This story took me a long time to write. Mostly because the rehabilitation of this little girl has been the most challenging rehabilitation I have ever done and it has consumed nearly every minute of a full year of hers and my life. This is the story of Imann (aka Kitty, aka Nonnie).
The shelter had called me on a Wednesday night because a little German Shepherd puppy was not able to keep any food down. No matter what they tried, she continued to vomit everything she ate and she was becoming very weak. They had tracked down some vet history from the former owner showing that since she was at least five weeks old she had been treated for parasites and was currently on meds for coccidia, but evidently they could not figure out why she continued to vomit. At the time, she weighed 5lbs and the owner was still keeping her. After three weeks of constant vomiting, here’s a surprise, the owner dropped her off at the county shelter and conveniently failed to mention that she had any medical problems. He said his wife didn’t want a puppy.
I picked the puppy up on Thursday morning. She looked terrible! She was so thin that I could feel all her ribs and hip bones. She was so weak that she stumbled when she walked and just looked generally very sad. My intention was to bring her straight to our vet, but I decided to give her a bath first because she had dried vomit all over her. Ugh! Poor little girl.
After her bath I took her up to the clinic. We weighed her and she still weighed 5lbs (three weeks later). We ran a parvo test which was negative, and a giardia test which was also negative. So Dr. Mark gave her fluids and put her on some pro-biotics (for intestinal support). We decided I should try feeding her tiny amounts of food every hour. So that’s what I did. I stayed up all night on Thursday night and it was so frustrating! The puppy was so starving she would eat a tablespoon of food ravenously, and a few minutes later, up it came. Over and over. It didn’t matter what I offered her, or how small the quantity. She just couldn’t keep it down. She moaned and whimpered a lot and I could see she was miserable because she was soooo hungry, but just couldn’t fill her little tummy.
I called Dr Mark at home at 6am in the morning and told him I thought the puppy was going to die — soon, if we couldn’t figure out what was wrong with her. So Dr. Mark picked her up at 6:45am on Friday morning and took her up to the clinic for an x-ray. I was sure she must have had a partial obstruction (swallowed something she shouldn’t have), or some kind of severe congenital deformity…three hours later I hadn’t heard anything so I called the clinic. Dr. Mark told me he hadn’t called because he didn’t know what to tell me, other than that something was “very wrong”. He was only able to tell me that he could not actually see her heart, lungs or abdomen. He was stumped. He told me he sent her x-rays to the radiographer at 7:30am and still hadn’t heard back (he would usually have gotten a report back within an hour or two), and it turned out that was apparently because they wanted to consult with a few more radiographers because her x-rays were so confusing to everyone. Finally, they all agreed what they were looking at was a congenital defect called a “persistent right aortic arch” and it causes a secondary condition called “mega-esophagus”. Her esophagus had dilated to such an extent that it was shoving all of her other organs over into a corner. That’s whey Dr Mark couldn’t see them! The condition is not common but is seen in German Shepherds and a few other breeds. I’ve included a photo of her x-ray below. The big blob that sits where her heart should be, is actually her esophagus. The swirly stuff in her stomach is gas because she kept trying to eat and was gulping air when she vomited.
So now we knew what was wrong with her, but what do we do to fix it?? It was late on Friday evening by the time we had a diagnosis. We determined that the only way she could possibly keep food down would be to have a liquid diet (like Ensure for humans), given by syringe, while holding her body upright for 15 minutes so the liquid could travel through the esophagus down to her stomach. She needed to be fed small amounts of this liquid every two hours. So the clinic called around and found the liquid diet she needed at the emergency vet clinic and I raced over and picked it up just before 9pm. Then I raced back over to our vet clinic and picked up the puppy, and got ready for my second night attempting to get the puppy to keep food down. It worked! I fed her tiny amounts by syringe, while hanging her little body in the air from my arm. She kept it down. Each time I fed her she was stronger and more ravenous. It was so exciting to witness! Finally, that tiny body was getting some nourishment.
By Sunday, she was already able to take much more of the liquid food, had been able to go to the bathroom, and was acting almost like a normal puppy! I continue to hold her with her little legs dangling in the air for 15 minutes and she had not vomited once! I nicknamed her Kitty at the time because the minute I would put her down, she would pee and then come over to rub against my legs, just like a cat. She also made these funny sounds while digesting her food and it sounded like a cat meowing. Dr Mark told me she needed to have surgery but would have to gain some strength for a few days first. The picture below is of me, somewhat of a zombie after no sleep for a couple of days, and Kitty, hanging there peacefully while the liquid travels down her esophagus to her happy little tummy…
So, Imann (Kitty), was scheduled for surgery the following Wednesday morning. Two vets would work together to try to remove the band of tissue that caused the mega-esophagus. I was told her prognosis was guarded. They told me she might not survive the surgery, but also, her esophagus might never return to normal size. Apparently people have built special chairs for adult dogs with this condition called Bailey Chairs, that allow the dog to eat while upright and stay that way long enough for the food to make it through their esophagus. Obviously, we preferred that this little girl would get to eat like a normal dog, but we figured we would take that one step at a time.
The staff at the clinic was really amazed when I brought Imann in for her surgery. The last they had seen her on Friday, she was weak and sickly looking and cried a lot. She had gained 1.5 lbs in four days and was active and happy! She greeted everyone and was full of love and kisses.
The surgery took 1.5 hours and was very scary for the staff. There were two vets, three certified vet techs, and several vet tech assistants involved in her surgery, and during the difficult procedure she turned blue and her lungs both collapsed, but they kept her breathing and worked hard to get the procedure done. The vascular anomaly was very deep and situated just next to the aorta so it was very difficult to locate. We all tried not to think about the high statistics of puppies who don’t make it through this surgery and everyone at the clinic worked extra hard to keep her alive.
Dr Mark and Dr Bob found the area, removed the tissue, and put her on oxygen and a morphine drip. When I got back to the clinic she was very painful but her color was great! When you think about it, they had to open her chest and rib cage and then place a tube in her lung and a clamp on one side. She was a very strong girl who really wanted to live!
I brought her home that night and she cried a lot, but she was also alert and looking around. She didn’t want me to
go too far, so I tried to sneak off and take care of things quickly while she was dozing. That first night was a hard night for Imann. For one thing, she’s a very clean puppy and didn’t want to soil her bedding. Unfortunately, after being on fluids during her surgery she really had to pee a lot. She just couldn’t seem to get comfortable, and kept climbing off the wet spot to find some place dry. Of course moving hurt, so she would cry from the pain. I dozed off on the sofa for an hour and when I woke up, there she was, standing in a puddle of urine staring up at me. I was surprised, but I knew exactly what she was trying to tell me. “I’m hungry!” So she took a tiny bit of food. Sadly, the position she had to be in for the food to go down was extremely painful after surgery. I just tried to reassure her and keep her calm. But I knew as soon as she started chewing on my necklace (a favorite past time), that she was getting back to herself, even in spite of the pain.
I dropped Imann off at the clinic the following morning so they could monitor her and hopefully pull the chest tube that was there to drain fluid off her lungs. We all knew that tube had to be very painful…
When I got back to the clinic at the end of the day to pick her up they had taken the tube out and Imann was just as happy as anything. She looked great! She was no longer crying in pain and was walking around acting just as if she hadn’t just had her chest opened up one day earlier! I’m telling you, it never ceases to amaze me what some of these little animals can go through and come out on the other end as if nothing bad had ever happened. The big question was whether her esophagus would go back to normal size and I was told it would be about a month before we could tell. At that time they would take a barium x-ray so they could watch the food move through the esophagus.
September: Over the next few weeks, Imann grew increasingly hungry, but every time I tried to increase her food, she would vomit. So, I researched online and tried rolling up little balls of wet puppy food into marbles, then holding her in her upright position to let them go down, but she would vomit them up within a minute or two. We also tried meds to coat her esophagus, but she just didn’t seem to get any relief. The worst part is that she was obviously in pain before she would vomit. She would wail and cry for a minute before the food would all come back up. Torture! This is a saucer of marble sized meatballs we were trying.
October: Several more weeks passed. Imann continued to only be able to eat a liquid diet through a syringe. I mixed A/D wet food into the liquid Clinicare (like Ensure) and she would eat about 120-150 cc per feeding, about every 4 hours. She went almost two weeks without vomiting on that routine, but then back to vomiting for a few days. Poor, sweet girl was so hungry, but absolutely could not keep anything down. We got a good routine going. I stood her in the sink and she rested her arms on my arms while I plunged one 60cc syringe, then chucked the empty in the other side of the sink and quickly started on a second pre-filled 60cc syringe. She was full of play and loved to drag my cell phone, my home phone, and my glasses off the sofa and into her bed with her. She hardly chewed on them, just liked to have them with her. Took me a while to figure out where my missing phones were. I would call them and follow the ringing sound that was coming from her bed. * Note: Some very kind person anonymously built and left on my driveway, a “Bailey Chair”. I admit, it took me a few days to figure out what the contraption on my driveway was! Finally Wilma P and I were looking at it and contemplating how a cat could use it when she suddenly said, “Maybe it’s for the puppy”, and that was it! I realized it right away. Imann was so small at first that she just slid out the bottom at first.
She was always very good spirited, even though she was really always starving and eating was her priority. I could never get her to play with toys and it made me sad. I dressed her up for Halloween and she seemed happy trotting along wearing her sheep costume.
November: Imann and I had a rough ride for another month. She would do really well on her liquid diet so I would get bold and feed her more gruel (A/D mixed into the liquid) and she would do really well and start to put on weight, then suddenly, just as I would be about to graduate her to the next step, she’d start to vomit again. NO!!! She’d vomit and vomit for days. Even when we’d go back to just liquid nutrition she would vomit. I finally got her on an anti-emetic for vomiting and she would still vomit, but much less. I started feeding her protein shakes, made from Ensure with extra protein powder. I also fed her baby food. A few days of that and she started to do better so I introduced gruel again, and she continued doing well so I tried gruel in a bowl, and although she would still vomit, it wasn’t much. I fed her canned puppy food in a bowl and she whined and belched a lot afterward, but she kept it down! She ate that way for three days and only vomited about once per day. She was 4.5 months old and only weighed 7lbs! We would try her on various anti-emetics for nausea and vomiting, and that would help for a couple of days, but she’s always go back to vomiting and all of the weight she had gained would disappear in two days of vomiting. I cleaned up more vomit in those months than any human should have to clean up. She wouldn’t just vomit her meal up in one regurgitation, she would vomit a big puddle, and I would crawl around on the floor cleaning it up, then I would disinfect the floor and carry the mess out to the garbage in a plastic bag. When I came back in the house, there she’d be, looking sad and depressed, and there would be two more large puddles of vomit on the floor. That was better, though, than cleaning all the vomit if she vomited in her crate. Then I’d have to take the crate outside, hose it out and disinfect it. I’d bring the crate back in the house and within minutes, she’d vomit in her crate again. I couldn’t put her outside to vomit, either, because there was a risk she’d eat something on the ground and start the entire nightmare all over again. There was NO easy solution. I would call Dr Mark and sob with frustration and sadness.
Here’s a picture of her during a check up at the clinic. She is 5 months old and looking pretty good, even though she is grossly underweight.
The next few months were a blur. Imann decided she was going to get more nutrition through other than food. She started vacuuming up anything she found on the ground. Hair, leaves, dirt…and of course, those things clogged her esophagus and caused her to vomit more. So, I had to walk her only on a leash, in order to monitor everything that went into her mouth. I was crating her, but discovered she was eating her own poop (another thing that clogged her esophagus — ick!) So she started wearing a basket muzzle, but we quickly realized she was still vacuuming, right through the muzzle. She also started eating the blankets she was laying on in her crate. Even with the muzzle, and even after I put a metal grate over a towel in the bottom of her crate. She would find one tiny string and pull it through and that was all it took to get that towel up and chew it up. Needless to say, as soon as she would eat more of her liquid diet, up would come the liquid — and the pieces of towel! I never had to use anything to induce vomiting if she had eaten something she shouldn’t have — all I had to do was feed her. And all of this time, she continued to lose weight from all the vomiting.
Finally, we decided to put a food tube down her nose and so it would bypass anything in her esophagus and let the liquid go straight to her stomach. This worked — sort of. The end of the tube that I was using to syringe the food through was stitched to the side of her muzzle and I had to pull it through the basket muzzle in order to feed her. She would sneeze and much of the food would shoot back out of the tube (all over me). I was so discouraged watching her waste away, and at 10 months old, she weighed in at 16lbs. Dr Mark and I were finally considering euthanasia. Her protein albumin level was so low that he felt she was about one point away from dying, anyway. I went home and contemplated what there was left to try. I took a can of wet puppy food and put it in a Magic Bullet, then added water until it was full. When I blended it, it turned into what I called a “meat shake”. It really looked like a chocolate milk shake. I found the highest elevated food dish I could find and started with a cup of the shake in the dish. She lapped it up hungrily, and 15 minutes later, she had not vomited. I was shocked and somewhat hopeful, but I had been down this road before. I waited another 15 minutes and finally gave her another cup of the shake. It was working! She had kept two cups, equal to one can of food down for half an hour without vomiting. After that, I tried to feed her that way in increasing amounts, but any more than one cup and she would vomit. So I kept going with one cup increments. Two cups, 15-20 minutes apart, every four hours. There were still bouts of vomiting, but only once every week or so. MUCH BETTER!
When she was one year old, Imann finally weighed in at 21lbs! An average female German Shepherd would have weighed between 60-70lbs by then, but I didn’t care. She was alive and growing! I cried when she picked up a toy for the very first time and threw it high in the air, and then pounced on it. At one year old, she was finally feeling like a normal puppy!
At 14 months, we finally felt Imann was strong enough to be spayed. She weighed 23lbs. Dr Mark said she had a huge uterus, which didn’t really surprise me. She has the organs of an average sized adult German Shepherd, in a miniature Shepherd’s body.
Here are a few pics of her at 15 months old. She weighs 26lbs. I continue to feed her meat shakes four times per day along with a high calorie liquid supplement, and she continues to be a super skinny, mini Shepherd, but she’s a happy, girl, and that’s what matters most. Imann has been the single most difficult rehabilitation I have ever done. And, what’s love got to do with it? Everything.