Monday, February 13, 2012

By Michelle Gerhard Jasny V.M.D.
Published: April 23, 2009

I wasn't expecting many emergencies. People would be busy with Easter egg hunts, church, Easter dinner. Even my fellow Jews probably wouldn't call, preferring a quiet Sunday recovering from two Seders the week before. So I was surprised when the phone rang early that morning. "Our dog, Blossom, is in labor and seems to be having trouble," the worried voice reported. Oh, great. "What kind of dog is Blossom?" I asked, trying to sound cheerful, while visions of pregnant St. Bernards flashed before my eyes. "A Lhasa Apso," the voice replied. I relaxed a little. It wasn't a huge dog, and litter size was likely small, but a few more questions made it apparent Blossom should be seen immediately.

A family of four arrived with the dog, squeezing into my minuscule exam room. Blossom had been in labor for hours without producing a puppy. Her belly was huge. A small greenish mass protruded from her vulva.

"Did you have an X-ray or ultrasound to tell how many pups?" I asked, pulling on a sterile glove. "They said maybe eight or nine," the owner answered. Wow. That's a lot. Average litter size for a Lhasa is four or five. Probing with my finger, I felt one tiny leg in the birth canal. That was it. I tried to manipulate the pup but it was soon evident something was drastically amiss with the positioning. The pup was stuck like a cork in the neck of a bottle. It was C-section time.

Blossom didn't have time to go off-Island to a special emergency clinic with a board-certified surgeon, ICU, anesthesiology technician, and round-the-clock care. We needed to make do with what we had. I called in my assistant, Elise, then rounded up my husband and daughters, and Blossom's four family members. One of the major concerns with a caesarian section is that when you anesthetize the mother, you end up anesthetizing the fetuses, which may already be compromised from prolonged labor. "When the pups come out, clear any fluid out of their mouths and noses, towel them dry, keep them warm, and rub them to make sure they keep breathing," I instructed, setting up piles of towels and hot water bottles.

Soon Blossom was anesthetized, on intravenous fluids, and prepped for surgery. Even asleep, contractions rippled across her belly as her body kept trying to expel the obstructing puppy. As I opened her abdomen, she pushed again. The enormous uterus spilled out onto a waiting surgical drape. "Get ready," I shouted, incising the uterine wall. Puppy one. Two. Three. Four. Each placed on a towel and delivered to a person in the back room. Dogs have a bicornuate uterus with two horns like an elongated letter Y. I moved to the other horn. Puppy five. Six. Seven. Eight. Some were breathing sporadically - some not at all. I called out instructions. Elise gave medications as directed to stimulate the ones in need. I reached for Puppy nine who was lodged at the base of the Y, the cervix, its head twisted sideways, one front leg extended forward. A few firm tugs dislodged the pup. I moved it back into the uterine horn and out the incision. The family had wisely agreed to have Blossom spayed, so I then turned my attention to finishing her surgery.

Twenty minutes later, Blossom was awake and meeting her eight squealing, squirming babies. Only Puppy nine didn't make it, having never taken a single breath. By lunchtime, Blossom and her entourage went home. "Kind of an appropriate emergency for Easter," I remarked to my husband as I sank into the couch. "You know. Spring. Birth. Rebirth. All that. Hopefully I'm done for the day." The telephone rang. A Golden Retriever had eaten a chocolate Easter bunny. The owners had already induced vomiting but were still concerned. I explained that it was difficult, although not impossible, for a large dog to consume enough milk chocolate to be dangerous. Most chocolate toxicities involve small dogs eating semi-sweet or dark chocolate. Doing the math, I assured them their Golden was not at risk. Sending my kids off with Dad for the Vineyard Gardens Egg Hunt, I headed back to the couch, but soon, the phone rang again. Another Golden Retriever had eaten another chocolate bunny. Really. I'm not making this stuff up.

Early afternoon continued the birth-related theme of the day. A very young cat whose family had not even known she was pregnant had unexpectedly delivered one tiny kitten at dawn and a second, stillborn, later in the morning. Although purring happily, mama was paying little attention to her one live kitten. The placenta, now dried and dirty, still hung from the umbilical cord. The mother had a little milk but the kitten was not latching on. Since the average feline litter is four to five, we took X-rays, confirming that there were no more kittens inside. I removed the placenta and gave mama an oxytocin injection, to promote milk let down and maybe elicit more maternal instinct. The owners went home with milk replacer and instructions on how to care for the lone kitten, but the little one was just too weak and sadly passed away later that evening.

You won't believe my next call. A message reporting a beached seal. Really. I'm not making this up...an Easter seal. Unfortunately every time I tried to call back I got a recording saying the mailbox was full and thus was unable to give advice. I contacted the appropriate people but since the caller had not identified which beach, there was little more to do. FYI, if you see a seal on the beach, leave it alone. It may just be sunbathing. Your attention will stress it more - and seals can bite. Unless it has obvious injuries, the recommendation is to wait 24 hours before intervening. If the seal is injured, or has been there more than a day, stay clear, and contact the New England Aquarium Hotline. They will send trained personnel.

As my kids came home with their bounty of chocolate eggs, I thought about the day - about spring, birth, death, and rebirth. The phone rang one more time. My last emergency of the day. A sick rabbit. I kid you not. My Easter bunny. I wondered if I could request that next year he not leave the chocolate where the Golden Retrievers can reach it.