Kenjiro Yagi's Peaceful Days: Insulinoma in Dogs

Cashew's Battle with Insulinoma Journal

Summary

Born 9/1/2007 (now 12 years old)
Jack Russell / Pitbull Mix - 25lbs - 27lbs
First sign of hypoglycemia - October, 2019
Diagnosed with Insulinoma - January 4th, 2020
Started Prednisolone - January 6th, 2020
First Grand Mal Seizure - January 11th, 2020 4:30am
Surgery to remove tumor - January 13th, 2020
Start 1 Insulin - January 19th, 2020
Start 1/2 Insulin - January 25th, 2020
Half Zonisamide - January 31st, 2020
Stopped insulin - February 2nd, 2020
Half Zonisamide every other day - February 6th, 2020
Stopped Zonisamide - February 9th, 2020

SUPER SUMMARY, because this got too long

October - Cashew started to twitch and lose balance during walks. Sleeping 90% of the day. Thought it was the weather or food. Was getting more frequent.

January 4th - Met doctor. Diagnosed with Insulinoma. Malignant tumor. Told she would last about a year, maybe longer if surgery but not by much. I have an emotional breakdown. Cashew continues to get worse.

January 8th - Met oncologist. Cashew is examined and doctor determined she is a good candidate for surgery. Serious discussion with loved ones and support groups. Scheduled for surgery

January 11th - Cashew suffers 6 grand mal seizures in one day. Cashew hospitalized until surgery

January 13th - Surgery successful! Healing begins and gets better everyday!

January 27th - Cashew is back!

🤞Crossing my finger for her and enjoying her everyday.

January 27th, 2020

🥳 Cashew's glucose is at the desired 80-120mg/dL level.

Cashew's blood glucose today before lunch

💁🏻‍♂️ Here is Cashew fighting with Daisy today

It's good to see her do this

January 26th, 2020

Cashew finally got a shower because her stitches have healed

Cashew getting a shower

She ran around the house to dry herself afterwards. I think she is pretty much normal now.

Rubs rest of the day

January 25th, 2020

Blood Glucose 9am - 182mg/dL with no insulin shots

Cashew BG reading 182mg/dL today morning

After this, she ate normally and was waiting at the backyard door, looking at me like "why is this not open dad?"

Then it's a Saturday, so we went to the school

Dr. Rivara found it funny that she told me to not give her insulin if she's under 200mg. So Cashew is staying right under it.

Dr. Rivara advised to give Cashew half the insulin to see if we can get her BG to the 90-130 range.

This video is from today!
The last 30 seconds of this video is my favorite

January 24th, 2020

Blood Glucose 8:40pm - 162mg/dL 🥳 with NO INSULIN SHOT!

Cashew *may* not need insulin shots IF her blood glucose stays this way!

This is after me poking her multiple times and chasing her around the house for 20 mins. She is not happy and started hiding from me afterwards.

Cashew looking at me in disbelief

January 24th, 2020

Blood Glucose - 107mg/dL 🥳 with insulin shot

2 weeks ago, cashew had 6 grand mal seizures in one day and doctors/team was trying to help her. 😭

She was on iv for 2 days and had surgery. 🏥

Today, her blood glucose was 107 and stitches are out! 🥳

Leaving Sage Hospital with a big shadow

and afterwards, we went to a park. She can finally run, but seems a little out of shape

Thank you to everyone at @Sage Hospital. Especially

Dr. Rebecca Regan
Dr. Catherine Rivara
Dr. Bill Banz
The tech team working around the clock!

👍👍👍👍👍👍👍

January 23rd, 2020

Healing Day 10 out of 14

Tomorrow, Cashew has an appointment to *hopefully* get her stitches out and doctor also wants to check her blood glucose.

These are pictures from today

Cashew went for a short walk at the local park

Mashew slept in the sun

January 22nd, 2020

Healing Day 9 out of 14.

She was able to walk around the park today with no struggles! Said hi to a few other dogs too.

Everyday, she is getting better! 🥳

Here are some pics from today

Cashew listening to me talk to her.

We took a walk around our local park

January 21st, 2020

Healing Day 8 out of 14.

Cashew is almost normal again! 🥳
She wanted to play most of the day.

She is still on zonisamide and insulin shots.

Cashew watching me play Mario Kart

Cashew played ball with my sister

Cashew also ripped her snowman's hat.

Cashew ripped snowman's hat

January 20th, 2020

Healing Day 7 out of 14.

Back to hiding her bone

January 19th, 2020

Healing Day 6 out of 14.

Blood Glucose - 206mg/dL at 8pm

Her insulin shots started today at 9am. Her glucose isn't normal, but it's A LOT BETTER!

Thought Cashew was showing signs of low glucose, but BG is relatively normal

My sister and I took Cashew to Stanford mall, but she couldn't walk too much.

Cashew struggling to walk

Showing Cashew the new Anthropologie store but she was not interested

Many people walked by saying "nice sweater" to her. 😄

She got home and started playing with her toy

Her stitches became a little irritated from all the walking.

Sorry Cashew, we will relax at home until the stitches are out.

January 18th, 2020

Healing Day 5 out of 14

Blood Glucose - 620mg/dL at 11:59pm 😣

She is getting better everyday!

Cashew facetimed with my sister today

Cashew facetiming with my sister

Cashew, my sister and I visited the hospital.

They explained and showed us how to do the insulin shots.

Strangely, all of this including the first pen of insulin was free! 🤔 Someone has donated their insulin to the hospital. 🙇🏻‍♂️ Thank you Dr. Catherine Rivara!

Nurse showing us how to do the insulin shot

I am planning to monitor her blood glucose as I give Cashew these insulin shots.

Later that day, I heard "the stomp." It's the type of walk Cashew does when she wants to go for a walk!

Cashew out for a walk! 5 days after surgery

She only walked about 50ft, but that's 10x better than before!

January 17th, 2020

Healing Day 4 out of 14.

Blood Glucose - 560 mg/dL at 10:30am 😣

Doctor visit to check on Cashew's glucose level and I knew something was up because it was taking a long time.

Doctor came and told me Cashew's glucose level is at 560 and she is now diabetic or always was. 😩

This could be temporary or permanent.
I would assume something like this, after all she did remove a piece of her pancreas that over produced insulin right?

Research paper saying it could last few days to a few months

So, visiting Dr. Catherine Rivara tomorrow to get insulin shots. It feels a little too soon to jump onto fixes, but I did read longer term high blood glucose can cause damages.

Cashew sleeping on the new rug

On a positive note, she's getting better. She is using the rug. She went out to pee on her own. She slept next to me yesterday night. She even told me to roll down the window.

Back to enjoying car rides

January 16th, 2020

Got a call from the hospital about the biopsy! I didn't quite understand what was said, but was told it's a good result.

Cashew is going in again to get her blood glucose checked tomorrow to make sure that her pancreas is actually producing the right amount of insulin.

Meanwhile, the healing continues.

zzz

Every 4 hours (or while she's awake), heat pack on stitches for 5 minutes

This morning. She can't seem to sleep. Will give her pain meds with lunch if she can't sleep by then.

January 15th, 2020

I'm relieved she got through the night without a seizure.

2nd Day After Surgery Summary

✅ Condition is improving!
✅ Stopped shaking
✅ She peed / pood no problem.
✅ Stitches look clean
⚠️ Learned to take her outside right when she wakes up so she can relieve herself.
🙅🏻‍♂️ She was really picky about food. Had to be fresh meaty things for her to start eating.
🙅🏻‍♂️ Still seems dizzy or confused. Probably the anti-seizure medication.
🙅🏻‍♂️ Really weak. Sleeping 95% of the day. Glucose Reader is coming tomorrow so crossing my fingers 🤞

The routine for Cashew's healing

Calendar of Dog Post-Surgery Schedule

Here are the medicine she takes minus the karo syrup ( for now 🤞)

All the medication for Cashew

Furbo has been a life saver. I can work and watch her at all times.

Monitoring remotely. Furbo has finally come to use!

January 14th, 2020 - Cashew is home (1 day after surgery)

She's gone through a lot. She was shaking all the way home. Every time I talked to her, she stopped shaking, but it continued.

Cashew really scared, unaware of what's going on

She's usually a tough dog, but she looked so helpless and scared.

Healing begins

Cashew is home, but she is drunk and in pain.

Cashew is back and sleeping

I'm trying this Wholetones channel (as recommended by Tania from the support group) and it seems to have put her to sleep.

4:30pm Update : She seemed to be annoyed by me. She went to the very end room. When I came over, she was upset. So I left her alone but setup a webcam incase anything happens (still scared for seizures) or licking her stitches

Webcam setup to watch over Cashew sleeping

Let's see

She has stitches
Her hair is shaved here and there for all the tubes / plugs she's had.
She is totally dizzy.
Assistant told me it may be 4-5 days before her first poo, but she pooed right when she got home.
She had 2 accidents and seems very scared / trembling. It could just be anesthesia is wearing off.
Assistant told me that when issues like this happen with dogs, more usually follow right after it.. so to have a lot of fun with her while she's active.

What needs to be done

Maropitant - helps with nausea
Prednisolone - Steroid. She needs to take this to ween off of it for the next week
Zonisamide - anti-seizure medication. Needs to take this for a month or so. This will cause her to be drowsy.
Gabapentin - Pain killer if she is in pain.
4 Times a Day - I have to massage and cool or heat her stitch area
Watch out for her to not lick her stitch. Use cone of shame or give her clothes while I cannot watch

January 13th, 2020 - 5:30pm After Surgery
Dr Rivara called and said Cashew is doing great after her surgery. Her glucose shot up to 300 so now they are tapering off (or stopping) glucagon and removed one of the 2 anti-seizure medication she's on.

🙏🏻 Preying for no more seizures

If Cashew is still doing good by tomorrow afternoon, she may go home.

Doctor confirmed if I have enough Prednisolone to taper off. She still has 20 days of supply left

Cashew listening to "dog relaxation music"

This is from few days ago, I think we will be doing this a lot during her healing at home.

Personal
It feels like my glucose levels also came up. Finally felt like eating so I had a poke bowl delivered. Thank you DoorDash!

Poke Bowl from DoorDash

January 13th, 2020 - 1pm - Surgery
12:58pm - Doctor Catherine Rivara called and said Cashew is going into surgery now.

Doctor said no news is good news.

If no calls by 4pm... it's good news.

I'm dying here.
🙏🏻 🙏🏻 🙏🏻
I'm dying....

How long has it been. 10 mins now.

Now I understand all the scenes in movies where family is waiting outside for the doctor to come out and they stand up when the door opens.

2:17pm - The hospital called

Me - "OH NO"

Other side - "...."

Me - "I'm sorry, I was just told that if I get a call early, it's bad news"

Surgeon - "No, this is your surgeon, Bill Banz and I was calling to let you know that Cashew just finished surgery. Her tumor was on the surface and isolated so I just removed it and looked around, but all looked ok. She is now going to ICU to recover and we will give you a call back around 4-5pm."

Me - "omg thank you so much. thank you thank you thank you..."

January 13th, 2020 - Morning of Surgery
Don't know when I fell asleep... Jumped up to the phone ringing. Dr. Rebecca Regan is not in today, so Dr. Catherine Rivara called. I feel lucky to have two doctor's take on the situation. Summary

Cashew is doing well. (on medication to keep her glucose up and hasn't had a seizure with anti-seizure medication)
Cashew is still on anti-seizure medication and needs to be on it for a few weeks. Mentioned brain surgery IF seizure continues afterwards 😓
Anesthesia will start at 1pm and I'll be told what's going on every step. 😳
Surgery will be performed on Cashew's Pancreas' right side which is the trickier side so fluid may build up in her stomach and a tube needs to be used to clean her stomach out. (something like this)

🥺🙏🏻 Please please please

January 12th, 2020 - Visiting Cashew
Less than 24 hours until surgery!

Visited Cashew at her Intercontinental Hotel Room.

Cashew on anti-seizure medication

So good news is her BG is up to 170 from glucagon and dextrose.

Bad (and very concerning) news is that she still had 2 seizures even after BGs were up. Doctor put her on an anti-seizure medication so she was very drowsy.

We will need to face the seizures later, but for now, Cashew has to get her BG up on her own which is what caused her initial seizure.

Cashew can still understand there are visitors

Cashew recognized me and tried to come towards me 😭
She can barely get up.
Her head kept falling over, but she kept trying to get out. 😂

She still recognizes me.
Touching her and seeing her calmed me. I think from not having her for a day and the phone calls about seizures made me feel somewhere inside that I was going to lose her. I sniffed her stomach area. A little different smell, but still the same warmth.
Sage staff is very good. Everyone was busy doing something.
Cage looked comfortable. Blanket underneath
Collar with bells to let them know if Cashew has seizures
🙇🏻‍♂️Thank you Sage Pet Hospital Staff! Constant checking of BG and feeding every 2 hours and taking good care of our babies.

She went back to sleep so she probably thinks I'm still there

January 12th, 2020 - T-minus 30 hours until surgery
I was so worried last night that I don't even know when I fell asleep.

Got a call from the doctor at 8:30am!!
I swear I pick up their calls before the 1st ring ends

Please don't let it be bad news.

Cashew is doing relatively well. Dr. Regan said Cashew had another seizure last night at 10pmish, but once given glucagon, she is back up to BG 100 and has energy, but her BG did drop to ~50 again this morning. Cashew just needs to keep up until the surgery. Was told other than the tumor, she is a very healthy dog so she thinks surgery should fix her (don't forget the risks, and if her glucose doesn't come up after surgery, I need to be ready to make difficult choices)

I don't think Dr. Regan is supposed to be working today? This hotel.. i mean Sage hospital really rocks. Thank you for calling me with all the updates. Thank you for feeding Cashew every 2 hours and monitoring her around the clock. I feel Cashew and I am really well cared for.

She apparently went out to go walk around and poo/pee.

Cashew 2 years ago. It was difficult keeping up with her.

Was asked if I wanted to visit her. DO I!?
I'm going.. but a little later 😅

Don't worry buddy, I'll be there!

January 11th, 2020 - Night
Another 40 more hours until Cashew's surgery and Cashew's at the hospital until then.

Time is moving so SLOW.

I'm just cleaning around the house to keep myself busy.

I'm preying that Cashew is just sleeping at the hospital.

Cashew not sure how to get the ball in the pool

This is Cashew just 2 days ago.
I can't believe what's happening. Please Cashew, come back home.

Cashew and I doing a Shipt Order

This is just 3 months ago! Cashew and I were delivering groceries for an elderly couple ranting about this order.

Come back!

January 11th, 2020 - First Grand Mal Seizure
Cashew suffered at least 5 seizures.
4:30am - I woke up to Cashew having her first grand mal seizure.
Applied karo syrup to her gums
Last Prednisolone was at 8:45pm. (~8 hours ago)
Last meal was at 1am. (~3-4 hours ago)

E-mailed Sage Veterinary Center with what happened and to see if they can move Cashew's surgery even a day sooner and that I can drive in anytime if there are any cancellations so please call me.

7:15am - Second seizure
7:30am - Called Doctor
8:15am - Dr. Regan's teammember (Beth) called back and said to up the Prednisolone to 10mg (from 5mg)
Changed Cashew's surgery to Thursday (a day sooner) with Surgeon Scott Christopher

It's a horrible thing to see your baby going through this and I really appreciate Dr. Jennifer Koga for giving me heads up that Cashew will have grand mal seizures later on and to have Karo Syrup for when it does.

I just didn't expect it so soon.

Cashew's really scared right now. I really really hope this doubling up on dose will stop her from having the seizures.

9:30am - Third seizure
9:40am - Called doctor
9:55am - Arrived at Sage Hospital. Beth took Cashew right away
10:10am - Dr. Regan says Cashew's glucose is at 30 so she should stay to be watched over. At this point, Cashew is scared of being at home and being attacked by seizures so I totally agree. I hope she is getting some sleep over there.

12:11pm - Was told Cashew isn't bouncing back up so they would like to keep her until the surgery (which they were able to move to Monday). I feel so powerless when she is having a seizure so I think she's in the best hands.

and the new bill..

Bill for Hospitalization until Surgery + Surgery

1:34pm - I called and gave them my credit card #. Worker said "it's approved" and I said "wow"

The next 3 days is going to be the longest 3 days ever.

I bought a new rug for us so you better come back Cashew! Let's roll on this together!

I regret not pushing to get her done ASAP and I'm VERY thankful that they made time for Cashew on Monday.

4:50pm - Dr. Regan called to let me know that Cashew had another seizure (5th one), but her glucose is now at 60 due to dextrose. For some dogs, seizure may continue even if glucose level is relatively good. Cashew will continue to be fed every 2 hours and monitored closely. May need to use medication if seizure continues.

Thank you so much Sage staff, Dr. Regan's team and the surgeon that said she can do Cashew's surgery on Monday.

January 10th, 2020 - T-minus 1 Week
All we can do is wait for Cashew's surgery date.

Until then, I have alarm setup to feed and give medicine to Cashew. She still has lethargy (sleeps most of the day), but I was happy to see she came out while I was doing work in the backyard. I setup her bed in the sun.

Cashew enjoying the sun. Pardon my butt.
This photo is kind of symbolic isn't it? 😅
Cashew's sick, but happy (in the light).
I'm keeping myself busy to let time go by.

January 9th, 2020 Noon
Went out for a walk and Cashew is now sleeping. Still on the lethargic side, but no twitching. Thank you prednisolone.

Cashew sleeping at 1pm

My brother talked to some oncologists he personally / professionally knows and Dr. Rebecca Regan is highly spoken of. Also the numbers (90-95% success rate) seems to be about right according to the people in the business. But he said that the risk is real so be ready for them.

We also got back a radiology report for Cashew already! Thank you Sage and Dr. Regan's team. They personally called me to answer questions too.

Veterinary Radiology Specialists Report

January 9th, 2020 Morning

Scheduled an appointment for surgery January 17th (Friday) with Dr. Bill Banz
Spoke/Wrote to a lot of people for what they thought about surgery vs medicine. I really can't thank enough to my family, members of the Insulinoma Support Group, and loved ones. People are so nice 😭
E-mailed Dr. Regan for a report on exactly what they found so I have a record of it.
Cashew is now on Prednisolone 2.5mg twice a day
Cashew will be left at the hospital at 8:45am and I have to leave her at the hospital overnight. 😓 When Cashew was a real baby, I left her once at the hospital and she looked so sad (had droopy eyes) and didn't even sniff me. I have to do that again... but this needs to be done for her.

For now, she is doing fine.

Cashew / Daisy Stare Off

This is from yesterday, this is her staring at her rival, the neighbor's dog, Daisy. They bark at each other through the backyard fence, but so nice and polite when there is no fence.

Personal

The worries and negative thoughts come at night when I get tired, but I'm optimistic about the surgery now. Eating breakfast, catching up on work and watching a movie as Cashew sleeps in the same room.

January 8th, 2020 Evening

Cashew and I have returned!

Cashew was trembling and I was ready to walk out so I don't have to make her go through this again. 3rd hospital visit this year.

The oncologist Rebecca Regan told me about Insulinoma. Everything I've read.

Cashew meets Dr. Regan

Cashew surprisingly liked the doctor. Doctor sat down which made Cashew stop trembling and Cashew sat down too. I couldn't stop smiling because this was like her before she had the partial seizures. Just looking at me like she's bored.

So here are the notes

Prednisolone 5mg per day is very minimal for Cashew's size. She can be up to 15mg/day so go ahead and give her the 2.5mg twice a day and I can always go down later. It should work within a hour.
Diazoxide - the same response as others. It's VERY expensive at $700+/month and pharmacy usually doesn't have them. I can if I want.
Prognosis - 6-12 months on medicine. 1.5 years + 6-12months with surgery. 1.5 years is average, it could be less or more.
Diet I have her on is perfect. Protein based. Stay away from carbs or sugar (no bread, rice)
Dextrose water or Karo Syrup - That'll raise her insulin levels. Only give it to her if she's about to have a seizure or have no energy to eat
CBD Oil - It's like Coconut Oil 5 years ago. 90% of our patients use it, but there's no scientific evidence. But people swear that it helps calm the dogs and helps with cancer. I had to stop her. "90% of your patients use it?!" "yes" "so..😯 uh.. no scientific evidence"

OK. So X-ray / Ultrasound came back

Cashew has a 1cm sized tumor on her pancreas.
This is the ideal candidate for a surgery

Price / Cost

$1200 for examination

Radiology + Ultrasound Price

$6700 for surgery

Insulinoma Cancer Surgery Price

This is cutting a piece of Cashew's pancreas
90-95% chance of success
5-10% Pancreatitus which means she'll be vomiting and in discomfort. This can be treated and will not shorten her life
In rare case, Cashew may die from anesthesia (1% rare) or pancreas not reacting well. Doctor said, this rarely happens but has to be said.

If these were facts and if this was my body, I'd take the surgery.

I'm aiming for her surgery next week.

Gives me time to spend with her incase surgery goes wrong
Gives me time to run this by family / doctor
Gives me time to read other perspectives online
Part of me doesn't want to wait. It's giving her cancer chance to get bigger

She was a lot better afterwards so went to the park

Walking at the park, a little cold

Then we played this old game.

January 8th, 2020 Morning

Today is Cashew's oncologist day! I'm going in with the expectation that surgery is not an option. Notes for myself.

Make any decisions based on what I would choose for myself.
Predisolone 2.5mg (half of recommended dosage) started yesterday. How soon to see results? Cashew still has twitching randomly with 5-6 meals / day.
Is Diazoxide a better option for Cashew? Prednisolone seems to have a lot of side effects (not yet seen on Cashew). Why is prednisolone recommended first? If price is the only downside, I prefer Cashew to be on Diazoxide over Prednisolone.
Prognosis. How much longer. Will she be in pain.
What sort of diet should she be on?
Dextrose Water vs Karo Syrup when she is having low glucose.
CBD Oil?

Personal Stuff

The crying doesn't stop. It gets better and worse if that makes sense. I am taking her to the oncologist today so I saw myself in the mirror and wow. I heard about the puffy eyes, but I think it gives a nice youthful pink shade to my face, but I haven't shaved in a while. I haven't ate properly (maybe 4 meals in the last 5 days? and haven't showered since Cashew's diagnosis.

Yesterday, I lied down next to the sofa. I left the TV on with rain sounds. I was reading about Golden Globes and knocked out.

I had a nightmare about Cashew. I had left her at some party with Ricky Gervais and they had thrown her in a closet. I came to save her and when I saw her in the closet.. I woke up.

I must've been making noise in my sleep, because when I woke up Cashew got up to sleep next to me. Maybe she's telling me it's ok or she's just cold. I think the latter 😂

So nice and warm.
She's annoyed, but I'm smelling her much as I can.
Hard to explain, but her nose area smells like dried honey and her paws smell like tortilla and I can't get enough of it.

January 7th, 2020 Afternoon
Blood results are in! Cristi Blackwolf from Adobe sent me "Cashew's results did come back as indicative of an insulinoma. The results were already sent to SAGE"

I think I had that 1% hope in me that doctor would find that it wasn't insulinoma.

Results show High Insulin, Low Glucose

Today around 4pm, Cashew wanted to play ball! She can still catch the balls well! I probably threw about 20 balls and she caught a good half of them. She jogged around the backyard. Is the prednisolone already working or is this just her regular self?

And then she ran with my neighbor's dog! I thought I'd never see that again.

Followed by twitching.
She got out of it, but when the neighbor's dog barked, Cashew got up, then she started to twitch. Excitement definitely seems to trigger the partial seizures.

January 7th, 2020 Morning
Cashew has eaten every 4-8 hours, but the partial seizures are getting longer and more frequent today.

I started her on Prednisolone 5mg / day. I also bought a pill splitter to give her less dosage once she stabilizes.

Called Sage Hospital and had them move the appointment for a consultation with Rebecca Regan to tomorrow.

Some notes for myself to give to Dr. Regan

Cashew's blood glucose was at 29 (normal range is 70-138) and under 40 January 2nd and 4th.
Been feeding every 5-6 meals a day
Used Predisolone on January 5th and again on January 7th. 5mg/day divided in 2
Partial Seizure seems to have started end of October and getting more frequent and longer

Things to Think About

Should Cashew have surgery to extend her life for X months. Things to consider
Risk of earlier death (chance of pancreatitis)
How much longer does her life look now?
How many months can she get on best outcome
Would I consider exploratory surgery
I really need to sleep well to have a clear mind tomorrow. I will try to make a decision based on what I would do if it were my life and I don't think I will have regrets.

Things to Ask

Is Diazoxide a better option for Cashew? Prednisolone seems to have a lot of side effects. Why is prednisolone recommended first?
Prognosis. How much longer. Will she be in pain.
What sort of diet should she be on? Dextrose water? CBD Oil?

January 6th, 2020
I found this group, Julie's Canine Insulinoma Support Group on Facebook and it's been SOOOOO helpful. People are so kind and understanding. Everyone's in the same shoes trying to figure out what's best for our best buddy.

Joining this group is a must.

Some hopeful posts like doctors giving a time of 3 months and lasting 3 years.

And there are other way around where 1 year turned into 2 months.

What kills me the most from reading online is that Cashew will eventually have a grand mal seizure where I need to have her put to sleep.

I don't want her to pass away like that at the hospital she hates. At the same time, I don't want to give up on her while she still has the will to go out and walk.

It's REALLY hard to think of it now, but she loves to sleep in the sun. If time comes, I wish I will be able to have Cashew euthanized outside in her favorite bed under the sun surrounded by the people she loves.

NO! I must not think this way! I have to think how much fun she's going to have once she can get her blood glucose up! It's limited time, but I have to focus on making it the best for her!

January 5th, 2020
We went to a school we often went to. Took pictures.

When I tried to return to my car, she sniffed out the ball in my backpack and told me to throw it. Then she forced me to go to walk around the block.

Right when I thought she was faking this whole thing to get her ways (upgraded food, 24 hour attention, walk long as she wants), she started having her partial seizure (twitching, losing balance). She walked towards me after it was over and it really really really breaks my heart. I cried.

Cashew got rubs for the rest of the day for hours.

January 4th, 2020
Snapping out of it and trying to focus on Cashew's life!

Feed 5-6 times a day to keep glucose normal - Setup a board to mark when she ate last so I can remember when the last time I fed her was.

Food is still the same, but she loves the Salmon and the dry-freeze food

I'll start boiling chicken and occasionally cooking for her.

Contact People - Cashew is still here and aware. I'm not much of a social person, but I contacted the few people that was part of Cashew's life. That's what Cashew would want. Cashew loves almost everyone she knows. If Cashew wasn't limited by my anti-social lifestyle, she'd probably have a house party full of people that cared about her.

Setup an environment - I want Cashew to be comfortable so the house will be full of places to sleep until I determine where she likes. I know. it's a mess.

Take a lot of pictures / not be on my phone while I walk with her - I'm guilty of usually browsing on my phone while walking with Cashew. Not anymore. I just got back from watching her walk and it made me cry and laugh.

January 4th, 2020 - Grieving Process Starts
I'm having such a hard time and don't want to burden anyone. My best buddy I've had from when she was a baby is diagnosed with terminal cancer. She has been with me for everything. Saved me when I felt awkward at social occasions. She forced me every day to take a break from my computer to go out. She made me laugh everyday. Really. every day. She's the best comedian I know. She listens and is so considerate. All the quiet walks. I loved it how I give her a big hug and a kiss and her paw would try to push me away. or if I ask for a kiss and don't let her go, she'd reluctantly lick my nose. She sleeps on my bed, but when she sees me getting ready to sleep, she gets up to move over. She's always next to me brightening my day.

And now, I have to say good bye to her? I just can't... I really can't..... It's been like a nightmare that I can't wake up from.

I usually don't let go of her until she gives me a kiss

But this time, I didn't so she is annoyed

January 4th, 2020 - Cashew is diagnosed with Insulinoma
The technician used what looks like AlphaTRAK 2 to quickly determine Cashew's blood glucose was too low

I took this picture thinking it's going to be fine

Huge sigh of relief. "That should rule out a brain tumor and maybe a medicine or something like insulin shots should do!" Jennifer Koga stepped in and I said "Great news RIGHT?" and she had this 😅"well... not quite" and I listened.

Cashew's low blood glucose is caused by Insulinoma. A tumor in the pancreas. This is malignant.
Will give me some Prednisolone to help with glucose levels.
Asked me if I know what a grand mal seizure and said Cashew will have those. 😭
I should schedule an appointment with an oncologist to get better prognosis.

My family needs to discuss if we want surgery or not, but even with surgery, this is cancer so it will come back.

List of places for oncologists. Was recommended Sage

Reason for not calling oncologist - Whatever the result is, I don't intend on getting a surgery anyways

I'm not the sharpest person or maybe I was in shock. I'm used to hearing a solution when going to the hospital. A medicine. Insulin Shot, etc. so I asked clearly in the simple language I know

How much time does she have left?
Doc : It's about a year.

So... it's not going away. No solution?
Doc : No. 😅
Me : 😅 (I'm trying not to think about what she's saying)
Doc : I know it's a lot to take in 😅 Let me go write you up a summary of what I said and also send you off with Prednisolone
Me : 😅 (looking at Cashew looking at me helplessly) Sorry buddy, no solution this time

Cashew's Blood will be sent to confirm if Insulin is high, but doctor said that's just for formality and she most definitely has insulinoma

Feed Cashew 5-6 times and give prednisolone to help with glucose levels

Use Karo syrup (corn syrup) if she has any seizures. Karo syrup on the lips will get absorbed into her blood stream right away and help.

Blood test results will confirm insulinoma by 1/8/2020.

Scheduled an appointment with oncologist (Dr Regan at Sage) for 1/10/2020. The front desk person never heard of insulinoma which made me look through Yelp reviews. They have an overall 4/5 stars. Seems expensive, but other hospitals are similar in the bay area and Sage seems to have a relationship with Adobe Hospital.

January 2nd, 2020 afternoon
E-mail showed Cashew had VERY low blood glucose level.

I was relieved there's a chance it may not be a brain tumor

Doctor asked me to come in again to have Cashew's blood checked again to confirm the low glucose levels
Scheduled an appointment for January 4th, 2020

January 2nd, 2020 morning
Jennifer Koga (Cashew's primary care) / assistants had done the following

Overall body check, said she is very healthy for a 12 year old
Blood Pressure test - seemed fine
Urine Test - Followed Cashew out to pee outside and placed the bucket underneath her when she started. I laughed how fast Cashew peed - Came back normal
Blood Test - Was told I'd get an email with the results
Doctor at this point suspected, it's probably neurological, but let's wait until the blood results.

December End, 2019
3-4 days of feeding Cashew the usual salmon food. Her twitching / loss of balance episodes weren't going away, it seemed to be happening more often. Maybe about 10 seconds long and 1-2 times a day. Usually happens the moment she comes out and she's fine once she starts walking.

Scheduled an appointment with Adobe Animal Hospital.

Scheduled appointment for doctor on 1/2/19
Sent video to my brother which sent the video to Jennifer Koga. My brother highly respects her at Adobe Animal Hospital and I trust my brother.

Update : This is a partial seizure as shown here

Partial Seizures - Credit to Canna-Pet

December, 2019
Family has been telling me Cashew is getting clumsy like she fell over during a walk or sometimes she doesn't want to go for a walk.

One day, I saw her twitching and losing balance too. Maybe it was the recent change in food. Switched to the "Nulo Limited Turkey" to give her a little variety I think around November. "Nulo Limited" has helped so much with Cashew's fur and itching. So, I switched back to the Nulo Limited Salmon.

November, 2019

I noticed Cashew has been sleeping often, but didn't think much about it. Maybe the Winter weather. She always hated the rain and the cold. Sleeps, goes for a light walk around the block with my dad. Eats at the dinner table with the family. Yes, she sits at a chair. Bowels movements perfect, appetite's good, occasional drives and walks at the park with me, occasional play fight with me where she runs around the house. all was normal.

October, 2019

Cashew is 12, but she is an active 12 year old. Still running around the house and going for a daily walk either around the block or to the park. I let Cashew choose the path to walk and we often get in a non-verbal argument when I want to go home and she wants to walk more. She knows the turns to make the walk longer and she'll stand and stare at me. I stare at her, but I usually give in. Family tells me she's getting older because she gets tired from a few ball throws. True. When she was younger, she could stay at the park ALL day and the ball throwing would not end. I bought one of those long chuck-it sticks and throw the ball far as I could so she wouldn't return for maybe 30 seconds until I have to do it again.