I have a 6 yr old pure black lab
~120 lbs, not over weight, just a big dog.

About 6 months ago, my mom took him for a walk around the neighborhood. IT was probably mid 90's, but our street has intermittent shade and a creek for him to cool off in. After the walk, he was acting confused. He was disoriented, walked into a corner and could not figure out how to get out. He could not walk up the 2 steps to our porch to come inside. He fell over and began shaking violently, foaming at the mouth, and was "running in place" while laying on his side. He could not be woken up. This only lasted 30 seconds or so. Afterwards he could not get up. We grabbed towels and alcohol to cool him off, and after a half hour or so, he got up and was back to normal.

Fast forward to about a week ago, he was outside playing (retrieving). He is a duck dog and we practice with bouy's or frozen ducks. This day it was just bouys. The temp was ~40 and he was only outside running for 10 minutes or so. When he does run though, he is 100% all the time. He will exercise until he has nothing left and cannot run any more.

This particular day, we came back inside before he over-exerted himself. He went up stairs and laid on the bed. A few minutes later he walked back into the room very slowly, acting confused and without purpose. His breathing was very rapid and his tongue un-naturally far out. He walked down the hall and went into another seizure. He lost control of his bladder, went for another "run in place" and was foaming at the mouth with his jaws locked shut. He had 3 more seizures about 10 minutes apart as we tried to calm him down, cool him off, ect. Finally we took him to the hospital.

They administered something (vikaden?) to knock him out to stop the seizing. They also put him on a IV, took blood tests, ect. He was out of it for about 8 hours after this (came home on a stretcher, couldn't get up to pee, just slept basically. Finally he just stood up, walked around slowly for about 5 minutes, and then went back to normal. He has been perfectly normal ever since.

The blood work has come back and this is what the vet sent me:

Quote :

" Interpretation of Rascal's labwork as it relates to causes of seizures secondary to low Glucose: Not Addison's disease because the Potassium is low, not high. Not liver diease because the ALP, ALT, GGTP and Total Bilirubin are normal. Questionable values - Unknown why the Phosphorus and Potassium are low. There are some human medications that can lower Phosphorus and Potassium, but Chris said that Rascal has not gotten into anything like that. Unknown why the Globulins are so high - Globulins are antibodies, which whould make you think about severe infection, but the White Blood Cell count does not support that. There is a cancer called Multiple Myeloma that can cause high Globulins, but usually those animals are also older and usually have a "bone mass" of some sort that can be found on physical exam. Next, the last bloodwork has come in: Insulin level 196.4 (normal 5-20) Glucose 41 (normal 70-138) For the insulin level to be that (inappropriately) high, this means that there is a tumor somewhere in Rascal's body that is secreting Insulin abnormally. (The insulin level is supposed to drop once the Blood Glucose gets below 80.) Hepatomas are tumors in the liver that sometimes can secrete insulin. Although not as commonly as insulinomas, it would be a better prognosis, because you can surgically remove a hepatoma for a potential cure. Insulinomas are a rare tumor in the pancreas, but are usually in older (8-12y) dogs. Insulinomas are highly metastatic, meaning they spread to other places/organs. But this is the most common tumor that causes low glucose and high insulin. I agree with the Leesvillle doctor, Rascal needs an ultrasound. If they find a lump anywhere, have them aspirate it if they can to get cell samples before surgery. If there is one lump in the liver (possible hepatoma), I would definitely pursue surgery because you have a better chance for a cure. If there is a single lump in the pancreas (insulinoma), then you have to weigh the cost of surgery with the potential that it has already spread to other places. If you do pursue surgery, then watch the glucose carefully after surgery. If it stays low, then there are other microscopic insulinomas still secreting insuin. If the ultrasound reveals multiple masses already, I would pursue medical treatment, which includes Prednisone thereapy to lower the insulin. You could also discuss with an Oncologist if there are chemotherapies available. I would recommend that you get the ultrasound at the Veterinary Specialty Hospital - they are a referral facility (I have no vested interest) that has board certified veterinary specialists. So, that the continuity of care would be greater if the ultrasonographer finds a tumor, the internist/surgeon/oncologist can be right there to make recommendations on the best coarse of action. I have already been speaking with (and sending copies of the bloodwork) Dr. Jim Hummel at VSH in Cary 233-4911 (Tyron Rd & Cary Pkwy). But you could go to the satelite VSH North 861-0109 on Capital Blvd (near 540) as well. The exam/evaluation with the Internist is $120 and the ultrasound is $380. The referral has already been made, all you have to do is call either VSH-Cary or VSH-North and schedule an appointment. If you have Leesville do the ultrasound, ask if they are calling in a Board Certified Veterinary Ultrasonographer. Then ask them to forward the ultrasound results to one of the referral centers. In the mean time, I would feed Rascal multiple meals a day, so that he doesn't have such a wide swing in his blood glucose (high after a meal and then low for several hours.) Example, 4 meals a day..... you do not have to feed him a larger quantity throughout the day, just divide his meals so that he has some glucose in his system all day long. You may also limit his play time..... don't encourage more than 5-10 minutes of play at a time and give plenty of treats during and after playtime. He can play multiple times a day if he has breaks and treats to restore his glucose. "

Do you feel this is a accurate daignosis/prognosis?
Should I continue on this route and get a ultrasound?
Can anyone at NCSU vet school hook me up and get me in there?

any other thoughts/advice?

thanks in advance!

1/14/2010 12:03:20 PM

1/14/2010 12:35:43 PM

Your point is what??

no vets on here?
nobody will take me seriously?
someone else has had a similar situation?

i am well aware of where the search button is, thanks!

did you even read my post?

1/14/2010 12:49:24 PM

i can proudly say i aint read all that shit


tl;dr

1/14/2010 12:53:10 PM

Yeah based on that blood work it seems reasonable, my mom has had 2 labs develop tumors early (none that affected insulin/glucose) out of the 5 or so she showed. There's a fair amount of material about dog tumors, see if you can compare early blood work of confirmed hepatomas/insulinomas and if they are similar to yours. At 6, an ultrasound where they are looking for tumors is a great next step as it is a common problem and early detection is key.

1/14/2010 1:09:00 PM

http://www.cvm.ncsu.edu/vth/clinical_services/onco/appointments.html

1/14/2010 1:15:17 PM

your vet can get you a referral to the CVM the same way he could refer you to VSH.

1/14/2010 1:18:45 PM

Sorry to hear about your dog man, I hope you find the problem.

Also, that's gonna cost $TX, eeeek

1/14/2010 1:30:36 PM

my dog had a benign hepatoma, although it had nothing to do with glucose levels iirc. she was 9 years old. it did not end well. here's the thread if you think you can handle reading it. it might be tough to do in your current situation.

message_topic.aspx?topic=460197

summary: dog had large tumor in her liver. vet school did surgery to remove it. dog couldn't clot, vet school didn't know til after the surgery. dog basically bled out internally a day or so after surgery. horrible horrible experience. she may have lived another couple months or years had we not done anything, but she had been in pain for a while and we had no idea.

just for reference, my mom spent just over $10,000 at the vet school. bailey was there for 3-4 days.

each case like this is very dependent on the particulars of the tumor, its location, etc. livers are really bad about bleeding. not know your dog, but if he was mine, i'd ask the vets (multiple ones) if he was in pain, can the seizures cause any damage, will this kill him, etc. i would try everything else before surgery. i was very traumatized by what happened to our dog, so i'm biased.

good luck with your dog. i wouldn't wish what we went through on anybody.

[Edited on January 14, 2010 at 1:46 PM. Reason : ]

1/14/2010 1:44:50 PM

Taking him to the vet school would cost a disgusting amount of money.

1/14/2010 2:30:31 PM

I think insulinoma is a very reasonable diagnosis. There aren't a lot of things that cause sustained elevated insulin levels in the face of low glucose. Other concerns would be Addison's (which the bloodwork ruled-out) and a hepatoma (but the liver enzymes aren't elevated and it's probably functioning well enough since golbulins are high).

Your pancreas secretes insulin in the face of high glucose levels, usually after a meal, to sequester glucose as glycogen. High glucose=high insulin, low glucose=low insulin. Your pup has high insulin levels regardless, so he's sequestering any and all residual glucose which is why after high physical exertion (lots of glucose/energy depletion) there's nothing left to support adequate brain function resulting in the seizures. This seems to happen only after being active because your dog's body has been able to adapt to the hypoglycemia to maintain normal everyday function, but the activity causes this fine threshold to be crossed.

An insulinoma affects the insulin producing cells of your pancreas, causing them to not turn off properly. It usually affects animals older than 8y, there's a predisposition for retrievers and larger breed dogs. At diagnosis nearly 80% are malignant and 50% have metastasized. This means check nearby lymph nodes...and it will be important to do chest and abdominal x-rays to looks for metastatic masses.

So an ultrasound would be an excellent first step. A good ultrasonographer will be able to identify a mass in the pancreas if it exists and will also be able to ID metastasis in the abdominal cavity if it exists as well. But one issue with insulinomas is that they are fairly small and easy to miss, so don't mess around with price, you want someone proficient at finding these things. CT scan is better, it's much more difficult to miss on CT and you can tell if there is vascular involvement as well as a more accurate few of surrounding lymph nodes, but the price is higher.

From here...Rascal will have to have surgery to remove the tumor entirely if possible, or remove as much of it as they can as well as any metastases. The best prognosis comes with surgical therapy combined with medical therapy. So this will involve feeding a high fiber, low carb diet, frequently. You're trying to avoid an insulin spike which comes when you get extreme changes in glucose levels. Also, glucocorticoid therapy will probably be started (prednisone) as it antagonizes insulin, hopefully keeping levels low. There is chemotherapy available that you can talk more about with the specialist. You'll also likely be asked to come back every 1-3 months for glucose checks to make sure his levels are being maintained.

I know it sounds like a lot, but it's a treatable condition. And although it comes with a guarded prognosis, the quality of life for Rascal can be maintained with treatment for a decent period of time! But it is worth further investigating more diagnostics (ultrasound) to at least rule insulinoma in or out as it can be a significant cause of Rascal's current condition.

1/16/2010 1:01:07 PM

Thanks for the responses. You guys were quite on target, which is very impressive!

Went to the VSH on friday, but the prognosis wasnt very good.

Blood glucose was 51
The ultrasound found
1. Liver nodgules, possibly malignant/metastatic
2. benign prostatic hyperplasia
- noticed in different liver areas are hypoechoric nodules with hyperechoic rims and hyperechoic internal features. the largest of these well-marginated lesions (6 or 7 noted) is 1.43 cm and the smallest is .81 cm. leaisons of this appearance are sometimes malignant/metastatic, of endocrine origin.

problem list:
1. insulinoma with suspected metastatic hepatic spread
2. heart murmur

bottom line;
Prognosis with non-resectable insulinomas, which is likely in rascals case, is less than 1 year with medical therapy.


Prednisone 10mg. 1.5 tablets twice daily by mouth..

I have a very sick dog apparently.. This sucks. He will be 6 in march.

Thanks guys.

1/16/2010 8:46:47 PM

Sorry Buddy. Definitely not a diagnosis you want to have to deal with in such a young dog

But truly enjoy the time you have with him he'll remain pretty healthy and happy for several months on the prednisone.

1/17/2010 1:34:33 AM