Nightmares on Chylothorax
These are emails that I had sent out about Jaime over the past two weeks….followed by todays’ update and pictures.
Email #1 – Wednesday July 22
This is not a good week for Jaime’s 
(This was in response to Helen Turin’s Jamie also having problems).
Monday morning when I let out my Jaime she didn’t run around the yard the way she usually does, she just peed and stood by the door. However, when I gave her breakfast she gobbled it down in a manner befitting any good corgi, so I relaxed a little.
Then when I went to put them in their runs for the day she seemed to be working to get her breath – sort of like a dog who has something stuck in its throat.
Since her mother died of a chylothorax, which I had never heard of before, I rushed her straight to my vet where she stayed while I went to my first day of work at my new job. My vet said she looked fine, but did an x-ray anyways and her chest was filling with fluid. They tapped it, and sent it for testing along with blood work, and called the Small Animal Clinc at the Ontario Veterinary College. Monday after work I picked her up and drove her out to Guelph.
She has been constantly monitored and had all sorts of tests to rule out heart or trauma – it appears it is once again an idiopathic chylothorax. Tomorrow they will operate to attempt to tie off the thoracic duct and lymph nodes that are draining into her chest. Please keep her in your thoughts tomorrow – she’s only three years old and should have a long life ahead of her
This may be something that you want to watch out for – like I said the symptoms were no more than a bit of irregular breathing, however, had it been left she would have drowned internally. I wonder how many times a dog may have been ruled a death by heart failure, when it could have been this silent killer. I never would have known what killed Sabra without doing an autopsy, and thankfully that made me concerned enough to take Jaime in early.
Email #2 – Thursday July 23
The good news first, Jaime has come through the surgery, they are sure that they have stopped the leaking lymph node, and she is in the ICU recovering.
Now for the details.
The advantage of using a Veterinary teaching hospital such as the Ontario Veterinary College, is that the latest technologies and procedures are available, and if there is something that may be of benefit, they have no hesitation in going out and finding out about it. The disadvantage of course is that you pay dearly for all of it!
The surgeon discussed with me that the normal surgery for a chylothorax was normally only given 50% odds of success. However, there had been recent claims by other hospitals of having 90-100% success by using other procedures in combination. The lymph nodes are normally the diameter of a hair, and that is what they are trying to tie off, since a Chylothorax is fluid from the lymph nodes leaking into the chest cavity so they ligate the thoracic duct (or attempt to). Recent studies showed that by injecting dye into the lymph system and following its path, allowed them to more clearly determine the location of the thoracic duct, increasing the success rate.
This is a description of the procedure:
CCA-TDL: For performance of the CCA-TDL procedure, the basic approaches to the abdomen and the thoracic cavity are the same as for the current standard treatment (TDL alone). In brief, this will require the dogs are anesthetized, clipped and aseptically prepared for surgery. A single surgical field is draped which encompasses the abdominal incision and the right chest for the thoracic incision (there are 2 incisions made for the treatment). The lymphatics are outlined by injection of an abdominal lymph node with new methylene blue dye and by contrast lymphangiogram. The dogs are then rolled into position for the chest incision and the thoracic duct is located and tied off (ligated) using the standard methods. After ligation, a repeat contrast lymphangiogram is performed to confirm complete occlusion of the thoracic duct and all its branches. The cisterna chyli is then removed in the abdominal cavity (this is through the same incision used to perform the lymphatic dye study so no new incision is necessary).
Apparently the CCA or Pericardectomy – increases the success rate from 50 % to 88% according to the University of Wisconsin Vet Med website.
Along with this the clinic also suggested a CT scan to study her lymphatic system. Since it wasn’t necessary to the procedure which was already in the $5,000 range I declined this – however, they called me again this morning and asked if they could do the CT scan at no charge for research purposes.
The surgery apparently went well but they still have Jaime on a chest tube, to continue draining her chest cavity and dry out her lungs which were soaked, resulting in a small pneumothorax . The post surgical scans show that they did successfully stop the drainage, however, the surgeon commented to me that the CT scan showed that the lymphatic system in Jaime was quite twisted, and not what they normally see. She was curious if anyone else has done this type of scan and seen this – so if it is a Corgi trait, or a Jaime trait.
So for tonight Jaime is being kept well doped up and is apparently more stressed about the cone, than anything else. She has apparently been a hit at the clinic because of her friendly nature and her tendency to do a “flop puppy” (flopping on her side like her bones have disintegrated) for anyone who will talk to her. I don’t know if she’s going to be quite as happy with everyone at the hospital after today, but I know that she is in the best place she can possibly be right now.
Apparently Chylothorax is known in Afghans, and while I will never breed Jaime now (a HUGE disappointment for me!!), I can’t help but wonder how many times this condition has gone undiagnosed in Corgis. I caught it early, and she was in the vet that morning. But the symptoms were so subtle, that no one would have realized she was sick without knowing what to look for
Email #3 – Saturday July 25
I went to see Jaime this morning. She is still in the ICU at the Ontario Veterinary College.
It was rougher than I thought it was going to be. When I saw her with her totally shaved side, and IV going in and the chest tube still draining her, I broke down, and I didn’t want to do that and upset her. It was just too much like Chris with all of the tubes going in and out.
She is however, bright and responsive and interacting with people. Apparently she is a great favourite of all the staff and students. The surgeon said to me that Jaime has totally reversed her opinion of corgis and that a number of the students are actually thinking about a corgi as a breed for themselves. Admittedly Jaime does very little to advance the cause of the “Lesser Corgi Society”.
Jaime is in a crib – just like a baby crib – with sides that slide down for access. She has the two pumps giving her pain meds, so she is in a “happy place”, but unfortunately is still leaking chyle into the chest, so the chest tube needs to stay in and suction until it stops. Hopefully that will be soon, as I don’t want to think about the alternatives.
The surgeon took me into a room and showed me all of the radiographs and the CT scan that were taken before and after the surgery. In the pre-surgery xrays you can see the lymph ducts going from her leg, along her spine, down to the thorax, and around the brisket area. On the post surgical xray there is a definite stop to the duct before it reaches the thorax where it was ligated, and the lymph nodes in the chest don’t show either, so the ligation was successful. The second part of the surgery after tying off the thoracic duct is to cut a small window in the pericardium (the sac surrounding the heart) to allow it to expand.
All we can do at this point is continue to pray that the chyle leakage stops as the lymph system creates new pathways for drainage and the pressure is relieved on the surgical site. I wish it had stopped immediately and she could come home, but if good wishes and lots of love can save her then hopefully she will be home soon.
Thank you to everyone who has sent her good wishes. Jaime can use the positive vibes.
Email #4 – Monday July 27
I had another visit with Jaime tonight at Guelph .
On the positive side the pneumothorax has healed and she is off the continuous suction. On the negative she is still draining chyle into the chest, however they are now draining it out every two hours and measuring the amount. It does seem to be slowing a little, and tonight she is starting on Rutin to see if that stops it.
Jaime is pretty well the darling of the ICU and getting lots of attention. She is going outside every two hours, and eating well and demanding belly rubs and pets. Apparently during quiet times they also tie up her drain so she doesn’t’ step on it and allow her free access to the ICU.
She was quite upset when I left tonight, and tried to climb out of her crib after me
We’re still on a day by day hope and prayer pattern. There was a rotation of doctors today and the new doctor is less positive about a favourable result than the previous one. I was insistent that if he didn’t believe she could recover, that he hand her case over to someone else. I’ve already had someone I love killed by a doctor who wrote him off without giving him a chance, I will not go through that again. He still insist the odds are ony 50/50 that this can be resolved, but he does agree she is fighting a good fight. He is starting her on the Rutin tonight and has a couple of other possibilities that can still be looked at.
Anyhow, I’m exhausted, and this is not the way to start a new week! Keep Jaime in your thoughts!
……and now for today’s update:
There is finally some positive news to report, we seem to have turned a corner.
On Monday the new surgeon was saying that he didn’t feel Jaime’s prognosis was very good at all. On Wednesday though, they aspirated a little less chyle from her chest (500 ml vs 600 ml). Yesterday they drained about half of what she was producing before (300 ml), and then after leaving her for 10 hours she had only produced 60 ml last night!!
There is now hope that she is going to get through this. Through it all she has maintained a wonderful, positive attitude and she wins everyone over that she meets. I don’t even think he realized he said it, but the surgeon was talking today about doing her spay “WHEN she gets through this”, not “IF” as he was a few days ago.
I spent an hour with her tonight in a visiting room and got these photos. This looks MUCH better than what I walked into a week ago. She has no I.V.’s or suction tubes, other than the one tube to drain her chest. The bad poodle cut really doesn’t do her justice though. The pictures aren’t great because its hard to sit on the floor and scratch the important places with one hand and use the Blackberry camera with the other! You can see from the first picture she does thoroughly get “into” a good chest scratch though 
One issue I am going to have hopefully soon though, is needing someone to babysit her during the day while I’m at work. If you know of anyone between Dundalk and Brampton who is knowledgable enough about dogs to recognize a problem starting, and can keep her quiet during the day please let me know!
In the meantime, thanks everyone for you continued prayers and good wishes – it does seem to be helping.
