Ema Becomes Even More Complicated

Ema is waiting and seeing

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Today, Ema was supposed to be undergoing the procedure that we hoped would save her life. Instead, she is sitting here on my feet, as I write this. Ema, it turns out, is even more complicated than we’d thought, and it all has to do with doors.

Allow me to explain, as briefly as I can, and bearing in mind that I am a layperson, and not a veterinarian. This explanation comes to you courtesy of the very excellent University of Guelph Veterinary Cardiologists, Dr. Schuckman and Dr. O’Grady.

Picture your heart as two separate rooms, divided by a wall.

Each room has door leading into it. Ideally, this “door” should open fully, allowing blood to pass through it easily.

Ema’s “door”, however, does not open fully.

Ideal door and stuck door

Luckily, our “rooms” don’t really need their doors – it’s perfectly fine for the doors to remain wide open all the time, or to be non existent. In the balloon procedure, a catheter would be inserted into Ema’s neck, and fed into her heart. There, the balloon would be inflated, essentially tearing her door off of its hinges, leaving her ‘room’ wide open, and allowing her blood flow to move normally through her heart.

However, consider another option with doors.

What if, in addition to the door being stuck, it’s also in a frame that’s too small – much, much too small? In this case, even removing the door isn’t enough, because the frame just isn’t large enough to allow sufficient flow of blood into Ema’s room.

Ema's Door

This is, in essence, Ema’s issue. Removing her door  ( doing the balloon procedure to correct the pulmonary stenosis) wouldn’t be enough to improve her heart’s functioning to any serious degree. However, there’s another procedure that should be able to help her – a surgical correction.

The surgeon will, more or less, tear out Ema’s door frame, building her a wider one shored up with surgical mesh. Ema will then have a wider opening, and no stuck door.

Unfortunately, Drs. Schuckman and O’Grady don’t perform this procedure – they’re the “Balloon Team”, as they informed me. A Cardiac surgeon is needed to perform this, and Guelph only has one at the moment, and she happens to be on holiday until November 8th. Even then, she apparently hasn’t done many of these procedures (do I even need to mention that it’s a rare and complicated surgery, done only by a handful of people in North America? That should go without saying, since this is Ema we’re talking about). So, there’s a chance that Dr. Bisson, Guelph’s Veterinary Cardiac Surgeon, might be more comfortable referring us to a Veterinarian who has more experience in performing this surgery. This will mean sending Ema to perhaps Purdue, Cornell or Ohio State.

So, we sit and we wait. We wait for the Cardiac Surgeon to get back from holidays, then we wait for her to look at Ema’s file and decide if she can perform the surgery. Then, we either wait for a referral to another vet, at another University. Then we wait for a surgery date.

In the meantime, Dr. O’Grady said quite succinctly that “Ema is on a crash course with death”. He was frankly surprised that she’s doing as well as she is, and has survived for as long as she has. He asked, tentatively, if we could possibly tape one of Ema’s seizures – he’s never actually seen one himself, and it would be a great teaching tool for students at the university. Ema had another one this morning, and while I’m all for increasing the pool of knowledge among Veterinarians, grabbing a video camera is not the first thing that comes to mind when your  puppy falls to the floor, goes rigid and then screams in terror.

Financially, we should be OK. This new procedure shouldn’t cost much more the balloon procedure does, but it carries with it both better success, and greater risk. If Ema survives the surgery, her recovery success rate is as great as 95%. There is, however, a 50% chance that she won’t be able to survive the surgery. I’ll take those odds, because without the surgery there is a 100% certainty that Ema will die, and that it will be a slow, painful and terrifying death.

I’m not thinking about that right now, however. I’m just watching the clock and waiting, and so is Ema.

If you would like to read the actual veterinary report written by Dr. Schuckman, please click here to download the PDF.