From:
macdoodle99@yahoo.com
Date: 2001-04-17 20:06:00 UTC
Subject: F/u Mackenzie's insulinoma surgery
Hi, thanks to those who answered my post regarding when to do
insulinoma surgery on my 7 year old ferret Mackenzie. As it turned
out, it was not difficult to convince my vet to operate. As a
reminder, she started having anorexia and teeth grinding about 4
weeks ago. After two weeks not responding to carafate (empirically
for gastric ulcers, which she has had before), her blood sugar was
tested and was 46 and the diagnosis of insulinoma was made. At the
time, I asked my vet if Mackenzie could have two things going on
because I thought teeth grinding was a sign of abdominal pain. He
said it was a sign of nausea, and hypoglycemic ferrets are often
nauseated. He did say she could have something else going on but at
this time felt that we should start by treating the insulinoma.
Initially she was grinding her teeth only with meals. But later she
began grinding her teeth between meals. She never responded to
increasing doses of prednisone, and I assumed her teeth grinding was
a sign of hypoglycemia. Within five minutes of feeding her she would
stop grinding her teeth for a few hours. (I never checked her blood
sugar during these times because I just couldn't bring myself to clip
her toenails short enough to make it bleed.)
Today she underwent surgery, 4 weeks after her symptoms started.
This is what my vet told me: When he opened her up, he saw blood in
the peritoneal cavity. It looked like she was bleeding from the
renal capsule. Apparently her omentum also looked bad and was
bruised and had lots of petechiae. During the course of the surgery,
the petechiae spread and she seemed to ooze blood easily. The
tissues seemed very fragile. She had a tumor in the tail of the
pancreas, tumor adherent to the duodenum, and a large tumor in the
caudate lobe of the liver (I think he said caudate lobe). Her
intestines looked very inflamed. Due to all the petechiae and
oozing, he was concerned about DIC and apparently tried to do what he
felt was most urgent and then get out. He took out all three tumors,
but didn't really spend any more time looking elsewhere for other
possible "metastases". Post-op on an apparently low dose dextrose
drip, her blood sugar was 143. She seemed stable post-op although
she is continuing to ooze blood from the center of the incision. He
had called in his partner in the middle of the surgery to help him.
I spoke to her later when I went to visit Mackenzie. She thinks she
has insulinoma and lymphosarcoma and some sort of enteritis, maybe
eosinophilic. Mackenzie is stable in the immediate post-op period
and is staying at the hospital (wasn't so sure I should leave her
there. I thought she could die tonight and I would like to be with
her. But, they really felt she was stable and that it was in her best
interests to stay there, even though no one is there over night.)
Obviously we all think her prognosis is extremely poor. I did
consent to sending the tumors off for path. (I thought they would do
that automatically.) It's amazing: She just had a check up 2 months
ago and everything was fine and her screening chem panel and cell
count and everything was all normal. (Blood sugar then was 87.) We
are all also amazed at how strong and energetic she has been given
the findings during the surgery. The vet now agrees that the teeth
grinding was most likely from abdominal pain and not hypoglycemia.
(That comment was for Dr. Williams who commented in his response to
me that he didn't think hypoglycemia was associated with teeth
grinding.)
I will let you know what the path shows.
Kristy and Mackenzie