Health
Freddie's Story
ENGLAND AFGHAN CLUB MAGAZINE 1997 - Updated 2006
Since my own dog’s diagnosis, I now know of other Afghan Hounds who have been diagnosed with this type of specific pancreatic tumour & some who possibly did have this condition but it was not diagnosed before their deaths.
I have also been contacted by owners in other breeds and passed on relevant information.
I hope that by detailing my own experience, it will be of help should anyone find themselves in a similar situation in pursuing the appropriate routes to obtain a correct diagnosis & the best possible treatment for their dog’s needs.
FREDDIE died April 1998. My very special CH. AMSHURA NIJINSKY.
“The Spirits welcome you to their world of forever, where life continues & death is never”
INSULINOMA A SHARED EXPERIENCE.
In response to the many questions that I have been asked about FREDDIE following his recent illness and because I have always advocated that we should SHARE our experiences, especially when it comes to illness and medical conditions that may arise in our dogs, in hopes that in doing so, such may be of benefit to others should they be faced with similar situations.
I have attempted to detail the events that led us after weeks of frustration & mis-diagnosis, to be referred to the specialist vets at the Animal Health Trust, Newmarket, August 1997 where FREDDIE had surgery for the removal of a tumour from his pancreas.
Such tumours may develop in ANY dog over the age of 4 years of age. Whilst they may not be common, they are said to be certainly NOT uncommon.
The term INSULINOMA is used to describe these pancreatic islet beta cell tumours. They produce an excess amount of the hormone insulin, some 70o/o are malignant & can be highly invasive in their spread.
The text books suggest that there may be a higher incidence in BOXERS: GERMAN SHEPHERD DOGS: IRISH SETTERS & POODLES but NO sex predisposition.
Clinical signs are those of low blood sugar (HYPOGLYCAEMIA )
These signs are.
Restlessness, weakness, disorientation, ataxia, preceeding to a variety of neurological signs which can include episodes of uncontrolled barking; urinary incontinence; twitching & convulsions, (a full blown fit).
The hypoglycaemia becoming more frequent & severe ultimately proceeding to coma. Such episodes are prone to occur following exercise, excitement, or fasting but they may also occur AFTER feeding which can stimulate insulin release.
FREDDIE’s symptoms were initially insidious; the first obvious indicator that something was wrong was his apparent slowing down, he lost his “bounce” and “skittish” antics. .
Those of you who knew him well were aware that this has always been a most aptly named dog, NIJINSKY by NAME, by NATURE!….The Dancer….The Horse….full of verve & energy always “Dancing” spending more time on 2 legs than the 4 that nature provided for him! Always so full of “joi de vie & swift of foot.
When I let him off for free running exercise, I noted that he did not bound off in his usual manner but tended to amble gait followed by short bursts of energetic exhuberance, this had started as early as May, maybe earlier, but in all other aspects he had seemed normal. Later I noted a marked increase in lethargy.
On our daily walks on the forest, it seemed to be that it was me pulling him along on his lead instead of him taking me & he began hanging back in comparison to the other dogs, always eager to turn back toward the car park instead of continuing along our normal tracks. In hindsight it seemed he was becoming almost as slow as my then 13 year old MAX, (BRIGADIER GERARD) but the weather was beginning to get very warm & humid & possibly played a contributory role in masking those early symptoms.
At the AHA Champion parade in early June, I had felt that he lacked his usual verve within the show ring arena, maybe it was again the sticky heat or the indoor arena at the Coventry venue, that day was especially stuffy.
When my vet came home the day we had to put Max to sleep after his stroke I got him to check out FREDDIE, airing my concerns, but he said on physical examination he could find nothing wrong from cardiac and respiratory assessments….From then on FREDDIE began a rapid decline.
We had episodes of him sitting “Star Gazing” staring into space, panting, almost hyper-ventilating; a racing pulse rate; his respirations could be in excess of 70per minute. He became reluctant to stand for long periods of grooming, In the bath he would hardly stand preferring to lay in the water, something he had never done. He also became disorientated and agitated but such symptoms were very fleeting.
He was almost like a “wind up clockwork toy”, when we set off on our daily walks, he would commence with all his usual verve but after what seemed such a short time or at any stress or excitement (meeting dogs or cats en-route) he soon appeared exhausted. The walks got shorter ands later he started to develop a lack of co-ordination, staggering gait, begining to tremble & twitch.
Visits to my vet throughout these episodes with my detailing my observations (why was he always so NORMAL at each visit!) produced no positive conclusions.
His “Star Gazing”, spaced out episodes increased in frequency & duration, lasting from seconds to 5 or more minutes with “normal” periods in between. He never became unconscious and would respond to his name call .His lethargy becoming more marked, even noticed by friends. The effort in him walking from one room to another during such periods could tire him to the point of exhaustion. I suspected
a low blood sugar with such symptoms and had requested a blood test when I had first observed his pattern of behaviour
I was informed that all was within normal levels ….Lesson learned ALWAYS insist in a copy of ANY lab tests…even if YOU cannot interpret you will find someone who can!!
Later events revealed that the blood testing HAD shown evidence of Hypo glycaemia! for a variety of excuses this had NOT been picked up by the examining vet at the time. I continued to voice my concern & opinion relating to the hypo- glycaemia suggesting to the vets that maybe be my dog had a tumour, pancreas or brain (I was thinking along the lines of a pituitory tumour which can produce similar signs. I was informed my dog was EPILEPTIC, and these episodes were signs of petit- mal attacks and I could /would not accept this diagnosis! Too true I would not, certainly in view of my dogs’ age group, no previous fit history, the incidents always occurring AFTER exercise, bathing grooming etc and as most people are aware, epileptic dogs do NOT tend or have their fits in such a pattern.
I refused to allow my dog to commence on anti-convulsive drug therapy, thanking God for my nursing background to stand my ground. My request for a second opinion referral was allegedly pursued by the vet I had been consulting but somewhere along the lines of communication, there was a breakdown with the dog’s presenting symptoms not being given in detail to the referral vet. Determined to take this further I decided to maintain a daily diary and treat my dog as if he was Hypo-G.
He always appeared hungry even allowing for his normal excellent appetite which had not diminished. I changed his feeding regime, increasing to some 3/ 4 small meals daily, this was to accommodate my suspicions & he certainly appeared to respond to this.
I recorded ANYTHING & EVERYTHING that might seem different by keeping a diary of events.
I noted signs of urinary incontinence even whilst he was standing eating his food, sometimes he would also cry & howl whilst eating. All my observations and records were to later prove VERY beneficial in compiling his case history for the AHT vets.
The positive indicator finally happened. In early August, following a short early morning walk, we soon returned home & within 5 minutes he started to stagger about having difficulty in getting into his bed culminating in a Grand- Mal fit. Immediately calling the vet’s surgery, I found myself at last speaking with a vet who was listening to what I was telling her. The relief that someone was listening to my dog’s history and this vet also had personal experience of Insulinomas (in some 11 years in practice she had diagnosed 3 such cases) even before seeing my dog, she was immediately alerted to the possibility of the diagnosis….In fact she was diagnosing my dog’s condition BEFORE she had actually examined him.
We went immediately to the surgery for blood samples to be taken and YES the blood sugar was VERY low, even allowing for the fit and we were to be referred to the AHT immediately .In the interim I was advised that he should be fed 2 hourly with glucose laced drinks in addition to the increased feeding regime I had already adopted. He went rapidly downhill in 24 hours and the next day we were sent to Newmarket as an Emergency. The diagnosis was confirmed by further blood tests finding his insulin levels above 62 iu/ml (normal range 5-20) X-Rays of his chest & abdomen, in addition to ultra sonography, revealed no obvious abnormalities. They were looking for secondary deposits. These highly malignant tumours can spread quickly to liver, spleen and lungs.
You can imagine my despair, we had wasted over 6 weeks to come to this diagnosis and I would never know what that time lapse may have cost.
I was informed that they were prepared to undertake an exploratory laparotomy and hopefully would be able to locate & remove the tumour….BUT…...I was warned that this might prove to be inoperable, even without secondary deposits of the tumour to other vital organs, These tumours can be almost microscopic in size, like grains of sand & can be difficult to detect with the native eye, having already spread in surrounding pancreatic tissue.
To maintain his sugar levels and to allow me to have him home prior to his surgery, he was given the drug DIAZOXIDE which by blocking the release of insulin can give a temporary control (this drug is also used when surgery is considered not feasible)
FREDDIE was fortunate, the findings at surgery were the very best of the options I had been given. A single discrete mass measuring 1.5cm (about the size of my thumbnail being removed. The pathology showed this to be malignant with satellite deposits already being present in the surrounding pancreatic tissue that was removed, separate from the lesion.
He initially did very well post- surgery & I was allowed to visit him in the hospital daily but on the day prior to his intended discharge, he developed an acute pancreatitis (inflammation resulting from the trauma of the surgical procedures) I had been forewarned of this as a possible complication post- surgery but I could not believe that we were to be dealt with another blow especially as I had been told this complication did not happen that often!. The weekend was fraught with anxieties when he took a real nose dive with the outcome looking very bleak but he got through thanks to the expertise and care given to him throughout and from then on we were on an upward curve.
Freddie finally made home, being discharged the August Bank holiday w/e having been at the AHT almost 3 weeks.
He was prescribed Cimetidine 300mgms daily for a further 10 days, this was control any gastritis that might arise following the pancreatic inflammation & a re-introduction, slowly to his normal feeding regime.
I cannot speak highly enough of the care he received from this specialist onocology team, they not only coped with FREDDIE’s physical needs but this one very worried owner’s, psychological needs. They never attempted to pull the wool over my eyes, were frank and honest and gave me no false illusions,it was ALWAYS to do what was considered in FREDDIE’s BEST INTEREST and above all to maintain a QUALITY OF LIFESTYLE.
FREDDIE’s progress has been maintained since his surgery and apart from his “Lack of jacket”, he had a dramatic coat drop some 5/6 weeks after his surgery, he now looks very “old fashioned” in coat pattern. For anyone who may have questioned his shape beneath all that hair, his excellent conformation was visible for anyone to see!
Few would realize just how ill this dog had been. He has an excellent appetite and has gained in his body weight & muscle tone. He is on a recommended low fat diet because of the pancreatitis episode. His diet consists of fresh chicken, rabbit, fish & pasta. He also has tinned Chappie , advised on its low fat content. Initially he was started on low fat cottage cheese & fish then on to the canned Hills Prescription Diet. (He did not like! too bland!) We had to re-introduce him very slowly to solids & his normal regime, giving his feeds little & often,
I reduced the feeding but he continues with 3 meals per day, plus drinks morning & evening with free access to water at all times.
His exercise routine is back to normal and he has enjoyed brief holidays in Norfolk & with his friends in the NE England, coping well with any changes to his daily routine.
His Insulin/Glucose ratio remains within the normal & he is seen on a regular basis at the AHT for follow up as well as monthly checks by my own vets.
From my experience, I would suggest that EXPERT advice and guidance on treatment protocols be sought a.s.p. when the possibility of any malignancy be hinted at, or diagnosed. Treatments may be costly, both emotionally and financially. Pet Insurance may ease some of the financial pressures.
Each owner will deal with the emotional aspects in their own way.
I found I needed to talk it out & am indebted to my friends and especially to the AHT vets and nursing staff for their patience, kindness & understanding.
I consider we were fortunate. Whatever the long term, and the prognosis must remain very guarded, at least I can gain some satisfaction in knowing that my dog received the very best in care to maintain a quality lifestyle for however long he is with me….The mean average is 1/ 2 years given his diagnosis.
Sylvia Evans. AMSHURA 2007 - Updated 2006
Updated 31-01-06
©Sylvia Evans -2006- 2007 - 2008 all rights reserved