Keja (pronounced Kee-ya) is a 9 year-old German Shepard. My husband and I have had her since birth and we are all she knows. She is our house child and is with us always as we are retired. She has no idea that she is any different from us.

Our story begins in February 1998. As Keja was walking through the house, all of a sudden her legs gave out on her and she went down. She tried to get up only to go down again. We rushed her to emergency at our Vets. After assuring our Vet that there was no way she could have been poisoned, X-Rays of her back were taken and a blood sample was drawn. The X-Rays showed no abnormalities. When the blood work report came back, our Vet gave us the devastating news. The results showed a high amount of Insulin and a low glucose reading in the same sample. According to our Vet, there was only one diagnosis that fit that reading, Insulinoma. Insulinoma is a highly aggressive, malignant tumor growing in the pancreas. Our Vet referred us to WSU (Washington State University) Veterinary Teaching Hospital for consultation and options.

A complete physical examination took place along with blood work and an ultrasound. The blood work confirmed the diagnosis, however, the tumor could not be seen on ultrasound. It was explained to us that though insulinoma is not a common diagnosis, not seeing the tumor on the pancreas does not mean that there is no tumor. The pancreas is hidden behind the liver and a tumor would not be seen until it had metastasized onto the Liver.

The next phase in this story will be about our options. It is important that I go through this background as we progress to Keja's eventual diabetes diagnosis, as it was arrived upon in a manner never before seen by them. We had two options: surgery, or no surgery and try to control the tumor with medication. The normal procedure in the diagnosis would be surgery. If the tumor was not readily visible, a surgeon would feel his way through the pancreas.  If he could not feel or see the tumor, it would be a 50-50 shot as to which side of the pancreas contained the tumor cells and should be removed. In any case, the patient would probably experience a side effect called pancreatitis. It is a condition that occurs when the pancreas is disturbed in any fashion. It would make the patient extremely ill and possibly death would occur. The portion of the pancreas removed would then be sent to a pathologist, who would confirm whether or not the correct side of the pancreas was removed. If the wrong side was removed, the surgery would need to be performed again to remove the remaining pancreas tissue. Again, the chances of a devastating side effect of pancreatitis would be high. If in fact the patient even survived all of this, the tumor would grow back on the liver, while at the same time making a diabetic out of the patient because all of the pancreas would now be removed. Making a diabetic out of the patient is the reason they prefer not to remove the entire pancreas to begin with. The bottom line is, the disease is fatal no matter what medical procedure is performed.

Armed with all that clinical information and our hearts, we made the decision not to have the surgery done. The side effects were too horrible and the disease was fatal anyway. We did not want Keja to suffer needlessly, that was our main concern.

Keja was placed on a drug called Prednisone. It is a steroid designed to suppress the tumor. We began to discover the side effects from that drug were horrible. Some dogs do very well on it. Others cannot tolerate it. Keja was one that could not tolerate it. The worst of the side effects being her skin was thinning and sores were appearing everywhere and not healing. It was awful. I weaned her off of the drug knowing the tumor would begin to grow. As soon as I was to see signs of the disease taking hold, I would have her put down, as suffering on her part was not an option we were willing to accept. Keja was given 2 months to live.

Instead of getting worse and showing signs of suffering, Keja started to get much better. Her personality returned and she was full of joy. About 5 months down the road, all of a sudden she started waking up in a sea of urine in the morning and drinking water like there was no tomorrow. Those symptoms are, of course, the classic signs of diabetes. The problem, however, was that even though her glucose levels were rising, there was still a large presence of insulin in her blood stream. They were unable to figure out why. After running a barrage of blood tests, WSU decided to go ahead and give her some insulin anyway and see what happened. The insulin brought her glucose levels down, however, to this day, her blood still shows a high amount of insulin present. The insulin in her blood was just floating around not doing much of anything. WSU could not find where it was serving any purpose or on the same token, doing any harm. It took 6 months to stabilize her. During that 6 months, Keja developed cataracts and is quite blind. We have to make sure there are rugs on all floors that are not carpeted as the weakness in her legs will never completely recover. She slips on floors that do not have carpet or rug. We again chose not to have surgery because of the trauma it would cause. Even though she is blind, she does very well and has adjusted to it.

Throughout this entire ordeal, we were keeping meticulous records of everything from urine strips to blood curves, times, dates, etc. Now Keja is quite alive and well.  She receives two insulin injections per day 28 units Humulin NPH in the morning and 10 units in the evening. She eats Hills Prescription Diet RD Formula, 3 scheduled meals & free feed.  We monitor both urine glucose and blood glucose every so often or if physical signs appear. The physical signs we watch for are severe, such as immediate weakness in her legs (more so than normal). She will also become glossy eyed and rather lethargic when she is headed toward a lower than normal glucose reading. When her blood glucose is too low, we put human Carb Tablets in her food and she is fine in about 20 minutes.  

Because of the diabetes, Keja gets a lot of urinary tract and yeast infections. I am able to spot these at their onset because of the expertise I have developed in looking at urine samples. When the sample is dark and concentrated, it should be a negative or very low spill reading on the urine glucose test strip. When the sample is light, it should be a high spill reading. When you get a dark and concentrated sample with a reading of a high spill, that means there is a urinary tract infection taking hold. If a sample can be taken to the Vet within 20 minutes before it starts to break down, the Vet can spot the high concentration of white blood cells in a sediment test, which is an indication of an infection. The other point is, Betadine mixed with water to look like a weak tea solution, can be dabbed around the vaginal area or ear area with cotton. Betadine kills yeast. If your pet is susceptible to these infections, applying the Betadine on a regular basis (2 to 3 times a week) can actually help prevent these infections from taking hold.

WSU is doing a publication on Keja for the Journal of Veterinary Medicine. They notified us about a month ago that the first draft has been completed. I hope you find Keja's story interesting. I cannot tell you how the story ends as we are still living it. She is stable and happy and a bit overweight.  

Thank You,
Karen Heynen 

Keja passed away in March 2001, probably due to complications of pancreatic cancer.

Contributed October 2000
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