It Started With a Turtle

The tiny dog’s dark eyes shifted urgently between her owner and myself. Her miniature head was sleek and round. She was a Chihuahua, the smallest recognized dog breed and proud, scrappy descendants of an ancient Mexican lineage. For now she sat patiently on the exam table, wrapped in someone’s red down vest, but I could sense her anxiousness. It was 2:30am, one of our new intern doctors had called asking me to come in. When your phone rings at 2:00 am you can count on it not being good news or money. Still when the young doctors call, you are duty bound to respond. That is one of the few unwritten laws of veterinary medicine: when young doctors ask for help you have to help them. You help them because someone helped you. You help them because when you were new someone guided you through a difficult case and probably even held your hand. To pay back that debt of kindness you must always be there for those who ask for your aid. Like the Navy Seals motto, “We don’t leave anyone on the beach,” no one is left behind.
Cold fluorescent light bounced off the steel exam table and was glaring. I had been asleep just twenty minutes before and my eyes were still adjusting. Once in a while you recognize how artificial that artificial light actually is. Sometimes you can grasp that the biggest difference between night and day is the light we see. The little dog was in obvious discomfort and panted softly. It was a dystocia, the inability to deliver puppies following a full-term pregnancy. Canine pregnancy (gestation) typically last 63 days. The intern had called since this little dog was 2 to 3 days past her due date and had been straining for several hours without producing any puppies.
I turned my attention back to the dog on the table. Her name was “Precious,” she was 2 years old, and this was her first litter. Her entire family had made the somber journey to our hospital with her, a frazzled young couple and their three wide-eyed children, and they all regarded me intently with a combination of hope and concern. The woman explained that Precious lived with an intact, 5 year old Chihuahua named “Charlie,” and that they thought the breeding was accidental. Accidental for them maybe, but not for Charlie! It took me back to a similar case many years earlier when I was fresh out of veterinary school. A sweet elderly couple had brought in a pair of Maltese dogs, “Biff” and “Betty.” The dogs were littermates and about a year old and neither were spayed or neutered. Their complaint was Betty’s abdomen seemed to be getting larger and larger with each passing day. I examined both dogs and informed them that Betty was a few weeks away from having puppies. The woman of the pair was horrified and gobsmacked. “Biff would not do that,” she cried incredulously, “he is her brother!” I politely explained, at least in the dog world, that love recognizes few boundaries and even less etiquette.
I carefully unwrapped Precious from her down cocoon and gently palpated her distended abdomen. I could make out at least one fetus but that was all. Using your hands in physical examinations is critical but is no match when compared to an x-ray or the accuracy ultrasound provides. Precious was a tiny dog, just barely 4 pounds, and the pup I could palpate felt huge. Her panting was getting worse, she had a fair amount of vaginal discharge, and had not eaten in 24 hours. She was clearly miserable.
Certain breeds are overrepresented with regard to dystocia or difficult birth. Chihuahuas, English and French Bulldogs, Pugs, Boston Terriers, and Persian and Siamese cats have a higher incidence of complicated deliveries requiring Caesarian Section. These breeds all typically possess large, “domey” heads, wide shoulders and deep chests, and small, narrow pelvises and birth canals. Another complication in Precious’ case, Chihuahuas are prone to small 1 or 2 pup litters, where in the absence of adjacent siblings, a single pup can become almost indeterminately large resulting in fetal oversize and the maternal-fetal disproportion which requires a Caesarian.
The overnight intern had been right to call me. There are few true surgical emergencies; gastric dilatation volvulus (GDV or stomach torsion), mesenteric torsion, intestinal obstruction, urinary obstruction, hemoabdomen, pyometra, lacerations with extensive blood loss and a few others, but dystocia has certainly earned the right to be a member of this dreaded group. The first time you encounter any of these conditions as a young graduate veterinarian is truly chilling. This is what you have trained for and pray that you are up to the challenge. Hopefully there are some older, seasoned veterinarians around to help guide and shepherd you through tough passages and fortunately at our large practice we have many such veteran shepherds.