From:
Bruce Williams, DVM
Date: 2001-11-20 06:32:00 UTC
Subject: Re: Insulinoma
--- In Ferret-Health-list@y..., TR1212@A... wrote:
> Dear Friends,
> I need to make some decisions but it seems to be very difficult for
me right
> now. Need to know I'm doing the very best for my little guy. Oscar,
male,
> about 4 (we're guessing, a rescue with no info). Six months ago had
adrenal,
> chordoma and stomach surgery. Had a hard time the first three days
after,
> from that point on has done very well. Was diagnosed with
insulinoma approx
> 4-6 weeks before surgery from bloodwork. Has shown no signs. Eats,
plays and
> usually poops fine. Loose and seedy today. 10:30 am vet appt.
tomorrow for
> that. Pepto in the meantime. Our original vet took the wait and see
approach
> in regards to the insulinoma. No meds or surgery mentioned. I also
think
> something may be going on with his right adrenal. The area on his
neck where
> the vet shaved to do bloodwork has grown back very little hair.
He's also a
> little agressive to one of his sisters. Now, what I need to know
is, would it
> be best to put him on meds for a period of time and then at some
point do the
> surgery? Should I put him on meds at all at this time? I believe
that this
> kind of tumor "seeds". Are we taking a chance of it becoming alot
worse by
> not doing surgery now? We have found a vet who does cryo so when he
does go
> in for the insulinoma, the adrenal will be taken care of too. He's
doing so
> well right now and I know that both of these surgeries often times
create
> other problems. Addison's, high BG levels. I'm having such a hard
time trying
> to decide what to do. I know surgery is inevitable and don't have a
problem
> with it, I just can't make the decision if now is the right time. I
think I'm
> feeling that I'll be subjecting him to the high BG levels and
addison's and
> feeling crummy when at this time he's so bouncy and happy. Will I
be creating
> something at an earlier time in his life than necessary? Now,
instead of
> maybe a few months from now? Most decisions that I've read seem to
be decided
> because of age and other non-surgery issues or because the symptoms
are so
> bad that something needs to be done immediately.
Dear Tiffany:
It is always better to go in before the situation becomes critical,
while the patient is the best surgical candidate. If the diagnosis
has been made, and you are committed to eventually doing surgfery,
sooner is always better than later for a number of reasons. Medical
treatment allows the neoplasms to grow larger and increases the
chance of post-surgical complications.
If the surgery only involves one adrenal, then Addison's is not an
issue. (And Addison's is certainly not the end of the world. I have
a bilateral adrenal at home who gets a monthly shot of Percorten and
bounces around happily,her old normal self.) Post-surgical diabetes
is a rare complication, whose incidence is markedly increased in
animals with either longstanding insulinoma or prolonged medical
treatment (another reason to do surgery early).
The theory that these tumors "seed" is unproven, and an
oversimplification. Yes, 40% of cases recur within 10 month, but this
is not due to metastasis, but an unchecked (and as yet unidentified)
metabolic condition which causes hyperfunction of islets of
Langerhans. If your vet believes that these neoplasms tend to
metastasize around the body, well that has been disproven in ferrets.
Bottomline - an early surgery in the vast majority of cases, has the
best chance of prolonging quality of life.
With kindest regards,
Bruce Williams, DVM