Bertie is back to health
A SMALL stumble on a dog walk may not usually be cause for a visit to the vets, but when Bertie's owner noted this becoming more and more of a frequent occurrence, she booked him in for a check-over.
A few weeks and tests later and Bertie found himself undergoing exploratory surgery – however he has since recovered well from the whole ordeal.
Bertie, as a 10-year-old West Highland White Terrier, had never been the bounciest of dogs, but recently he had seemed to be struggling on walks and behaving oddly. Bertie's owner couldn't put her finger on how or why, and so booked a routine appointment at the vets. Initially, a physical examination didn't reveal anything worrying but that wasn't to be the last of Bertie's visits to the vets.
Less than two weeks later Bertie returned to the practice for a re-examination. His back legs had increasingly been giving way and he was starting to have moments where he would shiver and shake. The next step was to take a blood sample and await the results. These tests revealed a lower than normal blood sugar level. Sometimes, a problem may not be obvious from the examination of a pet, but further tests may reveal the underlying issue – owners know their animals so well and can often pick up on the most subtle of signs.
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From this information we chose to measure the level of Bertie's insulin. Low blood sugar, or glucose, can be due to a tumour of the insulin-producing cells of the pancreas – an 'insulinoma' – and though it is uncommon, it is always worth considering in these cases. The condition results in an over-production of insulin which in turn causes blood sugar to drop. When this happens, an animal can show signs of weakness such as stumbling, tremors, and in severe cases, seizures. Sure enough, Bertie displayed a very high level of insulin – this fact combined with low blood sugar gives us a diagnosis of an insulinoma.
The treatment of choice for Bertie's condition involved surgery – with the aim of removing the tumour. However, these decisions are never straight forward and should always be made in light of the patient – age and chance of a positive outcome are just two factors that help us balance out the risks and benefits. Bertie's owner had a dilemma of whether to proceed with a surgery that may be unsuccessful or a course of medicine that posed fewer risks but would result in a reduced life expectancy. While Bertie's owner thought over the options, he was fed more frequent meals consisting of a specialised diet to keep his blood sugar within normal limits. Initially this helped to keep Bertie's stumbles at bay, but when they started returning despite his more regular meals, Bertie's owner had come to the decision of surgery.
It's a requirement for all patients to be starved overnight before a general anaesthetic is to take place – but this could result in Bertie's blood sugar dropping to a dangerously low level. To stop this from happening, Bertie was placed on a drip containing glucose, and hospitalised overnight. Before any surgery, X-rays and ultrasound scans were necessary to rule out any spread of the tumour. If the tumour had spread to other parts of his body, there would be little advantage of surgery, but the tests were all clear and he was prepared for the surgical theatre.
Once in surgery, it was still unclear what would be found. It may have been that the tumour was inoperable or even spread throughout the pancreas making any removal very difficult. However, fortunately for us and Bertie, the surgery went to plan and the Westie recovered very well indeed. He was hospitalised overnight once more – the fluid drip was still necessary to help the pancreas recover and to provide Bertie with sugar as he had to be starved for 24 hours following the operation; any post-op meals could be too much for Bertie's pancreas to handle.
The next day, Bertie's blood sugar was measured and it was found to be within normal limits. He was discharged to continue his recovery at home, and at his post-op checks we were pleased to discover that Bertie's sugar levels were exactly where they should be. Although it is very likely that Bertie's tumour will eventually return, because of the surgery he experienced we could ensure that Bertie had a longer life to look forward to and at time of writing we are pleased to report he's doing very well!
Shepton Veterinary Group