Chockie Deglow

Up until November 15, 2018 Chockie had pretty much been the healthiest dog I’ve known. That is the day everything changed for us. I couldn’t understand why Chockie was coughing... I don’t take him to parks, kennels or around other dogs, so not kennel cough. I knew to count his respiratory rate but didn’t know why or what it meant. I only knew it should be under 30 and his was near 60. I was so lucky that Torrey Pines Animal Hospital got us in same day. I was shocked when Dr. McClellan told us he had a grade 5 heart murmur (from no heart murmur the previous May 2018), his heart was enlarged and he had fluid in his lungs.  This was his first episode of Congestive Heart Failure. Luckily we were able to easily get him out of this episode of CHF. Looking back I felt so naive, uneducated, even stupid. I feel like I’m pretty dog savvy, I ran the Southern California Section of Italian Greyhound Rescue for years, but I had no idea what this was or what I was doing. Chockie was started on Pimobendan and a low dose of Lasix. 

Chockie had his first Echo on November 20, 2019. At that time, on the referral of our vet, we used a mobile cardiologist who came into our vets office. He told me he expected his echo to be much worse with the symptoms Dr. McClellan and I had described. He said Chockie had a murmur is V/VI, severe degenerative mitral thickening but mild leak, mild left cardiac enlargement, normal right heart size and intact atrial septum. The treatment was to add Enalapril, continue the Pimo and the Lasix at a reduced dose or we could go off if we felt his respiratory rate was ok (I later found out we probably shouldn’t have been doing this). He suggested to follow up with a renal panel in one week, chest X-rays and echo in six months and to continue to monitor his respiratory rate.

Chockie held fairly steady until Mid-March 2019. One morning I left for work, Chockie was happy and normal. I came home 4 hours later and immediately new something was wrong, his respiratory rate was between 60-75. I was able to take him into Torrey Pines Animal Hospital for chest X-rays and they confirmed another episode of CHF and he was given a Lasix injection. At that time we also increased his Lasix dosage a bit. We kept having to increase his Lasix dosage for the next few weeks.

Chockie’s six month follow up was April 5, 2019, which could not of come at a better time. Still being naive about all of this I thought his condition would be status-quo.  The cardiologist called and told us he had very bad news, that his valve had completely torn (this is what I heard, not sure if this is what he really said) and he probably had six months to live and to keep him comfortable. We were not expecting this news, I remember this like it was yesterday, we were so depressed. The echo report noted: Severe mitral valve regurgitation and flail leaflet. Moderate left atrial hypertension. Recent congestive heart failure. The left heart size continues to grow larger. Today left atrial pressures are increased. The flail anterior mitral valve leaflet likely occurred recently causing progressive leak and clinical signs of CHF. In addition to lasix, Pimo and Enalapril the cardiologist added Amlodipine. We were told to just keep him comfortable.

After the cloud of depression finally lifted I thought to myself they fix people, why can’t they fix dogs? And that’s how I found Mighty Hearts. I had everything ready to submit to the RVC except for the echo videos and unfortunately my cardiologist didn’t keep them. I was able to get Chockie back in for another echo on May 7, 2019 to get the videos and was able to submit everything to RVC on May 8th, I got a response from RVC on May 9th, and we had our call on May 15, 2019. Everything was still so new to me, I asked Dr. Brockman what stage Chockie was in and he told me B2. We got our surgery date of September 23, 2019. We thought that is far away but he’s stable so this will be no problem. I can’t tell you how wrong we were.

I started having a really hard time getting Chockie to eat, he became very finicky and wouldn’t eat out of a dog bowl.  He would eat something one day so I would run out and buy a bunch of it and the next day he would run away from it.  This frustrated me to tears, I would spend 2.5 hours in the morning and evening trying to get him to eat. Some days he would just eat plain pasta and I thought it was better than nothing. I later found out they start doing this when they can’t breathe.

June 1st - 5th. Leading up to June 1st, in addition to Chockie losing interest in eating he also had another Lasix increase. I noticed a change in his breathing and it started to get upwards of 50. I took him to the ER, hoping we could just have a lasix injection and go home. They did X-rays, put him in oxygen and gave him a lasix injection. I begged the ER vet, Dr. O’Donnell, to let me take him home where he would be much more relaxed. I think she felt there was enough improvement that she discharged him. 

The next day, June 2nd, I monitored Chockie like crazy. He didn’t want breakfast and his respiratory rate ranged from 30 and crept up to the 60’s. I took him to the ER at 8:15PM, this time thinking they would want to hospitalize him and I would allow it. It was a different ER vet, he did chest X-rays, oxygen therapy and a lasix injection and didn’t feel it was necessary to keep him because he didn’t hear much crackling in his lungs. I still kick myself for believing that vet that Chockie was ok. When we got home around 10:30PM I didn’t feel there was any improvement. Between 11PM and 4AM on June 3rd his respiratory rate got up into the 90s. At 4AM I took him back to the ER, they immediately put him in oxygen and admitted him. I later found out his respiratory rate was over 120 when I brought him in. It took him 10 hours in oxygen with lasix injections to get his respiratory rate into the 80s. Dr. Botha and Dr. Itsvan were the critical care specialists looking after him and took amazing care of him. They along with my cardiologist couldn’t understand why his respiratory rate was so high when his lungs were pretty clear.  Chockie stayed in the hospital until June 5th. During that time there was a veterinary cardiology convention and the two cardiologists that are attached to the hospital were away at the convention and no one was available to do an echo. They finally got him stabilized and on June 5th he was discharged. They increased his Lasix again and added Spironolactone. At this point he was on Lasix, Pimo, Enalapril, Amlodipine and Spironolactone. 

On June 7th I was able to get Chockie in for an echo with my cardiologist. He told me it was bad, that he actually saw a ruptured chordae this time. He noted: “Severe mitral valve regurgitation and flail leaflet/ruptured anterior leaflet chordae tendineae. Mild to moderate left atrial and pulmonary hypertension. Recent return of congestive heart failure. The mitral valve is unstable and I assume the recent mild interstitial pattern was refractory pulmonary edema.”  He asked if there was anyway we could get moved up because he didn’t believe he would live to September. I asked him if he could live another month and at first he was hesitant and then said yes. On this day I actually lost hope for a little bit, I felt so helpless and I didn’t know how we would make it to his surgery date of September 23rd, it seemed like we were at the end.

I was so hopeful that Chockie would get his surgery date moved up as I had seen happen to many others. I was keeping in very close contact with RVC and even called them, I was so desperate.  We got his surgery date moved up by two weeks to September 9, 2019 but that would be it as the team was going on a break from mid July-September 2.

June 9th-10th. On June 9th Chockie was very restless, wouldn’t eat, didn’t pee or drink since 9:45am and his respiratory rate was upwards of 60 so at 7PM back to the ER we went. The next morning June 10th, the ER vet called and said he was the same as last night, he was not in oxygen, kidney values were the same, still wouldn’t eat and they were waiting for a cardiology consult (the cardiologists were back, thank god!). Around 2PM, Dr O’Donnell one of my other favorite critical care specialists told me she talked to Dr. Orvalho, one of the cardiologists attached to the hospital, and as soon as they could squeeze him in for an echo he was stable enough to come home.  

Dr. Orvalho (UC Davis Vet Med) called late that evening to go over his findings and he restored my hope. He said if he didn’t know Chockie’s history he would not of thought that Chockie was in as bad of condition as he was in. He said based on his echo he felt his heart was stable today.  The valve was prolapsed and flailing which likely meant there was a chorade rupture (as our other cardiologist saw on June 7th). 

Dr. Orvalho said that we needed a plan/protocol for Chockie. He told me I was chasing his heart failure and having to be reactive because I didn’t have anyone to really follow up with.  Which is true, I did follow up with my vet and cardiologist but obviously my vet is not a cardiologist and I was having to go through my vet to get cardiology info. We talked for 30 minutes and went through all Chockie’s meds and he made a few adjustments. He was concerned with Chockie not eating and his kidneys, his BUN is just a bit high and when I took him for a follow up they would do a more detailed renal panel with SDMA. Dr. Orvalho was so incredibly helpful. He gave me so many suggestions on how to get Chockie to take his meds and said there were still more meds we could play around with.  I told him of my concerns on Sunday, that he didn't out of his bed from 9:45 until 5:30PM, I thought he should at least of been peeing or drinking. He said he is probably very tired and their bladders grow so he was not concerned.  I told him about how restless he is at night and he said they do feel worse at night, just as humans do. We talked about his surgery date in September, I asked if he could make it. He didn’t say yes, but didn’t say no like our other cardiologist did. Dr. Orvalho asked how long he’s had MVD, I told him November 2018 and he said dogs usually live 12-18 months and he thought Chockie would live 18 months so it sounded like a yes to me. He also said that we need to get him stable and in good shape for surgery. I felt so good after this conversation, I felt so hopeful and knew there were still more meds that could help him. 

Dr. Orvalho told me everything happens for a reason. He said obviously if you can get an earlier surgery date that would be ideal but sometimes we are under pressure to do a procedure and we don’t have the exact team we would have wanted and something goes wrong. This really stuck with me and maybe I was just trying to convince myself that we will make it to our surgery date and everything happens for a reason.

July 16th-17th. With the help of Dr. Orvalho we were able to keep Chockie out of the hospital until July 16th with yet another episode of heart failure. He had an overnight stay in oxygen with lasix injections. The next day July 17th, Dr. Orvalho performed an echo and didn’t see any changes from the previous echo, his lungs were significantly better than the day before and almost clear. I asked what brought this on and he said probably from the worsening of the disease.  At this time he switched him from Lasix to Torsemide, Chockie had dosed out on Lasix and was getting it three times a day. The Torsemide would be just twice a day.

Toresmide is supposed to be something like 10 times as strong as Lasix but I didn’t feel we were seeing the results that we were supposed to. Since the switch to Toresemide I noticed his breathing pattern had been quite different. While he was awake it was 40-50’s and dropped drastically when asleep to 20-30’s, while on Lasix there wasn’t such a big fluctuation and it always stayed in a similar range, awake and asleep. It didn’t feel right to me and I scoured the internet to try to find something similar to what was happening to Chockie but I couldn’t.  

July 25-29th. On the evening of July 25th Chockie was back in the hospital because his respiratory rate was upwards of 88.  The next morning Dr. Hodge, the other cardiologist, called me to tell me he had taken over Chockie’s case. He heard a bit of fluid in his lungs but his respiratory rate was sill too high. They were switching off between additional doses of Lasix and Torsemide. He felt that his blood pressure, for his condition was too high and added an additional dose of Amlodipine. The afternoon of July 26th Dr. Hodge called and said Chockie was still in oxygen, his breathing had gone down from high 80’s to 60’s and he still heard some abnormalities in his lungs. On the morning of July 27th Dr. Hodge said his lungs sounded better and his respiratory rate was going down at night but pretty high when he’s awake, like I had also observed. He said they were working on weaning him off oxygen.  When I picked Chockie up at 1PM to bring him home, Dr. Hodge said he increased his Amlodipine to twice a day and started him on Hydrochlorathiazie. While we were going through Chockie’s discharge instructions I didn’t think he was quite right but I thought once we got home he would settle. He did not settle at home. He couldn’t get comfortable, was very lethargic and wanted to be carried to go in and out to potty, something he never did and his respiratory rate was 60 asleep and wake. So at 6PM back to the ER we went. The morning of July 28th the ER vet said his respiratory rate was “mildly elevated” 50-60. Later that morning Dr. Itsvan, one of our favorite critical care specialists, called and said his respiratory rate was still high they were going to start him on Lasix injections (not sure why they didn’t start on them the previous night). She said his disposition was ok he sleeps most of the time. She said he would not pee for them and thought it would be good for us to come take him out to empty his bladder. This was news to us and empty his bladder he did when we went to visit! On July 29th Dr. Orvalho was back in the office and said he seemed to be doing better, respiratory rate was now in the mid 30’s, his heart and lungs sounded better, still a little crackly but not too bad. He said his renal panel was significantly worse and that his SDMA went from 10 to 19 but he had been hospitalized with Lasix injections, new meds and he had not been eating so hopefully when we brought him home it will improve. I asked Dr. Orvalho why his breathing pattern had changed and he told me honestly that the Toresmide 2 times a day was probably not enough and that we would increase it to 3 times a day and also supplement his potassium. I had been starting to think is this fair to Chockie to keep him alive for this surgery and will he make it to his surgery date of 6 weeks from this very day.  I decided I had to ask Dr. Orvalho two realistic (dreaded) questions:

Is Chockie suffering? Will Chockie make it to surgery 6 weeks from this date?

He said Chockie was not suffering but when he is having a hard time breathing he is uncomfortable but not suffering. He said if Chockie was stable he would say yes he could make it to surgery but he was worried given the pattern he had lately.  He said Chockie has not given up yet. This was kind of a low point for me and I started to question what we were doing. I really didn’t want Chockie to suffer.

From the time we picked Chockie up from the hospital on July 29th, when his Torsemide dose was increased, until his surgery date of September 9th he started to stabilize and thankfully his kidneys stayed ok. His respiratory rate was 20-30 and only a few rare occasions of it spiking but no more hospitalizations. We stayed in very close contact with Dr. Orvalho and went in every other week if not every week.  Chockie had an echo a few days before we were due to fly. I was so nervous I could have thrown up, I always felt like we were getting bad news. Dr. Orvalho asked me how I thought Chockie was doing. I told him he seemed ok, his respiratory rate was pretty steady now. I was waiting for Dr. Orvalho to drop the bomb of bad news but he didn’t, Dr. Orvalho said his heart had shrunk not a ton but it shrunk a little bit, I could not believe it. This is where I can look back now to what Dr. Orvalho said - everything happens for a reason. We were desperate to get an earlier surgery date but we didn’t. We had to wait our turn and in return Chockie got stabilized on Torsemide and we could fly with a little less worry. When we left for surgery Chockie was on the following meds: Torsemide, Pimobendan (Vetmedin), Spironolactone, Enalapril, Amlodepine, Entyce, Cerenia and Potassium.

At Chockie’s pre-op appointment Dr. Anne Kurosawa told us she saw two ruptured chordaes and he was stage D but stabilized as if he was stage C.  She told us it’s very good he’s at his best for surgery as they were very worried about him. At a later time they all told us they never thought they would meet him. Chockie had surgery on September 9th, the most nerve wracking day of my life! The surgery and repair went well and by the evening he was sitting up looking around. The next day we were able to briefly see Chockie, Dr. Dan Brockman said he didn’t hear much of a murmur anymore, he was stable and out of oxygen, drinking lots, not eating yet, the fluid coming out of his chest dried up and they were able to remove the chest tube. We visited Chockie everyday. On September 12th (Day 3 Post-op) Dan told us he was still not eating (which is normal) and was feeling more comfortable so they were going to pain score him instead of continuing with pain meds. He told us he could not hear a murmur but his echo showed a very small leak in the mitral valve which is very common. Day 4 Post-op Chockie ate some turkey breast we brought. He had just had an echo and they saw tricuspid leak so they started him on Sildenafil.  We noticed his respiratory effort was greater than the prior day and they felt it was partly because his red blood cell count was still low and felt he had a little bit of what they called the “Friday Blues”.

September 14th (Day 5 Post-op). When we went to visit Chockie the nurse told us they had put him in oxygen overnight because his respiratory rate was high but had weaned him off that morning and he was back in the ICU. He ate a little bit for us but his respiratory rate still seemed very high, he seemed very tired but could not get comfortable to lay. He did not seem right to us so I went to get a nurse and magically Dan happened to be in the hospital even though it was Saturday.  He watched him and said he doesn’t seem as perky. After listening to his heart he said it doesn’t sound the same, I hear a murmur, maybe there is a clot on his valve.  He took him straight back to oxygen and to do an echo. That afternoon he called and said Chockie is a paradox. The repair looked the same as the previous day, a little more leakage and they were putting him on Lasix for the next few days.  He said this could be caused by anemia or a clot. He said the change in the pulmonary hypertension from the previous day could also be from a clot in his lungs. He said his pulses feel good and his pressures are ok. His lab work came back as expected so no transfusion was needed and they didn’t feel he had an infection.  They increased his Heparin dose. Dan felt like there might be a clot interfering with his valve. I did find out much later that Chockie did have a clot or lesion on his valve, you will see Dan’s email to me below. So much happened during Chockie’s post-op recovery I asked Dr. Brockman to summarize it for me when we got back to San Diego.

September 16th (Day 7 Post-op). Chockie lost the use of his right front leg, presumably due to a clot. He was holding out his leg straight and would not walk, only sit. It was heartbreaking watching him be so uncomfortable. He ate quite a bit for us and his respiratory rate and effort seemed to settle but when we tried to get him to lay and relax with us he couldn’t.  He was rolling around on this back, which was not normal.  Dan visited with us and said his murmur had gone down since September 14th but that he probably has a few clots that should resolve themselves. Dan updated us later that day and said he was bright, eating and drinking. They started physio on his leg and Dan was personally massaging it. He was out of oxygen, they were considering stopping the Lasix, the pulmonary hypertension had gone down.  His WBC had gone down significantly and RBC had gone up, indications that things were improving.

The next couple of days Chockie continued to improve. He was walking better, breathing better, his pulmonary pressures were mild on the meds, they stopped the Lasix injections, his mitral valve was stable, his regurgitation had reduced from when the valve reopened on September 14th but still more regurgitation than straight after surgery. His murmur was a 4, the echo showed the regurgitation was hitting in one spot so that might of made it sound louder. There was probably still a clot on the valve and hopefully the body will start reorganizing it.

September 19th (Day 10 Post-op). My heart sank when Dr. Tom Greensmith a Critical Care Specialist, called to tell us he had something to discuss with us, we thought we were going to bring Chockie home the following day. He said he ate a little bit, he was a bit quiet, he was walking but over night he had a fever and his heart rate spiked. Tom he told us all of Chockie’s blood work came back as expected except his CRP (C Reactive Protein a marker of inflammation) had shot back up to 120 then 132, that coupled with the fever, spike in heart rate and clot on his valve were all signs were pointing to an infection and they had started aggressively treating him for Endocarditis (an infection on the valve). They started him on IV antibiotics, Amoxiclav and Baytril and if he didn’t show signs of improvement in 3 days they would get special permission to get him on a very strong one.  They were also culturing his blood to see if anything would grow, this was going to take 3 days if anything would grow at all. 

Thankfully for the next few days Chockie showed signs of improvement.  His temperature and heart rate had gone down to normal. The cultures hadn’t grown anything and they continued on with the IV antibiotics. We brought out his Froggie and he was so excited to see it, he started beeping it and shaking it.  He slept for us, devoured his food and seemed to be responding to the antibiotics. 

September 22 (Day 13 Post-op).  When we came to visit Dr. Inaki Checa told us around 3AM Chockie started to have increased effort in his breathing but his respiratory rate as ok. They put him in oxygen from about 3AM-8AM and gave him a Lasix injection. After doing an echo they saw he had pleural effusion (fluid in the chest, outside the lungs). That was the only change they saw; his heart, valve and pulmonary pressures were the same. His temperature and heart rate were normal so they didn’t feel it was chest infection. Since Chockie was still on Heparin they did not want to take a sample and did not want to stop the Heparin in case he was still going to throw clots. They decided to just monitor it for the time being. His demeanor was the same to us, he ate, walked and played with his Froggie. We felt his respiratory effort had increased but his respiratory rate was about the same as the previous day. 

September 23 (Day 14 Post-op). They gave Chockie his last IV antibiotics, removed his catheters and started him on oral antibiotics that he would be on for the next 6 weeks. They also stopped the Heparin and reduced his aspirin back to normal dosage to see if the pleural effusion would resolve. Dan said his murmur was also reducing and really wanted him to do some more walking and take deep breaths. This was the first time in MONTHS he had eaten out of a dog bowl and didn’t give up on trying to get the pieces of food out of the bowl. The plan was for us to bring him home the following day. 

September 24 (Day 15 Post-op). Anne called and said the pleural effusion had gotten worse, they saw more fluid in Chockie’s chest cavity and he was more symptomatic.  During his echo he went blue, he had not been fighting it rather he was just laying there. They decided they needed to sedate him and drain the fluid. Anne said she got about 20mL of fluid out of him and was not blood, which was good. There was still another pocket of fluid but it was close to his heart so she didn’t want to mess with it. They had sent it off to cytology and to be cultured. He had been coughing a little bit that day and he had crackling in his lungs, which they thought might have been pneumonia. He still eat really good for us.

September 25 (Day 16 Post-op).  Anne called in the morning and told me they kept Chockie in the ICU overnight and they had called her a couple of times over night about his effort as it had gotten worse. She scanned him and saw he had accumulated more fluid. The cytology came back as inflammatory cells so it was consistent with pneumonia or inflammation from the surgery. Tom tapped his chest and they got about 10mLs of fluid out but there was still more in there. They had put the IV catheter back in and had started him back on the IV antibiotics. I met with Anne before my visit with Chockie, she said after my visit they planned to put the chest drain back in. They were hoping once all the fluid was out from around his lungs they could then re-xray them and see how they compared from the previous x-rays.  His murmur was about a 2-3 and his heart size had not increased.  I saw Chockie for about 2 minutes in the ICU as I wanted to close the door to his oxygen cage because he couldn’t breathe, he was gasping for air, IT WAS ABSOLUTELY HEARTBREAKING. His effort had most definitely gotten much worse. This was probably the worse I’d ever seen him during our whole journey, before and after surgery.  When I got back to the apartment I completely lost it, I was hysterical.  It was the first time while being in the UK I felt like that. I am not an excitable person and usually do very well in emergency situations but this day was such a roller coaster.  Shortly thereafter, Anne called and said when they put the drain in they got an additional 120 mLs of fluid out and he immediately stopped gasping for air and ate a bunch of chicken. Talk about an emotional roller coaster.

September 26 (Day 17 Post-op).  Dr. Anne called in the morning she said clinically Chockie looked really good. He went running to the front of his cage when she went to see him, he ate really well again for Sarah.  At 2:45 AM they drained an additional 60 mL of fluid, she said he still had a little bit of effort but nothing like yesterday. They kept him in oxygen overnight night, the x-rays of his lungs showed the right one looked ok but the left one was very diseased, not as bad as she thought it would be though. When I went to visit Chockie Anne had just scanned him and she said no new fluid had accumulated since they removed the 60mL at 2:45 AM and they would probably remove the drain that afternoon. His pulmonary hypertension was still stable, no coughing, the cultures hadn’t grown anything and he was breathing much easier. Anne went to go get Chockie for me, she came back and she said I swear he was doing so good all day but all of the sudden he started having an increase in his effort. They took me back to the ICU to see him, he was sleeping but when he realized it was me he was very excited. We took him out for a a quick walk and then took him back to ICU. When he saw Sarah and Alison getting his food bowl out, he started barking and demanding his food! I fed him everything in his bowl, he SCARFED it down. I went to wash my hand and when I came back to say goodbye I knew he was going to start screaming, luckily he kept it down and when I looked back to him, he was craning his neck to see me. These were all very good signs from him, his personality was coming back, what a change from the previous day.  Anne called me that evening and said she had just scanned him and there still no fluid in his chest so they were removing the chest drain. She said they discussed Chockie at their meeting and since he still has effort and was oxygen dependent (he was in at 60%) they wanted to give him Lasix to see if it was pulmonary edema. My heart sank when I found out he was going back on Lasix but I told myself if this is was going to make him feel better then so be it!

September 27 (Day 18 Post-op).  This was my last day in the UK, I had extended my trip from 3 to 4 weeks and needed to get home to our other dogs. The plan was for my husband to stay in the UK with Chockie because we weren’t sure how much longer he would be in the hospital. Anne called in the morning and said Chockie’s demeanor was good, he ate, he was running to the front of his cage, playful and barking. After giving Lasix there were no more crackles, his lungs had cleared up and they were switching him to oral Lasix.  She had scanned him and there was no more pleural effusion,  his heart has shrunk being on the low dose of Lasix and the pneumonia had cleared up but he was still oxygen dependent at 60%. All his blood work looked good, his CRP was normal, the x-rays showed his lungs almost clear so it was pulmonary edema, the clot/lesion on his valve had caused him to go back into CHF.  Anne agreed to meet with me before seeing Chockie so I could see his echos through this whole process.

Echo prior to surgery - obviously massive leakage and huge left atrium.
Echo right after surgery - showed very little leakage. Echo 10 Days Post-op (9/19/19) - The left atrium was large and the leakage was much worse mostly likely due to the clot/lesion that formed. Echo 15 Days Post-op (9/24/19) - The left atrium was still large and there was still a lot of leakage. Echo 18 Days Post-op (9/27/19) - The left atrium had shrunk significantly on Lasix so he was responding very well to it. His pulmonary hypertension has improved as well.

September 28 (Day 19 Post-op) After my husband dropped me off at Heathrow he went to RVC to visit Chockie. Joon was on that weekend and told Alan that Chockie was out of oxygen, all his meds were oral, his temperature and appetite were good and he was very perky.  They had kept him in the ICU because they all knew him too well.  When Alan saw him he knew he was better, he was demanding to be stroked. Two hours into my flight I got a message that Chockie was going home and Anne had approved! They said he was stable and doing really well and thought it would be better for him to be out of the hospital.

Chockie did really well being with Alan out of the hospital. At first his respiratory rate was a bit high 32-38 but it slowly started going down, it wasn’t until he was back in the US for a week or two that it went down to the low 20’s. On September 30th Chockie went in for a recheck.  His lungs were still clear, his heart has shrunk more, his slight cough was either from his trachea or his virus (he had a collapsed trachea a couple weeks prior surgery), they lowered his dose of Lasix to see how he would respond.  This was the first time we really felt he made it! He was feeling so good, demanding attention, very alert with his supersonic vision and hearing. All the things he used to like to eat but started turning his nose up at were interesting again. 

October 3 (Day 25 Post-op) This was Chockie’s final discharge appointment, I woke up at 3AM so I could be a part of it. Anne was very pleased with his progress she said his heart had shrunk, his murmur was a 2-3, his pulmonary hypertension was gone and they had already previously stopped his Sildenafil so the Lasix also cleared that up, his leakage was mild to moderate compared to when his valve re-opened and the leakage was severe. The plan was to reduce his Lasix to once a day once he was back and settled in San Diego and have an echo with Dr. Orvalho on October 17th. 

Chockie came home on October 5th and he was like a new man with so much energy and a new zest for life. He had more energy than I ever remember him having, even as a puppy. He wanted to  run laps with his froggie in his mouth, he had never been that kind of dog prior to having MVD.  When we were home and settle I emailed Dr. Brockman to get clarification on what had actually happened during this crazy journey and this was his response:

“To answer your question, I understand that a lesion was identified on his valve.  If you recall, I was concerned that his murmur got much worse on the Saturday after surgery and suspected a clot (thrombus) on his valve.  I recall a “lesion” was identified at that time and at that time too, he lost the use of his leg (associated with lower blood pressure in the artery of that leg), thankfully only for a very short time.  The “circumstantial evidence” for a thrombus on the valve and thrombus affecting the front leg is pretty convincing. The only evidence that we have for an infection anywhere was a mild increase in body temperature and an increase in inflammatory markers (C reactive protein and white cell count) but we were unable to document bacteria anywhere.  He was given antibiotics as a precautionary measure and that, along with Anne managing his fluid build up was coincident with his recovery. 

Bottom line, in my opinion, he didn’t have an infection on his valve ever.  He may have had inflammation elsewhere (lungs, bladder) that was clinically unapparent that responded to antibiotics but we did not confirm that suspicion with any of the fluid/urine/blood samples we submitted.  Frustratingly, there are a lot of aspects of his clinical progression we don’t understand.  The most pleasing thing, of course, is that he is clinically much better.”

On October 17th we saw Dr. Orvalho for his echo. There was no fluid anywhere, no pulmonary hypertension, no arrhythmia, murmur was 3-4 and leakage was moderate. Dr. Orvalho said his left upper chamber was smaller but still enlarged, he said he was pleased with Chockie’s progress especially with all his post-op complications.  We did a renal panel and his kidneys looked good. At this point Chockie was still on Lasix once a day, Pimo, the 2 antibiotics (which were almost done), aspirin and Plavix. Anne reviewed his echo and felt it was similar to when he left although his heart was still a little large.  The plan was stay stay on the Pimo because of his heart size, stop the Lasix completely and have an echo recheck in one month.

We stopped Chockie’s Lasix on November 6th and other than GI Issues he was doing great! His respiratory rate stayed a steady 18. During this period of time Chockie started having severe upper GI issues, in addition to his lower GI issues. He would eat and then sit up for at least 2 hours after he ate, if he even wanted to eat. Without any invasive diagnostic testing I felt he was developing an ulcer. I discussed this with our primary vet and he advised giving him Prilosec.  We had Chockie’s follow up echo on December 3rd (which also coincided with Chockie being 3 months post-op) we finally got some good news with actual improvement.  Dr. Orvalho said his heart has shrunk; his leakage was mild compared to his echo in October it was still classified as moderate and he felt his murmur is right around a 3 compared to a 3/4 in October. Chockie’s progress was very slow but I was so happy he was progressing in the right direction. I spoke to Dr. Orvalho about the upper GI issues and he felt it was the Aspirin so we increased his Prilosec until RVC was able to review Chockie’s echo. When I sent off his echo images to RVC I asked them if we could stop the blood thinners as we were almost at the 3 month mark. This was Dr. Brockman’s response “Thank you for the update after Chockie’s latest echo with Dr Orvalho, we are please he’s doing so well at home and is full of energy! We have looked at his images as a team and are happy to report there are no signs of any clots and you can stop both Aspirin and Clopidogrel now.” This was the first time I felt like we made some real medical process.

Chockie has never been more full of life! You can just tell he feels so good, his eyes are full of life again and is back to doing everything he used to do before having MVD - making scandals, sleeping comfortably on his back, being the king. We are still dealing with some lower GI and eating issues which I have pinpointed to the US Vetmedin. We are lucky enough to have family in the UK and are able to get it there. Our next echo will be March 3rd and we will see if his heart has shrunk further and if he can go off the Pimo.

From all of this I learned a lot but the two important things are:

Everything happens for a reason. When we were so desperate to get Chockie’s surgery date moved up, he would not of been fit enough to fly. While we waited for his surgery he actually stabilized.  You know your dog best. If you feel something is off with them take them to the vet or if they are in the hospital, be pushy about it. It makes me very uncomfortable to be pushy but I realized I know all Chockie’s little idiosyncrasies and this helped us in his recovery.

Update,

Chockie had his 6 month echo last week, Dr. Orvalho said his heart looked almost identical to his previous echo. I heard back from Dr. Anne at RVC today and she said he Chockie could stop his Pimo. I am going to do an echo in 6 weeks for my own peace of mind since he had so many post-op complications. He is completely off all meds now and I'm hoping his GI issues continue to improve.

Breed: Long Haired Chihuahua
Age: 10
Diagnosis: Stage D
Surgery Date: September 9, 2019
Hometown: San Diego, California
Owner: Megan Deglow & Alan Walton
Instagram: chockietherussian
Primary Vet: Dr. McClellan & Dr. Tannler, Torrey Pines Animal Hospital
Cardiologist: Dr. Orvalho, UC Davis Veterinary Medical Center San Diego
Surgical Team: RVC, Drs. Dan Brockman & Poppy Bristow