It has been more than a decade since my initiation into the veterinary profession. But just when you think there are not many more surprises in store in terms of new and unique cases at work, you are proven dead wrong. This morning, I received a phone call that turned out to be the case of the decade for me. I woke up not to my alarm clock, but to my phone. It is rather rare that I get a phone call so early in the morning, so I made the monumental effort to get up to see who it was. It turned out to be the nurse on duty at the Tseung Kwan O clinic, who usually arrives at work early because she lives nearby. She said there was a frantic client waiting outside. Trained in basic triage, she noted the dog was not in any immediate life-threatening condition, but she wanted me to know about the client before I came in. I got the nurse to put the client on the phone so I could get a clearer idea of what had happened and if anything needed to be done immediately. It turned out to be Anderson Junior on the line. He is a television host with a daily lunch-hour variety show and known for his unique style and black-framed glasses. He was frantic and said his dog had been puffed up like a balloon for three days. Given what my nurse had told me, I wasn't so worried about the situation and suspected the dog probably had a puffy face because of an allergy. The most common reason for a dog to be brought in with a puffy face is that it has come into contact with something to which it is allergic, resulting in the skin around the face swelling. It can be quite disconcerting for the lay person, but is usually easily and quickly fixed with an anti-inflammatory drug. What was odd, though, was that Anderson Junior said that overnight he had poked the dog's ears with a needle to let the air out. Knowing his profession, I didn't think he was joking. My theory of allergic puffy skin was beginning to unravel. I jumped in the car and raced to work and found the dog a sight to behold. In all my years of being a vet, I have never seen such a situation. Anderson Junior has what I assume in a normal situation is an adorable dachshund, more commonly know as a sausage dog, but at this moment it was unrecognisable. The whole dog was like a balloon, the skin all over the body, including the tail, paws, ears, muzzle and torso, was bloated like a bizarre creature from hell. All the skin had been lifted off the underlying tissues by air. The long shape of the dog was gone and he was literally round. The bloating was so severe that the pressure on the chest had caused the dog to have trouble breathing. Massaging the skin, I could feel the underlying fat was also crackling with a mixture of fat and air. The poor thing had been in this state for three whole days. Anderson Junior, to his credit, being a rather sensible fellow, had three days before taken the dog to another vet near his home, who was treating the problem as an allergic condition. It was clear now that it was not an allergy. I quickly took some X-rays of the chest to see if he had punctured a lung, but he didn't. During the slight struggle to take the X-ray, the dog became agitated and puffed up even more, and was beginning to turn blue. I used a large-gauge needle and let out some of the air. This was a temporary solution at best, so I anaesthetised the dog and placed a more permanent drain in to release the air trapped in its chest. I got better X-rays of the neck and head, and noted a very slight defect in the dog's trachea, the airway in the throat. I got the nurses to prepare the neck for surgery and I noted a very small scab on the skin that coincided with a lesion on the X-rays. So I opened up the dog's neck and found the trachea was ruptured. There was a split between the cartilage rings of the trachea. The action of the dog's breathing was pumping air directly under its skin. I repaired the rupture and the dog woke up without much fanfare. It turned out to be a freak accident. In hindsight, the owner noted the dog had been bitten by another dog a few days earlier and it was likely the other dog's teeth had cause the blunt injury that ruptured the trachea. You may wonder what would have happened if we couldn't find the rupture? The dog would probably have died on Lunar New Year after a week vainly draining the air from the body as his breathing continued to pump air under the skin. It would have been a week of excruciating pain, like being skinned alive and not allowed to heal. Every breath would have been a struggle until its dying breath. Last-minute update: the dog has recovered wonderfully from the surgery today and will be going home on the weekend, just in time for a happy Lunar New Year.