The purpose of “Koji’s Story” is to create a community where owners of pets afflicted with Idiopathic Chylothorax can gather resources, collect information, search links, and communicate about this disease. It is run by two people who loved their Shiba Inu, Koji, very much. For more information on Koji, please read “Koji’s Story”.

Though we have personal experience and feel well versed on the subject of Idiopathic Chylothorax, we do not presume ourselves professional experts and urge you to speak with your veterinarian regarding treatment of this difficult disease.

We thank you for reading and wish you the best in your journeys ahead.

• Who Koji Was

The name “Koji” means “happy second son” and we named him this in memory of our late Pomeranian, a sweet orange puff named Charlie who had recently passed on. Paul and I were instant suckers for this little guy. Knowing that early socialization and obedience training has immensely positive effects on temperament, we began teaching Koji all we could.

He immediately showed signs that he was the “trouble maker” in his litter and after many chewed up heels, gnawed off dresser drawer handles, and shredded papers, he eventually became well disciplined and calm. That’s not to say he lost his spirit though. Koji was soon nicknamed “The Inspector” because he was forever supervising and inspecting whatever activity was going on in the house. Drying your hair? Koji was there to watch and learn. Playing a video game? A patient Koji sat next to you, intent on what the screen had to show. Koji was everything we had wanted in a dog, and more.

• Chylothorax Steps In

Around April of 2008, we started to notice that Koji was making odd noises. It would usually come in the evenings and to our ears, almost resembled the “I-want-a-treat-or-attention” whine he would sometimes do. We thought little of it and didn’t consider a vet visit necessary. However, within weeks it soon developed into labored breathing that would last all day. It almost seemed like he was gasping for breath, and we couldn’t explain why. We decided to take him to our local vet, never thinking it was more than allergies or that he had accidentally ingested something.

After many tests, overnight stays, and X-Rays, our vet recommended we see a specialist by the name of Dr. Adam Gassell at the Southern California Veterinary Specialty Hospital. Having Koji’s care in the hands of this incredible veterinarian was the best decision we could have ever made for Koji. He was straightforward, honest, never sugar coated his diagnosis, but still had a kind heart and we knew that he cared about Koji’s well-being more than his paycheck.

Dr. Gassell could see in chest X-Rays that Koji’s lungs were at almost half the capacity a healthy dog’s should be. He was literally gasping for breath because his lungs could only take in so much at a time. The doctor was afraid that Chyle- a milky liquid consisting of lymphs and fatty acids- was being leaked into his pleural (sort of like the chest) cavity. Not only was it preventing Koji from taking deep breaths, it was also creating scar tissue around his lungs, therefore preventing the necessary healing to ever get his lungs back to normal size. Hoping for the best, but expecting the worst, we eagerly awaited the test results.

After an initial Thoracentesis (pleural cavity tapping) was performed on Koji, Dr. Gassell confirmed that the liquid keeping his lungs from expanding was indeed Chyle (WARNING: Link is a test tube picture of actual Chyle taken from an animal). This lead him to the diagnosis of Idiopathic Chylothorax for Koji and his recommendation was surgery as soon as possible. That day, we took our little boy home and discussed what we were to do. The surgery was estimated at approximately $7000.00 and we were living on a tight budget as it was. On top of that, further Thoracentesis (sometimes weekly) would be needed after surgery and with the anesthetic included, was around $115 each time. It was a lot to consider. After a long talk, we decided to give Koji the best chance at survival we could and made plans to move forward with the procedure, knowing fully well how difficult this disease was to treat, even with surgery.

• The Surgery

In early May of 2008, Koji had his surgery and was able to come home with us soon after. The operation was meant to stop the Chyle from draining into his pleural cavity by performing a thoracic duct ligation and a Pericardectomy. Dr. Gassell was clear from the beginning that even with a successful surgery, Thoracentesis may be necessary to give relief to Koji’s lungs and to keep them from scarring even further. He also informed us early on about the low success rate for dogs that had undergone this invasive treatment. Though this procedure may have extended the life of past dogs by months, the Chylothorax typically caught up with the animal and took away their quality of life. In spite of these staggering odds, we knew Koji deserved a fighting chance and we were all prepared.

The first two months were truly a fight. Though Koji had come home to us, cone-head and all, he was no longer the active dog we remembered. Some days he would be excited just to go outside in the backyard. While others he would get winded just by walking down the hallway. It was always touch and go with his labored breathing and when it got really bad, when he’d have his “attacks”, we’d take him in for further tappings for instant -but never lasting- relief. His attacks were roughly 15 minute episodes in which he’d gasp for breath, his eyes would bulge out, his gums would turn pale, and his legs would swell and appear fat. We soon began documenting each attack and recording our observations to assess any patterns we noticed. To see some examples of these records, please read “Recording the Attacks”. We were instructed to get him on a low fat diet, as fatty dog foods only make the Chyle worse. A vitamin called Rutin was also recommended and we had read about its use in cats and dogs as a medical treatment of this disease.

Then suddenly, out of no where, it all stopped. His breathing became normal, his activity was mediocre but still lively and the attacks took a back seat. According to the treatment’s time-line, Koji was doing very well. We were told that roughly 2-3 months after the procedure we’d either see results, or we wouldn’t. These seemed like really good results to us! But this happy period was to only last 8 short weeks. Right after the 8th week, a very serious attack overtook Koji one night around 3 AM and another visit to the Irvine Regional Animal ER (Animal ER for short) was made.

• His Last Months

After that, things simply got worse. The attacks grew more and more frequent and became more aggressive. There were weeks where we’d take him in twice just to relieve the pressure in his chest. Each time we took him in, a kind staff member would look after him and he soon grew bonds with many of the technicians and vets that worked there. He never met an unhappy face in the clinic and we were so thankful for that. Especially considering these emergency visits were ALL within the hours of 2 and 5 AM, it was nice to hear a friendly voice and see a smile. In spite of it all, Koji’s friendly personality never wavered and the strength of his fighting spirit was apparent to all who met him. He was never fearful of the hospital and continuously had a wagging tail for each staff member who greeted him.

Mid October, one particular attack was so strong that he began throwing up white foam, his breath was so short we felt he was going to leave us then and there. We rushed him to the Animal ER for yet another Thoracentesis and afterwards a kind veterinarian gave us some difficult news. She shared that it was becoming more and more difficult to extract the Chyle from Koji due to scar tissue and he was becoming more and more stressed out each visit. She also showed us exactly how much they had extracted from his chest and though it may sound gross, a cereal bowl sized container filled with pink milky liquid was brought out to us. We could not believe that amount of fluid was flowing into his pleural cavity at such speed. We were basically being told to consider his quality of life. Was it fair to him to keep tapping his chest even though the relief was temporary? What kind of life was Koji experiencing, not being able to play, not being able to run without hardship? How much longer could we struggle to pay each visit? It was becoming abundantly clear that though the surgery extended his life, it was not successful in Koji’s case. His lungs could only hold out so much longer.

We thanked the vet for her honesty and care and left the office with heavier hearts than usual. It was then and there we vowed to spend every single minute we had left with Koji. For us, it wasn’t saying good-bye, but rather embracing his life and choosing to enjoy his days left with us. It wouldn’t have been fair to him to feel sorry for ourselves and wallow in our tears. He deserved parents that would spend quality time with him, simply enjoying one another’s company. And that’s just what we did.

It’s strange to still think of, but Koji’s last week with us was completely free of attacks or tappings- something that hadn’t happened in months. His energy level was high and he was eating full meals. We almost thought we had a miracle on our hands. Then, in the morning of October 25th (an almost perfect year since he came into our lives) Koji had his final attack. It was around 3 AM and I was sleeping for my early morning shift. Paul thought it was just another- nearly routine- attack and was trying to calm him down.  Koji came to find Paul at the computer and as he was stooping down to give him a little hug, Koji collapsed in his arms and stopped breathing. He rushed down the hall to our bedroom and awoke me with a shock. I almost felt I was dreaming until I saw Koji lying next to me, eyes squinted,mouth open, but not moving. As tears streamed down our faces, we felt two heartbeats from his chest and we said our last good-bye to our son.

Not a single day goes by that I don’t feel him in the house. His spirit lives on within our hearts and he deserved every single sleepless night, every single dollar spent, and every single happy day we were lucky enough to share with him. Thanks to Koji, I know the capacity in our hearts to love and to endure in the face of extreme circumstances. Though we miss him terribly, his memory will never die.

“Chylothorax is a condition in which a characteristic type of lymph fluid called chyle accumulates in the chest cavity and causes difficulty breathing. Lymph is the fluid that is drained from tissues and functions to carry protein and cells from the tissues to the bloodstream via small vessels, known as lymphatics. When the lymph is drained from the intestines, it contains a high quantity of fat and is known as chyle. Thus, Chylothorax is a collection of chyle in the chest cavity. The accumulation of chyle in the chest cavity leads to difficulty breathing because the lungs cannot expand normally to take in oxygen.

This condition may occur in any breed of dog, but some breeds appear to have a higher than expected incidence, including Afghan hounds and Shiba Inu dogs. Afghan dogs appear to develop signs related to this disease when they are middle-aged, whereas the Shiba Inu is often less than a year of age when the condition is diagnosed.”

Wow, what a mouth full, huh?

It is also important to note that the word “Idiopathic” in medical terms basically means of “unknown origin”.  So Idiopathic Chylothorax is not only difficult to treat, it is sometimes impossible to understand why it’s happening . This can be quite frustrating, but rather than focusing on the “Why is this happening?”, it was important for us when treating Koji to focus on “What can I do to help?”

For more information on what Koji’s surgery was like and what we did for him afterwards, please read “Treatment of Chylothorax” and “After Surgery”. (both blogs coming soon)