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Dog in crisis, looking for ideas

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  • Dog in crisis, looking for ideas

    Firstly, THIS DOG IS IN ICU.

    Secondly, it's not my dog--I'm just trying to get some ideas for a friend.

    The dog is a spayed teenaged Golden Retriever.

    Here's what I have from the owner:

    Thursday I took her to the vet and she had a growth removed from her foot – they cut and cauterized. She was very strong and difficult to hold down, hence why I am so baffle that Saturday night things changed so quickly.

    I could not get her to go outside before bedtime. I thought she was just being stubborn so I got her leash and decided to take her for a walk. She did got up and proceeded to go for her walk, however, she was moving very slowly. We got two houses down and she went laid down in the neighbor’s lawn and would not get up. I loaded her in my vehicle and my nightmare began. Her blood sugar was at 47. She was not walking because she was so week. She had an elevated temperature of 104 and no signs of infection. She took a turn for the worse at about 3:30a and would not even lift her head.

    Her blood workup is good except for her glucose levels. There were a few that were a little off the mark but not concerning. She has had chest x-rays, adnominal x-rays, and on a drip – antibiotics, pain medicine and dextroxe. She has been on a drip since about 1:00am on Saturday and finally as of last night she her blood glucose rose to 65. She sat up yesterday afternoon and even tried to get up to go home but she is still too weak. At that time her glucose was only 56. (the nice increase happened between 4 – 7p last night). They are upping her dextroxe.

    They feel that she has a tumor that attacks insulin. It is possible it is not showing in the x-ray but will show in the ultra sound. If they do not find anything, is there any diseases that you are familiar with that would attack her blood sugar like this? Her temperature is back down to the high side of normal. The other weird thing is her mouth seems to be tender or else it is itching her. When she was not responsive and could not sit up (Saturday morning), if I touched her around her mouth she would paw my had away. Then yesterday she kept pawing at her mouth. I have had them check it 3x for abscess, bite, etc. Nothing has been found.

    I realize I may have to make a difficult decision today as I do not want her to suffer, but if they can’t tell me what is wrong I feel there is still hope. Unfortunately I am not at my regular vets as I had to take her to the emergency center. They seem to be really good and I don’t feel my dog’s history will shed any light. I had a full blood work done about six months ago since she was aging and everything was fine.
    Does anyone have any ideas?
  • Original Poster

    This is my best guess: http://www.vsso.org/Pancreatic_Insulinoma.html

    The emergency vet does not have the dog on glucagon or diazoxide. Results from the belly ultrasound should be forthcoming shortly.


    • #3
      Isn't low blood sugar from too much insulin? I'm sorry to hear about your friend's dog, we've got a diabetic dog on 2x daily insulin and a restricted diet. Dog also has thyroid issues and is on steroids. He's running around like a 3 year old as as long as he's still happy, we're happy to keep him on them.

      I beleive the thyroid is what triggerred his low blood sugar stroke incident, that may be worth looking into.
      Nudging "Almost Heaven" a little closer still...


      • #4
        PS, not a vet, just my wife and I are living insulin, diets, and doggie pills for our Barn Dog. Best one ever, by the way.
        Nudging "Almost Heaven" a little closer still...


        • Original Poster

          Yes--I believe there was just some confusion regard low glucose versus low insulin...the dog seems to be hypoglycemic and over producing insulin. My friend is very stressed and doesn't have a medical background...

          The latest I have from her is that the dog is improving and up this morning, with only some lingering wobbling in the hind end. They are going to reduce/remove her glucose drip and see if she can maintain. Ultrasound has been bumped back to the afternoon.

          I think it's curious that she's improved with only glucose and antibiotics. Does a insulinoma resolve in that manner? Could this be infection based instead?


          • #6
            Good to hear. Sorry, i can't help on causes just have a very narrow perspective on diabetes and dogs, and a huge thumbs up for sick pups healing.
            Nudging "Almost Heaven" a little closer still...


            • #7
              Causes of hypoglycemia are NUMEROUS, including pancreatic cancer (insulinoma), liver failure, sepsis (overwhelming infection somewhere in the body), brain cancer/issues affecting insulin regulation, xylitol (in gum and sugarless things) toxicities, etc.

              In this case, I'd be looking at insulinoma first, but also heavily considering sepsis or liver failure...the latter 2 will definitely respond to antibiotics and supportive care. They should find evidence for or against insulinoma and possibly liver disease on an ultrasound. If there is fluid in the belly that shouldn't be there, they should sample it. Sepsis is a little more complicated to prove.

              FWIW not all places have glucagon for drips or diazoxide. I wouldn't put the dog on diazoxide until a definitive diagnosis of insulinoma is made. For keeping in the in the ICU, a dextrose (NOT dextroxe...eeeek sorry my internal spellcheck went crazy with that one) infusion should suffice. For what it's worth, dogs with insulinomas tend to do worse on dextrose CRIs since adding dextrose to the blood causes insulin release even further when levels of insulin are already high...kind of adding fuel to the fire. Those dogs I've managed with intermittent feedings and a little bolus as needed if clinical.

              With the mouth issue...I'd be really worried about what her calcium levels (ionized calcium, iCa, not total calcium) are. Dogs that have calcium imbalance can have facial itching or pain. The iCa level has to be specially done and won't be on routine bloodwork. They should be able to do it easily in the ICU though.

              Keep us updated, and it sounds like your friend's dog is being managed appropriately for now. I'm pretty sure the vets treating her DO have other differentials like those I've listed above, but are chasing the most likely diagnosis (insulinoma). Jingles!


              • Original Poster

                Thanks, Pancakes--I will pass the info on to her. I really appreciate your expertise and ideas!

                Wouldn't liver failure be pretty apparent on bloodwork? Is there anything in particular that could cause calcium imbalance and the hypoglycemia?


                • Original Poster

                  Ultrasound is back: definite tumor in pancreas (I don't know how large) with potential lymph node involvement. Vet is also cautioning that there might be more that the ultrasound cannot see.

                  Dog is stable right now, and my friend is debating pursuing surgery and treatment, or just treating with prednisone, or letting her go.

                  Sad day


                  • #10
                    Oh, crap. Sigh. Hugs to your friend and megajingles to her dog. That sucks.


                    • #11
                      SO sorry to hear this, such a terrible thing to go through.



                      • #12
                        Originally posted by Simkie View Post
                        Ultrasound is back: definite tumor in pancreas (I don't know how large) with potential lymph node involvement. Vet is also cautioning that there might be more that the ultrasound cannot see.

                        Dog is stable right now, and my friend is debating pursuing surgery and treatment, or just treating with prednisone, or letting her go.

                        Sad day
                        Oh poop. Surgery might be hard on her at that age. Definitely a hard call to make. If she's not feeling better in the hospital, or they can't get her on diazoxide and pred (you can get diazoxide from pharmacies special-ordered), then I'd let her go. It might be worth seeing how she responds, though. But I know how crappy this finding is and it's 100% a family decision where to go from here -- no right answers unfortunately.


                        • Original Poster

                          Oh, Pancakes, that a bummer to hear it might be rough on her at her age. I was hoping it could be an option.

                          She is feeling quite a bit better in the hospital--she is up and engaged and was very, very happy to see her mom this evening. It sounds like she is still unsteady behind, but that is much improved over not being able to get up at all.


                          • #14
                            Originally posted by Simkie View Post
                            Oh, Pancakes, that a bummer to hear it might be rough on her at her age. I was hoping it could be an option.

                            She is feeling quite a bit better in the hospital--she is up and engaged and was very, very happy to see her mom this evening. It sounds like she is still unsteady behind, but that is much improved over not being able to get up at all.

                            I know But the pancreas is a delicate area anyway to operate around. It really depends on the type of tumor, the extent, etc. Definitely up to the surgeons and the vets working with her as to what her risk level is. But, like I said, I've seen people who opted not to go to surgery manage their dogs on oral medication and they did much better than expected. My last case had seizures from low blood glucose and his owners considered euthanizing him, but then he started to improve...last we heard, he's doing great.

                            It's not easy, but I'm thinking of her and hoping she improves daily!


                            • #15
                              Jingles for improvement. I had one that developed enteritis, we think from a pancreatic tumor. He got better, then worse, then better, then worse, till I let him go. Did not do anything aggressive in terms of treatment for a host of other reasons. Anyhow, hoping for the best in this case.
                              "One person's cowboy is another person's blooming idiot" -- katarine

                              Spay and neuter. Please.


                              • #16
                                Aw, shoot. I hope she can come home for a few good days. how sad.


                                • Original Poster

                                  Morning update: when they visited late last night, the dog was back in crisis and not being well managed. Her blood sugar was very low. The clinic had discontinued the dextrose drip.

                                  This morning, she is back on dextrose (I'm not sure if she's on a continuous infusion or boluses) and is bright and up and walking around--the clinic told my friend that she looks great.

                                  There does seem to be some sort of clotting disorder (secondary to liver disease?) that is causing lesions in the capillaries.

                                  Pancakes (or any other vets): I know you have a tiny amount of information about this dog, but do you think it would be possible to get her stable enough to at least go home for a little while? The emergency clinic seems unwilling or reluctant to get her on glucagon or diazoxide, which seems a little odd to me?

                                  Thank you all for your thoughts and well-wishes! It sure sucks when they get old, doesn't it?


                                  • #18

                                    I'm so sorry for your friend, tell her we are rooting for her and the pup but remind her that second opinions are very very definitely an option!

                                    She should ask around (or her regular vet) for a specialist and find a way to either transport the dog or the records to get another view.

                                    That would allay lots of fears as to her current course of treatment.
                                    HaHA! Made-est Thou Look!


                                    • #19
                                      Originally posted by Pancakes View Post
                                      Causes of hypoglycemia are NUMEROUS, including pancreatic cancer (insulinoma), liver failure, sepsis (overwhelming infection somewhere in the body), brain cancer/issues affecting insulin regulation, xylitol (in gum and sugarless things) toxicities, etc
                                      Pancakes, I just want to thank you for explaining medical terms.

                                      Its a pet peeve of mine when vets or docs throw around medical terms as if the general public has knowledge of them.
                                      On that alone, I just want to say, I bet your explanations help ease the mind of many of your patients. A vet at New England Equine is also very good at bringing medical terms into a human understanding...and she is board certified in Internal Medicine so has extensive education and knowledge, but thankfully doesn't feel the need to 'impress/intimidate' her clients.
                                      Its scary enough for an animal owner or person being thrown a diagnosis, add on terms that they might not fully understand and add to the stress and fear.

                                      I hope things go well Simkie for your friends dog.
                                      Good luck.
                                      save lives...spay/neuter/geld


                                      • Original Poster

                                        Hey Chester's Mom,

                                        Yep, I've encouraged her to talk to someone else. CSU is right here, and their cancer center is very good.

                                        It's always hard for me in situations like this to know what the right balance is between helping and being supportive and potentially being perceived as pushy or stepping over the line.