[HannahandMo]

To Tube or Not To TubeThe answer to this depends entirely upon whether you want your puppies to live or not.
What! You say, tubing is the ONLY way to save puppies. And besides, it's fast.
Fast, yes, and deadly. It's one of those things that sounds too good (easy) to be true; and if it sounds too good to be true it is; we know that it is in our most private thoughts. Fast and deadly isn't doing your part by the bitch or the puppies. You may be certain that you are getting the tube in the esophagus (which leads to the stomach) and not the trachea (which leads to the lungs). But, this isn't the problem I'm referring to.
Consider this: when we eat, the process of eating stimulates waves of contraction throughout our entire GI tract. You know very well that as puppies nurse they defecate. That reaction is due to these waves of contraction, which are called peristalsis.
OK. So, we have a sluggish or weak puppy. We put it on the bitch and it won't nurse. What to do! TUBE. NO! If the puppy does not have a good sucking reflex, it will not have any peristalsis. This means the milk we force in through the tube will just sit there. When the tube is removed, it forces itself back up the esophagus, into the trachea, and ends up in the lungs. It does not travel down through the stomach into the intestine.
Now, how big is the stomach of a newborn puppy in your breed? 1/2 cc? Less? As much as 1cc? Probably not much more. That stomach is just a slightly wide spot on a narrow tube. So; let's stick 2 1/2 cc into it . Fast and Deadly. The stomach and esophagus will stretch a bit, then return to it's original shape and size after the milk runs into the lungs. Not going to raise many puppies that way.
Well then, what do we do? Easy. We give them sub-cutaneous dextrose and saline. Sugar in salt water. The solution which is used for IV therapy. All puppies need 3 things. Warmth. Water. Sugar. That' all they need right away and for an additional few days if necessary.
So, we take the weak puppy out of the whelping box. We drop a few drops of colostrum onto its tongue several times in the first few hours. Got that immunity taken care of. We keep it in a confined box with a heat source - a heating pad or light bulb, and we give subQ dextrose in saline to supply the sugar and water. We gently stimulate it to urinate and defecate. We've met all the puppies needs.
How much fluid do we give? We give enough to satisfy any current dehydration debt and to provide a cushion for an hour or two in the future. How much is that? It is enough so that when we refill the syringe with dextrose and saline, the last 10 cc injection we gave hasn't already disappeared. And it will disappear, just that fast, if the puppy is already dehydrated.
So first, we need to satisfy the back log, and then we put in some more. We want to raise a good sized lump - say the size of a golf ball on a 12-16 oz puppy. We want that golf ball to stay there a while. If it does, we can safely leave the puppy for a couple of hours. As time goes by, the fluids in this reservoir will be absorbed and the lump will disappear. Also, gravity will take a hand in removing the lump, shifting any spare fluids down around the neck.
We can keep this puppy going in this way for 2 to 4 days easily. There no danger here, if the area is clean when and where we inject, and as long as the needle is parallel to the body - not pointed down at the body. We don't want to pith the puppy (look it up). With the needle parallel to the body, the worst we can do is squirt the wall. The wall can take it. Fluids given intravenously, by contrast, would run the risk of drowning the puppy - excess fluids in the veins will force their way out through the lungs. This result is essentially the same as that of tubing. Not good. SubQ fluids are essentially outside the circulatory system - just in a repository under the skin. If a fluid defecit exists, they can be instantly drawn into the blood stream. Until then, they have no other effect on the body.
While we are satisfying the puppy's needs in this way, we will also repeatedly present a nipple to the puppy, several minutes after we have placed a drop of Karo syrup on its tongue. The Karo give the puppy an energy boost, so that when we place it on the bitch, it will make as strong an attempt to nurse as it can muster. We will also present the puppy with a bottle, as it will be easier for it to get milk from the bottle's nipple than from the bitch, most of the time, during the first couple of days.
One of the greatest deterrents to getting puppies started, after tubing, is the 'Pet Nurser' which is widely available. Few if any breeds will nurse off of this thing - maybe a couple of toy breeds I've never encountered. Rather, puppies from 4.5 oz to 2# and up will readily take a Playtex preemie, or Playtex 0-3 months nipple (slow flow), one which has a flat, button-like shape.
ANY puppy which does want to suck, but is unable to get enough from the bitch, should be asked to take the Playtex nurser. And if they don't learn to nurse from it within the first few minutes, as soon as an hour or two after birth, it's your fault, because they like this nipple just fine. Of course, you have to put the right stuff in it.
The concept of using a formulated synthetic milk replacer seems a bit bizarre. Cow's milk is good, it's complete, it contains the same things as dog milk. It's not quite as good as dog's milk, however, because it's too dilute. Cow's milk is 1/2 as concentrated as dog milk. So, all we have to do is go to the store and buy evaporated milk. Nothing could be simpler; comes in a can, easy to store and have on hand, useful for other purposes. We use the evaporated cow's milk, in the slow flow nipple (no modifications to the nipple, we want it to go in slowly, and to require some exercise from the puppy to make it work). We add a dollop of Karo syrup for energy and palatability, warm slightly, and that's it; it's perfect. Some of us seem to have a need to make life more complicated than it has to be. If you think your puppies suffer from the rare human problem where the size of the cow butterfat globule is too large for comfort, you can search out a source for evaporated, canned goat's milk. And you might wish to do that because it will make it seem as though your puppies have a special problem, not a routine, ordinary problem. However, goat's milk has no special benefit for dogs. It also must be fed undiluted from the can, with some Karo.
Note: The only puppies I have ever seen which were nutritionally stunted - and didn't recoup their early deficits when put on solid food - were 2 giant breed siblings which were fed fresh goat's milk. To this day these two are 'minis'. Fresh ruminant milk has 50% too much water in it. Evaporated ruminant milk is just fine as long as you don't screw it up by adding water.
If you are faced with total milk replacement due to the death of a bitch, you will eventually have to add an egg yolk (without the white) to a can of evaporated milk with Karo, in order to raise the protein level even more. But, there is no need for this when we're simply supplementing.
These puppies which are eager to nurse, but just can't get anything from the bitch's nipples, will have good peristalsis. They will work at the nipple and develop their lungs and their body muscles, though only a fraction as well as they would if they were working on the bitch's nipples.
One caution when supplementing the large litter to lessen the stress on the bitch. You must be careful not to OVER feed. The idea is to take some load off her, so you should keep her out of the box for some time every day. We don't want to supplement and then let them drink their fill from their mother as well, then we'll only have fat and colicy puppies, not a mother in better shape.
The next question is, will their mother lick them and stimulate the urination and defecation reflexes? If she's not yet into that, we also have to wash their tummies with a warm wet tissue. This will stimulate the elimination reflexes. We can't skip this part either. If we do, they'll all colic.
Some bitches, even though they have milk and the puppies nurse with no problem, just don't like to clean their puppies. If so, then it's our job. We caused these puppies to be born, the buck stops with us; if they need to be cleaned we have to do the job. We have to be gentle, but we have to be just as certain that we're successful in stimulating defecation and urination as we are that the puppies are getting enough to eat. What goes in must come out! One good way to help you be certain you're getting each one fed and cleaned is to place colorful yarn collars around their necks. This way we can identify each puppy at a glance, no waking them or dislodging them from a nipple in order to check markings. And later, when one puppy is repeatedly striking a pose we can see from a distance which one it is. Helps us identify that BIS Puppy.
Mary C. Wakeman, D.V.M
Canine Fertility Center