Should I get insulinoma surgery for my ferret?
Is insulinoma surgery safe? Is it more effective than medicine?
Artwork by Katelyn McManis for www.ferret.love. Do not reproduce without permission.
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I usually treat insulinoma with medicine (prednisolone and diazoxide aka Proglycem), but that's because most of the ferrets I've had with insulinoma already had it before I adopted them, and/or had other health issues going on.
I have gone with surgery for one ferret, my girl Imogen, and it turned out incredibly well. It was a recent procedure so I have yet to see how it compares long term. And it's just one anecdote, but I think in this case, anecdotal evidence is really the only thing you will find since there is so little research on ferrets in general, and this surgery is not performed very often. In certain situations I would definitely recommend surgery.
Things I'd look for in surgical candidates (and that I saw in Imogen):
- Excellent health aside from the insulinoma - importantly, this needs to be confirmed with blood work and an X-ray/ultrasound, you can't just look at your ferret and say "she seems healthy otherwise." Since many cancers are treated with prednisolone, if her ultrasound or blood work had indicated that she had another form of cancer, it would have made more sense just to keep her on prednisolone. And of course, if she were in bad shape, the surgery itself would have been more risky.
- Relatively young - Imogen was 6 and 1/2 years old when she got the surgery. Most people would consider that "old" for a ferret, but you have to remember that their average life expectancy of 5-7 years is mostly because they are cut short with cancer and other illnesses. Their natural life expectancy would be 8-10 years minimum (as it used to be decades ago). So a healthy 6 year old ferret should be considered middle-aged. If she were already 8 years old I would not have gone with surgery.
- Already on a raw diet - She has been on a raw diet since I adopted her around the age of 2. If you're feeding your ferret kibble, then surgery is pretty pointless - the complex carbs in kibble will most likely cause the insulinoma to return quickly after the surgery. You should switch your ferrets to raw anyways, but especially if they have insulinoma, and especially if you're considering surgery.
- Insulinoma was progressing rapidly - Imogen first started showing signs of insulinoma around age 6. Within a matter of months, her pred dose had been increased multiple times, and she was crashing frequently in spite of the high dose of meds. In her case, she had a pretty poor prognosis moving forward, so even if the surgery didn't help, it wouldn't have changed much.
- Visible nodules on pancreas - again, I would definitely recommend getting an ultrasound before the surgery to make sure your ferret is in good health otherwise. Hopefully, the ultrasound will also show visible nodules on the pancreas. If they're visible, they're easier to remove, and it's much more likely for the surgery to be successful. However, in Imogen's case, the ultrasound did not show visible nodules, so we were very uncertain going into the surgery if it would help her. Thankfully, once the vet (the amazing Dr. Childs at VCA West Suburban) was inside her, she saw a very large nodule on the pancreas and was able to remove it. So don't be discouraged if the ultrasound doesn't show anything, but if it does show one or two larger nodules, then you can definitely go into the surgery more optimistically.
When I'm talking about a "successful" surgery I mean that it actually helps the insulinoma, either slowing it down or completely stopping it. Of course, with any surgery, it could also be unsuccessful if the ferret simply doesn't survive the surgery. This goes back to point 1 - it's always going to be a risk when anesthesia and an invasive procedure is involved, but the healthier the ferret is, the less you have to worry about this.
While it is likely that her insulinoma will return, this has definitely bought her some time.
Before the surgery, she would crash about every other week, and would regularly have blood glucose (BG) readings below 50. Immediately after surgery they tested her and saw that it was 300! The morning after, I got a reading of 206 (unfasted). Since then she has regularly tested between 60-100 after a 3-4 hour fast. This is an incredible improvement.
I didn't just see improvement in the numbers though. For the first few weeks, she was still relatively inactive. I was a little disappointed, but I attributed that to her age more than anything. As long as she was no longer crashing I was happy. But as time has gone on, she has gotten more and more playful again. She's now 6 years 10 months old at the time of this writing, and she pounces on my younger ferrets, chases them through tunnels, chases after toys and dooks, just like a younger ferret again. Her behavior is like that of a healthy 3-4 year old. I'm so happy I went with surgery for her.
I hope this story is encouraging to some. If you're trying to decide and would like some more advice, feel free to contact me and I'll do my best to advise on what I would do in your situation.
October 4, 2022 - her initial surgery date
March 23, 2023 - Imogen has shown her first sign of low blood sugar since the surgery. It was pretty much inevitable, even though a large nodule was removed, it was likely that some of the cancerous cells remained. Her symptoms were pretty mild though, and I just supplemented her with some soupies. Unfortunately my blood glucose meter isn't working.
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