>Hi, I'm doing some research for my vet who will be performing insulinoma
>surgery on my 3 year old Chance in January.  He has done a ton of adrenals
>but has limited experience with pancreas surgery.  He would like to know
>what to do if no nodules are visible, should he close and try again at a
>later date?  He mentioned he experienced a problem with leakage (I believe
>he used this term) after removing nodules and infection set in afterwards.
>Any suggestions on how to avoid infection?  How long should a ferret fast
>prior to surgery and is there a waiting period after surgery?  I think I
>recall something on this list about that but couldn't locate it.  Any
>tips I can pass along to my vet will be appreciated.  He has read the
>Weiss/Williams article.  Also, what is the initial dose of pred after
>insulinoma is diagnosed?  I'm only giving Chance .1 once a day.  His
>blood glucose was 52 last time we tested.  He seems to be doing o.k.
 
Dear X:
 
My general recommendation is that if no nodules are visible, then a
partial pancreatectomy should be performed - that will take care of the
problem in 50% of the cases, and the post-surgical disease free interval
is longer than nodulectomy.
 
Infection is generally not a problem - your vet may be concerned about
inflammation and post-surgical peritonitis, but this is really not a
major concern if technique is good and excision is precise (usually these
nodules just shell out very nicely.)
 
Fasting should be 3-4 hours, tops, and dextrose can be given at surgery in
very hypoglycemic animals.
 
The appropriate dose of prednisone is the one that keeps the blood glucose
at a level that no clinical impairment is noted.  (Note that I did not say
blood glucose is in the normal range, as this can be difficult to achieve.
0.1 ml is pretty low, and a BG of 52 can be worrisome - I might double it
and see where that takes the glucose.  If you can get the glucose over 60,
then that would be appropriate.
 
With kindest regards,
Bruce Williams, DVM
[Posted in FML issue 3644]