Haru Kim

Pet Profiles 2022

Journey to Japan for Haru’s MVD surgery at JASMINE.

(The following are strictly from our own experiences. Yours could be different. The post is pretty lengthy as we would like to be as informative as possible for the families considering MVD surgery)

(1)Background:
Haru’s heart condition prior to surgery

During the regular health check up of Haru in mid 2020, my vet detected 1-2/6 grade heart murmur(As of now after all we have been thru, once any of my future dogs start having heart murmur, I will NOT take it lightly. Some vets advised it was not that concerning at heart murmur 1 or 2 grade. Well.. it is actually a serious sign as MVD has already begun) We didn’t restrict Haru’s activities much at all as we simply were not aware (or informed) of its seriousness.

Haru’s heart condition was quietly and quickly developed to advanced B2 in late 2021 with heart enlargement(LA/Ao ratio 2.2), severe regurgitation, mild pulmonary hypertension, 5/6 grade haert murmur, yet Haru was asymptotic: no coughing, no seriously heavy breathing, obviously never had episode of CHF.
She was normal in activity.
Her tongue/gum color was almost always lightly pale, feet were cold, making cooing sound everytime she gets lifted up though.
My ex-cardiologist suggested Vetmedin and Frusemide IMMEDIATELY as the heart failure maybe imminent and her life expectancy would be 1 year most with medications.
At given Haru’s asymptotic conditions, we learned that Frusemide could be hard on her liver and kidney. We made our own hard choice (after intensive research) of giving Haru Vetmedin only.

(2) Initiate the contact with JASMINE

Truly devastated.. but started to learn of MVD repair surgery found in this wonderful Mighty Heart Group.
We received a great deal amount of information and supports from Nate when we initiated the plan of getting Haru to JASMINE.(We are so grateful to Nate) In order to start 180 days quarantine, Haru did the rabies titer test right away since she was already microchipped a few years ago and she had two rabies shots since.
However, she failed the first rabies titer test although the rabies she got a year ago didn’t expire yet. We wasted about 45days as we needed to give her new rabies and did the titer test again.

We sent email with all the required test results by JASMINE such as echo images/videos, x-ray, abdominal ultrasound, blood typing test, medical records and etc directly to JASMINE by uploading them on dropbox.

JASMINE’s response was a little bit slow side but they always responded to my email after all, which is not a surprise considering the amount of emails they are getting from all over the world.

Once Haru is confirmed as a surgery candidate, we wired the deposit to JASMINE to secure the surgery date. There are few more tests we needed to do a week before departure.

One of them are related to blood clot called ‘Fibronogen’.

Haru got really elevated Fibronogen level and my vet told us it could be a indication of serious issues such as sepsis.

We got abosluetly panicked about it. Considering it could have been a lab error, we did the test again but the same result came in.
✔️

However, JASMINE told us it could happen with a heart disease patient. What a relief! But you know what..? JASMINE ran the same test at the pre-op exam and it came out just all normal.

So.. it turned out the test results in the US were error, twice.

The cost of MVD surgery approx $25k including airfare for two and 4 weeks of accommodations may not be as expensive as you think because treating multiple CHF episodes in ER in the US for 2-3 times with days of admissions might even well surpass it.
Taking time off for minimum 4 weeks was much more challenging to us.

(3) Japanese Animal Qurantine Service

I sent 40days advanced notice to AQS in order to receive the import approval letter from AQS.
AQS was truly responsive and helpful everytime I reached out to them with the questions. We forwarded pre-filled Form AC to AQS for review.
In doing so, I could be sure the contents of Form AC are all accurate.
Once I received the endorsed Form AC from USDA, I forwarded that to AQS as well for final confirmation.

(4) USDA health certificate

This was another big nail biting process. USDA really needs to improve their processing systems-I seriously do not understand why they are not providing onsite-in-person services.
COVID is not an excuse anymore because everywhere else is fully open EXCEPT USDA.

I emailed all the required documents: pre-filled Form AC, Rabies certificate, FAVN report, Import approval letter from AQS, Return shipping label, to my vet prior to the final health check up appointment. My vet electronically submitted them to USDA for endorsement.
✔️Please make sure you ask for a tracking number, which you can check the status of your application with.

Anyway… pls remember you really make sure over and over your application is PERFECTLY and CORRECTLY filled in before sending in either mail or electronic. Due to its being extremely time sensitive, you don’t wanna have your application rejected, going back and forth.
✔️Again.. strongly recommend using FedEx next day 8am delivery, pricey but totally worth it.
Note: If you obtain the approval from AQS that you can do the final health check up greater than 10 days period, be sure to enclose the email conservation or the letter indicating the approval of AQS when you send all other documents to USDA for endorsement.

(5) Japan Airline

We flew in JAL airline. I submitted all the required documents: rabies certificates, import approval letter from Japan, service dog registration, DOT froms to JAL in advance on the website.
The check in staffs were accommodating but needed to show them all the documents again
✔️ So please bring your copy just in case. They allowed the stroller to be checked at the gate and asked us to carry Haru in a carrier to the aircraft. Inside cabin, Haru was taken out from the carrier and snugged in my arms or laid on belly whole time of flying. The flight attendant didn’t even hint at all.
Actually, they acted like Haru didn’t even exist in the plane as if they were instructed to, which was super comfortable anyway.

(6) Arrival at Haneda airport

A light weighted dog stroller is a MUST. You will first face a long long walk in Haneda airport going thru all immigration and customs.
✔️Please make sure you close and lock the lid of the stroller though. Otherwise, the airport personnel/security will stop you to use the carrier.
Upon picking up your luggage, you should stop by AQS for import inspection.
The import certificate was alreay prepared and just asked us to double check the accuracy of the contents. They only confirmed the original seal on the Fom AC as it was already sent to them before I departed for their review.
Lastly they scanned Haru’s microchip to see if the number matched to the one in the paperwork. Whole process took about an 10mins.

(8) Oakwood Suites Yokohama

We really enjoyed staying in Japan and pet friendly Oakwood Suites Yokohama. You can enjoy free of stay for your service dog.

We paid about $2700 for 30 days. The room is euipped with a full kitchenette and washer/dryer. High security with guards gave me a peace of mind while staying and english speaking front desk staffs were very helpful. Free Wifi, Gym and lounge were super plus.

Very clean and conveniently located. There is a small Trader Joe’s sized super market called “Linkos” attached to the hotel. A subway station (Bashamichi) is literally 5 yards apart from the hotel. Plenty of lawn areas and covered outdoor areas around the hotel is very helpful for a dog who goes out for potty like Haru. Spectacular open city/ocean views are absolutely plus. Lots of restaurants and convenience stores are within walking distance. It takes about 45mins to get to Jasmine by subway trains(from Bashamichi to Nakagawa, one transfer in Yokohama) and about 25 mins by taxi. JASMINE is located right in front of Nakagawa train station. ‘Japan Travel’ app was helpful to navigate the train system.

Also staying in Japan was very impressive. It was our first time visiting Japan: people are very kind, extremely clean streets, good foods, and safe but not many places are pet friendly.
The language barrier wasn’t much inconvenience due to google translator with camera readers. All street & subway signs are written in english as well.

(8) Taxi Service

Taxi in Japan is very expensive. Expect $80-$100(including toll fee) for about 18km travel each way. Recommend the taxi service at least a few times thou: airport pick-up/drop-off and on the surgery/discharge day.

(9) Pre-Op with Dr. Sayaka at Jasmine

JASMINE was very thorough for pre-op exams. They took 2sides of X-ray, echo, EGG, blood typing test, full scope of blood test. We were so impressed with efficiency and speed of all tests/ results: in about 40 mins!!! Dr. Sayaka explained every steps: what to expect and what could happen during and after the surgery. Haru’s LA/Ao ratio was 1.82 at this time. We can download and install a chat app called “Chatwork” to communicate with Dr. Sayaka directly from this point and on. The front desk will walk you through how to do it.

(10) The Surgery

It took about 2 1/2-3 hrs.
There is a Japanese restaurant right next to the building and we waited there having a small lunch till we were called to the lobby.
Before the surgical team closed the chest, Dr. Uechi personally escorted us from the lobby to the surgery room with large glass walls.
He showed us the live echo feed of Haru’s heart conditions showing before and after the surgery on the monitors: beautiful heart beats with almost zero regurgitations. Dr. Uechi said Haru’s heart was very weak and he repaired total 8 chordaes: 2 ruptured and 6 streched chordaes.
The inventor of this remarkable surgical technology, Dr Masami Uechi was just humble and respecful all times.

(11) Recovery in ICU at Jasmine

As soon as Haru woke up out of anesthesia, Dr. Sayaka informed us her condition: stable but bleedeing tendency was noted. She said they would keep monitoring it.

Visiting was allowed everyday for about 30mins. For the first two days, I could meet her and pad her through a small window in ICU cell. Haru seemed she was in pain but still greeted me with wagging tail. Being a picky eater, Haru didn’t eat foods the clinic prepared. The staff asked me to bring her ordinary foods she liked. Haru was allowed to come out of ICU cell and I could feed her foods I cooked and spend some time with her in a visiting room from Day-3. Jasmine staffs were consistently kind and attentive.

Day 1.
The fresh new echo taken day 1 showed some regurgitations re-appeared, not severely as before the surgery but a bit more than expected. Lots of blood work numbers were off the chart, but majority of them were typical as post surgery per Dr. Sayaka. She said Pimobendan had not given to Haru as her original heart size wasn’t much enlarged and to see how Haru’s heart could heal without it. We were very worried about regurgitations thou.

Day 2 to day 4
JASMINE performed a blood test everyday. Thankfully, her bleeding tendency seemed under control. Still fluctuating low red blood cell count, high white blood cell count and platelet and CRP level.

Day 5-6
Most of bloodwork came out ok, normal platelet, white blood cell count and CRP was stable indicating no inflammation. Her red blood cell count still a little bit lower than normal.

Day 7: Discharge

The new echo shows her heart size got actually increased to 1.96 from 1.82(before surgery). Regurgitations on both left and right sides of the heart were observed and pulmonary hypertension still show and even slightly more than pre-op. The only good news was her left ventricle got significantly reduced in size thou. Dr. Sayaka recommended giving Haru 1/2 Pimobendan morning and night till the next echo which was 7 days away. We were so worried about Haru’s heart conditions but meantime understood her heart is in the process of getting healed from the surgery. Came back to hotel with Haru with mixed feelings.

(12) Post recovery at hotel

With positive thoughts that these all abnormalities could be stemmed from her extreme stress, being all alone in ICU cell without mom and dad, and also no medication and all hearty prayers from this wonderful people in MH group.

Day1 – 3:
Haru just slept 3 days straight as if she was a soldier who just came back from a war. We gave 1.25mg half Pimobendan to Haru twice a day as instructed. Tongue & gum color (light pale) were the same. No visual changes from the pre-op conditions. We were worried sick to the stomach.

Day 4-6
Good signs all of a sudden started to appear finally. Haru started to show improvements in activities, breathings, tongue/gum color, temperature, increase appetite, drinking good amount of water: all these changes from pale/cold tongue, very picky eater, not much water intake.

Day 7: Post op appointment
We were so so so anxious and concerned till Dr. Sayaka showed up with the test results. It was one of THE MOST nerve wracking waiting time in my life. Voila!! EVERYTHING turned out beautiful.

Her heart size got reduced to 1.46 from 1.92(at discharge). We were desperately hoping it to be around 1.80, but 1.46. Unbelievable!!! Blood works turned out all normal except few minor were still minimally off which would continuously improve. Dr. Sayaka said Haru’s heart seemed to work very well with Pimobendan, but the most significant part for the improvement was that Haru had been in completely stress free environment with mom’s loving care for a week. Still recommend giving Pimobendan to Haru till the next post check up in the US and will get advised the new dosage or hopefully none (maybe) accordingly.

(13) 5 days till going home

Haru continuously showing visual improvements. Eats, drinks, and poops better. Her tongue/gum stayed reddish pink and warm all day long. She started sleeping less and expressing her boredom. But we said No~~~ walking is not allowed yet for at least a month!!. Luckily, Haru is with very mellow temperament which helps her to be able to stay only in the bed even though I didn’t use a playpen to contain her. Mom however took her in the stroller around the hotel.

(14) Leaving Japan

We already set up the appointment with AQS for export inspection when we first arrived at Haneda airport. What you need to bring are ‘Import Certificate’ you have received upon arrival and filled in ‘Application for Export Inspection of Dog’. AQS building is located right next to Haneda Airport Terminal 3(1min walking distance). Once you are checked in at the reception, the inspector will take you to the back room for the paperwork and microchip scan. Finally, I was provided with the ‘Export Certificate’. The whole process took about 10mins.

I took JAL again back to LAX. Check-in desk asked for DOT forms and Rabies Certificate again although I already provided them by email to JAL in advance. Preparing the hard copy is recommended. JAL allowed me to do the gate check for the stroller and don’t forget to ask airline for gate delivery upon arrival at your destination.

Haru is doing super well at home. I can’t believe Haru got a surgery only three weeks ago. The recovery speed is unbelievably fast. There are no other words that can explain this whole special experience but MIRACLE. JASMINE truly made this miracle happen. Deeply appreciate them.We will keep updating Haru’s recovery and her well beings

Thank you all so much for everything and good luck with all mighty heart friends and furriends who are fighting for this terrible disease.
Pls feel free to ask us for any questions.