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CASE 7. A stitch in time saves nine "What
should I do with this 11-weekShih Tzu puppy with pink intestines about to
burst out of his belly button?" I asked myself. "Should I just mind my own
business and vaccinate the puppies as requested by Mr Formicelli and walk
away?" This stunted puppy would die in the next few days as the large intestinal loops get twisted further. The twists and turns of the loops strangulate the blood vessels. The intestinal cells die and the puppy dies in a very painful way. The diagnosis was a massive inguinal hernia. The treatment was surgery to close up the hole in the belly. The puppy was in a poor bodily condition with all her puppy fat lost. Was it now too risky to operate on her? Veterinary anaesthesia books mention that puppies less than 12 weeks of age are high risks, meaning they have a high rate of death from anaesthesia. The Shih Tzu was 11 weeks old. The puppy had licked it a lot of time since three weeks of age when the hernia was detected. The weight of the abdominal organs and the friction on the cage floor thinned the skin considerably to less than a mm now. I could see the large intestinal loops under the skin. Any time, the skin would rupture and the Shih Tzu, now skin and bones would die painfully. She was smallest of the four Shih Tzu puppies when I vaccinated her 3 weeks ago. I remember her very well because she had a large umbilical hernia of 8 cm in diameter, a size bigger than the width of two adult fingers. The assistant was very good at puppy care. He had seen numerous umbilical hernias in puppies and would have informed Mr Formicelli of this unusually large defect. He would have encountered puppies with small umbilical hernias of around 1.5 cm in diameter and surgery was not urgent in such cases. 3 weeks ago, I said to Mr Formicelli's assistant during vaccination: "This 8-week-old Shih Tzu needs surgery to repair the big gap in the muscle layer of the belly region. Do ask Mr Formicelli for permission. It will be hard to sell this puppy with such a large defect in her muscles." The assistant did not get back to me. I phoned him a week later and he
said that Mr Formicelli had not decided on the surgery. "Was it the $200
cost of general anaesthesia and surgery?" I asked him but he did not say
anything. Silence is golden. Many dog breeders and pet shop owners had to cut operating costs in this severe economic downturn attributed to SARS (severe acute respiratory syndrome) and I could understand that. But $200 should not be a big problem with Mr Formicelli who was a very successful operator, I thought. Yet, every dollar saved is a dollar earned. After all, Singapore Airlines reputedly the world's most successful airline over the past twenty years, was cutting salaries of pilots and retrenching staff. In retrospect, I should have phoned Mr Formicelli 3 weeks ago to warn him about the impending death but that would be tantamount to touting. Mr Formicelli might feel offended although he would be too polite to tell me off. Most important of all, there was no guarantee that an 8-week-old puppy would survive the general anaesthesia and post-operation days too. 3 weeks passed and now I could not believe my eyes. Her inflamed hernia skin was stretched a lot, weighed down by the internal organs. Just like pregnant women with stretch marks, but this was much worse. The herniated area was very thin now, due to continual licking by the puppy to relieve the pain and discomfort. The skin became inflamed. I could even see that a loop of the large intestine is inflamed, due to the friction between it and the floor. The large intestinal loops imprinted onto the skin making a U-shaped stamp. A triangular lump above the U-shape could be the lobe of a liver.
In a few days, the skin would rupture as it became thinner than paper. The
intestines and liver lobes fall out of the body. A very painful death,
just like being stabbed in the abdomen. Somehow, it was not right to abandon this Shih Tzu which was more lively and fatter three weeks ago. Is there a way to help this Shih Tzu? What could I do? Why should I be bothered? This hernia could be repaired but would the puppy survive the general anaesthesia and post-operation surgery? The chances were slim. Most veterinary surgeons would like to anesthesize puppies less than three months old. They are high anaesthetic risks. The surgeon gets a bad reputation - "the puppy died when the vet operated on it" would be spread by word of mouth and via the internet. It was so easy to walk out of this Shih Tzu puppy. Mr Formicelli was not at the shop. There was one foolhardy option. "Will you sell the puppy to me for $50?" I asked Mr Formicelli's mother. A silver-haired slim woman in her seventies, she was grooming a poodle. She did not need to work at all and could enjoy her mahjong sessions and shopping in Singapore, a city known to have more shopping malls than New York. She could afford the fanciful coiffured hair style, wavy and permed like
other Singapore's tais tais (ladies with wealth), but she simply had short
hair with two pony tails on either side tied by rubber bands."$200," she replied in a serious tone. Her sun-tanned face revealed no emotion. Nobody would purchase this sickly puppy. Therefore, it had zero value. This would be the time to back out of the offer. If she had said yes, I could not demur since I had asked her. "This puppy needs an operation," I murmured. "$100," she said without looking up as she clipped the puffed up head hair of the white toy poodle for its Singapore Kennel Club dog competition. Now, I know why Mr Formicelli is so successful in his canine pet shop business. He had good training from his mum. If she could sell this puppy for $100, she could sell ice to Eskimos. "The operation to repair the hernia will cost more than $100," I replied. I had blown away a second chance to back out. I had not done a veterinary examination of the Shih Tzu puppy. I had not even checked whether she had a normal heart and other hereditary defects. It was rash to offer to buy a such a puppy. "$50" Mr Formicelli's mother said. Better to get $50 than pay more for an operation for a sickly puppy. She knew about the fragility of runts, of stunted puppies in her four decades of pig farming which was extinguished by the Singapore Government's policy later. This puppy would not survive for the next few days. Now, I could not back out of her offer. I took the puppy back to the surgery and put her in a cage for observation for one day. She did bark a few times for attention. What a strong girl! But she was nibbling a bit of dry dog food just to survive. Like an anorexia nervosa teenaged girl who is afraid of being fat. I had better operate on day two as the intestinal loops turned fiery red under the skin. The intestinal loops could be twisting and the blood vessels would be partially strangulated.
Her rectal temperature was 37.7 degrees Celsius pre-operation. Normal
temperatures are around 38.5 - 39.0 degrees for a puppy. She was
going into hypothermia. I gave her a dextrose drip prior to anaesthesia to
increase her chances of survival.
The puppy was kept warm in a cage after the end of the operation. 12 hours
later, she could not sit up. Fainted. She was hypothermic
again and laid down on her side. Would she survive? She was forced fed an
egg. |
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BREEDERS: BE KIND TO PUPPIES - A puppy's life is
precious.
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