It all started when Dumpling, just turned ten years old. He was due for a full annual exam, I noted that he had a cough. My vet noticed a heart murmur that was never detected before (when we were living abroad in France), she referred me to the cardiologist for further diagnostics. July of 2019 Dumpling was sadly diagnosed with mitral valve heart disease. It was determined he was at stage B2. His left side of his heart was visibly enlarged. Immediately he had to start taking two different kinds of medicines, Vetmedin to keep his heart pumping more effectively, and Hydrocodone to help suppress his cough.

I discovered a group by the name of Mighty Hearts Project on Instagram where I learned of the cardiac surgery group in Japan led by Dr. Masami Uechi (Jasmine) where they have shown successful outcomes (>90% success rates) in dogs undergoing mitral valve repair for degenerative mitral valve disease. The surgery is a complete valve repair!

Immediately I began the preparations for Dumpling to get on the surgery waitlist, since this is a highly specialized surgery and only a few teams in the world perform it, all based off Dr. Uechi’s technique. Dumpling was deemed too early the first time we tried looking into surgery back in September of 2019, we were told to try again after another six months had passed by doing another echocardiogram. In the meantime, we started his 180-day quarantine to get into Japan.

April 2020, we did another echocardiogram and submitted the results to Dr. Takeuchi in Japan. This time, she said his heart has degenerated to a point where he was eligible for surgery. Unfortunately, she was right and on July 3rd Dumpling had his first check-in to the emergency room, due to congestive heart failure - his heart condition had slipped into stage C quickly! Time was of the essence. We had to get to Japan for his life-saving surgery right away.

Jasmine’s first opening was in the fall of 2020. We scheduled surgery around Thanksgiving/December of 2020, the first appointment we could get. In the meantime, the entire world was dealing with the Covid-19 Pandemic and travel bans, but I did not lose hope and thought things would open up for us.

In September the Japan Animal Quarantine Office granted him clearance to come into Tokyo after I submitted his Rabies Titer information after completing the 180-day waiting process. This was one hurdle completed but I was still not granted the temporary visa to get into the country yet. I went to the Japanese Consulate and submitting many documents for the visa, and it was denied in September, (they did not even want to submit it formally as it would mean I was banned from Japan for six months if rejected formally), as I am American and not a Japanese national. The rejection was a crushing blow and super stressful, we did not give up. I went back in the middle of October to apply again for a medical or tourist visa, unfortunately I was denied the visa and asked to retract my application again, cases of Covid-19 were too high and they couldn’t risk letting in any foreigners now. Of course, this blow was heartbreaking.

Due to the lack of a visa I had to reschedule Dumpling’s surgery from the week of Thanksgiving to January. For the next two months I checked with the Japanese Consulate with hope and diligence that they would accept my application and grant me the visa. I also had my Japanese friend call the Tokyo Visa office, and we tag teamed both of them from the USA and Japan offices to try to get them to accept my application, they finally did and granted me my visa in the final hour, week of Christmas! At the same time, I had to deal with the new legislation that took away the rights for ESA animals to travel in the cabin. Through much discussion and help with the great team at ANA, they decided to honor my original ESA pet in-cabin booking as it was made before the U.S. law took effect in January. Again, crisis averted. We did have a slight wait but no problems getting Dumpling’s forms for export with the USDA office.

On January 4th we were on our way to Japan. Upon check-in at LAX, the airline told me that my visa was no longer valid as new restrictions were placed on tourists due to the two new strains of COVID-19. I pleaded my case and after calling Japan she agreed to let us board on the condition that I sign a contract to see if I was denied entry to Japan and had to turn back, I would be responsible for all charges. When we landed that is when the nightmare began. Unexpected hurdle number two, apparently while I was in-flight Japan issued a new law that placed California on a new red list. The officer explained it was mandatory that I had to stay at a government hotel to self-quarantine, no exceptions, and pets were not allowed. No matter how much I tried to reason and plead it was no use this time...I was so sad realizing Dumpling and I had to be apart for two crucial weeks of pre and post surgery.

I had to pivot and quickly book Dumpling to be boarded at a friend’s vet in Tokyo and arrange him to be driven there alone with the Pet Taxi service, I was not allowed to go into Tokyo with him. The customs officers escorted me to my bus to go to the quarantine hotel after we separated at baggage claim. I was very sad and scared for Dumpling to be apart from me after such a long flight.

On January 7th I took Dumpling's pre-operative appointment via video from my quarantine hotel. Since we were apart, I had to make sure I was communicating with everyone on the ground (his pet taxi driver, his local vet boarding, and Jasmine) remotely. Mr. Izu, Dumpling's Pet Taxi driver kindly took a picture of the Jasmine building for me, and it is quite impressive, it’s a huge animal hospital! I met with Dr. Takeuchi over ZOOM and was so happy to see my little boy in the frame doing well. I took a little screenshot of Big D in the carrier, and he seemed content, he was grooming and burrowing in the blanket. Dumpling was tested for his blood work and overall heart check with x-rays and echocardiograms. He was cleared for his surgery in 5 days.

By January 10th the Japanese authorities surprised me by letting me out of the Quarantine hotel early, as I tested negative three times in a row. I had to sign an honor contract that let them track my whereabouts in Japan and had to report my temperature on a government APP daily for the rest of my two-week quarantine period, but was free to go to my AirBNB. I was thrilled to leave and was able to spend the 11th with Dumpling, a full day before his surgery. Last night I had Dumpling sleep with me and I cuddled with him, prayed, gave him a lot of soothing kisses and pep talks. He knew something big was coming up!

January 12th was his Heart Surgery Day. It was a hopeful, grateful, and nerve-wracking day. Mr. Izu picked up Dumpling at 6 am to take him on his solo ride to Jasmine (I was still in quarantine and was not allowed to go). He was so nice to help us take a picture together, as well as gave me a gift - a small calendar that had chihuahuas on it, just so kind! My heart hurt when I saw them drive off without me. Jasmine and I had a pre-surgery zoom where I met Dr. Uechi. We had a translated conversation together where he told me that Dumpling looked good for surgery. I thanked him and wished him good luck on the surgery.

After his 5 hour long surgery, I received communication from Jasmine. I was so anxious. He finished surgery and was now in the ICU. The surgery went well without any major complications. Bleeding was as expected for a cardiac surgery. Dumpling’s heart had 2 to 3 major chords that were broken and the rest were stretched. Today he has 7 new chords placed with goretex sutures. The goal of the new chords are to allow the leaflets to close better to reduce the regurgitation volume. It’s a miracle, a 1.5 year journey to get this done. I believe in science and the power it has to heal and save lives. I am beyond grateful for this blessing.

I was not allowed to see him during his week in ICU for recovery post surgery. The first three days were crucial to his recovery. Jasmine updated me a few times each day. He had anemia, low blood platelet count, and typical bruising. They tried to keep his inflammation down and stop blood clots from forming. I was also shocked to learn he had a partial seizure on the 15th. On the bright side he still had a hearty appetite and was strong enough to walk outside. Within that week his vitals all improved. The 19th was the big day. Time for Dumpling’s discharge from the Jasmine clinic and into my home (Air BNB) care. It was my first time seeing him post-surgery.

It was also the day that I was officially off the 14 day quarantine with the Japanese government. Seeing Jasmine in person was a wonderful moment - the crescendo of 1.5 years of hope and work towards Dumpling’s journey. It is brand new, big, and clean - a totally impressive new place where they do life saving work for dogs. The lobby was spacious and Covid-friendly. There were a few local Japanese patients, all little fur babies waiting patiently inside their carriers. Exactly as scheduled, Dr. Takeuchi opened the patient room door to welcome me. Dumpling was there and so shocked to see me. We had an amazing reunion where my little guy showered me with tons of kisses. He looked visibly tired and a little skinnier but all in all so good. He was ready to go home.

Her directions to me were clear, limited exercise and activity for the next three months. Feed him nutritious food (his appetite was hearty), and watch out for his heart and breathing. His vitals were improving and he was going to the bathroom regularly. He is down to one medication a day (blood thinner) instead of four. He had huge stitches and lots of deep colored bruises, but Sayaka told me it did not cause him pain. All good signs.

We did one last echo before his discharge and did not yet see his heart shrinking, she explained this process fluctuates in the next three months after surgery as his heart hopefully learns to be small again. Sayaka explained some dogs hearts never get small again, it depends on the muscle’s response and tissue reactivity. Because this was a repair, and not a replacement, the regurgitation will always be there a tiny bit. The heart will still continue to age, there are still the aortic and tricuspid valves that can leak, even if we repaired the main one, the mitral valve. We have added more years to Dumpling’s life and hopefully we won’t have to worry about the mitral valve ever again.

Friday January 23rd Dumpling had his last appointment at Jasmine. Dr. Takeuchi was able to remove the stitches that were on his neck and chest, his skin had healed nicely. Two thirds of his dark red bruising healed. She also did his bloodwork and another echocardiogram. Good news is that his anemia improved and his platelet counts were up. Bad news is that his heart size has not decreased yet, and she says it is because he is moving too much. Dumpling made a point to say hi to everyone in the staff, I think he knew he was thanking them and saying goodbye. So thankful for this incredible team at Jasmine Animal Hospital and Dr. Uechi and Dr. Takeuchi. They are such experts and so caring. Once I got their blessings and strict instructions (3 month recovery), we gave our kind goodbyes and I hope we never have to come back in Dumpling’s lifetime. Izu from the Pet Taxi drove us to the airport the very next day and we had a nice, uneventful flight on ANA back to Los Angeles, the crew was so nice to us. Our Japan journey was officially over and a success.

It is with gratitude and love that I can say Dumpling has recovered well from his surgery at Jasmine and is flourishing. His 12th birthday was spent on the beach in March. As we approach month five post-op, he had the green light from Jasmine and my cardiologist Dr. Emily Chapel to do 20 minute walks again and his heart has shrunk back down to the size of the beginning size of B2, which is quite significant for a brave boy his advanced age. He still has his coughing due to his collapsed trachea condition, (common in small dogs) but the coughs sound different than before the surgery, where it was due to his heart disease. He takes Vetmedin twice a day now to keep his heart pumping optimized, but no longer needs any other meds like Furosemide or Enalapril. He now has a bit of separation anxiety and is way more loving and close to me than before. I give him extra cuddles and kisses everyday, I am so thankful and really enjoy each day that is bestowed upon us. It’s such a gift from the amazing mitral valve surgery by the amazing Dr. Uechi, Dr. Takeuchi, and the wonderful team at Jasmine.

Dumpling and I LOVE you all and THANK you for supporting his surgical journey. He will forever have a place in his heart for you all and Japan in his little mighty heart.

If you have any questions about the surgery, Japan recommendations or need any support whatsoever please feel free to reach out to me on Facebook and IG.

Breed: Chihuahua Age: 11 Diagnosis: Stage C Surgery Date: January 12th, 2021 Hometown: Los Angeles, CA, United States Owner: Eva Yean Primary Vet: Dr. Jeff Werber Cardiologist: Dr. Emily Chapel, Access Specialty Animal Hospitals Surgical Team: Dr. Masami Uechi & Team at, Jasmine Cardiovascular Medical Center

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