Paraneoplastic syndrome?

In 3/2013 after suffering 2 "seizures," Clark was diagnosed with insulinoma from insulin level tests by the University of Wisconsin-Madison. X-rays, U/S's and CT's showed no tumors. I declined surgery and chemo (18 month expectancy) and decided to medically manage him with low dose prednisone and 4-5 small meals a day (6 month expectancy). Tramadol was also scripted out for some pain/weakness in his lumbosacral spine (I was unaware of this issue). Clark was eventually weaned off the pred in 1/2014 and to 2 meals a day with no seizures. He acted and was perfectly fine - like nothing was wrong since the 3/2013 Madison visit. In 6/2014, I came home from work to find Clark flat on his stomach, legs splayed to the side, and his food & water behind him which he could not reach. He was having a low blood sugar episode but did eat for me; however, he was not weight-bearing. Madison said Clark had paraneoplastic syndrome (suddenly?) with advancing hind end weakness/myelopathy even though his chest-xrays and U/S while there still showed no metastasis. He has no problems with his front legs or lifting his upper body off the ground; he can even pivot his body around in circles and pull himself around a bit (on carpet, grass and concrete). Clark still cannot lift his hindquarters off the ground without assistance and his rear feet both knuckle under when walking (I have NeoPaws boots to help with this though they are not 100%). His gait is unsteady and stumbly but he can walk and does better on smooth/flat surfaces or carpet, worse on slick floors (I have a small video clip I can send you). 10 days ago he had a spinal MRI at Madison which showed no malignancy and no pinched/slipped discs. They still think Clark has paraneoplastic syndrome though. He eats, drinks, is not incontinent, no vomiting or diarrhea, is BARH, barks at doorbells, neighbors, and neighbor dogs, and loves to sit outside. He also has recurrent UTI's. He looks forward to the pet sitter coming midday (for potty break and meal) and is always happy to see me. Couldn't he just have hypoglycemia without having insulinoma? Owners of dogs with degenerative myelopathy say Clark does not have that. What do you think? Could he have hip dysplasia? FCE? Is Madison focusing too much on the insulinoma/paraneoplastic syndrome when there isn't even any evidence of malignancy? What else could be wrong with Clark? Would he benefit from a cart or different booties? Clark is currently on pred, Tramadol, and Gabapentin. I have a degree in Biology and have worked in veterinary offices for many years so I'm not your average pet owner. I assumed I would only get referred to Madison anyway based on his conditions so I just take him there. Should I take Clark somewhere else? I have easily spent over $15,000 on Clark and although he is worth every penny, I also don't have any real answers for all of that money, in my opinion. My husband and I did not have any children (he passed away 31 months ago) so our pets have always been our kids. Thank you very much, Dr. Marie, for your insight and assistance. Clark and I really appreciate it.

Thank you very much for your reply.

Even without the surgery, Madison was convinced he had insulinoma even with no other evidence besides the insulin levels test. It was only after the most recent chest x-rays and ultrasound that they started thinking Clark may have had other issues, hence the neurology workup. The working theory was he should have had problems with all 4 limbs and not just the rear legs if it truly was paraneoplastic syndrome. But then when nothing showed up on the MRI, it reverted from neurological back to internal medicine/oncology. Clark would have needed to be off steroids for the EMG's, which would have been difficult for a dog with hypoglycemia. And the same for the Addison's test. That's the test I was really hoping Clark could have had 18 months ago. I just had a gut feeling about Addison's. The very annoying aspect I am being told by Madsion was that Clark was compensating for his rear legs for the last 18 months until he couldn't anymore. I just don't buy this. I would have seen some difficulties upon rising, stiffness, slipping on different surfaces (and definitely on slick ones). I know this first hand from my husband dying from melanoma. He too suffered from paraneoplastic syndrome from the steroids (dexamethasone) that he had been on. He gradually went downhill - arms and legs. Clark didn't have this. It just happened - boom - within 8 hours, he was down and he (his hindquarters) never came back up on his own again without my help. I know pets can compensate but he couldn't hide this, no matter how stoic or strong he was. My husband refused to be put on hospice - he would have none of that. He actually passed away from pneumonia.

On that day back in June, because he slipped/fell and ended up facing away from his food and water bowls, the hypoglycemic episode was brought on. It had probably been 18 hours since he last ate when I came home from work to find him the way I did.

My other issue is if you have a dog that has hypoglycemia due to proposed insulinoma, how does one explain how he can go 10 months on only 2 meals a day and no prednisone/ steroids for 6 months? There's no way Clark could compensate for low blood sugar. I have low blood sugar and become a maniac if I don't eat something and fast! Clark never had surgery on his pancreas, never had any chemo, never had holistic/homemade diets, no metastatic disease found upon hi-tech radiological assessment - nothing that the typical insulinoma dog would have had, tried, or experienced. And yet, Clark has paraneoplastic syndrome due to suspected insulinoma. I just don't see the dots connecting.

I had a cat that had diabetes and Cushings. I had a cat that needed 2 radioiodine injections to control her hyperthyroidism. I had a collie with idiopathic IBD. Another collie had a pelvic bladder but passed away (9 months ago) due to a stroke. I had a cat who went blind from herpes live to be 18 years old. I lost a 10 month old Siamese kitten to FIP. Lost another Siamese cat to lymphoma at 14 years of age. A Siamese-mix cat lived to be 16 years old but even Prozac, Valium, and a cat shrink could help him with his aggression. None of these pets read the veterinary textbooks and neither did Clark. And why have so many problem pets found us? Those odds have to be just as astounding. Because I was Biology major who never continued to get her DVM? Because I worked in the pet/veterinary profession for 20+ years so who better to care for them? Is there some big arrow in the sky pointing at our home for problems pets to stop here? The 3 cats I have now are the most boring, normal pets I have ever owned.

Thank you again for your insight, research (the VIN article was interesting indeed), and how quickly you replied to me. I really appreciate it.

Maureen