9. Milk coming out from the puppy's nose

Milk whitened the lips as it oozed out from the nostrils in both puppies during suckling. I recalled vividly the "Drink Milk Campaign" using celebrities in the U.S.A where milk consumption over the years had declined. Beautiful pictures of celebrites with milk circling their lips. The two puppies were having such white lips as they suckle the dam and would be natural for such a campaign.

"The 2 puppies are having flu," the young lady owner put them on the examination table when the puppies were 13 days old. Milk still comes out from their nostrils. One is forever suckling, not knowing when to stop."

This was the second time she came for consultation. 3 Shih Tzu puppies had been delivered by Caesarean. On day 6, she had consulted me as the dam was not eating. She had complained of milk leaking out from the nostrils of 2 puppies. I examined for a crack in the midline of the roof of the mouth (hard palate) but there was none. Normally, puppies die if they have cleft in the hard palate as milk would have been breathed into the lungs resulting in bacterial infections.

Yet, the puppies were thriving. One was growing very fast as it refused to stop suckling. The other was growing well too. The 3rd puppy had died while the owner stomach-tubed it to supplement the milk as advised by the lst veterinarian who performed the Caesarean. In that consultation, the dam was diagnosed as having the beginning of milk fever, a condition where her blood calcium levels have had dropped below normal. She was asked to improve the feeding and to give the calcium tablets prescribed by the first veterinarian and had no further complaints.

Now, it is day 13. The puppies had not opened their eyes. Big pups. Growing well. "Please check whether the puppies have flu," the owner said during this second visit.

A strange case. There must be a cleft in the roof of the mouth. The puppies were vigorous and objected strongly to having their mouth pried open with a pair of artery forceps. I spot-lighted the bright surgical lights onto the roof of the mouth to show to the lady owner the anatomy of the palates. The roof consists of the hard palate (a ridge rough surface) and a soft palate (soft tissue) behind the hard palate.

What's the purpose of the soft palate? Well, it closes the opening of the airways when the puppy swallows milk or food. People do have hard and soft palates as well on the roof of their mouths.

In this case, the spotlights shone on a depression of 2 mm in the midline of the soft palate in both puppies.

The depression is the hole in which the milk flowed through and get sneezed out of the nostrils or "leaked" out. No wonder the puppies had white muzzles of milk.

The puppies survived because the soft palate had closed the airways preventing the milk from flowing into the lungs. This is very interesting to the veterinarian but is of no comfort to the anxious lady owner.

"Will the puppies die?" she asked me. "Unlikely," I said as I can't guarantee that the cleft in the soft palate will not increase in length as the puppies grow.

Let the puppies suckle with the head upwards, rather than sideways or upside down," I advised.

"No milk oozes out of the nostrils when the puppies suckle in that position," the young lady rubbed her eyes as if trying to keep awake. She had to care for the puppies overnight as she did not want them to die. She had one out of three died earlier.

At least there was a diagnosis. But was there a cure? "No," I said. "It is not possible to stitch up the hole in the soft palate at this stage." Surgery would not be possible as the soft palate was position deep inside a small mouth.

Readers: If you click to view a bigger picture,you will see that the 6-day-old puppy nearer to you had a white upper lip. Now, that is the snow-white milk dripped down from the nostrils
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