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The pregnant Siberian Husky was long overdue

"Mr Formicelli will not blame you if the Siberian Husky's puppies are still born when you perform the Caesarian operation," Nurse Julia said over the phone.  I had to get out of the newly renovated Ang Mo Kio Library with its impressive high ceilings to talk to her as it was not courteous to talk inside the library. However many Singaporean parents let their small children screamed and played around the library premises and there was not much the librarians could do. At least these children would grow up with fond memories of fun at the library.

Nurse Julia continued, "The bitch had a normal first birth. However, she did not show any sign of uterine contraction for this second pregnancy and it is the 70th day after breeding. In fact, the water bag had burst this morning and no puppy was born." 

Mr Formicelli's veterinarian had left practice suddenly and this was the first time he had engaged me. I was as apprehensive about his reaction on receiving dead puppies and possible litigation as he was worried about my anaesthetic and surgical skills.      

Generally bitches gave birth at 59 -  63 days after breeding and there would be still births if the pregnancy extended to 70 days. Mr Formicelli was an experienced breeder of over thirty years and like his peers, would know that his bitch needed a Caesarian operation. 

Not an oxytocin injection to stimulate the uterus to contract and expel the puppies as suggested by me.  As to why he did not seek early veterinary treatment, it was a mystery to me. Most of the big dogs do not need Caesarian operations generally. 

Cost would be important for any breeder.  The veterinary fees for Caesarian operations vary from $150 to $1,000 depending on which veterinarian you go to but cost was not an issue for him. Each Siberian Husky puppy was worth at least one thousand dollars and one puppy delivered live would cover all veterinary expenses four times.  

The Siberian Husky came in a big roomy Mercedes van. I put the quiet Husky on the examination table. This 3-year-old bitch was thin although her dark red woolly coat fluffed out and hid her poor weight gain during pregnancy. The breeder had fed her well but she had no appetite. No puppy was stuck at the vagina area as this obstruction would stop birth.  

Her temperature was 39.2C which was within the normal range. I put the stethoscope on her abdomen.  I heard the small clicking heart sounds overlapping each other, as if the music of new life was not synchronised. "There are live puppies," I told the breeder. "More than one."  

There was no need to take any X-rays as this would add up to the cost. Monitoring of fetal heart beat and uterine contractions with equipment were not available for pregnant bitches unlike the situation in human pregnancies and to the breeder, the least cost the better for him as he has high overheads in Singapore's worst recession in forty years.  

Some puppies may die before weaning. He may not be able to sell all puppies at a good price during this period of intense competition from 140 pet shops set up by younger people. An impending Gulf War reduced  spending on buying puppies by Singaporeans.  

The question was: Would oxytocin injection work in this case of uterine inertia, a condition whereby the uterine muscle does not contract when birth is due? This would save the breeder some money on a Caesarian operation although it would reduce revenue for the practice.

An "informed consent" was necessary nowadays to prevent misunderstanding and litigation. Mr Formicelli was agreeable to the oxytocin injection. After the injection, where could we place the bitch so that she had a quiet place to give birth?  There were dogs barking in the surgery and this was not good for her.  The back of the wide Mercedes van was useful and I asked the breeder to drive it to a far dark corner away from the surgery. The evening was cool, the roar of the traffic noise from the expressway was muffled by the trees lining the road.    

How long should we wait? Nurse Julia offered to go to the shop to buy coffee and to get her regular puff of cigarette. The breeder was pensive. Would his bitch die on the operating table?   

We saw feeble uterine contractions on the abdominal area as we spied from the back window of the van. She needed a Caesarian. I switched on the anaesthetic gas and put a mask over her muzzle. As she was weak, she was induced within five minutes and an endotracheal tube of size 10 was inserted into her windpipe to transfer anaesthetic gas to her. The first puppy was facing backwards and would have been born with the back out first. It moved and cried when I removed the gelatinous amniotic membrane from its nose and opened its mouth, after clamping the umbilical artery and vein. That first cry was always a miracle of life which was always a happy thing for veterinarians doing Caesarian. 

The second puppy looked dead. Light pink tongue and no cries. Several pieces of yellow brown meconium (stools on the newborn) floated inside the amniotic sac. In human medicine, a reason for Caesarian for overdue pregnancies was that the meconium could be breathed in by the baby during natural birth and this would cause lung infections. 

This was the only one of the seven puppies with meconium passed. I held its head and body with both hands and swung it up and down to dislodge the fluid inside its throat. I rubbed the top of its neck up and down to stimulate respiration. No response. 

"Blow air into its mouth," I said to Nurse Julia. A mouth-to-mouth resuscitation while I continued so that the bitch would be under the anaesthesia as short a time as possible. I had given up hope for this puppy and another one in the same condition. Three more were still-born and therefore there would be five dead and two strong ones alive. There was a loss of at least five thousand dollars for this breeder.


The bitch recovered from anaesthesia within five minutes although she was dazed. Her gums and tongue were pale as if she had lost a lot of blood. I had given her dextrose saline, multi-vitamin, iron and an antibiotic injection.  

 "Put the puppies close to her," I said to a tired Mr Formicelli as he was about to drive off with the puppies inside a box.  "It is important for her to bond with the puppies."  She smelled her new born and I presumed she would be a good mother although she did not have much milk. 

Nurse Jane said that everything was fine with the mother and the puppies were doing well. I dropped on day 3 after Caesarian as I had to vaccinate some of Mr Formicelli's puppies. He had a good assistant from the Philippines, a very alert and careful with the nursing bitches, staying up all night to check on them. The assistant showed me the mother who was also nursing two or three Labrador puppies.

Everything was really fine. The nursing area was very clean.  The Siberian Husky looked at me and I did not go near as nursing mothers could bite strangers to protect their offspring.

It was great to see the four puppies fighting for their milk, a good nursing mother who cared for puppies from other dams and a very efficient and competent assistant.  

Two hours later, Nurse Julia phoned me, "The Husky's intestines had come out and there is a lot of bleeding!"

Now, if the intestines had prolapsed, this was a very serious life and death matter. The guts would be contaminated and become dead cells as the bitch would lick and maybe chew it off. This would mean another operation to cut off the necrotic guts and join the normal lengths back again. She would die from an infection of the inner surfaces of the abdomen, a condition called peritonitis. This was an emergency.

Stitch break down. The Husky had bitten off two stitches and the omental fat had dropped out of the abdomen
Under general anaesthesia, the omental fat was de-contaminated and clamped with forceps.	The dark red outer portionof the omental fat had been cut off. The healthy tissues had been ligated by catgut sutures before returning them to the inside of the body.
	After the muscle layers were sutured, the skin layers were sutured with horizontal mattress sutures.

It was not that bad. The bitch had opened up only two skin stitches and only the omental fat which attached to the intestines had herniated through. Another anaesthesia and surgery was required to remove the exposed fat. 

"The bitch would have to wear an Elizabeth collar for at least seven days for the wound to heal and be stronger," I said to the breeder's assistant.  Could my visit be stressful for her or was this a coincidence? I dared not visit the bitch anymore and she had no further problems. The breeder's assistant was extremely good as he had spotted the hernia early. Nurse Julia was also very good at saving the two puppies given up for dead. Both are valued and experienced employees hard to replace. 

Their dedication to dogs and small animals and their quiet observation and help saved numerous canine lives and helped their employer succeed in this dog-eat-dog business of breeding, grooming and sales in a highly competitive and increasing costly Singapore.

Twelve days later, I saw a good looking and clean Siberian Husky at Mr Formicelli's grooming shop when I went to vaccinate some of his newly imported puppies. Was she the patient I operated on earlier? Her rusty brown coat shone against white and she looked bright. 
I asked the groomer who confirmed that she was the one. 

She turned her head away to avoid me, probably associating me with the scalpel as many children associate dentist with painful extractions.  Were her stitches intact?  I just had to check them out. I asked the groomer to hold her up and the horizontal mattress sutures of the skin and the interrupted sutures underneath, holding the muscle and peritoneum layers were binding the operation wound well and there was healing. She had produced sufficient milk to nurse her own puppy and three other Labradors. An excellent mother.

Mr Formicelli is an experienced breeder but the Husky was a fastidious eater. Would she develop fits like tetanus in eclampsia, a condition of insufficient calcium in her blood caused by the nursing of too many puppies? The next 2 weeks would be very important.  

  
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