D. E. Larsen, DVM
“What do you think, Doc,” Bert asked.
“They are just drop-offs,” Jan added. “We don’t want to spend a lot of money, but my gosh, we have to do something for the poor little things.”
“How do you get so lucky to have two of them dropped off,” I said. “Even for dachshunds, they the pretty thin. I lifted the skin on the back of the smaller one’s neck. It held that position for several seconds before slowly returning to normal.
“She is dehydrated, not breathing well, her abdomen feels empty, and she is skin and bones. I don’t know; she may have a diaphragmatic hernia. That would be my guess, but we will need to get an x-ray to confirm that suspicion,” I explained.
“I don’t know,” Jan said, looking at Bert for a clue as to what he was thinking. “Can we do something simple, just to get some meat on their bones? There is really no need to take an x-ray because we aren’t going to fix anything on a stray dog.”
“Okay, let us hang on to them for a couple of hours. We will check a fecal exam and do a good exam. It could be a little deworming medication, some good groceries, and some TLC help. If not, we can decide on another course of action in a couple of weeks. What do you call them, by the way, just for the record?”
“I don’t know; we have only had them overnight,” Jan replied. “We will think about that over the next couple of hours.”
The fecal exam showed a massive infection of both roundworms and hookworms. Roundworms were almost always present in young dogs around Sweet Home, but it was unusual to see hookworms.
“A good dewormer and some canned food might do these pups a world of good,” I said to Dixie. “Give them a couple of weeks, and they will look like new dogs.”
The larger of the two pups had a normal exam, plus a 30-day pregnancy. That will add to the stress of recovery.
Palpation of the abdomen of the smaller of the two revealed almost no content in the anterior abdomen, and the empty abdomen allowed for the easy detection of a similar 30-day pregnancy. My guess was she had a diaphragmatic hernia (the wall between her chest and abdomen was ruptured). Dogs can live with this injury for a time if they survive the initial insult. Sooner or later, it will require surgical repair if the patient is going to survive. This growing pregnancy was going to be a problem for her respiration.
Bert and Jan returned to retrieve the pups in the late afternoon.
“We have decided on Anna and Maria for names,” Jan said.
“Any preference on which name goes with which pup?” I asked.
Jan looked at the two little dogs watching her closely from the kennel.
“Let’s call the small one, Maria,” she said.
“Anna checks out pretty good. They both are skinny and have a heavy burden of intestinal worms. We gave them some medication for the worms, and some good groceries will help put some meat on their bones.”
“That’s good,” Jan said. “”We are just going to do the basics for them. As far as we know, they could be gone tomorrow.”
“But that is only the half of it,” I said. “They are also pregnant. You guys really hit the jackpot.”
“And how does Maria check out?” Bert asked.
“Her problem is she very likely has a large diaphragmatic hernia. My guess is her liver, stomach, and a lot of intestines are in her chest. Sooner or later, this will become life-threatening. And as this pregnancy gets closer to term, her respiration may become an issue.”
“Do you think she can survive the pregnancy?” Bert asked.
“I don’t know. I think the best recommendation would be to spay her and repair the diaphragmatic hernia now.”
“She is just going to have to make do,” Jan said, glancing at Bert with a bit of a frown. “We have decided that we are just going to do the basics for now.”
“I understand that completely and they are probably lucky they found your house,” I said. “Make her a bed so she can sleep with her head and chest elevated. That will help with her breathing.”
“That is just the way it is going have to be,” Jan said.
“I know, but these little dogs grow on you after a while. Your thinking might change in the future.”
With that, the visit was over. Anna and Maria slipped into the recesses of my memory for the time being.
A full 6 months later, Jan had Maria on the exam table waiting for my evaluation. Maria was a completely different dog; no longer skin and bones, she almost looked like a typical Dachshund.
“You can’t imagine how many dogs we had running around with all those puppies,” Jan said. “But they are all adopted, and that was a chore in itself. Anna has even found a home. But Maria has her chest problem. She had to sleep in a box with her nose held in the air when she was pregnant. We have decided we need to repair her chest.”
“We know this hernia is at least 6 months duration, maybe longer,” I said. “Maria might have some permanent lung damage.”
“So, what are our options?” Jan asked.
“Not many options,” I said. “Fix her or not is just about it. If we repair the diaphragm and get the lungs to expand, we are probably home free. I have to hedge a little because her lungs have been collapsed for a long time, and we may have difficulty expanding them. If everything goes well, we can spay her at the same time.”
I looked at Jan with a curious eye. She was really attached to Maria now. I remembered warning her that these little dogs would grow on her.
“When do you want to do the surgery?” Jan asked.
“I think my surgery schedule is petty open right now,” I said. “We can schedule her any morning at your convenience, but the sooner, the better. We can monitor her all day. She will need a chest tube after surgery, maybe for the afternoon, maybe for several days. I don’t like to send them home with a chest tube.”
“Let us take her back and snap a couple of pictures of her chest,” I said as I handed her off to Dixie. “It will only take a minute, and we will have them for you to look at in the morning.”
“You warned me that I would get attached to her. I didn’t really believe you at the time. But she is so sweet, I think she is part of our family now.”
“No breakfast in the morning and have her here at 8:00.”
With the x-rays taken, Jan took a deep breath and gathered Maria up in her arms. Kissing the top of her head. She looked at me with some concern on her face. “This is a serious surgery, isn’t it,” Jan said.
“Yes, it is a serious surgery,” I replied. “It would have been more serious had we done it when Maria was first dropped off. Her condition at that time would have made it very risky. I can do this surgery, Jan. It is not something that I do every week, but I can do this. She is in good hands.”
“Doctor Larsen, I am not questioning your skill. I just feel so guilty,” Jan said.
“You should always question a surgeon’s skill, for your dogs and for yourself,” I said. “You have no guilt here. If there is any guilt, it is for the people who dumped her at your driveway.”
The x-ray showed Maria’s chest’s left side was filled entirely with abdominal content, liver, stomach, spleen, and intestines. No wonder the abdomen was mostly empty on palpation. The chest’s right side was intact, but there was some compression from the left side content. This was going to be a challenging repair.
Jan was prompt in the morning, coming through the door a few minutes before 8:00 AM. We were ready for her. I usually did not start surgery until 10:00 AM, leaving some time for early morning appointments and emergencies. But with this surgery, I wanted to get through it as quickly as possible so we would have the whole day to observe Maria’s recovery.
We were brief at the check-in. I went over the x-rays with Jan. They were dramatic films, even for a novice. Then we had Jan sign a release for surgery and say her goodbyes.
“If we get exceedingly lucky and can pull her chest tube this evening, I will probably send her home,” I said. “I wouldn’t plan on that, but it’s possible. You should check by in the late afternoon. I will give you a call when I am out of surgery to let you know how things are going. This is a major operation, and there is a possibility we could lose Maria. I would not expect that, but there are some pitfalls we have to get across.”
“We know you will do your best. That is all we can ask for,” Jan said with tears welling up in her eyes. “I will see you late this afternoon.”
We went right to the surgery with Maria. I placed an IV catheter in her right front leg and started IV fluids at a slow drip. It only took a couple of minutes to get her under anesthesia and on the gas machine. I double-checked the seal on the endotracheal tube. When we opened her abdomen, we would have her on positive pressure breathing. Due
to her small size, we had her on a non-rebreathing circuit. We would have to breathe for her using the bag in the circuit.
When she was prepped and draped, I made a long incision on the ventral abdomen. I needed an incision that would allow me the repair the diaphragm in the anterior abdomen and one that would also allow for the removal of the uterus.
I would repair the hernia first, and if all went well, we could do the spay. If there were problems, the spay could easily wait for another day.
Almost all the entire abdominal contents were in the chest, passing through a large rent in the diaphragm’s left side. Maria had most likely been hit by a car. At her small size, she was lucky to have survived the severe blow that would have been required to cause this size of a diaphragmatic hernia.
I started carefully pulling the contents back into the abdomen. The intestines were easy. The spleen and stomach proved a little bit of a challenge. The liver took some careful manipulations to pull it out of the chest without injury. After all the content was back in the abdomen, I packed off the large rent in the diaphragm with some lap sponges.
Now we needed a little luck to expand the left lung lobes that have been collapsed for over six months. Using the bag, we put slow, steady pressure in the circuit to expand the lungs. Much to my surprise, these lung lobes expanded quickly, turning from a dense reddish-brown color to a fluffy pink in no time at all. There were just a couple of small areas along the edges of the diaphragmatic lobes that failed to expand. My guess was they would return to normal after a few weeks of normal respiration.
With the lungs expanded to fill the chest, my concerns about a chest tube being needed for several days were probably unfounded. I placed and chest tube and attached a Heimlich valve.
That done, I just needed to close the tear in the diaphragm, evacuate the air from the chest to form a good vacuum, and we would be done with plenty of time to do the spay.
I routinely closed the abdomen. It was a long incision. I was reminded of Dr. Annes’ comment from school, “Incisions heal from side to side, not end to end. Always make your incision long enough to get the job done”.
Maria recovered quickly. I think she felt so much better with a fully functional chest that there was little post-surgical pain to control. I called Jan with a report on a successful surgery, and the news was warmly received.
By the middle of the afternoon, we were able to remove the chest tube. Maria was dancing a jig around Jan as they started out the door. One happy dog with a new lease on life and one happy client.
“We thank you, Doctor Larsen, and now Maria will be well enough to be adopted. That will be hard, but I have a special young boy in mind who can use a pet.”