Bonnie
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8 week old "Bonnie"
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16 weeks old "Bonnie"
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A breeder contacted me to report that he had this sick pup in his
latest litter that could not keep anything down?! ~ Being on benefits he
could not afford a veterinary consultation, and wanted someone to take it
off his hands. This poor little girl weighed only 2.5kg, and was a bag of
bones, desperately hungry.
A friend drove me down to Gloucester to collect her, and on arrival we
found that Bonnie was the result of a litter bred by these people
~ this was their second litter from the same dam in 6 months!!!. She was
found to be living in filthy conditions in a downstairs toilet area. I could
not wait for them to complete the adoption papers signing her over to me
and get this poor girl away from these people who, to them, her life meant
nothing.
On returning home I immediately phoned my vet Greg Firth who asked me
to feed her a tablespoon of soaked biscuits each hour and try to determine
if Bonnie was vomiting, or regurgitating. This being at 11pm on a saturday
night, I was asked to persivere until 1st thing monday morning when
Greg could see us both and try and determine exactly what Bonnie's problem
was. Bonnie appeared to be managing to keep down a certain amount
of her food served in these small measures but unfortunately took a turn
for the worse as the month went on.
Later in the month Bonnie was admitted suffering from severe breathing
difficulties. It was agreed that she should be X-rayed to determine if she
should be allowed to continue this way. Waiting at home for Dr Firth to call
was gut wrenching to say the least, but when the call came I was so relieved
to hear that there was a possibility they could alleviate her distress.
She was diagnosed as suffering from pneumonia and persistent right aortic
arch (PRAA). This condition blocks the entry of food to the stomach and,
if allowed to go untreated, irreversibly damages the oesophagus.
Bonnie needed to undergo surgery which would hopefully correct her condition,
but the chances of her surviving such surgery were slim, but both myself
and Greg decided that being such a little fighter it was certainly worth attempting
the delicate surgery needed to save her life.
Bonnie was admitted to intensive care where it was intended to feed her
directly by a tube into her tummy in order to get her up to a weight that
would give her at least a fighting chance of surviving her surgery.
From her case notes Monday 11th.
Admit to x-ray and assess if dog can carry on. Weight 6kg. Lat neck &
chest radiograph: cervical oesophagus unremarkable with tiny pockets of air
deligniating its course. Gross dilation of the oesophagus immediately cranial
to the heart base with ventral deviation of the trachea. Oesophagus caudal
to heart unremarkable. Findings consistent with Megaoesophagus due to vascular
ring anomaly. Small degree of pneumonia present. Advise Baytril & feeding
of semi liquid food little and often from a height till lung fields improve
then general anaesthetic and scope oesophagus to confirm heart base constriction.
Surgery if persistant right aortic arch confirmed.
From her case notes Wednesday 20th.
Poor nutritional state and some dehydration present. Elect to postpone
thoracotomy but place gastrostomy tube for feeding/hydration ahead of thoracotomy.
Weight 5.4 kg. Cannulate. Hartmann’s. General anaesthetic. Intubate O2/iso.
Endoscope oesophagus: constriction 40cm from nose with pulsatile right oesophageal
wall consistent with PRAA. Distal oesophagus unremarkable but proximal Megaoesophagus
present. Left paracostal laporotomy for gastrostomy tube placement; stomach
adhered with PDS to abdominal oblique muscles. Concentric purse string sutures
of PDS laid in stomach wall and Foley (20FG) catheter passed through stab
incision at centre of purse strings. Strings tied creating stomach inversion
around the catheter. Muscle edges apposed with PDS and skin closed with Ethilon.
Chinese finger trap suture tied to secure catheter to skin. Abdo wrap placed
with Melonin, Sofban & Vetwrap. Inj. syn, Metacam, Pethidine & Tagamet.
Pharynx cleared of fluid. Nasopharyngeal catheter with O2 supplied secured
and endotracheal tube removed on recovery with cuff semi-inflated.
Bonnie was now in the care of the staff at the Park Veterinary Centre,
Watford, and being fed through the tube into her tummy. Her weight and condition
improved daily, and by the Sunday morning her weight was up to 6.3kg.
Talking through all the details again, Dr Greg Firth pointed out every
possibility good and bad. There was an 80% chance of her not surviving the
surgery, and only a 50/50 chance of a full recovery. Given Bonnie’s obvious
will to live I felt obliged to offer her everything she required to do just
that, and as the odds were in her favour the decision was made to go ahead
with whatever surgery Greg could perform to save her. This was a very deserving
puppy and expense was not even considered, I would worry about that when
it was all over.
Monday 25th October, the big day. A call to the centre confirmed the surgery
was to go ahead as planned. This was going to be a long day of waiting! ~
When Greg called me at 8pm to say that all had gone well it was as if I
had won the lottery, but Bonnie needed another 24 hours of recovery to be
sure of how well it really did go?!
The surgery notes:
Left 4th i/c thoracotomy. Mediastinal pleura incised ventral to vagosympathetic
trunk & ligamentum arteriosum isolated. Aortic and pulmonary ends double
ligated with Vicryl and ligamentum sectioned between. Oesophagus freed from
connective tissue adhesions to pulmonary artery and aorta. Foley catheter
passed per os to facilitate dissection. Oesophagus completely freed and passage
of catheter made possible unimpeded. Ribs exposed with PDS Cruciate sutures
around adjacent ribs. Intercostal muscles apposed with Vicryl, serratus,
scalanus, and lateral dorsi muscles each closed with Vicryl. Vicryl subcut
suture and Ethilon skin sutures.
Chest drain anchored with Chinese finger trap & purse string suture
laid (drain placed prior to wound closure). Pneumothorac drained, I/c nerve
block performed with Intra-epicaine (total of 2ml inj). Foley anchored with
CFT. 10ml Urograffin inserted into tube and radiograph taken; all contast
in stomach without leakage.
AM Tuesday 26th October. With everyone expecting to find Bonnie feeling
very sorry for herself, they were very pleasantly surprised to find a bright
eyed, tail wagging puppy wanting her breakfast?!
An amazing recovery for such a young and weak puppy only proving to win
more hearts of the staff at the centre.
Her gastrostomy tube was removed late Tuesday afternoon and she was able
to resume feeding by mouth in an elevated position.
Bonnie came home on Wednesday evening. She was still bringing up a small
amount after each feed, this was only to be expected with such a dilated
oesophagus, but it is hoped that this may improve in time. At worst she may
have to continue this elevated feeding for life, and continue with liquidised
food, but for what little effort that takes I can’t see that being such a
problem. Bonnie now had a lot of catching up to do with only weighing 6kg
at 15 weeks old, but I am sure we will if it is up to her.
As an indication of how weak she was, and how drastic these procedures
have been I am showing you these pictures of her taken Thursday 28th.
Monday 1st November
Bonnie has been brighter each morning over the weekend, and this morning
she had a mad hour playing my other three dogs in the garden! ~ Here am I
concerned that the others may play too rough, and it was little Bonnie that
was doing all the chasing?!
All her morning meals were eaten with nothing coming back up, and that
was with only a few minutes quiet time in her crate after each meal. Without
the vomiting she is able to take full advantage of her rest and sleep, all
helping with the healing process.
This afternoon we returned to the vet just to see what (if any) weight
she had gained, and you can imagine my delight at seeing the scales registering
7kg.
Thanks to the veterinary and surgical skills of Dr Greg Firth, and the
TLC from the veterinary nurses at the Park Veterinary Centre, Watford, Bonnie
can now look forward to a brighter future.
Thanks also to Val O’Leary and Terrie Brown for all the fetching, carrying,
and driving around they have done for me (or should I say Bonnie?) over the
past weeks.
A special BIG thank you for the donations received towards Bonnie’s veterinary
care from fellow Helpline contacts, and the Rocky Trust Fund. They certainly
helped with the dent in my Visa card?!
I have received any number of messages of love and support for Bonnie,
and I am sure that she was as grateful for all of their support and good
wishes as I was.
Bonnie is now still eating a liquidised meal twice a day, and still in
an elevated position. We just place her bowl on the breakfast bar and
she stands on her hind legs with her front legs on a bar stool to eat her
meals. She still occasionally has a few bad days where she is unable to keep
her food down and we have to be constantly aware of the risk of bloat and
this has been problem that has caused us to rush her to the vets on two occasions
in the 21/2 years she has been with us.
To see her now playing with our other dogs and tearing across the fields
with the grace of a gazelle she was certainly worth every ounce of effort
it has taken to get her this far. There is no reason now that with
good management why she can not enjoy a full and active life.
In Late July 2007 Bonnie suffered considerable weight loss and general
deterioration of her coat and after a series of blood tests taken by our veterinary
practice she was diagnosed as having EPI .
Since being on the Pancrex powder her weight and general condition
has greatly improved although she is still not achieved the weight she was
maintaining before. With Pigs Pancreas being unobtainable due to the
recent outbreak of foot and mouth we will have to continue with the Pancrex
untill such times as slaughter house restrictions are lifted. Although
the Pancrex can work out as an expensive way to manage EPI we are more than
happy to absorb this cost having witnessed such an improvement in her general
wellbeing and seeing her return to her energetic play with newcomer Tala
and general playing with Bongo ans Kane. Having been through such a
lot since birth Bonnie seems to take everything in her stride and has to
be one of the most well known dogs in our veterinary practice. Bonnie
tends to treat the veterinary practice like a home from home and is only
too happy to return and meet old friends.
