From:
"Jeff"
Date: 2009-08-19 01:31:04 UTC
Subject: [ferrethealth] Re: older ferret with insulinoma, one previous surgery, on pediapred but....
To: <ferrethealth@yahoogroups.com>
Here is a past post from Dr. Williams that addresses a couple of important issues related to insulinoma meds. Note also at the end when he brings up surgery he mentions both nodulectomy and partial pancreatectomy. This is based on the results of a study that he and others did that found that the best results in dealing with insulinoma are surgery that gets rid of visible nodules outside of the pancreas and also removes part of the pancreas. So, if you do elect to do surgery, be sure to have a partial pancreatectomy. An experienced ferret surgeon would probably be able to know by feeling it what part needed removal. I have included the abstract of that study below.
Managing insulinoma with meds can be very difficult and you have to really be diligent or else the result could be / will be a seizure. You are already learning how to do it. When you see that a particular dosage results in more active and normal behavior, then you are at or near the dosage for the current time. Dosages will have to change over time as the disease worsens.
I would also agree, from experience, with what Tony wrote, in that giving meds three times a day, eight hours apart, has proven (for us) to be a lot more effective than twice a day, 12 hours apart. When Neo was near the end, I had to go to 4 times a day, 6 hours apart for meds, and was giving him meals every 4 hours. Not big meals, but just enough to keep his BG levels as high as we could (which at that point was dangerously low despite meds).
See the two past posts below.
Jeff
In Memory of Neo and Mr. Parker
Caring for Trinny, Morphy, Baby Girl, Luna, Dozer, and Possum the Million Dollar Ferret
From: Bruce Williams, DVM
To: ferrethealth@yahoogroups.com
Sent: Tuesday, September 18, 2007 7:32 AM
Dear Meryl:
I can address it right now. Diazoxide is an expensive drug which
rarely if ever works. It is a holdover from the old days when we had
less surgeons doing insulinoma removal, and if your ferret is otherwise
healthy, surgery is always the better option. It should be reserved as
an adjunct to oral prednisone in non-surgical candidates.
Is there an upper limit to prednisone? Technically no, although high
doses for a lng time are often associated with muscle wasting and
excessive deposition of fat (known as pred belly). I have used up to
5mg/lb in cases of lymphoma without horrible side effects, but that is
always a short-term issue, and would not want to try it for a year or
more. If someone is hitting 2 mg/lb/day, I generally strongly suggest
that they look at a surgical option, either nodulectomy, or partial
pancreatectomy.
With kindest regards,
Bruce Williams, DVM
**************
Here is that study:
BEGIN QUOTE
J Am Anim Hosp Assoc. 1998 Nov-Dec;34(6):471-5. Links
Insulinoma in the ferret: clinical findings and treatment
comparison of 66 cases.
Weiss CA,
Williams BH,
Scott MV.
Potomac Animal Hospital, Maryland 20854, USA.
The clinical signs and surgical findings were reported for 66
ferrets with insulinomas confirmed histologically. All of the
ferrets were treated with one of three modalities, and
disease-free intervals and survival times were gathered to
determine the most effective treatment. The three treatment
groups included 10 ferrets treated medically, 27 ferrets treated
with pancreatic nodulectomy, and 29 ferrets treated with
pancreatic nodulectomy combined with a partial pancreatectomy.
The mean disease-free intervals for each group were 22, 234,
and 365 days, respectively. The mean survival times for each
group were 186, 456, and 668 days, respectively. Based upon
the data, recommendations were made for treating insulinoma
in the ferret.
PMID: 9826281 [PubMed - indexed for MEDLINE]
END QUOTE
[Non-text portions of this message have been removed]
------------------------------------
Yahoo! Groups Links
<*> To visit your group on the web, go to:
http://groups.yahoo.com/group/ferrethealth/
<*> Your email settings:
Individual Email | Traditional
<*> To change settings online go to:
http://groups.yahoo.com/group/ferrethealth/join
(Yahoo! ID required)
<*> To change settings via email:
mailto:ferrethealth-digest@yahoogroups.com
mailto:ferrethealth-fullfeatured@yahoogroups.com
<*> To unsubscribe from this group, send an email to:
ferrethealth-unsubscribe@yahoogroups.com
<*> Your use of Yahoo! Groups is subject to:
http://docs.yahoo.com/info/terms/