One of our little girl puppies was not gaining weight, even though she was active and nursing well. We started her on colostrum and puppy support and were bottle feeding her. She was quite a little fighter, working hard to eat well and gain weight so we were all in the fight with her, helping in every possible way we could.
We typically don't name puppies before their forever family does, but this girl was such a little fighter that she earned herself a nickname. She had a little cowlick on her nose so I had been calling her Cowlick, which morphed into Cowgirl, which developed into Jessie after the Toy Story cowgirl.
At a day and a half old, we got her in to see the vet and they discovered a very large cleft palate. That is not typically survivable for most puppies, but it is possible to try to tube feed a cleft palate puppy long enough (about 3 months) to be able to do a very specialized surgery that could save them. We considered that treatment option, but Jessie had also already aspirated and developed pneumonia. Our vet thought that Jessie had very little chance of recovering from the pneumonia to be able to even try to treat the cleft palate, and in the meantime, the pneumonia was extremely painful and felt like constantly trying not to drown. So after a lot of tears and second and third opinions from other vets in the office, we had to make the devastating decision to humanely let her go and stop her suffering.
It may seem a little silly that we would be so attached to and heartbroken over a not-quite-two-day-old squirmy little puppy, but we really do pour our hearts into these babies, right from the very start. All the way back from months ago when we start to plan a litter, we put a lot of love and work into giving happy, healthy lives to the puppies we produce. We were there for her very first breath, then we spent so much time feeding and caring and loving on this little girl that that just deepens the attachment. So even though it happens and every breeder goes through losses, it really is emotionally devastating. We find comfort in caring for her siblings and her mom and knowing we did everything possible to love on her for every second of her short little life.
(This picture is of Jessie snuggled in to a blanket for a nap after a bottle feeding).

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