October 27, 2015
They say communication is the key to understanding. Hmph! Many years ago I was in conversation with a Southern grandmother. “I like Datsuns”, she told me. Encouraged by this opening, I nodded in agreement, saying that I believed both the Datsun and Toyota cars to be very dependable. Warming to the subject, I began to share a story about my Aunt Bea’s wonderful little car when the woman interrupted me, frowning. “I was talkin’ about Datsun DOGS”! There was a beat of silence. “Oh, oh, of course, Dachshunds!” I spluttered. I can’t remember the rest of that conversation for the life of me, but it was only one of many lessons I absorbed over the years as I’ve struggled to explain pet maladies and medical eccentricities to my clients….
The elderly woman sat expectantly in the client seat we provided in our exam room. In my hands I held a tiny eight day old puppy. She had brought the puppy to me because it had stopped nursing that day and she was quite anxious that all go well for her charge. I examined him, checking the roof of his mouth for a cleft palate or other deformity. His ears were pressed tight to his head, his eyes still unopened. His heart sounded normal. The puppy appeared to have been eating well, with a full, rounded tummy. As I lifted up his tail my eyes stopped. I carefully twirled him in my hands for a closer inspection. The skin under his tail was smooth, unbroken by any opening that should have been there.
Oh. I looked over at his owner, still sitting up straight in her chair, a kind smile upon her face. As our eyes met she appealed to me, “Do you know what’s wrong?” I nodded slowly, my mind racing over the possibilities for treatment and successful outcome. Because I could think of none, I was slow to respond.
“Your puppy has a congenital defect, Atresia Ani,” I replied.
The woman’s smile widened. “Good, so you can fix him?”
I realized that my medical diagnosis made no sense to her – oh, so many hard-earned terms thrown out the window over the years, as I struggled to re-phrase body diseases into language comprehensible to all! I stared at this good woman fixedly and tried again. “You see, he was born without an anus.”
I must have been rocking in my agitation, as the woman began to gently move backwards and forwards in slow rhythm to match. “Yes”, she nodded, “I’m glad you can help him. When will he be better?”
The pressure was unbearable as I realized I still had not conveyed his diagnosis to her. Another tense silence and I suddenly blurted out “Your puppy was born without an asshole!”
Shock at my language and immediate comprehension registered in her eyes. The smile faded. Neonatal medicine was rudimentary thirty years ago in veterinary medicine. The condition of Atresia Ani is found in newborn puppies, a congenital defect characterized by the malformation or even complete lack of an anus. The intestine cannot empty. The puppy cannot defecate. Feces builds up inside, bloating the belly. Death ensues. Atresia Ani is rare, but when seen is more commonly found in female dogs of the Boston Terrier or small Poodle breeds. Surgical correction is not simple : the tube of intestine, the rectum, cannot just be connected to a newly created opening in the skin to connect the two. Without an anal sphincter there is no way to open and close, no way to regulate defecation. Feces will drip out at any time, called fecal incontinence. This is not appealing to most pet owners, faced with a lifetime of diapers, careful hygiene and skin care. In extreme cases of Atresia Ani part of the intestine may not have developed at all. To asses a case for surgery requires in-depth radiographic study. In addition, one must be certain no other congenital defects exist which would adversely affect the outcome. This case was entirely beyond the scope of a general practitioner and seemed unthinkable in a patient weighing less than 150 grams. How the puppy survived for so many days was itself a sad miracle. The puppy was being poisoned by the body waste he couldn’t eliminate and I had to recommend humane euthanasia. The client was lovely about it, though saddened that we could not help her puppy. There were other healthy, thriving puppies at home. But it was this little one that needed her care who had tugged at her heartstrings. I remember her fondly, and her puppy, of no particular importance to the world, but he mattered to her and she made his short life matter to me.
Christine B. McFadden, DVM