Saturday, April 12

Roma Needs Your Good Thoughts and Wishes

This week, one of our volunteers received a late night phone call from an ER clinic. A pair of backyard breeders had dumped a 2 day old puppy with a slight cleft palate at their clinic, and they wondered if we could take her.
This is one of the reasons breeding dogs is not something to take up lightly as a way to make "extra money" or to show children the "miracle of birth." Breeding French Bulldogs is extremely risky. Your mother dog is almost certainly going to require a c-section to deliver the puppies, and she may well die while being intubated or as a consequence of complications. Puppies born to mother dogs who were not given proper nutrition prior to insemination, folic acid in this case, can be born with cleft palates--sometimes even with careful nutrition, birth defects occur. For a
brachycephalic breed like French bulldogs, cleft palate is very nearly 100 per cent of the time a death sentence, unless the cleft is minor and there is someone willing to devote weeks to the feeding of the puppy round the clock. Most backyard breeders, as was the case with this puppy, aren't willing to do that, and no puppy mill operators will.

By a stroke of nearly unbelievable good fortune, the volunteer who took the ER clinic's call is an MD, an anesthesiologist. She left her home in the middle of the night to fetch this puppy and bring him home to foster her until she can be transferred to another volunteer, a nurse, who will continue the round the clock feedings. We asked our volunteer to describe what it is like to keep this puppy alive. She's promised to take more photos and we'll update readers as we go. The puppy's name is Roma. Today she is 6 days old. Here is the note from her foster mom:
"I can tell you what life is like here right now since I am home. I worry about her constantly and go to check on her at least every 15-20 minutes. I have her in a small crate padded with towels that sits on a heating pad that is currently tucked into the corner of my couch in the living room. I put a pair of rolled up socks in with her which she often lies up against like she might a sibling. I also keep a box of baby wipes in the corner so they can be warmed and ready to use (more to follow)

I took pictures of my set up - exactly as I described it above, but probably can't get them out with this computer at home.

I didn't get home from work last night until almost 8 pm. I got her all set up on the couch as described above with all her supplies laid out in from of me on the coffee table. This includes a "pee-pee rag", a clean towel for holding her, multiple syringes, KY jelly, a stethoscope, paper towels, pillows - anything I need to grab in a rush. In the kitchen, I have her formula pre-mixed in a container in the frig as well as a container of the anti-biotic slurry I add to her food in a prescribed dosage every 12 hours. Her feeding tube and used syringes get flushed, rinsed and dried after every feeding. I have them lying on the counter on a paper towel to dry in between. ( took a picture of this, too)

Her formula is a mixture of puppy replacement milk, Esbilac, which I bought at PetsMart with some baby rice cereal added in. It can't be too thick or it won't go down the feeding tube. To this mixture I added a dab of Nutrical, a "high calorie dietary supplement" gel for puppies and a tube of "Bene-bac" which is a pro-biotic containing lactobacillus to give good bacteria to her gut.

The reason these little guys have to be hand fed by some method is because their oral cavity is open to their nasal cavity via the opening (cleft) in the top of their mouths...this means they can't create a suction on their mother's teats to make the milk let down. They would starve.

They have to be either bottle fed or tube fed. Both of these methods intrinsically has the same lethal complication. If even a little bit of food gets in their lungs, by gagging, overfeeding, poor technique, bad luck, fate - it doesn't matter - they will get aspiration pneumonia and die.

I have been on-line and done a ton of reading about tube feeding vs bottle feeding as well as reading all the email that has come across the FBRN list (THANK-YOU everyone for all your help!!) about how people personally saved cleft palate puppies. I can tell you my experience so far.

I started out tube feeding because that is what I was told to do at the Emergency Clinic where I picked her up. I can tell you this - that first night, at 1:00 am, alone, with a 3 day old (somebody didn't know how to count) puppy's life in my hands was scary stuff. I have been a practicing anesthesiologist for 15 years (and ICU nurse before that) and am quite accustomed to taking peoples' lives in my hands, sticking tubes in them, etc, but here was this tiny little helpless technique with the tube had to be flawless. The pressure was on and hasn't let up since.

Those first couple of feedings at home were hard on both of us. I couldn't find a stethoscope (to help verify that the tube was in her stomach - more to follow) so I had to pass the tube multiple times, hold the very vigorously squirming baby up to my ear while injecting a little bit of air through the feeding tube (which is about the size of a piece of regular spaghetti) to hear that distinctive "pop" or gurgle that let's you know the tube is in the stomach and not the lungs. I am trying to do this while she is squirming and trying to push the tube out of her mouth. I thought I would never get it right....but I did - only with great stress and effort, tho. That morning, at work, with extra loving hands to help me hold her and the tube, etc, it all went much more smoothly.

That day, I read about the possibility of bottle feeding, so after work, I drove to PetsMart and bought a bottle set that came with 5 or so nipples of numerous shapes and sizes. Again, it's 8 pm by the time I get home.,...I have to heat a needle to make the right sized hole in the nipple - too small, the formula won't come out, too big, I'll drown her....numerous attempts, I think I get it right. You don't use the bottle like you normally would, you sort of drop the formula on the front of their mouth while holding them upright and let gravity and their natural swallowing do the rest.

In Roma's case, 2 things happened that made it not go well. One, she would take some of the formula - only a little - get sleepy and conk out!!! I couldn't put any more in her mouth - it was just coming out the sides and I was afraid she would aspirate (suck it into her lungs = death) - very bad. Also, she wouldn't get getting enough formula. #2, the formula didn't come out smoothly enough (this could have been me mixing it to the wrong consistency, a poorly made hole ??) but one time the formula came shooting out like a spray and in horror I though I had surely drowned her and she was going to die and it was my fault. OH NO - no more bottle for me. The tube was a sure thing as long as my technique was flawless and she got more food that way.

Here's how the tube goes. I get everything ready in front of me:
1. 5cc syringe with warmed formula drawn up (usually 3-4 cc)

NOTE: the feeding tube came "marked" at the right length to reach her stomach - the emergency vet marked it. As she gets bigger, this mark will have to be moved as the distance from her mouth to her stomach gets longer.

2. feeding tube with 5cc syringe attached to the end - syringe drawn back with 3cc of air in it
4. pre-moisted the first 1-1/12" of the feeding tube with KY
5. stethoscope
6. peepee cloth
7. towel
8. baby wipes (pre-heated)
9. pillow
10. paper towels (for a dab of KY and a place to park the used items)

I sit on the couch with a pillow in my lap covered by the towel. I have the peepee cloth on the coffee table. I hold Roma over the cloth, feet touching it) and gently rub her lower tummy with a warm baby wipe in downward strokes to stimulate her bladder (her mother would lick her for this). I watch for the little drops of peepee. Sometimes it takes a little time, but it works. I dab her behind clean and rest her in my lap on the towel covered pillow. I put the stethoscope in my ears. I hold her in my left hand - kind of high on her body with her butt sitting on the pillow. I have the formula filled syringe on the table right in front of me - literally at the same level (my coffee table elevates) or I hold it in my mouth. I put the stethoscope up to Roma's chest/belly and hold it with my left hand, too. I take the slightly pre-lube feeding tube and bring it to her lips. I don't force it in, but gently introduce it and she will often start to swallow it as I gently advance it. Most of the time it goes down very smoothly. I stop advancing when the mark reaches her lips.

NOTE: if she starts to gag, I pull it back, wait for her to calm and start again.

I have to watching to make sure the tube isn't sliding out WHILE I take the syringe on the end with the air in it and "inject" a couple of cc's (ml's) of the air while listening through the stethoscope to hear the little "popping" or gurgling sound of the air reaching her stomach. If the tube is in her lungs - you won't hear it, plus she'd probably be coughing and gagging. It can still be a bit tricky because she is squirmy!! I try to get it right the first time so I am not filling her up with air.

If I get the confirming sounds, this is were it gets a little harder and I wish I had extra hands....I have to hold the tube in place with my left hand (without squeezing her too hard or covering her nose - and she is squirming like the dickens and trying to push the tube out). With my right hand (and my mouth or a finger or 2 from the left hand), remove the air syringe from the end of the tube and put on the formula syringe - it's a tight fit. Rechecking all the while to make sure Roma hasn't dislodged the tube despite my death grip on it, I slowly start injecting the formula. Often, after a cc or so, she will start to calm down - it's almost like she sighs and is thankful for a filling tummy. But sometimes, she just keeps squirming. I finish the formula slowly, wait a second, grab the tube near her mouth and pull it out in one quick smooth motion.

By this time, she has often worked up quite a bit of foamy saliva and at first this scared me thinking it might be formula, but it's not.

You can see why it goes so much more smoothly with a second pair of helping hands!!

It's important after feeding to let her suckle on a finger to help pull down any bacteria or mucous out of her nose into her stomach. Sometimes she really gets into it and sometimes she doesn't.

I gauge the amount of formula by how long it's been since the last feeding. 2 hours, I give her less, 3 hours she can take about 3.5 cc and this will increase as she gets older. You can see how much fuller her belly is after a feeding.

Often after a feeding she presents me with a little solid pellet of green poo. I wipe her face clean and then her behindy. Even if she doesn't suckle, I hold her for a while, head upward and then put her back into her nice toasty warm crate.

Then I have 2 - 2.5 hours to do as I please, except I still have to check on her, just for my own peace of mind.

2:15 pm 12April08

I just finished a feeding. My 5 year old Frenchie, Maxine, continues to be very interested in the baby. (The other 2, Cosette & Roman, don't really seem to care too much). I let Maxine come up on the couch and sniff her and lick her while I held her. Roma didn't seem too interested in suckling, so I just held her. She does root around in my palm like she is looking for a teat, but isn't always satisfied with my finger. I've put her back in her crate, took the tube and syringes and rinsed and dried them in the kitchen. Tube feeding isn't a sterile procedure, but it's important to keep everything clean. The supplies are all lying on a paper towel on the counter drying in the wonderful breeze we have today. It's an absolutely gorgeous day - cool for Florida in April and bright, bright sunshine - Chamber of Commerce weather as I call it. The river (which I can see from the computer here) is sparkling and the Spanish moss is waving in the branches of the big Live Oak tree on the river bank. I think I will spend some time at the computer trying to figure out how to down load songs onto my new iPOD. I'm pretty good with computers, but we'll see..."

What she didn't tell you is that she hasn't slept in 24 hours. Roma needs every good thought, prayer and hope she can get. She is by no means out of the woods. It's not even a 50/50 chance that she will survive. But if we can keep her alive, and keep her tummy full and if the cleft is not severe and if we can repair it with surgery when she is old enough, and if she doesn't choke or aspirate and if any number of other potential disasters we haven't imagined yet do not befall her, she may live to grow up.

We know you will hold her up in your thoughts and keep her warm in your hearts,
The Frog Princess
PS Here is a YouTube video that shows a vet doing the procedure on a very sluggish baby English bully. He makes it look so easy! Amazing what 20 years of experience can do for one's confidence.
Follow up note: Last night, Roma was sneezing and had a runny nose. She was whisked to the ER vet and her foster mom put together a humidified oxygen area for her. She has started medicine for pneumonia. Please send your good thoughts for this baby and her exhausted foster mom.


Anonymous said...

God Bless You! As an RN myself, and a frenchie nut, I can only imagine what day to day life is like. I will be keeping you and Roma in my prayers. Patty (and Frenchie kisses from Zombo)

Anonymous said...

Wow...This is amazing. Thank you so much FBRN for helping this little girl. Roma's foster mama is an angel. Best wishes for this little girl and hope her foster mom can grab a nap!

You are such a dedicated group!

Anonymous said...

Roma's Foster Mom is one amazing lady! My thought and prayers are with you both.

Anonymous said...

Sweet sweet Roma. Hugs and prayers to you and your wonderful caretakers.