From:
williamsdvm@comcast.net
Date: 2003-03-22 04:18:32 UTC
Subject: RE: Help and second opinion needed on Insulinoma treatment
To: ferrethealth@smartgroups.com
Message-ID: <30180590.1048306712087.JavaMail.root@scandium>
Author wrote:
>> .1- Is it true that in insulinoma cases, a surgery ,If the ferret is a good candidate, is ever the best treatment ? Or this statement is valid only for the first one?
Surgery is still the best treatment - it is not uncomon for ferrets to have two or more.
> Or putting in another way: Even having already went trough a partial pancreatectomy(about 50% of the organ) last year, will be the best choice in terms of time and quality of life to make an exploratory and try a nodulectomy on the new growths?
I think that is a fine idea.
> . 2- What are the elements we can use to establish if she is a good surgery candidate anyway? Is the glucose level one of then?
> If yes, what can be considered safe?
Glucose is not a prognostic factor, ferrets even with minimal glucose levels can be administered glucose in IV fluids before during, and after surgery. The duration of symptoms is probably a more important prognostic factor.
> . 3- My vet told me that in cases of insulinoma that included spleenomegally; if the spleen "shrinks" when Prednisone is introduced (which absolutelly did'nt hapen to her untill now) , it could be an indicative that a linfoma is present too. Is it sounds?
No - the only way to tell if the spleen has lymphoma is to remove it and sent it off for pathologic examination. Spleens often change in size.
> Or as I have red many times in this list, the unique way to diagnose linfo is with an aspiration or biopsy in a organ or limphnode?
Biopsy is best, aspirate is not really adequate.
> . 4- Considering all that we read about growths in the liver rarely being primary caused, do you think that the hepatic carcinoma she had could be a metastasis from her left adrenal ?
Didn't you say that the lesion in the adrenal was hyperplasia - if this is true, then it isn't metastasis. However, adrenal carcinomas and hepatic carcinomas can look identical, and only very special tests (not available everywhere) can truly tell the difference between these two lesions.
> . 5- She has no bold spots, only a slower growht of her fur. As I said her remaining adrenal had grown to 0.8 mm . Do you think that, going to surgery we may think about to remove it?
The average size of an adrenal is 0.5 cm - so you may be moving into dangerous territory. Most adrenals over 1 cm in diameter contain adrenal malignancies.
> . 6- She's having black and tarry pooping now (but not all the times) and whining when pooping, all times (not when urinating just when pooping) I don't now Why. Must we just start with some ulcer medication? Or are there any specific tests to do before?
No, black tarry stools are very characteristic of ulcers - my recommendations would be to start meds now, and to treat aggressively - this would be a major complication to her having surgery.
With kindest regards,
Bruce Williams, DVM
>