By Rhianna Depew, RVT…
Dr. Steven Cole, our board-certified cardiologist, approached me and asked a very delicate question. “How do you feel about doing anesthesia on a two-week-old, tiny puppy?”
“Puppy” as she was aptly called, since she hadn’t acquired a name yet, was a cute and cuddly, and very fragile Burmese Mountain Dog neonate that was already having cardiac issues at her young age. She had patent ductus arteriosus, or PDA, which is a congenital vascular communication between the aorta and pulmonary artery. This is normal for humans and animals in the womb, however in some cases, this vessel fails to close normally at the time of birth.
If left untreated, a PDA can cause severe cardiac enlargement, and eventual congestive heart failure (fluid in the lungs), or pulmonary hypertension (high blood pressure in the lungs).
In fact, most dogs with an untreated PDA do not survive the first few years of life. Because of how tiny she was, she wasn’t a good candidate for the typical, minimally invasive technique with catheters. Instead, Puppy needed open chest surgery in order to accomplish the PDA ligation; but that also meant a lot of risk, and a whole host of potential complications.
Dr. Cole knew I loved challenges, and was always up for our most difficult cases, but this one was different—a suckling neonate under general anesthesia is extremely high risk. But we were determined to do everything we could to help this puppy, so I started planning ahead. I thought about this small, delicate puppy every day leading up to the procedure, as well as the night before. She kept me awake, going over every detail and making mental checklists of everything I needed to get her safely through her risky life-saving surgery.
That morning I woke up early and wanted to make sure I arrived at the hospital ahead of schedule to start planning and preparing. This was the smallest heart surgery I had ever assisted with. She would need the tiniest versions of all the equipment we normally used. Tiny catheters, tiny endotracheal tube, tiny, tiny doses of medication and anesthetic drugs. I calculated all the “what if” emergency medications ahead of time and went over and over again everything we needed. I went over to Puppy’s cage and scooped her up. She fit into the palm of my hand and had the typical clumsy movements of a newborn. She was incredibly soft, and made the cutest little squeaky puppy sounds.
She fit into the palm of my hand and had the typical clumsy movements of a newborn. She was incredibly soft, and made the cutest little squeaky puppy sounds.
I gave her a kiss and held her up to my cheek and told her that she was going to do great, and that there would be plenty of days of running through grassy parks, toys, and treats in her future. Then I placed her back in her bed of cozy blankets so she could get some rest before her big procedure, and so that I could go triple check that everything was in place.
When it came time for surgery, we prepped the puppy before we put her under anesthesia and had every warming device at our disposal to keep her temperature up. I gave her micro doses of anesthetic to get her sleepy, placed ET tube in her trachea to control her breathing, hooked her up to the anesthesia machine and patient monitor, listened to her little heart beating on the monitor, and gave her some tiny breaths.
Then, I remembered to breathe, as I was holding my breath with each step taken to prepare Puppy for her big procedure. We were on our way.
Our board-certified surgeon Dr. Jana Norris, along with Dr. Cole, arrived into the OR, and we wasted no time getting right to it. The room was silent. We were all hyper focused in our tasks at hand: to accomplish this procedure and get this puppy out quickly and safely. Dr. Norris’ skilled hands were each the size of the entire patient, and they worked precisely and efficiently around the puppy’s tiny heart and lungs. I continuously watched between my monitor, the patient and the doctors, monitor, patient, doctors, monitor, patient, doctors—trying to stay a step ahead at all times. You could cut the tension with a knife, and I don’t think any of us had taken a full breath, then….
Dr. Norris assured everyone in the room with a confident “I got it.”
Puppy was doing great under anesthesia, and knowing the mission was accomplished, I could feel some nervous tears welling up. We finished the surgery and gave each other well deserved verbal high fives. I brought our tiny patient into recovery and stayed by her side until she fully woke up. Within a couple of hours she was back to being her cute and wiggly self, and wanting to be bottle fed.
Puppy was able to go home a few days later and recently came in for a recheck with her beloved cardiologist. She’s doing very well and is expected to grow fully to her Burmese Mountain Dog size and live a long, happy life. Puppy will be a constant reminder that preparation, precision, dedication, and team work, are all crucial to saving an animal’s life. For now, Puppy will continue to steal our hearts and bring joy to the hospital with each and every visit.
From Left to right: Dr. Jana Norris, Dr. Steve Cole, and Registered Veterinary Technician, Rhianna Depew.