How Can You Mend a Broken Heart?

Mexiletine -- 7:30 A.M.

Lasix, Enalapril, Pimobendan, Sotatol -- 8:00 A.M.

Mexiletine -- 3:30 A.M.

Lasix, Enalapril, Pimobendan, Sotatol -- 8:00 P.M.

Mexiletine -- 11:30 A.M.

This is Hamilton's and our regimen for at least the next 30 days. His diagnosis is congestive heart failure due to underlying heart disease or dilated cardiomyopathy. The Mexiletine and Sotalol regulates his heart rhythm. The Enalaprin and Lasix help with his fluid retention and kidney function. The Pimobendan is a new drug which in trials has improved the pumping strength of damaged hearts from heart disease.

The key to Hamilton's long term survival is his body's ability to stave off the side effects of the drugs, which primarily are kidney failure, and his heart's ability to regain its muscular strength to avoid fluid congestion in his lungs.

The weakening of the heart is the primary killer of dogs predisposed to cardiomyopathy. It is so lethal in some breeds, such as Doberman Pinschers, that death is often only 30 days after diagnosis. Pimobendan is a promising drug just approved by the FDA in 2006 for dogs. In trials it has extended the life of Dobermans over a year.

Hamilton responded to the drugs well in the hospital where they were given to him at first intravenously and then in pill form. At home we at first had a hard time giving him his pills. We tried pill pockets and hiding the pills in his food. He either spit out the pills or ate around them. Worse, he began to associate certain foods with the medicine and refused to eat. We finally steeled ourselves and began to place the pills in whole form down his throat. This required us to keep opening his mouth to be sure that he swallowed them. He has a long muzzle and tongue and it is easy to lose sight of the pill as it sits in the back of his throat. He can use his tongue to either work the pill back out or to hide it inside his jaw.

Although he intensely dislikes taking the medicine he explicitly trusts us and does not show any aggression when we pry open his mouth and place our hands down his throat. He sits as we command and swallows his medicine with some encouragement from us.

Once we got our wits back, and remembered that the carrot always works better with dogs than the stick, we began to give him a reward after he successfully took his medicine. It would be an exaggeration to say that he looks forward to taking his medicine but he eagerly pops up after the ordeal is over, tail wagging, walking behind us into the kitchen where he knows he'll receive a dry beef liver or other favorite delicacy.

When we took him for an exam after his first week at home on the medicine he failed his electrocardiogram. His cardiologist, Dr. Boileau, determined that the dosage of his medicine for the heart arrhythmia needed adjustment. He wanted to stay with the Sotalol and Mexiletine because they had the best prospects for not causing kidney complications. He prescribed a 100 mg increase in the Mexiletine. Hamilton had to stay in the hospital for another two days to get readjusted to the new medicine regimen.

We took him home that Friday and he seemed happy and doing well. We gave him his 11:30 P.M. Mexiletine pill and my wife went to bed. I was too wound up so I stayed up and read. About an hour later I heard Hamilton whimpering at the foot of the bed. He was on the floor. The cedar chest at the foot of the bed blocked my view. At first I thought he was dreaming. He often moves and makes noise when he is in rem sleep.

To be safe I got out of bed and stood by him. He was on his side and his eyes were open. I laid on the floor beside him and petted him. He began to move, at first gently, then violently, jerking himself back and forth. I held his back and tried to pull him up. He could not get his legs underneath himself. He was wiggling on the floor like a fish desperate for water.

I yelled for my wife to wake up. Hamilton was dying.

I threw on some clothes, called the animal hospital and hurried down to the lobby of our building to get the luggage cart. Hamilton is 65 pounds and would be impossible to carry if he was squirming and shaking. I asked our night concierge, William Carney, to help me get Hamilton on the cart. William is the type of person you would want to have your back in a dark alley. Solid and sullen there was a reason he worked the night shift.

My wife had dressed. William followed me into the bedroom and took Hamilton in his arms and carried him out. The jerky movements had stopped but Hamilton was paralyzed and his eyes were wide open trying vainly to understand what was happening to him.

In a stroke of luck, it being a Friday night, I had been able to park in front of our building, so I didn't have to waste fifteen minutes getting the car from the garage several blocks away. Bill placed Hamilton on my wife's lap in the the back seat, and I sped off. It was 1 A.M. and pouring rain. This being New York, neither the time nor the weather kept people from clogging the streets. There were no police directing traffic so each intersection was anarchy, with cars blocking the intersection, as if life or death was at stake for the drivers to get to their restaurant or club or home or wherever, while Hamilton's literally was slipping away on my wife's lap.

She pleaded with him to hold on. He was still but his eyes were open and frightened and his breath was short and rapid. I cursed and sped through stop lights when I could. I drove as fast as possible on the wet streets, frightened that the car would spin out of control. His 24-hour Emergency Hospital was in Chelsea, three miles from our apartment in the Financial District. I had told them my fears and that we were bringing him in as soon as possible.

I kept expecting my wife to tell me to slow down. He was gone. I looked in the rear view mirror as often as I safely could to see his face. Finally I pulled up to the hospital and we carried Hamilton to the door. It was locked. I pushed the buzzer. No one came. I pushed it again. A nurse cautiously came to the inside door. Wet and leaden I felt Hamilton slipping from my grip. She buzzed us inside.

I explained Hamilton could not walk. My wife sped through his medical history. A doctor had arrived and had heard what she had said. The doctor said to place Hamilton on the floor. He splayed out like Bambi on the icy pond. He squirmed and whimpered. We pulled him to the intensive care unit elevator. The elevator lowered him down. We sat in the lobby and waited.

The doctor returned in a half hour. She said the problem seemed to be resolving itself. He was walking in ICU, albeit wobbly. She suspected he may have suffered a series of small strokes, not uncommon she said with his form of heart disease. The next 24 hours would tell us what the prognosis would be. She said the good news was that his heartbeat was good.

We debated staying at the hospital. The doctor discouraged us, saying they would be sedating him. We sullenly went home. Exhausted, we fell asleep. When I awoke I realized it was nearly 6 A.M. and we had not received a call from the hospital. I took solace in that.

We received the diagnosis that afternoon. Hamilton had suffered a neurological episode. It was a side effect from the increased dosage of the Mexiletine. He hadn't had a stroke after all. Dr. Boileau was going to adjust the arrhythmia medicine, shifting the additional dosage weight to the Sotalol and reducing the Mexiletine to its previous amount. Hamilton could come home on Sunday. Friday night was just part of the healing process.