The Little Prince Saga
A puppy with Patent Ductus Arteriosus
Roxy was big as a barrel. Her temperature dropped and her due date approached. 08/28/2017 she started the day with light contractions and some nesting. The contractions were coming at infrequent intervals so the day wasn’t very eventful. It was her first litter and as the afternoon approached I became a bit nervous. What, if something went wrong and I had to go to the emergency clinic? For peace of mind I decided to go to my vet for some x-rays. His face was happy when he told me that he saw about 8 skeletons and that by tomorrow all of them should be born. He also mentioned that he saw a smaller puppy, a runt. I was not concerned because I thought it could be normal to have a smaller puppy in a large litter. Soon enough the full meaning of the tiny pup would be revealed.
As the evening approached Roxy’s contractions became stronger and more intense. At 10:00 pm the first puppy was born. More puppies followed about 10 – 15 minutes apart like a smoothly run assembly line until 3 puppies were born. Then there was a break in the action and after a pause something very tiny came out. For a moment I couldn’t see which part was the placenta and which was the puppy. I picked up the sack and thought that I might be holding a dead pup. My husband and I looked at each other in disbelief. The small object looked like a dead bird and made no movement. Roxy’s head came around and started quickly to unpack. I helped her opening the sack at the head. I noticed a gasp, then nothing. I took piece of cloth and wiped the mouth. I heard the first noise and this little creature was alive. It then dawned on me what the word “runt” meant. The puppy boy weighed only 4.5 oz (130g) and was about ⅓ of the size and weight of the others. It’s head seemed to be the largest part of the body, his little legs not thicker than a pencil pointing in all directions. Roxy treated the puppy like every other puppy and licked it with vigor. She pushed it around with her nose until it found its way to the nipples. His mouth was so small that he could barely fit it around the nipple but he tried earnestly and his instinct told him that this was the place to be. Four more puppies were born and all clinged to Roxy’s nipples to take in the first milk, colostrum, that soon would make them grow big. We watched the tiny puppy boy closely and decided to wait and see what would happen. I prepared myself that he might not make it through the night and that I most likely would find him dead in the nest the next morning. I was at peace with this idea as mother nature makes the best decisions. It was 2:00 am in the morning, the new family had settled down, we cleaned up and went to bed to get some sleep.
The next morning my first action was to check on the puppies and to my surprise I saw the little runt suckle on a nipple. Roxy cleaned him and nurtured him like all the others which I interpreted as a positive sign. I put him on the scale and he had lost 15 g. I wasn’t sure if he really got milk because the nipples were so large that he could hardly grab them. It was clear to me that he needed extra support from us. I did research on Google, watched videos on how to feed an orphan. I called a breeder friend who breeds Afghans who I knew had experience with several litters with small puppies. He recommend to immediately start tube feeding the puppy every 3 hours and gave me detailed instructions on how to do it. I had everything I needed in my birthing supplies and prepared Nature’s Pharmacy Puppy Bac mixed with Fading Puppy Formula. I cradled the little boy, who was smaller than my palm, and I was afraid that I could hurt him or puncture his stomach and that he would die in my hand. I braced myself because I realized this pup would either die of starvation or by me puncturing a hole in his stomach. I measured from his mouth to his belly button and marked the tube. I held him in a natural position and inserted the tube at the side of his mouth. The puppy started swallowing and the tube went gliding down his throat on its own. I slowly pressed the plunger and 3.9 cc went down into his belly. I was relieved and happy! I noticed that his energy level immediately increased and he was determinately moving towards the warmest places at his mom’s body. He liked it best under her armpit or between her hind legs.
I had the birth of the litter announced on FaceBook and to my surprise people from all over the world showed interest and affection for the little runt. Because this was the D litter and I referred to him as “der kleine” (the little one) a friend expanded that to “Der Kleine Prinz”and he had his name and a fan club was started. He now became The Little Prince. Not a single day passed without people sending support, cheering him on and showing interest in following his journey.
Roxy seemed to know that this little creature needed her special attention. I came to the whelping box and Prince and another puppy were somehow lost in a corner. Roxy stood up and sniffed one puppy and then Prince. I held my breath as she opened her mouth. Her shiny white teeth approached Little Prince and grabbed him. I thought she would eat or hurt him. She carefully picked him up and carried him to a different place in the whelping box, layed down and softly placed him between her front legs, then pushed him gently towards her nipples and laid down and fell asle
We started tube feeding Prince every 3 hours around the clock. My husband did the night shift and morning and I stepped in immediately after work to midnight. Prince started gaining 10 g per day and his energy level steadily going up. In addition he still nursed at his mom. The puppies were small enough for him to have enough space. However, he seemed to be overwhelmed by the amount of milk Roxy had. When he suckled and the milk began to flow it started dripping out of his nose and sprayed into his mouth and I noticed a gargling sound. I recognized this sound as a possible problem and became concerned. These symptoms were typical for cleft palate or wet lung. Perhaps he had aspirated milk. After 5 days I decided to have him checked at my vet to make sure he was healthy but in the back of my mind I was prepared that the vet could find something wrong that we would then have to do whatever is best for him. I tucked Prince into a tupperware and went to the vet. The vet set the puppy on a towel and Prince immediately started to move around and attempted escape. He was a strong squirmy tiny puppy. The vet checked his mouth, hard palate, soft palate and his throat. He listened to his heart as well. There was no evidence of cleft palate, no fluid in his lungs and his heartbeat was strong. So the advice was to keep him warm and go on with the tube feeding. As long as there was a consistent weight gain my vet was not concerned.
I was really happy to share the good news with Prince Facebook fans and kept up with the feeding. Prince’s belly filled out and he was above his birth weight in no time.
All the puppies gained weight quickly and grew rapidly. The gap between his siblings and Little Prince increased because he didn’t gain as quickly as the others. Just when we thought we had it all figured out a new challenge appeared. The other puppies were so strong and large that it became harder for Prince to get to a nipple and defend it. He was a tough little guy and we watched him wiggle himself between the bigger bodies to get to nipples that were more at the bottom but we felt he needed our help. Roxy had her pups on a 2 – 3 hours schedule and we watched through a security camera. Whenever she laid down to nurse we placed Prince on a nipple at the front end and shielded it with our hands. Milk still came out of his nose so we placed him on a smaller front nipple so he wasn’t overwhelmed by the milk flow.
At around 10 days the first puppies opened their eyes and we were curious to know if Prince would open his eyes too. We were happy to see that his eyes also opened at about 2 weeks and I could feel his teeth coming in as well which gave us an indication that he was developmentally about where the others were. He moved around on 4 legs in the same drunken sailor style as the others and didn’t seem to be much bothered when his brothers and sisters stumbled over him. We noticed that he slept more than the others but thought it was due to his small size. In a way it kept him out of trouble.
At 3 weeks of age we celebrated a milestone. Prince obtained 1 lb. He was still sleeping more than the others but his weight gain seemed to increase after we steadily increased the amount of milk replacer.
Prince became more and more popular on Facebook. People came to visit him at our house and wanted to hold him. Belgian fanciers and other people sent him gift packages filled with toys and treats. I posted pictures and videos of the other puppies Prince’s popularity soared and everyone wanted to point him out in the pictures. Due to his indomitable spirit he had become a celebrity and his fanclub was steadily growing. People were very kind and we were encouraged to do the best we could for Prince.
For the rest of the puppy crowd it was time to introduce their first meal. It was a feast and the pups dug in with great enthusiasm. Prince was not particularly interested in the mush so we initially introduced him to a pate (royal taste buds?) and slowly mixed some of the puppy mush under his food. He responded beautifully now gaining 1 ½ oz (50 g) per day. I still thought that he should be gaining more quickly. He also looked very different than the others. His ears were perfect like elf ears and he had a fierce look in his eyes but his legs were still thin, his coat was fine and scarce and he wasn’t chubby.
On the other hand he was very energetic and playful. He liked toys and loved to play tug with us and made us laugh. He was our little squirrel or pocket Belgian. We really had so much fun with him and he grew to our hearts.
We always kept an eye on him around the other puppies since their bodies were so much larger. They started wrestling games and he tried to participate. He growled at them when they grabbed him and he even initiated the game. He never thought of himself as being smaller than the others.
As 6 weeks approached I had to think about placement of the puppies. I had some families in mind for Prince as some had specifically expressed a desire for him. Despite this there was an internal question and I was not sure. My instincts told me to schedule another appointment with my vet to have him checked once again. For the first time at that appointment when my vet listened to his chest he heard a heart murmur, Grade 5 out of 6 which suggested a severe problem with the heart. The heart murmur wasn’t detected at 1 week of age because a young puppy’s heartbeat is so fast. Two days later Prince was scheduled for an ultrasound to get a clear diagnosis and prognosis. The ultrasound revealed PDA Patent Ductus Arteriosus. Before a puppy is born, the fetus’s blood does not need to go to the lungs to get oxygenated. The ductus arteriosus is a hole that allows the blood to skip the circulation to the lungs. However, after birth, the blood must receive oxygen in the lungs and this hole is supposed to close. If the ductus arteriosus is still open (or patent) the blood may skip this necessary step of circulation. The open hole is called the patent ductus arteriosus. When a puppy takes the first breath, pressure occurs which closes the duct. This didn’t happen for Prince. When the ductus arteriosus remains open there is increased pressure in the pulmonary arteries and this causes dilation of the right side of the heart.
Prince’s heart was already so severely dilated that the cardiologist was surprised he had energy to play with us and that he was doing as well as he was. It was miraculous that this puppy had gained weight and was alert and curious and playful. The vet informed us that Prince could go into heart failure at any time. Surgery was the only choice to save his life. There was a non invasive option where the surgeon inserts a catheter in the arteries at his hind legs and place a plug to close the duct. The success rate of this surgery was very high and a dog could live a normal life.
For this option Prince needed to be a minimum weight of 2000 g and size. The other option was invasive heart surgery to close the duct. Ideally he should have had 2000 g but Prince had only 1500 g. I calculated that it would take him 10 – 14 days to reach this weight given his current rate of gaining 50 g per day.
I was heartbroken as it was clear to me that I couldn’t place a puppy with such condition into a home not knowing if there were other related health conditions and I would not be able to guarantee health as I do with all my puppy placements. I personally had not planned to keep a puppy. It dawned on me that I had to make a devastating “breeders decision” to let him live happily with us until his time runs out.
Of course surgery was an option to save his life but who would want to have this puppy or willing to pay for such a procedure. I discussed the situation with some close friends who suggested plans to organize a fundraiser to cover at least a portion of the cost in case surgery was an option. I decided to openly share the situation and my decision to not place Prince with some of my prospective puppy people. One home came forward and asked for more details about the surgery and prognosis. After long conversations we worked out some details and went ahead with the plan for surgery. We did one more test to rule out a liver shunt which is sometimes related to heart conditions, luckily that test was negative for the condition. A race with time began because unless I was able to get Prince’s weight to the 2000 g mark he could die of congestive heart failure before he was ready for the procedure. Another week went by and I was able to get him to 1850 g. He still insisted on playing with the others but now I noticed him breathing with an open mouth. I could feel and see his heart vibrating when I held him in my hand. I contacted a friend who was a technician at the cardiology at the NC State Vet Clinic. She was very concerned after she saw the details of the ultrasound and shared it with her veterinary colleagues. Miraculously, she was able to schedule an appointment the next day. The pre op exam revealed that Prince was not a candidate for the non invasive procedure because he was too small but that the invasive procedure was an option even though there was a number of great risks because of his very small size. After conversations with the surgeons and doctors I signed the paperwork and said goodbye to our little Prince, not knowing if he would survive the procedure and if I would ever see him again. Surgery was scheduled the next day. I was sitting on pins and needles until the call in the afternoon. The voice said that the surgery was not without complications but Prince was alive and recovering in ICU. I was relieved and finally able to take a deep breath. The next day I went to pick him up. I expected a tired and lethargic puppy but Prince was his old funny self, licked my face and went home with me. His heart had shrunk ⅓ in size. I was eager to share the good news with Prince supporters on Fb. There was an unbelievable positive energy. I was truly touched that we were showered with many positive comments and commitments from people all over the world. The little guy had also burrowed into their hearts.
There were also negative discussions from other breeders and fanciers who disagreed with the decision to save this small puppy and attacked me as a breeder. Many formed opinions without knowing many of the facts. The debates were difficult to read and threatened to turn a good result into the opposite for us during a very sensitive time. It was very painful to read them. At any time during this process it would have been so easy for us to just post “RIP Little Prince”. There was also a strong majority of people who stood by our side throughout the process and thrilled to learn of the positive outcome, especially the family that had the courage to step forward and firmly decide that they wanted to provide a home for this little being. We learned that good prevails and that we can accomplish things when we stand together as a community, regardless if it’s for a tiny puppy or larger issues in life.
Only days after his surgery Prince weight gain and energy level increased significantly. His little body now got the oxygen and power to fully use the nutritions and grow. He grew so fast that we could see a difference in one day. During the recovery we kept him in an x-pen separated from his big brothers and sisters. Yellow boy was Prince’s special friend. Whenever Prince was crying Yellow boy climbed over the x-pen, left his siblings and ran straight to prince to play with him from outside the x-pen and keep him company. We kept Prince for another 2 weeks and then a new chapter in his life began with his new owners Stephanie and Liz!
Prince would not be alive without the joined effort between my veterinarian, the cardiology team at the NC State Veterinary Hospital and whole hearted dog lovers who supported the surgery with donations and encouragement.
If you want to follow Prince Gorham’s life https://www.facebook.com/Princeupdate/
Long live the Prince!