Royal Veterinary College (RVC) Queen Mother Hospital for Small Animals

Hawkshead Ln, Brookmans Park, Hatfield AL9 7TA, UK Phone: +44-1707-666-366 or +44-1707-666-399 qmhaheartsurgery@rvc.ac.uk

The Royal Veterinary College outside of London, UK

The Royal Veterinary College outside of London, UK

Dr. Dan Brockman and his team with their patient, Rusty

Dr. Dan Brockman and his team with their patient, Rusty

RVC Interviews with Dr. Dan Brockman and Poppy Bristow answering questions about their mitral valve repair program.

Mitral Valve Repair Surgery Overview

Mitral valve repair surgery is performed by Dr. Daniel Brockman (Professor of Small Animal Surgery) and Dr. Poppy Bristow (Fellow in Cardiothoracic Surgery and Lecturer in Small Animal Surgery) with the support of Alison Young (Head Theatre Nurse) and Sarah Carey (Theatre Nurse) at the Hawkshead campus of the Royal Veterinary College. You can find a bit more information on the history of heart surgery at the RVC by reading this Q&A with Dr. Dan Brockman.

To secure a surgical date, contact the RVC team at qmhaheartsurgery@rvc.ac.uk. The team will request the complete medical records of your dog to assess the prospects of surgery. Please include the following information when contacting the RVC:

In order for us to assess whether your dog is a suitable candidate for surgery we will need the following information, preferably from your cardiologist directly,

  • Echocardiogram scans, images and videos

  • Cardiologist Echo reports

  • Full medical history from your primary care veterinarian, We prefer them to submit the records to us. If they can’t (please include their name, contact details and email address)

  • Results of any recent blood work

  • Copies of any radio-graphs (X-Rays)

  • A full list of current medication and doses

  • A table of resting respiratory rate (please count the number of breaths per minute when your dog is fully asleep - usually evenings)

  • Let us know if your dog ever received a blood transfusion?

It’s best to aggregate all of the records in a shared folder using a file hosting service such as Dropbox or Google Drive.

Once we have received this information we can discuss the case in our weekly meeting.  We will then be in touch within 3-5 days

 ***We will not be able to respond to any new requests until we have all this information due to the high demand***


Current costs & payment instructions 

As of January 2019 the new total cost for mitral valve repair surgery at the RVC is (17,500) pounds.  The RVC requires you to wire a (2,000) pound deposit during your initial consultation period for candidacy to hold your place for surgery. This is to be paid no more than two weeks after getting your surgical date.  The surgery payment of (12,500) pounds must be sent one to two weeks before surgery

The remaining balance of (3,000) pounds can be paid at checkout bringing the total cost to (17,500) pounds.  The RVC does accept credit cards, Visa and MasterCard so you could wire the initial two deposits then pay the residual amount via credit card at checkout along with any other extra charges that may occur in the event of extended stays due to unforeseen complications.

Please contact the RVC for the most up-to-date information on pricing and payment procedures.

qmhaheartsurgery@rvc.ac.uk

The recommended stay in the UK is 3 weeks. Surgeries are typically performed on Mondays, every other week. You will be scheduled for a pre-op exam on the Thursday or Friday the week prior. The post-surgery recovery can last between 7 and 10 days. Your dog will spend the first 3 - 5 days after the surgery at the ICU; it will then be transferred to the hospital ward for further recovery and observation. At the end of the 7 - 10 day recovery period, your dog will be discharged. It is recommended that you plan to stay another 5 - 7 days after the discharge for at least one follow up visit before your dog is cleared to fly back home. The ICU staff will monitor your dog during their stay at the hospital for signs of infections or other postoperative complications. The RVC heart surgery team will further perform follow-up echocardiograms to determine the success of the mitral valve repair, analyze residual regurgitation and the effect of the surgery on the size of the heart.


Travel Procedures for US-based dogs

The best way to travel is to fly your dog into the London Heathrow Airport as an ESA or service dog on a US-based airline. The Gatwick and Luton airports do not accept dogs at their terminals.

Attention

“As of December 18th 2018, two airlines that have accepted ESA/Service dogs in the cabin of the plane, Delta Airlines and United Airlines are currently placing eight hour flight restrictions times for all ESA animals. American Airlines directly, not sponsored by British Airlines seems to have not adopted this rule yet, so they are the best option for now. We are looking into this and any alternative routes or airlines that can be used to bypass this new policy like flying through Boston etc, stay tuned”

Forms required for travel

Emotional support / psychiatric service animals

You must complete, submit and receive approval of all 3 forms before your animal will be allowed to fly:

  • Medical / Mental Health Professional Form

  • Veterinary Health Form, or vaccination record with current rabies vaccination information

  • Confirmation of Animal Behavior Form

Download the emotional and psychiatric service animal document packet 

Instructions

  1. Read and complete all 3 forms

  2. Submit all 3 forms together at least 48 hours before your flight

  3. Keep documents with you during your trip

Email Special Assistance 

Fax forms to: 817-967-4715

All service and support animals

If you have a flight over 8 hours in your itinerary, the Animal Sanitation Form is also required stating your animal won’t need to relieve itself or can do so in a way that doesn’t create a health or sanitation issue.

Animal Sanitation Form 


The following procedures below are instructions on how to fly with your dog in the cabin to the London Heathrow Airport.

Step 1: Microchipping

Your pet should be implanted with an ISO compliant (11784 and 11785) microchip. ISO compliant microchips are 15 digits long.

AVID, FECAVA and Trovan microchips can also be read; however, it is highly recommended that your dog has an ISO compliant chip. The USDA accredited veterinarian can implant an ISO-compatible microchip in addition to the non-ISO one your pet currently has. The number and implant dates of both microchips must be documented on the USDA form.

Step 2: Rabies vaccination

The rabies vaccination must occur AFTER microchip implantation. It may be administered the same day as the microchip implantation but any rabies vaccination before a microchip is implanted is invalid.

The number and implantation dates of both microchips must be documented on the USDA form and at least one of these microchips must have been implanted before your pet’s most recent rabies vaccine.

Vaccinations valid for 1 year are acceptable. 2 or 3-year re-vaccinations are only acceptable if you can document initial vaccination and all revaccinations since then. If the current vaccine is older than 1 year and you cannot document the entire history of rabies vaccinations, you will have to re-vaccinate before the UK trip and ideally, before getting the USDA forms.

If the rabies vaccination is new, you must wait 21 days before entering the UK.

Step 3: EU Health Certificate

Have a USDA accredited veterinarian perform an exam and prepare the USDA form exactly ten (10) days before your arrival into the UK. Make sure that your veterinarian includes the name of the rabies vaccination product on the form. Make a copy of the form before overnighting it to the USDA, ideally the same day the veterinarian generates the form.

Step 4: USDA Approval

The USDA approval can be done in person at your local USDA office.  If you prefer to handle the approval in person, you must bring your dog's rabies vaccine certificates for all rabies vaccinations documented on the health certificate.  These vaccination certificates will be required by the USDA at the time of health certificate endorsement.  Make an appointment at the closest USDA office well in advance.

If you cannot go to a USDA office in person, you can overnight the original USDA form that was prepared by the veterinarian to the nearest regional USDA office along with all supporting documentation. Enclose in the envelope a pre-paid overnight-shipping envelope and a check payable to the USDA in the amount of $38. See the USDA user fee page for more details.  You can also pay the fee with a credit card over the phone.

You should receive the final USDA-endorsed forms 2-3 days after you overnight the forms to their office.

Please note: The EU health certificate is valid for travel within the EU for up to 4 months from the date it is issued by the USDA Accredited Veterinarian as long as the rabies vaccine documented on the form has not expired. 

Step 5: Notify HARC

Email the Heathrow Animal Reception Center (HARC) at harc@cityoflondon.gov.uk and include the following information:

  • Scanned copy of your USDA form as prepared by your veterinarian. It does not need to be endorsed by the USDA yet.

  • Scanned copy of your most recent rabies vaccination certificate.

  • PNR number of your flight, i.e., the booking reference number, usually a combination of 6 letters and/or numbers.

  • Letter from a physician, a training certificate or a registration card to demonstrate that the dog is an ESA or service animal.

If you need any further information, review the center’s website or talk to a representative on the phone at +44-20-8745-7894. They are open 24 hours, year around.

Once the HARC reviews your documentation, they will email you a confirmation that your documentation is in order. You will then need to call them on the phone to make a credit card payment. The fee, as of April 2018 is £366.

Step 6: Preparing to fly with your dog

The HARC will issue a pre-approval letter for traveling with your dog, usually within 24 hours of receipt of payment. Contact your airline and provide the pre-approval letter. You will also need to fill out the airline-provided forms to document that the dog is an ESA/service animal. You may need a letter from a physician to document that your dog is an ESA/service animal. Note that both Airlines usually and require that all documentation be submitted at least 48 hours before your flight.  Some airlines also require other forms such as proof of training and other safety-related documentation.  The HARC will also require a letter from your physician, a training certificate, or a registration card to document that your dog is an ESA/service animal.

Once the airline approves and manifests your dog, call their Accessibility desk to request the most appropriate seat for someone flying with a dog. If flying economy, request that you get a bulkhead seat, at the front of the economy section. On most planes, the bulkhead seats have the most space in front of your seat, often sufficient for other passengers sitting next to you to be able to get out of their seat without disturbing your dog. 

Step 7: Tape Deworming

Schedule tape deworming of your dog with your USDA-accredited veterinarian to be performed no less than 24 hours and no more than 120 hours (5 days) before your arrival to the UK. The tapeworm treatment needs to contain the active ingredient praziquantel. Bring the USDA-endorsed forms to the veterinarian office; the veterinarian needs to include the tape deworming details in the final version of the USDA forms.

Step 8: USA TO UK

When flying to the UK, bring your original USDA-endorsed forms, a copy of your rabies certificate and a copy of all of the documentation provided to the airline to document your dog as an ESA/service animal.

Upon arrival in the UK, staff from the Heathrow Animal Reception Centre (HARC) will wait for you at the gate. If they are not there, do not leave the gate. You may call the HARC on the phone to notify them that you have arrived and someone should be at the gate promptly. The HARC staff will review all of your documentation and issue a customs clearance letter that you will need to provide at customs, after clearing through immigration. It is recommended that your ESA/service animal wears a clearly marked service vest to expedite processing through immigration and customs.

Step 9: Immigration

Clear immigration as usual. Be prepared to show your USDA form and the clearance letter from the HARC. Once you clear immigration, take the “have something to declare” lane and walk to customs. If no one is there, use the phone on the wall to call them. Someone will come by and review the letter that the HARC provided you. You will now be officially cleared to depart from the terminal.

Do not surrender any of the forms you bring with you. Any officials that request them should simply review them and then return them to you. You will especially need your USDA forms upon your return to the US. Be prepared to be routed to the agricultural inspection line where your entire luggage will be inspected using the USDA X-ray machines.

Heathrow Airport to the RVC clinic

Heathrow Airport to the RVC clinic

Note:  The above steps are the current USDA requirements for traveling to France. These requirements can change without notice so visit the USDA website to verify all steps before proceeding.


Planning Your UK Stay

Many hotels in the UK are pet friendly. Most hotel chains will also honor service dogs and accept their stay regardless of their pet policy. It is recommended that you use a hotel or an apartment that has a refrigerator to allow for storage of food or/and treats used to administer medications (if needed). One such serviced apartment many families have used is Harpenden House Serviced Apartments. Tony has been very kind to our Mighty Hearts families and has put together this document with great information if you should wish to use his services. The Novotel Stevenage Hotel, is also located around 15 miles from the RVC hospital.

Given the (rural) location of the RVC hospital, it is highly recommended that you rent a car. Please drive slowly on the local roads; they tend to be very narrow and sometimes require taking turns at crossing narrow bridges or single-car passageways, not to mention driving is on the left side. It is recommended that you rent a small, automatic transmission car, otherwise use a car service or local trains.

Many hotels will provide a breakfast option. There are many restaurants and pubs that will let you bring your dog for lunch or dinner. See the Doggie Pubs for a list of dog-friendly restaurants and pubs.

Bring some of your dog’s food with you to more easily transition them to any local foods you may end up using after the surgery. Avoid any dietary changes right before the surgery; it can cause diarrhea which can further complicate the surgery and the recovery process. There are a plenty of pet food stores in the area around the RVC. The two I successfully used to find a good selection of food and pet products are the Partners Pet Supermarket (website, map) and Pets at Home (website, map).

Keep in mind that the UK uses a special, three blade Type G power plug and 220V electricity. Make sure that all electrical appliances you intend to bring are dual voltage (110V/220V) and that you bring at least one Type G adapter. The easiest thing to do is to buy one Type G adapter and a 110V/220V power strip. This way you adapt the power strip and then can plug in all of your (dual-voltage) appliances directly into the power strip. Note that a typical power strip you buy at a hardware store is NOT 110V/220V compliant - they typically only work with 110V. The power strip has to be specifically advertised as 110V/220V compliant. Here is one from Amazon.


Transportation from airport service we recommend

Manor Cars Airport Transfers

Other Helpful Tips

  • It is essential that you register your dog as an ESA in order to fly in cabin with you.  Dogs fragile with heart disease or returning back to the US after surgery should not be separated from you, and must be walked in the cabin on the way back to the US to avoid blood clotting.  For ESA guidelines, please see our General Travel page.

  • Buy a service vest for your dog to avoid questions about the nature of your dog and help you get better service at the airport, on the plane, and at immigration.

  • Buy wraps, diapers, or pee pads and practice with your dog prior to the flight. This is especially helpful if your dog is on diuretics and needs to relieve itself frequently.

  • Bring a paper bowl on the flight; the flight attendants are happy to accommodate you with water as needed.

  • Research relief area options for the airports you will be using PetFriendly Travel.

  • It is important to keep your dog calm on the flight.  Your cardiologist can work with you and a holistic veterinarian to determine the most appropriate method for your dog to remain calm, given their heart condition. Caution the use of any sedatives, please if you must look into holistic care options, test in stressful situations before going on an airplane.

  • Some airlines recommend using a muzzle. However, unless your dog is extremely comfortable wearing one, it is not recommended to use one. Your dog likely has an increased respiratory rate due to their MVD; using a muzzle, even a soft/basket version will still likely increase their anxiety level and may further increase their respiratory rate as well.

  • When you enter security, you will usually be given two options: a) either walk through the metal detector with your dog on leash and then get patted down by a security official or b) if your dog is well trained, you can remove the leash and collar, insert them into a basket that goes through the x-ray machine, then walk through the metal detector by yourself and call your dog to follow you behind.

  • Here is a list of useful supplies to bring with you in your carry-on bag: paper bowls, ziploc bags, paper towels, disinfecting wipes, flushable wipes, small garbage bags. Get a water bottle from one of the convenience stores once you pass security.


References

  1. The RVC Cardiothoracic Surgery website

  2. Email inquiries about the surgery to qmhaheartsurgery@rvc.ac.uk

  3. Travel information to the UK as provided by the RVC

  4. Heathrow Animal Reception Centre website

  5. Policies on travel with assistance animals at London Heathrow

  6. USDA travel abroad with your pet website

  7. American Airlines travel with support and service animals in the cabin website

  8. The RVC Frequently asked questions

  9. RVC document explaining the surgery intervention and current processes.