The $10,000 Dog

A challenging diagnosis and the benefit of an owner with pet insurance.

Fig. 1: After a median sternotomy, Shelby’s lungs were evaluated and a bleb was seen in the caudal dorsel left lung.

Courtesy of Veterinary Pet Insurance

When Christine Gowen took her 7-year-old Labrador retriever, Shelby, to the veterinarian for a cough in January 2010, she could not have been less prepared for the eventual outcome.

 After an initial diagnosis of kennel cough, a few days on medication and several follow-up calls to the veterinary hospital, alarm bells started going off all the way around. Gowen, an employee of Veterinary Pet Insurance Co. (VPI) in Brea, Calif., has seen many examples of veterinary medical issues that were more serious than they originally appeared, so she and her family were concerned.

The veterinarian took some radiographs, and the journey to the $10,000 medical bill began.

Shelby presented with no history of trauma or cardiac/respiratory disease, had not been to the dog park, boarding kennel or groomer recently, and appeared to have a normal appetite and energy level. Her owner indicated that she was breathing oddly, taking deep, slow breaths, and was coughing occasionally. The exam was relatively unremarkable, although her respiratory rate and heart rate were elevated at 28 and 90, respectively.

Diagnosis

Shelby was re-presented on emergency a week later. She was in obvious respiratory distress, was tachypneic and had decreased lung sounds on the right side.

Radiographs revealed a moderate amount of free air in the chest cavity, more significant on the right side than the left. No other pathology was identified. Initial diagnosis: spontaneous pneumothorax.

While traumatic pneumothorax is relatively common in dogs, spontaneous pneumothorax is relatively rare1. Shelby was provided torbutrol, her chest was tapped, removing about 1385 cc of air from the chest cavity, and she was placed on oxygen and kept for overnight monitoring.

The following evening, Shelby appeared to be doing well, but recheck radiographs revealed a significant amount of air present in the pleural space. An additional 1120 cc of air was removed from Shelby’s chest and she was kept for an additional night of rest and monitoring. Oxygen therapy was discontinued.

The next morning, Shelby went home with strict orders that she rest and that her owner monitor her breathing.

Treatment

By that afternoon, Shelby was unable to lie down, was having difficulty breathing, and was taken to the emergency hospital.

Quick Tip
Don’t miss the signs of spontaneous pneumothorax in a dog with no history of trauma and no underlying pathology.(Percentage represents the cases presenting with the following clinical symptoms.)

Dyspnea (70%)
Anorexia (42%)
Tachypnea (22%)
Cough (20%)
Vomiting (17%)

A chest tube was placed and she received a CT scan which identified a pulmonary bleb on the dorsal aspect of the left caudal lung lobe. Surgical intervention was recommended. After a median sternotomy, Shelby’s lungs were evaluated and an obvious bleb was seen in the caudal dorsal left lung (Figure 1). The lung was resected, all lung tissue was checked for leaks, a chest tube was placed and the chest was closed. Shelby happened to have a couple of additional soft tissue masses (later diagnosed as mast cell tumors) that were also excised and biopsied.

Treatment Debate

There is debate as to when surgical intervention should be considered in cases of spontaneous pneumothorax, but in a retrospective study of 64 cases between 1986 and 1991, both the recurrence rate (3 percent) and the mortality rate (12 percent) were significantly lower for dogs treated with surgery than the recurrence rate (50 percent) and the mortality rate (54 percent) than those treated medically alone.

In that same study, a definitive lesion was found in 34 of the 36 dogs that were treated with surgical intervention with the presence of bulla as the most common finding. As seen in Figure 1, a bulla was also the cause of Shelby’s pneumothorax.

Happy Endings

This story has a happy ending. After a five-day stay at the specialty hospital, Shelby returned home and eventually recovered fully. 

Post-surgery
Shelby, a 7-year-old Labrador, recovered fully from spontaneous pneumonothorax. Courtesy of VPI

So how does pet insurance fit in? Gowen wrote about her dog’s case after it happened.

“The thought of your beloved pet undergoing open chest surgery is alarming,” she wrote. “To top it off, the veterinarian looked me and my husband squarely in the eyes and told us that it would likely cost $10,000 to save Shelby’s life. Should we proceed? I didn’t have to think twice about that. Not because I had banked a spare $10K, but because Shelby had a VPI policy since she was 3 months old. I knew that we’d be reimbursed for a portion of the surgery, and I knew my healthy and active 7-year-old dog had the quality of life to justify saving her.”

Ultimately, Shelby’s bills for her pneumothorax and additional mast cell tumor removal totaled $11,778, of which the Gowens were reimbursed $8,091.

An affordable premium is important to pet owners. In this case, the monthly premium for Shelby was $41 per month (plus an optional $12 per month for wellness coverage).

Pet insurance helps pet owners like Gowen make the best health care decisions based on their pets’ needs and their veterinarian’s recommendation, rather than on the cost of treatment.

The veterinary field can play an important role in helping pet owners be better educated on ways to safeguard their finances in regard to caring for their pets, especially in the current economic climate.

Whether it is through a policy with VPI, a health care credit account or a combination of the two, financial preparation is key to making optimal health decision for any pet, not just the $10,000 dog.

Dr. Young is director of professional services at Veterinary Pet Insurance Co. and sits on the Board of Directors of the American Association of Corporate and Public Practicing Veterinarians. She earned her DVM degree at The Ohio State University.

This Education Series article was underwritten by Veterinary Pet Insurance of Brea, Calif.

REFERENCES
1. Puerto, David A, Brockman, Daniel J., Lindquist, Christopher, Drobatz, Kenneth. Surgical and nonsurgical management of and selected risk factors for spontaneous pneumothorax in dogs: 64 cases (1986-1999). JAVMA, Vol 220, No. 11, June 1, 2002. Pgs 1670-1674.

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