Heidi, the three-year
old bulldog, waddles across the floor of the prep room. She tries to sit, but
her hugely distended abdomen makes that uncomfortable for her, so instead she
stands, and pants. Her thick eyelids droop with weariness. Sam and I lift her
onto the prep table with some difficulty. Heidi gurgles and splutters as we set
her down, then starts panting again. Green viscous fluid drips from her vulva,
onto the table. We haven't much time.
Sam raises Heidi's vein with some difficulty; this is
uncomfortable for Heidi too. Not because of her distended abdomen, this time,
but because her elbow dysplasia makes it hard for her to stretch her leg
forward. I look sadly down at her. Her whole life is a struggle with her own
body - whenever she tries to walk, or eat, or defecate, or breathe, she has to
wrestle against her own bizarre anatomy. I inject the propofol into her vein,
her eyes roll downwards, and she starts to sink to the table.
'We'll take it from here, love,' I say, and Sam smiles.
Placing an E-T tube is difficult too - Heidi's soft palate is too long for her
mouth, and it takes some searching before I manage to locate her epiglottis -
but the moment it's in place, Heidi's tongue loses its alarming bluish tinge
and turns a reassuring pink.
'Probably the best lungful she's had for a while,' Sam
says, as she ties the tube in. We roll Heidi onto her side and start prepping
her abdomen for surgery. I don't want to roll her on her back until absolutely
necessary; her abdomen is so bloated I'm worried what the weight of it would do
to the spine, and the blood vessels that run below it. We can't support her
blood pressure nearly as well as I would like - Heidi's owner has declined
intravenous fluids on cost grounds - and so I just want to get on with the caesarean
as quickly as possible.
It's late on Monday night. Heidi was booked in for an
elective caesarean this Thursday, which would have been her 63rd day of
pregnancy; a sensible precaution, because fewer than fifty percent of bulldogs
manage to give birth without the operation, but in the last few days Heidi's
abdomen has swelled to alarming proportions, and over the course of the day
it's become clear that the pups need to come out, ready or not, or Heidi isn't
even going to make it to Thursday. The green discharge, which started in the
last hour, generally indicates that the placentas have started to separate from
the wall of the uterus.
Sam and I carry now extremely-heavy dog into theatre, and
I only swear and complain about my back once; something of a record, as Sam,
who is just over half my size, politely points out. I look at Heidi's immense
abdomen, and suggest there is probably more swearing to come. I'm right.
As I scrub, my mind wanders back to a consultation I
had with Heidi and her owner, three years ago. It was her first adult
vaccination, when she was about fourteen months old. Heidi's owner, a short, likeable
man, tells me that he was thinking of breeding from Heidi, and wants to know
what I think. I glance at Heidi's clinical notes, and try to hide the
expression of dismay that must have crept across my face. Despite her tender
years, Heidi has had surgery four times - twice to replace prolapsed tear
glands, once to correct her entropion (a condition where her eyelids are so
fleshy that they scroll inwards, allowing her fur to press against her eyeball,
leading to chronic pain and frequent eye ulcers), and once to surgically remove
her tail, which is so deformed it has formed a tight-corkscrew shape, leading
to repeated severe infections around her back end and, again, chronic pain. I
wonder how I can delicately state that Heidi is about the worst candidate I can
imagine to have more progeny. I want to grab him by the lapels, and scream 'No,
no! A thousand times, no! Can't you see how much she is suffering, just trying
to walk?', but I feel that's not very professional.
While I am thinking, the hitherto likeable owner, who
seems slightly surprised that I am not immediately excited at the prospect of
Heidi producing puppies, says, 'I'll have all the tests, you know. I want to
make sure I'm doing the right thing.'
This gives me an in. I calmly, and, I think, quite
logically, explain that I don't need to do any 'tests' to tell me that Heidi is
a poor choice of mother, both medically and genetically. All the conditions that
she has had surgically corrected, as well as the many she has which can't be, are
heritable conditions, and any puppies that she has is likely to suffer from
them too. I further explain that the Kennel Club, finally drawing a line in the
sand long after the country behind the line has been invaded and razed,
wouldn't allow any pups to be registered, due to the number of corrective procedures
that Heidi has had to endure.
As I talk, I see Heidi's owners attention start to
wander. I'm not saying what he wants to hear, so he's stopped listening. I say
it again, in a slightly different way, and then again, finally ending with an
extremely strong recommendation that Heidi is speyed as soon as possible. This
last is too much for Heidi's owner. At reception, I hear him asking never to
see 'that vet' again.
Now, three years later, Heidi's owner doesn't have much
choice, because I'm the vet on duty tonight. When I admitted her tonight, he
didn't mention his request not to see me, and I didn't mention my advice never
to breed from her. There didn't seem like much point.
Now scrubbed up, I enter theatre and don my surgical
gloves. Heidi's abdomen already has a long scar along it; this isn't her first caesarean.
In fact, it's her third. Heidi's owner says he won't let her have another
litter after this one. He said that last time, too.
I open her abdomen with a large incision, cutting through
the scar tissue of her previous surgeries, and ease the huge, bloated uterus
out of the wound. Incising it, I remove the first puppy in its amniotic sack.
It is enormous: truly a camel would have more chance passing through the eye of
a needle than this puppy would have had of passing through Heidi's pelvis. I
hand the puppy to Sam, who quickly breaks the sac, clearing the fluid, while I
start to milk the next puppy towards the incision in the uterus.
'Nick...,' Sam says. I look up, and understand why Heidi
was so bloated. The puppy looks like someone has been at it with a bicycle
pump, bearing more resemblance to a hippo that a bulldog. The skin is thickened
and distorted with fluid, and has torn in a number of places around the mouth. As
Sam gently shifts the puppy's position, its abdomen splits open, and she gasps
in dismay. Fortunately, was dead before I ever removed it from the uterus.
'Anasarca,' I mutter. Also known as 'water' or 'walrus'
puppies: a condition of bulldog pups that causes severe oedema in the days
leading up to birth. Mild cases might, just might, survive. The pup I have so far
removed is not a mild case.
So it goes for the remaining four puppies that I extract.
All of them are severely affected. Two of them have weak heart beats, so I ask
Sam to euthanase them for me.
Heidi's colour has improved dramatically now that we have
reduced the load on her uterus. I wish, once again, that we had her on fluids,
but she seems to be doing well now that all the puppies are out. I start to
suture up the uterus. When I admitted Heidi, I asked the owner if he would like
me to spey her at the same time, as he already had suggested that Heidi
wouldn't have any more litters. He declined.
Suturing up a caesarean is often done to the noise of
puppies crying for their mum's milk, but tonight Sam and I finish the operation
in silence. Afterwards, Sam stays with Heidi while I telephone the owner with
the news. He's annoyed and depressed. Of course he is: a single live pup would
have recouped double the cost of the caesarean. He wants to know how many of
the pups were female. We didn't think to check at the time, and I do so now.
Only one of the five was a bitch, which seems to be some comfort to Heidi's
owner. Bitches are worth more than dogs. Finally, with genuine concern, he asks
how Heidi is. I reassure him that she's fine, and he sounds relieved. He thanks
me for my help. I put the phone down, and sit down in dispensary, looking up at
all the medicines I have at my disposal to treat sick animals, and wonder just
how complicit in Heidi's suffering I am.
*
Well... this was going to be a short introduction to a post that discussed dog breeding, breeders, and some of the difficulties I encounter in practice... but I'm afraid it rather got away with me! I'm going to follow this post up, hopefully at the weekend, with a (hopefully) less emotive piece discuss some of the points I touch upon above. The above caesarian is an extreme case, but the details are not, I'm afraid, exaggerated. This exact scenario was occurred, with minor variations, to me personally, on three occasions, and I suspect it won't be entirely unfamiliar to any vets reading it, either.
Ugh! You're right, we all know this moral dilemma too well.
ReplyDeleteI constantly struggle between feeling like 1) if I could just find the right way to explain something, that the message would finally get through and help the owner do the right thing for the pet OR 2) I should just be as blunt as possible and draw the line in the sand, saying "this is not right, and I won't play a part anymore". Does #2 ever help? Does #2 ever get through to anyone? Like you worried here, does not insisting make us complicit? Does drawing that line in the sand cut off any communication and chance for education?
Bulldogs especially are disasters - when I see one with eye issues, skin issues, arthritis, and horrible dental disease and I they finally start treating the dry eye, do I keep trying to make a little bit of progress at a time, or do I tell them I think it's cruel they're not treating this pet's many chronic conditions?
For me it often depends on the situation and the pet's quality of life. I always try and approach with the assumption that the owner's intent is to do the right thing.
I think Krista Magnifico put it best when she said - I just try and not regret anything later. Whether it's something you said or didn't say - you just try and do what will let you sleep at night.
I couldn't agree more. In fact this was an element of my book on the profession! http://biowrite.wordpress.com/category/pets-and-vets/
ReplyDeleteThanks for posting this.
Cheers
Eric