From:
Shortley, Lisa
Date: 2001-05-18 07:09:00 UTC
Subject: Insulinoma - final treatments?
Hi everyone!
In March I had posted about Sterling (4.5 year old male)
having insulinoma. He had surgery on 3/30 and my local vet
removed two dime sized masses from his pancreas and sent them
off to histo. She also removed 25% of his pancreas at this
time and a large left adrenal.
The report came back "islet cell carcinoma" one was off of the
pancreas and the other was the pancreatic lymph node encased
in the islet cell carcinomas. Dr Williams, I know you
remember this case.
Sterling has continued to do poorly since his surgery - even
moreso than before his surgery. He has episodes consisting of
foaming at the mouth, drooling, extreme lethargy, stumbling
(when he is even able to walk), and he does not eat on his
own.
I had been feeding him a mixture of Chicken Gravy and duck
soup. He has gained an excessive amount of weight (at surgery,
he weighted 2.7lbs and is now at 3.1 lbs). His pedia-pred was
gradually increased to 1cc two times per day. Despite all
these measures, each of his weekly glucose readings have been
52, 60, 50, and 63 respectively. All readings followed a 1-3
hour fast - nothing longer and despite his feedings, his
glucose has remained dangerously low. While I know that he is
supposed to have a 4 hour fast, appointment scheduling did not
allow for this. And I suspect that had he been on a 4-hour
fast, his readings would have been even lower.
I spoke with a more well-known vet about Sterling's case and
he reviewed the pathology report. He recommended a second
insulinoma surgery where the vet would be much more
aggressive. When I spoke with my vet about Sterling and what
he had said, she reported that while she understands how much
experience he has with this, she saw his pancreas and it's bad
- he had nodules all over it, and it had already spread to his
lymphnode (and his spleen was reported as being lumpy). He
had not come out of the first surgery well and she does not
believe that a second surgery would help buy him any quality
time (if any time at all). It would not remove the problem.
I again spoke with the more experienced vet about this and he
agreed that following her report of what the pancreas looked
like, that surgery would most likely not help the problem. He
recommended placing him on Proglycem (.1 cc twice daily) in
addition to the 1cc of pedia-pred twice daily. We started
this new regimen 11 days ago. Sterling's glucose readings
continue to be low (50's-60), he continues to have episodes
(on average 1-2 times daily). Nothing has improved.
I know that with Proglycem, there is a thought that if it is
not helping, it's hurting and to stop treatment with it. What
I don't know is, how much time should be given for it to help?
When should we stop the Proglycem?
Another question, and I even hesitate to ask this, is: Is
there ANYTHING further we can do for him? Anything that could
maybe possibly boost his quality of life or help raise his
glucose? I think I know this answer and even though I'm not
sure I want to hear it, I'm welcoming ANY thoughts on this.
I'm not sure otherwise he'll be around long. He's doing very
poorly.
Thank you all,
Lisa Shortley and Sterling too