to be examined by the foremost experts in veterinary medicine. When I bring my buns to see a vet here, they’re not being seen by a vet who sees a couple rabbits a month, these vets see several rabbits a day, they specialize in small animals and any patient exam is done in front of a crowd of students taking notes because it’s a teaching hospital, these are The Experts. These are the most rabbit-savvy vets it would be possible to get and I am so unbelievably grateful for this level of expertise. The one vet that’s dealing with Delilah’s ears has rabbits himself!!

So I’m 100% at ease when it comes to them performing surgery. They are are the best of the best, the vet I talk to is not the vet that does the surgery, it’s a rabbit dental expert, or a small animal cancer surgeon, and so on.

And let me tell you that’s a HUGE source of stress lifted from me. Lahi has to get at minimum annual tooth trimming, so he undergoes anesthesia a LOT. Last year they heard a heart murmur and urged me to get an echocardiogram so they could accurately prepare the anesthesiologist to adjust accordingly. Heart problems? No big deal, as long as we know what they are and how to account for them!!

It’s stupidly expensive and they are VERY test-happy—my last vet, while very rabbit savvy, had never recommended bloodwork, and last year before they’d try to remove the melanoma on his ear they wanted bloodwork, xrays, echocardiogram, ultrasounds... all with perfectly logical reasons that made sense and were important, but in my experience clinic vets are a lot more likely to forge ahead toward what would *most likely* fix what is *probably* the problem while minimizing costs to the client. OVC vets want to know *exactly* what the problem is and be 100% sure of the best course of action before acting.

They were reluctant to go ahead and amputate the toe without knowing what kind of tumour it is, because it would be pointless and cruel to force him through surgery and recovery on his toe, just to find out that it’s malignant and they’d have to take the entire leg. Now though, with the weirdest possible result, they want the toe because they couldn’t get a good result from the one on his knee. If it really is a similar type of cancer to what it appears to be, taking the toe will probably be enough. However, they said given that he had a melanoma on his ear, it’s far more likely that it’s actually an unpigmented melanoma.

I asked about quality of life on a rabbit group on Facebook and immediately got a number of responses indicating that tripod bunnies actually do quite well, generally. Someone even pointed me to a “disabled bunnies” group, though I haven’t checked it out yet. However I think most of those people failed to see the main issue I’m worried about for Lahi—he’s not a young thing that can bounce back easily from any setback. A two-year old might easily acclimatize to the loss of a leg, but a 13-year old?? And he’s already got mild arthritis and sore hocks, what would the added stress do to that?

Their environment is set up to accommodate how much both my buns love to climb, and it would probably devastate Lahi to no longer be able to make his way up and sit in his favourite spot on the top shelf of the condo to oversee his territory.

And that’s my issue here. I’m not worried about the surgery, I’m fully confident that the OVC surgeons would do the best job and he’d heal as well as possible. I’m worried about his quality of life after the surgery. What’s the point of forcing him through a painful surgery and lengthy recovery in an attempt to cling onto a few more years of life, if those years will be miserable?

 

[Lauren Kiernan]

I definitely think you are right to question the stress of surgery and rehab at his age with the likelyhood of him not having much longer anyway due to life span constraints. It seems like you have great information and vet care and are realistic. Go with your gut feeling on what is right! What an amazing long life for a bunny. He looks great.

 

[JBun]

I think you have to gauge his current health otherwise at this point. If he seems to have good body condition, good muscle tone and strength, and doing well aside from this problem, then he could possibly recover well from the surgery and cope well with the demands of one less leg. However if he is showing his age, not as spry or strong, sleeping a lot, not moving around and keeping up muscle tone, then surgery might be too much to recover from. From your account, it sounds like he's doing relatively well for his age and may stand a good chance of recovery.

If you do consider surgery, I would suggest for sure getting bloodwork done if you haven't had it done recently, to make sure the organs are functioning well. But whatever you decide, you have done a remarkable job with him and treating the health issues that have cropped up in his life.