Page 2 - RVC Clinical Connections - Summer 2025

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Despite these risks, surgery was Milo attended his local practice a fortnight
recommended due to an expected improved after surgery for evaluation of his surgical
prognosis compared to long term medical wound. He then returned to the RVC to be
management. As such, Milo’s owner wished re-examined by the Soft Tissue Surgery
to proceed with surgery. team in mid-April for routine reassessment.
Milo underwent general anaesthesia Milo had continued his excellent recovery
for attenuation of the extrahepatic with no signs of concern.
portosystemic shunt and castration. Milo He underwent a repeat bile-acid
would not tolerate full attenuation of the stimulation test to evaluate his liver
shunting vessel, documented by increased function. This had been markedly abnormal
portal pressure. As such, a cellophane band preoperatively and if persistently abnormal,
was placed around the shunting vessel to Milo may have needed to undergo repeat
achieve partial attenuation, which was well surgery to further attenuate the shunting
tolerated. vessel. Pleasingly, his postoperative result
The intention of this surgery is to allow was completely normal. With this result,
scar tissue to slowly form around the combined with Milo’s perfect recovery, we
attenuation, resulting in gradual closure of were content that Milo’s liver function had
the shunt, increasing blood flow to the liver recovered.
and encouraging normal development of the This condition can affect every patient
liver. differently, depending on the location Milo fully recovered back at home
and size of the shunting vessel. Milo was
severely affected by his shunt, requiring Update from the owner
emergency stabilisation for severe “When I first got Milo, he wasn’t very playful,
neurological signs. The severity of Milo’s which I initially put down to his personality.
condition preoperatively, increased the But he had little appetite, dribbled after
risks for him to undergo surgery, despite eating, was very clingy, and lethargic. He
stabilisation. also had sneezing fits, small spasms, and
Although, long term medical management occasional accidents. Our local vet couldn’t
was an option for Milo, this manages his find anything obviously wrong, though Milo
clinical signs only as opposed to correcting remained underweight and wasn’t growing.
the shunting vessel – and generally gives a One night, he began losing control of his
poorer prognosis for patients, with a shorter back legs and walking into walls. We rushed
life expectancy. him to the vet, and he was referred to the
Due to the severity of Milo’s neurological RVC, where tests confirmed he had a liver
signs, the risk of developing PANS, which shunt.
can lead to blindness, seizures and death, “After surgery and a special diet, the
was high. Milo’s owners had been fully change in Milo was immediate. His coat
prepared that there was a high chance that became softer, he grew more independent,
Milo could develop this postoperatively. started eating well, and became energetic.
Therefore, for Milo to beat the odds and sail His weight doubled, and follow-up blood
through the surgery and recovery with no tests were outstanding. He’s now off all
cause for concern was absolutely fantastic meds, back on normal food, and living a
– and he will now live life as a happy, healthy happy, playful life with his buddy Gizmo.
Milo at the RVC
cat. “I can’t thank the RVC and the vets
enough. They explained every step,
Recovery treated Milo with such care, and supported
Milo successfully recovered from the me throughout. Grace, in particular, was
surgery and was hospitalised for five amazing – her compassion and personal
days postoperatively to monitor him touch meant everything. Thanks to her and
closely for any signs of PANS. Somewhat the whole team, Milo is not just surviving –
unexpectantly, he recovered extremely well, he’s thriving!”
with no signs of concern. He was eating,
bright, comfortable and neurologically
normal, so was discharged to continue
medical management, a low protein diet and
strict rest while he continued to recover from
surgery. Milo post-surgery For small animal referrals, please call:
01707 666399
Email:
qmhreception@rvc.ac.uk

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2 Summer 2025