From:
Pam Sessoms
Date: 2001-10-24 07:55:00 UTC
Subject: Re: [Ferret-Health-list] no surgery recommendation for
insulinoma
On Wed, 24 Oct 2001 farrell_cynthia@h... wrote:
> One of our ferrets was just diagnosed with insulinoma, given that she
> exhibited many of the symptoms and had a fasting BG level of around
> 60. We're unsure of her age, but believe she's about four, and is
> otherwise in good health.
>
> Our vet's recommendation was to not do surgery but treat it medically,
> putting our ferret on Prednisone. A consideration with the surgery
> was that there is no assurance for how long it would be effective, and
> in as little as 6 mo. we might be back where we started.
I have heard that recommendation before from a few people I really do
trust. But I am a believer in surgery for insulinoma first, if the ferret
is up to it. An otherwise healthy 4-yr old sounds like a good candidate
to me, as long as her heart is in good shape. A ferret can survive with
*a lot* of its pancreas removed, and if a diseased section can be just
taken away, then all the better, in my opinion. Sure, the darn stuff will
probably come back at some point, but it can be quite a long time in some
cases, and then you have a good "head-start" on the disease and have
postponed starting on meds. They can then be your second wave of
treatment. Now, others have had great luck maintaining long-term on meds
and frequent high-protein snacks, so certainly that is a good option too.
Anyway, here are my anecdotes. I have had a lot of insulinoma in my
house, and the ferrets have always received surgery for it - in a couple
of cases, even a second surgery after the low blood sugar returned,
especially if there was another problem to treat surgically at the same
time. I just lost a wonderful nearly 8 yr old insulinoma ferret to
cardiomyopathy. She had surgery in March of 2000 and went on pred nearly
a year later - we still had plenty of room to increase her pred and even
to add proglycem if needed. My other old lady ferret, Sonic, now has
cardiomyopathy and some neurological problems as well and will probably be
lost to something other than insulinoma although she has had it for a long
time. In fact, she was temporarily a diabetic from insulinoma meds -
although rare, they can have complications, just as surgery can. I have a
boy ferret whose pathology reports have always said his insulnoma is
unusually aggressive; he's had surgery for it twice and is still not on
any meds. He is bouncy and happy but will probably have to start meds
when his low blood sugar returns since there isn't much left of his
pancreas to remove at this point!
I have *never* seen any of these three fuzzies have a classic insulinoma
seizure, or even nausea and drooling. Their presenting signs have just
been lethargy, with the low blood sugar appearing on bloodwork. Now, I
did lose a wonderful rescue guy to insulinoma combined with gastric
ulcers, but his case was neglected and he was having seizures daily when
he came to me. Surgery and then meds kept him happy for about a year...
I suspect that being aggressive early on may be a "good thing," but it's
very hard to extrapolate from such small numbers.
For something more concrete than experiences at "Pam's House of
Insulinoma" (lol), there was an article published in a respected,
peer-reviewed veterinary journal that examined long-term survival of
insulinoma ferrets given various treatments. It's not a randomized study,
and all the ferrets were patients at the same hospital and had the same
surgeon. One group just got meds, another received a "regular" surgery to
remove nodules on the pancreas, and the third received a nodule removal
with a partial pancreatectomy (this is the procedure my guys have all
had). The third group did the best, followed by the second, and the
"meds-only" group had the shortest survival time after diagnosis. Here is
a citation:
Weiss CA, Williams BH, Scott MV. Insulinoma in the ferret: clinical
findings and treatment comparison of 66 cases. Journal of the American
Animal Hospital Association Nov-Dec;34(6):471-5, 1998.
There is some discussion of the article at:
http://www.ferret.org/101medical.pdf (requires Adobe Acrobat viewer).
Anyway, I am running on here. One thing I would caution about is that if
you decide to try surgery, but your vet hasn't done this surgery or hasn't
had good luck with it, then you may want to check around to see if there
is anyone else around with a good track record. Vets can have a "knack"
for different procedures...
Good luck!
-Pam S.