The Raw Entrepawneur Interviews Mighty Hearts Project

The Raw Entrepawneur

The Raw Entrepawneur looks at the transformative journey of holistic pet service entrepreneurs, overcoming obstacles, chasing their passion and creating a mass movement. This show is for holistic pet service entrepreneurs who are passionate about their craft and want to create an impact and change the world. To help them learn from other entrepreneurs to give them the confidence to start their own journey of growth, self-discovery and creating a movement that's changing the lives of clients and their pets to create a ripple effect of positive change around the world. A raw uncut look at the journey of fellow holistic pet service entreprenuers – their successes and failures.

I was honored to recently be interviewed by Amrys Wang from The Raw Entrepawneur where we discussed how Mighty Hearts Project came to fruition and about my daughter Zoey Marie Estes’s two mitral valve repair surgeries. This is our journey, I hope you enjoy it.

Nate Estes

Levi's Surgery Story

Kim, Ginny, and Levi. Photo taken by Carolyn Scott Photography

The biggest unexpected surprise for our family came in July of 2016, when we took Levi in for a routine physical exam prior to having his teeth cleaned.  Dogs have to go under anesthesia to have their teeth cleaned, and Levi has traditionally had some issues related to anesthesia and we wanted to be safe.  His last checkup was in April 2016; he went in for an ear infection and at that time, he was in perfect health (except for the ear infection, of course).  So it came as quite a shock when the vet announced that he heard a heart murmur level 4/5 for the first time in Levi's life.

A lot of small dogs develop a gradual heart murmur that starts low and builds as the dog gets older.  We would not have been surprised if, at 9 years of age, that Levi had a minor heart murmur.  But to go from zero murmur in April to a level 4/5 in July is alarming. 

Heart murmurs in dogs can occur for many reasons, but the most typical of which is degenerative mitral valve regurgitation.  The mitral valve is a flap in the heart that allows blood to pump into the ventricle, but not backwards towards the lungs.  As a valve should work, it allows one-way movement.  Degenerative mitral valve disease causes the thickening of the valve to the point at which it does not close properly and blood moves back and forth ineffectively in the heart.  In response, the heart enlarges to allow for a larger capacity of blood pooling and to keep blood pressure in the body stable.  Eventually, the excess fluid will back up into the lungs causing congestive heart failure.

We went to the cardiologist at the earliest possible moment.  He confirmed that Levi did indeed have a level 5 murmur caused by degenerative mitral valve disease exacerbated by a chordae tendonae rupture.  There are chords in the heart (literally what country singers croon about when they sing about heartstrings) that help coordinate the movement of the mitral valve flaps.  If they break, the effectiveness of the valve is compromised significantly.  That explains why it was not a gradual increase in murmur grade, but all at once.

We were devastated by the news, and we were further shocked when we were told that Levi had 6-9 months before he experienced congestive heart failure, and possibly a year left to live.  We left with this news heavy in our hearts.  Our devastation turned to anger and frustration.  Why is there nothing that anyone can do to correct this issue in dogs?  Humans have open heart surgery to repair the heart valves all the time - it's practically routine!

We emailed veterinarians at UC Davis, Cornell University, and several other highly respected veterinary schools in the US, along with one point of contact we found for veterinary surgeons in France.  We heard back from the French doctors - they asked for more information about Levi and his results from our cardiologist. 

We sent them, and held our breath. 

We found more information about the doctors in France, and other dogs and owners from the US who had gone there to have the repair done.  We called.  We coordinated.  We kept researching.  No veterinary team in the US performs this procedure.  Only one surgeon in the world - renowned Japanese surgeon named Dr. Masami Uechi - performs these operations currently in Japan, Singapore, and France.

Levi was in the loving care of Dr. Jean-Hugues Bozon and Dr. Sabine Bozon during his surgery and recovery

When we finally got word from the Clinique Veterinaire Bozon in Versailles, France that Levi was a candidate, we were still in a little bit of disbelief that this was possible, that this was actually something that we could and possibly WOULD do.  Were we crazy?  Would other people think we were crazy?  Can we logistically pull this off?

Maybe we are crazy, maybe we just love our dog.  We stopped caring what anyone thought of what we were doing.  And yes, we logistically pulled it off . . . one day at a time, one piece at a time, one foot in front of the other.  When you want to do something that seems impossible in foresight (and hindsight), you have to know that the little steps in between to make it happen just come as long as you keep moving.  We never lost faith, even when it was tested over and over again.  I was taught that my heart and my hope are infinitely bigger than I ever realized. 

It was unexpected.  All of it.  The diagnosis.  The plan of action.  Even the result.

Levi with Dr. Neal Peckens at CVCA

We expected resistance and judgement anytime we talked about cardio-pulmonary bypass surgery for our dog . . . in FRANCE.  But, everywhere we turned, friends and family knew exactly what Levi meant to us, and agreed we were doing the right thing for him.  Our vets Dr. Carole Richards and Dr. Chris Vanderhoof at Caring Hands Animal Hospital, and Dr. Neal Peckens at CVCA, were 100% on board with us when we made the decision to go forward with it.  They ran tests, and re-ran tests, and asked questions, and cared for us as owners.  They cheered us on, and helped Levi recover when we got back.

We knew before we even went to France for the surgery, before we even knew Levi would live through it, that we wanted to be of service to Dr. Sabine and Jean-Hugues Bozon.  We didn't know how, but we felt so inspired by what they are doing.  When we met them, saw their clear vision of the future, learned about the many leaps of faith they took to get where they are, and witnessed the loving care they put into every living being that they touch, it was very clear to us and a few owners who came before, that we would need to take our own leap of faith to help them, and to help this cause in some way.  And that is one of many reasons that Mighty Hearts Project was born.

Though most of all, it was unexpected what two people with love and hope in their hearts can accomplish together.  I do mean Ginny and myself; however, we saw it in Dr. Sabine and Jean-Hugues as well.  Their love for each other and their love for saving animals is unparalleled.  Dr. Sabine taught us not to ever lose faith in something that is important to you.  If the solutions presented to you are unacceptable, find new solutions.  

We are currently on a mission to find new solutions for dogs in the United States.  We will not lose faith.

Levi, sitting up in his oxygen recovery cage just a few hours after his mitral valve repair surgery at Clinique Veterinaire Bozon in Versailles, France

Bellissima's Surgery Story

“This is our big story of one small cute girl and the big love between us forever.

—Tomáš Kučera”

We have had Bellissima (Belisa) from the very first day she was born because we also were parents to her mummy.  She has three siblings which were all given to our friends so that they would be in good hands.  We also had new parents for Belisa, but we felt that we belonged to each other so we kept her.

She is typical terrier, excited about everything, angry at everybody, and so much energy - crazy like a puppy.  We had to have her spayed because she was suffering from false pregnancy (or pseudopregnancy).  She was mothering her toys and having problems with her mammary glands.  Our doctor told us that after being spayed, Belisa would be calmer and not so interested in sex with her toys… but that was not true at all.  She wanted to have sex with everything and was even crazier than before.

After that she started to limp on her left back leg and was diagnosed with a luxating patella.  We found a specialist from Croatia, Dr. Dokič, who gave her a titan implant in her leg.  Unfortunately she had to have an additional operation because the titan implants are made of two pieces and they split up.  She also had a groin hernia which was the first time we saw her crying in pain.  She had never cried in pain before that.

In 2014, she had her first epileptic seizure.  We were shocked because at that time we didn’t know about epilepsy in dogs.  We read a lot of information about epilepsy and learned that there is no true cure.  We finally decided not to visit doctors who would only give her drugs and scare her more.  Every time a seizure was coming she came to us and let us know that something was happening to her, so that we could hold her, talk to her, and try to distract her from what was happening, which worked quite well.

Also in 2014, our doctor told us that she had a heart murmur but it was nothing to worry about. We didn’t know any better and believed our doctor.  In October 2015, Belisa was put on Vetmedin (Pimobendan) and Furosemide.  Again, our doctor told us there was nothing to worry about.  In August 2016, we were visiting our doctor and he told us everything was still fine.

In December 2016, our doctor told us that Belisa was getting worse.  Of course, we thought, because she had started to cough during the night and we didn’t understand why.  We asked him how much time she has left and his answer killed us.  6 – 12 months.  He told us that there was one person in the world that might be able to help us, Dr. Uechi, but it's too expensive.  Nothing is too expensive if our love has just a few months of life left.  We didn’t know the price, but we knew that we could sell our flat, our cars, our company, even my kidney, anything, just to save her life.

We googled Belisa's condition and Dr. Uechi, and thanks to Kaori and her story of Ralph, we found this amazing group of selfless people.  Of course we didn’t believe or understand why there is only one person in the world who could help us.  It seemed so strange to us.  So in January, we flew to France to meet Dr. Sabin Bozon to discuss the surgery and assess whether we were doing the right thing.  We have never ever met a doctor this kind.  She is an angel.  She explained everything to us and spent a lot of time emailing us answers to all of our questions. This was the most helpful thing during this time, when you are losing all hope.

We did all the tests in our country, including magnetic resonance because of Belisa's epilepsy, to ensure that her brain was fine, and then we had to decide whether to do her surgery in March or May.  We knew the risk of the surgery (every surgery is a risk, of course, however, this is not like her leg, it's her heart!), and preferred May.  However, we decided to take Belisa to visit Dr. Sabine so that she could see Belisa and give us better advice about when to do the surgery.  We selfishly wanted May, but this was not about what we wanted, it was about what Belisa needed.

Dr. Sabine gave us advice to go in March because she was not sure if Belisa would stay stable until May.  She told us during that visit that there was another problem called Myocardial thinning, which is another risk with Degenerative Mitral Valve Disease.  She gave us another type of medication for Belisa.  From that visit until the surgery we were giving her multiple medications at specific times of the day.  We were very tired because some of them were very late in the evening, some of them very early in the morning, and most of the time during the night we were not sleeping because we were checking on her to see if she was fine and still breathing.

On March 17, Belisa had her last recheck with Dr. Sabine and she told us that all the numbers of the tests were much better.  On March 21, the day of surgery, I told Belisa in the morning that we belong to each other; we will stay together forever no matter what.  We will be waiting for you in the front of clinic, be strong girl, we know you will come back to us.  I am certain she understood us.

If Marla, Michael, and Dominique were not also at the clinic in the days after Belisa's surgery, we would have just sat quietly for the whole time of post-care (which is seven days normally, and we paid for one extra day to be sure) in the car in front of the clinic.  Car?  Yes, the journey to France by plane takes about 1.5 hours, but we went by car so that Belisa could go pipi anytime she needed to and she wouldn't be as scared of all the people.

After waking from anesthesia post-surgery, Belisa had some problems with breathing because she also has a collapsing trachea.  Even today her breathing is not 100% better, but I am sure it will get better.  Dr. Sabine explained to us that an enlarged right ventricle is not as life threatening as the left side.  The left side is already smaller after the surgery.  The right side will get slightly bigger and it will take some time, but it will get smaller again.

Our journey back home was also not easy.  We left France at 1:30 am because we knew Belisa would be calmer at night.  When we were about 400km from France, and 600km from our home, Belisa started to cry and kept her right back leg (the healthy one) up.  We turned the car around and drove back to Dr. Sabine.  She gave Belisa some drugs for pain and we started our journey again.

When we arrived home, she was not able to walk normally.  Even the front leg was bad.  Today, we don’t know exactly what happened to her (all the doctors we spoke to about it have different ideas – orthopedic, spinal, neurologist etc.), but she is now walking almost like normal and we are sure it will just take some time to be 100% good.

This is our big story of one small cute girl and the big love between us forever.

Zoey's First MVR Surgery Story

Zoey was diagnosed with Mitral Valve Disease (MVD) in July of 2016. 

We were told it was a disease of the heart where the valve degenerates causing a regurgitation of blood back into the heart, ultimately leading to congestive heart failure and death. They said nothing surgically could be done to fix this, only medication to delay its onset.

As you can imagine we were devastated, left without any hope. Zoey was only given a year left to live.

I searched frantically online for something and found that Cornell University hosted a team of Japanese doctors that perform Mitral Valve Repair surgery. Dylan Raskin was able to secure the funds to fly them to the US, hotel them and cover all the medical expenses.

His dog Esme was almost at death's door but two years after this surgery is more than saved, she healthy and like a puppy.

Sadly, the doctors are only performing this surgery in France, Japan, and Singapore and are the only ones qualified in the world doing the surgery. I learned all I can about this and in the end, I flew my dog from Los Angeles to France for an open-heart mitral valve repair surgery.

The surgery was done October 26th 2016 by Dr. Masami Uechi and Jean Hugues Bozon of the Clinique Veterinaire BOZON 2424 in Versailles France.
 

Zoey is healing well and her heart has already reduced in size. 

Her energy level is like a puppy.  Zoey is off Pimobendan and Enalapril for good.  She only requires blood thinners for the first three months of recovery to avoid blood clots.  No running or jumping as well until cleared by Dr. Sabine Bozon who is Zoey's cardiologist in France.  In addition to her work Dr. Sabine also does the Pre-operative patient profiling and is the director of the surgical aftercare program for her clinic.

Prior to surgery, Zoey's heart was extremely large and her left atrium vein was dilated and stretched. 

The surgery also revealed she was almost going to have a chord rupture. Once this is healed, her heart will continue to shrink and her murmur should reduce as well.

Our three-month post-op check is on January 28th with Dr. Hodge from UC Davis's satellite office in San Diego. Zoey's surgery had no complications and was expected to have a 98 percent result. We feel truly blessed with the level of care we have received from the 6 day ICU care from the Bozon clinic.

Currently, no US surgeon is able to perform this surgery unless they'd study abroad learning Dr. Masami's technique, bringing it back to the US.

The surgery involves heart and lung bypass machine (seen in pics) which the Bozons are the only certified specialists outside of Japan qualified to do small animal bypass.

It involves strengthening the mitral valve with a gortex loop and reattaching the valve to the heart wall with six gortex chords to replace the stressed or stretched out chords. In addition, they strengthen and add extra chords to the heart to ensure any possible future ruptures will have no ill effects on the condition.

The goal of this surgery is to restore them to the B1 stage and repair the valve as much as possible to reduce the regurgitation.

By using the gortex material, there is no rejection. Valve replacements have been attempted yet failed because the body rejected it. Anti-rejection medications didn't work.

This surgery is currently the only option to save dogs suffering from MVD and most cardiologists are unfamiliar with it.

This is history in the making.

I am always asked about the cost and why is it so expensive so here it is.  The clinic is using state of the art medical equipment that most human hospitals dream of having, such as the mentioned cardiopulmonary bypass machine and a cell saving machine that allows for a transfusion of Zoey's own blood during surgery should she have needed it. Donor blood is also available onsite in the case more is needed.

I didn't have the money but was able to secure high-interest rate loans that I barely could afford. I did this without hesitation to save Zoey.

God bless,
Nathan Estes