Lessons From Zoey's One Year Checkup

UC Davis Veterinary Medical Center in San Diego, CA

Zoey’s one year checkup was done October 28th 2017.  Zoey’s cardiologist (Dr. Hodge) was a bit worried Zoey’s left atrium and left ventricle (LA/LV) numbers were increasing after each checkup.  According to Dr. Hodge, Zoey’s pressure and her regurgitation were shown to be the same since having her surgery a year ago.  Naturally We were concerned about the increasing LA/LV values and sent the records off to Dr. Sabine and Dr. Uechi to review them.

Dr. Timothy Hodge evaluating Zoey

I’m delighted to say that It was great news. Dr. Sabine and Dr. Uechi compared Zoey’s numbers from her surgery echos to her 3, 6 and one year checkups and the values appeared to be the same since she had her surgery in 2016. It was extremely important for me to learn exactly why it was being seen differently with my doctor and share with you all what I’ve come to learn. 

Basically Zoey has a larger than normal pulmonary vein (ostium) since before her surgery and standard measuring practices can give false numbers if you don’t account for these results.

According to Dr. Sabine, the 1st reconstruction is of the Long axis LA diameters in telesystole at 3-6-12 months. Measured 2, 1.84 and 2 cm, basically they are the same measurements ; the SAX measurements are somehow difficult with Zoey because she has a very large pulmonary vein ostium compared to other dogs. As noted, (Zoey had this before her MVR surgery)

Echocardiograms showing Left Atrium (LA) measurements at 3 months, 6 months, and 12 months post operatively

The 2nd reconstruction is of the long axis LV diameters in telediastole at 3-6-12 months. They measured 2, 2 and 2 cm = same.

Echocardiograms showing Left Ventricle (LV) measurements at 3 months, 6 months, and 12 months post operatively

The 3rd reconstruction is of the long axis view of the mitral regurgitation color flow map at 3-6-12 months = same ; so there isn’t any chance for the LA pressure to increase considering that the 12-month MR is the same as the 3 month and the 6 month post-op checkups.

Echocardiograms showing regurgitation at 3 months, 6 months, and 12 months post operatively

This is the manner in which Dr. Sabine uses with Dr. Uechi to review the cases post-operatively. 

Zoey with Dr. Timothy Hodge at UC Davis

It’s very important to note, all operators can cut a heart a little differently and measure slightly differently during the same examination or during different examinations a few months apart. Some other factors like Zoey's large pulmonary vein ostium can make the measurements difficult to compare. Also, after surgery, some hearts have mild different anatomy because of the sutures, or because it has possibly turned a little in the thorax etc... Zoey is doing very well and there is no need for concerns.

Zoey is still off all her medications and doing quite well.  I write this in hopes you all understand how important it is to have the doctors review your records after each checkup and assess.  My doctor wasn’t doing anything incorrect and I completely trust him.  The surgery repair is just widely unknown and many don’t understand the long term results. As more of us return to the US with our babies we all can help play a vital role in educating everyone, awareness is very important.

Zoey with her favorite person on the planet, daddy Nate

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