Veterinary costs appeal – Tiggy
Tiggy
Pug, Age 2
Tigger, now Tiggy came into Holly Hedge with numerous health issues despite being only six months old; a congenital liver shunt, breathing difficulties, regurgitating food with bouts of sickness and episodes of passing out.
Diagnosed by our vet with BOAS, Tiggy also needed an exploratory laparotomy due to suspected hiatal hernia which was confirmed. Once fully recovered from her BOAS surgery she went to a soft tissue specialist for the complex portosystemic shunt operation, hiatal hernia repair and spay.
With hospitalisation, aftercare and medication the total cost was a staggering £11,126.
Tiggy has now been adopted and is absolutely doted on by her new owner.
Read some of Tiggy’s extensive veterinary history notes below
History
Came into Holly Hedge as a home from home adoption – owner couldn’t afford the ongoing medical treatment. She came to us with a liver shunt and on a vegan diet as meat protein was poisoning her blood.
Veterinary Notes
Tigger came in to Holly Hedge vet for bloods but will need to go to the practice as they need to do them 2 hours apart for a bile test.
Scan booked at Specialist. Scan determined that she needs a flo-oscopy (hernia repair to help with her gastro issue), she will have the op after xmas. Liver shunt op needed also and will do before goes to a new home.
Post op check – had been doing well until today eating and drinking and quite bright occasional retch. Today looked to eat but then decided not to, normally likes her food. No vomiting but possibly some regurgitation and swallowed it. Physical Exam: mucous membranes moist, lungs sound clear bilaterally – unable to examine pharynx conscious obviously. In the next day or 2 may need sedation to check pharynx. Already on ab as aspirated on recovery from general aneasthetic. startgabapentin in case any discomfort.
February 2023
Tigger went to specialist for hiatal hernia repair, liver shunt and spay on 28th February 2023. One week later Tigger was re-admitted to specialist after deterioration in her condition.
Further follow up, Good improvement seen so far with Tigger’s post surgical symptoms. Re-see in 2 weeks to assess further.
Six week post op check at specialist after an elective attenuation of extrahepatic (porto-caval) portosystemic shunt (Liver shunt) and surgical correction of hiatal hernia.
Substantial improvement since her last appointment, Tigger remains on medication – Levitracetam, AMC, Omeprazole and Lactulose oral medication as well as a low-protein diet.
Tigger presented as bright, alert, responsive and fully compensated. Surgical wound has healed completely.
Next step, apt at practice for biochemical blood panel (with particular attention to liver parameters) starved including bile acid levels, then post meal, repeated bile acid stim test.
Haematology is also recommended. Results will then indicate next steps in medication regime
March 2023
History / Examination:
Tigger re-presented to the Vale Referrals Animal Hospital about 6 weeks an elective surgical
attenuation of extrahepatic portosystemic shunt and surgical correction of hiatal hernia.
Diagnosis:
Status post operation (congenital extrahepatic portosystemic shunt, sliding hiatal hernia, 28.2. 2023).
Treatment plan:
Complete biochemical blood panel (with special attention to liver parameters) should be done pre-prandial (when starved) including bile acid levels, and then post-prandial (after meal) repeated bile acid levels for comparison. Haematology profile is also recommended.
Instructions:
Future long-term plan will be specified based on blood results.
Diet: She can go back to low-protein, low-fat diet for the time being.
Medication:
As before, till blood results are evaluated.
Re-examination with referring veterinarian:
The owner should make an appointment to arrange for above mentioned blood examination.
Tigger was seen today for repeat blood sampling to assess liver function. She is much brighter (and wigglier!) since the operation.
I have forwarded the blood results to specialist and received this reply, The plan will be adjusted based on these results because she is doing well; it might look as follows:
First week: STOP Antibiotics
Second week: STOP Levetiracetam (if doing well)
Third week: STOP Lactulose (If doing well)
Fourth week: Increase protein in the diet (if tolerating to be off medication)
This protocol will require constant, careful patient monitoring. In addition, re-introducing the drug might be required in case of deterioration. So if all goes well we can stop all medication in 4 weeks time and see response to a more normal dog food diet. But if any return of neurological signs, restart the last medication that was stopped and book back in for a review of liver values.
May 2023
Ears better but still significant otitis, sore ear flaps and discharge present in canals. Add cleaner and clean bid before applying 0.5ml surolan at least another 7days. Has dermatitis, scabs and scurf on dorsum around head and tail base mainly. Not especially bothering dog. Advised malaseb baths twice weekly. May need anti-biotics/steroids/investigations in due course but try without first. Likely allergies.
Meds dispensed:
Bottle of Malaseb. Bottle of Epiotic. Bottle of Surolan. 3 x Omeprazole 10mg boxes (28) dispensed
Re-check ears – all fine stop meds. Generally doing really well.
:
Tigger is a pug who was rescued when she was a puppy. Unfortunately, she was diagnosed with BOAS
(Brachycephalic Obstructive Airway Syndrome) with concurrent sliding hiatal hernia and
CEPSS (Congenital Extrahepatic Portosystemic Shunt) with secondary micro hepatica last year.
Tigger underwent surgery on 28th of February 2023 which included application of ameroid constrictor (3.5mm) around the shunting vessel (to provide gradual occlusion of the vessel and restoring blood supply to the liver left-sided gastropexy) and a liver biopsy sample was taken. Tigger was spayed (ovariectomy) at the time of the surgery. Tigger recovered well from the surgery and was discharged on 2nd of March 2023 following a good recovery.
Sadly she was struggling to eat at home, and was not taking her oral medication well and she gradually deteriorated in her demeanour. She represented on 4th of March in the morning as an emergency because of her abnormal behaviour (disoriented, circling, bumping into walls, generalised weakness with collapsing and splaying legs, facial twitching and compulsive behaviour); however no paroxysmal activity was seen. Tigger was hospitalised and stabilised with retention enema (lactulose), intravenous fluid therapy and intravenous medication (midazolam, antibiotics, pain relief, omeprazole) and she was started on levetiracetam. Her blood glucose was normal on admission and an inhouse blood test revealed ammonia within normal limits. An abdominal ultrasound was also repeated and was considered unremarkable. Tigger made substantial improvement whilst in the hospital and was discharged on the 7th of March. No seizure-like activity was observed over the hospitalisation but a rectal diazepam was prescribed for a case of an emergency.
Tigger was re-examined at specialist today (Thursday, 16th of March 2023) and significant improvement was reported. She is more playful and bright, alert at home, however her mentation remains abnormal (lost learned behaviour and training, episodes of being subdued, struggling to comprehend food etc). No compulsive behaviour, circling and weakness is observed anymore but she shakes her body a lot and is hesitant to be stroked on her head. Her appetite was reported to be good (back to normal). No vomiting or regurgitation was seen since the surgery but episodes of suspected melena (digested blood in her stools) were reported. No other concerns were raised.
Clinical examination:
On presentation, Tigger was bright, alert and responsive (playful in the consult and interested in the environment). Her vital parameters were within normal limits. Nothing abnormal was detected on her thoracic auscultation. Abdominal palpation was unremarkable, and her wound has healed to full extent. A soft yellow/orange stool was present within the rectum, no evidence of mucus or blood. A generalised muscle wastage was observed. No discomfort was elicit on spinal palpation, she had normal range of motion of her neck and her head/oral exam was unremarkable.
Her body weight was: 6.2kg today.
Her neurological exam remains abnormal but gradual improvement is observed. Her hesitation to be touched on her head is associated with her PSS (Portosystemic shunt) diagnosis.