>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]