one sick puppy. Very sick. This might be physically sick, though seldom used for life-threatening illness. Or if used for a serious illness, it is done so only after the threat has passed. Alternatively, it might refer to someone whose ideas or ways of thinking are deemed to be “sick” in the sense of deviant or socially abhorrent.

While Carl Hiaasen's novel, Sick Puppy, contains a canine character, it is clear that he intends this appellation to apply to most, if not all, of the characters in the book based on their bizarre attitudes and behaviors and not the state of their physical health.