1360. Case-study: C-section & Eclampsia in a Poodle X

TOA PAYOH VETS toapayohvets.com Date:   12 April, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Caesarean section & eclampsia in a poodle X  Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS First written:  11 April, 2013 Date:   12 April, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 On March 28, 2013, at around 8 am, a young lady phoned me to enquire about my fees for a Caesarean section for her dog. Her PoodleX dog that had not given birth to another pup since before 4 am. She discovered the first pup had been born naturally but it had died. "The fees would be $800," I quoted. "I live in Paya Lebar and will arrive in less than 20 minutes."   I ate my breakfast fast and drove fast the 20-minute drive to Toa Payoh Vets as this was an emergency C-section and time is of the essence. However the lady did not turn up till around 9.30 am. She was reading from her smart phone wrapped in a pink cover and putting the phone on her ears. She seemed to be speaking to somebody for a long time.  I knew there were some indecisions as to whether the C-section would proceed. "The dog had given birth naturally to one pup in her first litter," her mother said over the phone. "She had done it before. Why spend money on C-sections? Why not wait and see?" The young lady had waited and knew the consequences of procrastination. She cared for the life of her dam. Yet she was not the decision-maker.     "Is there an alternative to C-section?" this young lady of the internet generation that would do a lot of internet research about C-sections asked me. "Yes," I gave her a straight answer. "Your dog can be given an oxytocin injection to stimulate and contract her uterus. We could wait and see. But your dog has large pups, more than one as you can see from her much swollen belly. I would estimate 2 or 3 pups. They are large pups and the dam may not be able to push them out even if one pup could be born naturally.  In the end, the pups will die and decompose. You will still need a C-section to save the dam." This dog had uterine inertia but now was not the time to educate the owner about uterine inertia. I had other things to do as well. This was an emergency C-section and there was an objection by somebody in the family. C-sections cost money. Natural births are free of charge. I did not want to hard sell. This was the heartlander owner's decision. C-sections in dogs cost $1,000 - $2,000 as there was much work and time involved as you would see in this case study.  If the cost was $250, there might not be any objection from her mother. This C-section surgery itself took around one hour as there were complications with two pups not crying and breathing when they were taken out of the womb and had to be revived. It was 10 am before permission was given for the C-section. My intern Ms Toh had arrived for work and I asked her to video the process involved in an emergency C-Section and produce an educational video. Saturday, March 30, 2013 1346. Follow-up on the Caesarean section - young don't talk, she sms   For the past 2 days, I phoned the young lady but could not get through her mobile. Today Sunday, Mar 31, 2013,  I texted her: "Is CC OK? Pl tel me. Dr Sing. Toa Payoh Vets." She texted immediately: "Hi Dr sing. CC is fine. Nursing well." That is how the young Singaporeans communicate. Sure saves a lot of time. Below are the images of the Caesarean section from www.toapayohvets.com. An intern will produce a video later.     Saturday, April 6, 2013 1351. A panting high-fevered dam with 2 one-week-old extra-large pups   On April 6, 2013, at around 8 am,  I was surprised to receive a phone call regarding the poodle X I had performed Caesarean section one week ago, being unable to stand up and panting furiously. "She is having milk fever," I said over the phone. "Give her some milk and honey and bring her to the Surgery at 9 am. The owners were there at 8.30 am. Last week when I rushed to the Surgery which took a 20-minute drive, the owners were slow in arriving. There were some indecisions as to whether they wanted to do the C-section and so my rushing down to perform the emergency C-section was in vain. This time, they were much earlier as the dam was in distress. All 4 limbs extended. Neck extended. Tongue out. Panting non-stop. I got Nai to take the rectal temperature which was 41.9 deg C. It was extremely high and delays in seeking medical treatment mean death. I gave the IV drip (Hartmann) together with 1 ml of the Calcium. Within 5 minutes, the panting stopped and the temp was 39.6 deg C. The dog recovered. "Not a single drop of milk for the puppies," I advised. "Otherwise, the same problem will recur. You need to buy milk powder for the puppies and bottle feed." The dam recovered but there is the common problem of feeding and nursing the two very young puppies. No experience at all. FOLLOW UP MARCH 30, 2103 10AM Caesarean section done by me. 2 extra-large pups. All went home on the same day. MARCH 31, 2013 10.59 am SMS from me Is XXX ok? Pl tel me. Dr sing Toa Payoh vets MARCH 31, 2013  11.38 AM SMS from owner Hi Dr sing. XXX is fine. Nursing well. APRIL 6, 2013  9 AM The dam had milk fever. Treated and recovered well. APRIL 6, 2013 SMS  5.09pm SMS from owner Hi Dr Sing, I am CC's owner. You told us to bottle feed the puppies. But they are refusing to drink. Is there anything I can do about it? PHONE I phoned to advise using very warm milk, ensuring the teat has more than one hole and placing the pups near their mother. Less concentrated milk. APRIL 6, 9.47 AM SMS from me Are puppies drinking bottled milk now? 10.31 pm SMS from owner No, they drank very little milk. 11.33 pm from me SMS Give milk every 2 hours APRIL 7, 2013  12 AM SMS from owner The puppy stool is watery. Is it normal? 5.30 am SMS from me Usually soft stools. New milk makes it watery 5.30 am They hardly drink any milk. The tummy isn't round and full like it used to be. Use syringe to feed warmed milk every 2 hours at least 20 ml till they are full. Or buy goat milk powder to give milk. You need to feed the amount (20 ml). Very few people are successful in rearing 1-week-old pups. U need to read up on internet on how to do it. SUNDAY APRIL 7, 2013 4pm Phoned the owner. No response from her mobile. APRIL 7, 2013  11.02pm The owner texted to me. Hi Dr Sing, Puppy is finally drinking milk. I went to make my own milk for them by Googling and I bought human milk bottles instead of the dog pet shop bottles. The nipples for the bottles are much softer. Thanks for your help!   1359. Follow up on Caesarean-section-milk-fever dam    I did a follow up on the lady by phoning her yesterday, April 11, 2013 and managed to get her on the phone. She said the extra-large pups are thriving on the "internet-researched" milk formula of yogurt-egg-yolk as in the link given by her below. The puppies were much larger than the sole pup naturally born in the first litter a few months ago. Also they drank 30-40 ml of this formula every 2-hourly, "not 20 ml" as suggested by me. I did not comment as the "20 ml"/2 hourly was a minimum for puppies at 7 days old. "What are the feeding times?" I asked. "Every 2 hourly except from 3 am to 7 am". Her mother helped her. Nowadays, the internet has much more information for pet owners and the younger generation can have more specialised knowledge on feeding orphan puppies than a veterinarian. The two puppies disliked the pet shop supplied milk powder and were losing weight. They also dislike the milk bottle nipple bought from the pet shop. But they loved the internet milk formula and human baby milk bottle. Vets can listen and learn much from the younger generation on some aspects of veterinary medicine as they focus on specific problem areas. Other home-breeders have successfully reared puppies using syringes and cow's milk or goat's milk. In all cases, they need to spend 2-hourly of feeding and know how to stimulate the puppy to pee and poop. Most vets in urban Singapore will not have many cases of C-sections in dogs unless they provide inexpensive loss-making $250 C-sections like I did some years ago and performed over 200 cases of C-sections from the professional dog breeders at Pasir Ris. Still vets need to know: 1. How to perform the Caesarean section competently 2. How to revive the distressed puppies (not crying or moving) when taken out during the C-section. 3. How to treat eclampsia 4. How to advise regarding "orphan" puppies. I will be producing a video on these aspects to educate vet student and pet owners.   On Wed, Apr 10, 2013 at 7:35 PM, J@gmail.com> wrote: Hi Dr Sing,   CC's owner here. We went over to your clinic 2 weeks back for the C-sect. Here's the link to the puppy formula. http://leerburg.com/bottlefeeding.htm They did mention that using a human milk bottle is better than the pet dog milk bottle so I actually bought the human milk bottle. The nipples are much softer than the dogs milk bottle.   Thank you! We will come back for the vaccination in 1 1/2 weeks time.   ------------------------------------------------------------------------- EMAIL REPLY FROM DR SING DATED April 11, 2013 Thank you for sharing info on how you successfully feed the 7-day-old puppies since their mother has eclampsia (milk fever). Eclampsia usually occurs in the first litter for small breeds but your dog had given birth naturally once earlier. The present milk congested mammary glands will reduce in size with time. She had no milk produced when I saw her for the treatment of milk fever 7 days after her Caesarean section and this could be due to the fact that the two pups had drunk all the milk. In retrospect, the two extra-large pups could have been given alternative milk (e.g. goat's milk formula or the one in your email link) for some periods of time, giving the dam time to recover and produce milk.    The two extra-large puppies would have died if you have not researched the internet. Now they have put on weight and do not have watery stools as they dislike the pet shop supplied milk powder and bottle. First vaccination for your two pups will be at 8 weeks of age since they don't live in an environment with lots of viruses as in a professional dog breeder's farm.   Best wishes. Update will be on this webpage: http://www.bekindtopets.com/dogs/20130411eclampsia_toapayohvets.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

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