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The Case of the Week for the week of October 6, 1999

Prissy Chafin is one of those cases that you don't ever expect to see but you know that you still need to pay attention to because "Ya' just never know". We saw her first for her current problem on May 1. We know Prissy quite well after seeing her for many years for general health maintenance. However on May 1 Prissy had a new problem. She was having seizure like episodes that would come and go. Her problem seemed to be most prevalent when she seemed to feel the best and was quite active.

On examination she seemed quite normal but was a little nervous. She showed some sign of kidney failure and her blood sugar was a little low. We placed her on fluids and she seemed to be doing quite well. However, we also noticed that after being active she tended towards seizures activity. When we checked her blood sugar when these episodes occurred we found it to be very low. We knew that her appetite was good and there was no evidence that her liver was failing (thus failing to make blood sugar). The situation called us to think of a problem with insulin production . . . however, tumors of the cells that produce insulin are not common.

We started Prissy on a medication that causes elevation of blood sugar when insulin is present in excess (Proglycem) and had good results. Prissy became more or less normal. We did testing on Prissy (when NOT on Proglycem) and found a low blood sugar with a very high blood insulin level . . . consistent with the presence of a tumor of the cells in the pancreas that produce insulin. Treating tumors of the pancreas with medicine is usually considered to be a temporary solution and surgery was scheduled. A tumor was found on the pancreas and removed. The cytology of the tumor supported the presence of a tumor and histopathology confirmed the presence of a tumor of the beta islet cells.

Surgery of the pancreas is difficult at best. The problem is that there are many ducts present that must be closed and the tissues themselves are prone to cause destruction of adjacent tissues if they are traumatized at all. We have done surgery of the pancreas before with good success but we knew that we had to be very careful with this surgery. Because there was very little margin between the tumor and the adjacent blood vessels a very narrow margin could be taken. We were pleased with the surgery as we finished.

However, in the days following the surgery Prissy showed a very poor appetite and considerable nausea. Laboratory work indicated plenty of problem with pancreatic inflammation. We also had problems with a developing HYPERglycemia. In effect we had turned Prissy from a dog that was dying from a form of malignant cancer that was usually fatal to a patient that was dying of pancreatitis and diabetes. We were able to provide support for Prissy and she pulled out of her slide with pancreatitis and the diabetes responded to the use of insulin. It appears we will be able to withdraw the insulin. We hope that this does not indicate a regrowth of the tumor. However, we know that about 60% of these tumors do recur.

Mrs. Chafin looks pretty pleased to have her friend, Prissy back (10-6-99)



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