Jilly was "diagnosed" with Insulinoma in the middle of March '99. She'd been loosing weight for a year. Last May she was 0.85kg, then she went down to 0.7kg for about half a year and then even further down now. In the middle of March she was about 0.65kg. Then one morning (19/03/99) she had a bad wobbly spell so that more or less confirmed Insulinoma for me. I let Jilly run around the house because she was so hyper and then suddenly I thought I wasn't seeing right because she went down on her one back leg and after that she went down every few steps and then fell on her side in the end. It looked so bad. I had her put on pred straight away.
A few days later I went to Karen's so her vets could do a proper blood glucose test. So we took Jilly to the vets, she had her blood glucose test and it was 2.5 mmol/l, at the very bottom of the normal range. When I told the vet that Jilly had been on pred for almost a week, she said that in this case the blood sugar is low so Jilly has Insulinoma. Karen and I both bought Hill's A/D and I bought a coffee grinder a day later to grind ferret food so since then (25/03/99) Jilly has only been eating her special "mush", the A/D mixed with ground ferret food and water with a bit of brewer's yeast added. She loves it and won't touch anything else. [Update August 2007- In the past we used brewer's yeast for ferrets with insulinoma because the chromium in brewer's yeast was thought to help control/ normalise the blood glucose. It does but only for diabetes where it helps *lower* the blood glucose so not a good idea to use on insulinomic ferrets.]
Then I was away in Germany from 02/04/99 - 15/04/99, Karen looked after the kids while I was gone. When I got back from Germany on the Thursday and saw Jilly, I couldn't believe my eyes. She was sooo big! We weighed her and she was 1.0kg when she was only 700g 2 weeks before! So I was quite happy to see how well she looked. :-)
But things changed for the worse then. Sunday night (still at Karen's) I noticed Jilly's lymph nodes were enlarged on the neck so I thought I take her to the vets just to make sure it's the lymph gland and not that it feels big because it's covered with fat. Well, the vet said the glands on the neck were pretty much enlarged and she could also feel the glands in the groin and said you weren't supposed to be able to feel them in a ferret. She said it could be that they are enlarged because of an infection but really thought it was more likely to be Lymphoma. She told me she thought it was an aggressive form and Jilly could deteriorate very quickly from one day to another and she gave her about a month to possibly 6 months to live... There was I hoping I could have up to 2 years with her and now I may only have a couple of weeks or months with her...
Jilly also had another blood glucose test a few days later (yes, I was still at Karen's), it was 3.2 mmol/l. Which is within the normal range.
Jilly is fine at the moment, just fat (obese). I read a post on the FML, some people had to put their ferret down because it was too fat, couldn't move properly anymore, just moved by pushing itself with the hind legs and in the end it used to lie in it's own mess so they had to have it put to sleep. So I thought there is no way I'll have this happen to Jilly so I put her on a "diet". She used to eat a mush made of Hill's A/D, ground ferret food and water. Now I've cut the A/D out. I have to feed Mason because he can't eat and he gets ground ferret food with water so I had a look if Jilly eats it and she does. At first I had to sort of force her to eat but now she even eats all by herself, I don't even have to spoon feed her! When she was still on the A/D mush, there were times when she didn't want to eat and it took ages to get her to eat and she would also gag as if she felt sick but now she licks her mush out of the bowl and gives the impression that she feels fine and has a good appetite. So she's doing great right now. Which doesn't mean that it won't go downhill tomorrow. But as for right now she is okay.
Jilly is still fine, she gets run of the house once or twice a day, she is usually up when I get up, the first thing I do is clean the ferrets' toilets and then she asks to go out so I let her have a run while I get ready and have breakfast and then I put her back in the room when I feed her. She goes up and down the stairs which I think is good exercise, some days she's fitter than others, some days she runs around a lot, other days she lies down on her tummy after a few steps. She's been much better since I stopped her herbal supplements, she had Echinacea, Pau D'Arco, Red Clover Tops and Ester Vitamin C mixed in her cat milk once a day. I stopped giving her all that and her appetite has got better and she doesn't gag at all now and seems much brighter.
Jilly is still going strong, she eats her mush and has a run in the house at least once a day and manages to go up and down the stairs, I am glad that she is so stable and hope she will continue to be so well.
Jilly had a dental today and is okay, Louise did the dental and took some teeth out but I was too scared to look in Jilly's mouth for a few days afterwards. I gave her Hill's A/D to eat when we were back home and she licked some of that but looked like she was in pain. But 24 hours later, Jilly looked much better and ate well, she now eats ground ferret food with water and A/D. The vets gave me a sachet of some new stuff that I'll try on Jilly and Mason, it's called Logic Oral Hygiene Gel from Sanofi Animal Health Ltd and it's like a paste and you give it to the animals and it's got enzymes in it that break down plaque and has a mild abrasive action so it should prevent teeth from becoming bad. I've ordered a tube so hopefully that will do the trick. The dental cost me £50.00... Karen and I were joking about the price, a spay is only £35.00! Karen said that open heart surgery would probably be cheaper than a dental! She asked what they did, put diamonds on all her teeth and gold plate them? Or fit some dentures? I said that the vets charge £1.00 per minute so we joked that they probably cleaned, polished and waxed every tooth and then the vet looked at it 10 minutes later and thought "Nah, I pull it out". Or the vet fainted when she smelled Jilly's breath and like 10 minutes and £10.00 later she came round but I still had to pay for it... ;-) So okay, that is just Karen's and my humour, I do like my vets really and am not complaining! Just joking... Karen's fault, honest!!! ;-)
Jilly is still doing fine, I stopped her pred after she had her dental, I slowly weaned her off it. And she's been better since. When she was on pred, she'd always gag before eating her mush, I'd hold her on my lanp in front of the bowl with mush and she would turn her head and start gagging like she felt sick. She hasn't done that since I stopped the pred. She eats well but is just slowing down. She sleeps more than the others but I do see her run around and play so she is stable for the moment.
Jilly has been fine since I put her on BARF. She doesn't like bones in the minced meat so I liquidise her meat and bones so she still gets bones. Her appetite has been brilliant and she eats at least 3 times as much as she did on the ground ferret food and water mush. She hasn't had any low sugars even though she's not on pred anymore and has got stronger. Putting her on raw meat was the best thing I've ever done for her...
But she did have another dental on Monday 13/11/00, and the vets removed a skin (mast cell) tumour as well. I took her to the vets on the Saturday before so the vet could have a look at the tumour. I saw Mr Jones and he took the scab off the tumour and it looked horrible and was bleeding. So Mr Jones wiped it with antibacterial soap to have a good look and then put something on to stop the bleeding. He wanted to give Jilly a local anaesthetic and cut it off! There and then! Not with me holding her! So I said he can do it under general anaesthetic and do her teeth at the same time. The back teeth were bad. So Jilly had the tumour removed and her teeth cleaned on the Monday and was really good afterwards. :-)
Friday the 4th of May we took Jilly to the vets, she had all her teeth out... The ones on the sides anyway, not the canines. She hasn't been eating solid food for over 2 years now and her teeth had tartar on them and she's had quite a few dentals where they cleaned her teeth but the more dentals they have, the worse the teeth get so they were getting really bad and her gums were awful so I said take all the teeth out and then at least she'll have good gums and a healthy mouth. 2 teeth had already been taken out at the last dental. Jilly had a tube down her throat for the anaesthetic so her throat was a bit sore and she kept coughing, poor thing. She was alright Saturday, her mouth was sore but she was eating well and she looked happier even though she was in pain but it seems she feels relieved. She had bad breath from the teeth so maybe a bad taste in the mouth as well so that is gone now... :-) Now, 5 days later she is almost back to normal, eats happily and looks better! :-)
Just another little update. Jilly is doing fine now, I forgot to write another update in May. On the 16th of May we almost had Jilly put to sleep. She was suffering from bad low sugars and would run around like a headless chicken as if her brain had gone (probably deprived of blood glucose...). She pooped and peed on the floor and then ran through it again and again and eventually she'd collapse but then she'd pick herself up again only to keep running around again until she would collapse again... It was really horrible to watch and she was so hard to feed, when I offered her some meat she'd try and eat it but her tongue would just push it away and then she would bend her neck backwards and in the end I thought it would be best to let her go. Louise had a look at her and then suggested we would put her on prednisolone again. I didn't think that pred would make a difference but agreed to try it- and it worked wonders! We gave her 1/2 mg morning and night and within a few days, Jilly's sugar was back up and she stopped this pointless running around and stopped messing on the floor and she ate properly again. No low sugars until a bad episode in June where she almost went unconscious so I upped her dosage to 3/4 mg morning and night and so far she is doing really well on it. I control the amount she eats so she hasn't gone fat, not any fatter than she was anyway, her weight is stable at around 1kg. And she hasn't had any bad low sugars since.
But she's had problems with her mouth, she keeps getting abscesses. End of June she had an abscess right under her lower left canine tooth. She was in agony and it's horrible to see her like that but the antibiotics helped very quickly. In July she had another mouth infection/ abscess. This time I didn't take her to the vets, I just put her on antibiotics. Mouth cleared up quickly again. Then on Thursday the 16th of August she had yet another abscess in her mouth... Wednesday night she wasn’t keen on eating, really I should have known that she was coming down with yet another mouth infection. So Thursday morning she had yucky stuff around her mouth and was in a lot of pain and definitely didn’t want to eat so we took her to the vets and it was an abscess in her mouth… When Louise looked in her mouth, the abscess must have burst properly and lots of puss came out so Louise wiped her mouth with a cotton bud and then anaesthetised her to see where it was coming from… The abscess was at the back of her mouth, she opened it up with a needle but there was nothing there, nothing in there that could have caused the abscess. I had hoped it was around one of her remaining little teeth that are next to the canines but it was somewhere where there were no teeth left... She had gone so bad what with the pain and not wanting to eat or take her pred and the resulting low sugar... I am amazed how well she is, she never went unconscious and is such a little tough creature... At least now I know, next time she’s not keen on her food I will put her straight on antibiotics...
Jilly had another skin tumour removed today. It was growing on the right side next to her tail and was bleeding and bothering Jilly so we had it removed. She also had "nappy rash" again, she first had it in January or February this year, suddenly her bum became red because she got it wet with urine every time she went to the toilet. Back then she had it for 3 or 4 weeks and then it cleared up as suddenly as it had appeared.
Jilly was put to sleep today (Thursday). She went downhill in the last week, her bum never cleared up, it stayed red and sore and bled easily, just a little bit but it must have been very painful for Jilly. After she had her tumour removed, I couldn't wash her bum anymore so I used to clean it with baby lotion and cotton wool which worked really well. She was on a long course of antibiotics, I used Sudocrem (a nappy rash cream which is a really good healing cream) and Savlon (another healing cream) but nothing cleared/ healed her bum. Jilly also had become pretty much resistant to prednisolone and had a constant low sugar except for a few episodes a day when she felt okay and even had a run in the house. But most of the time, especially about an hour after food, she'd have really low sugars. She would come out of bed, run around disorientated and then poop and pee on the floor and after that she'd keep running around and also run through her mess some of the time. When she went to the toilet, whether it was in the toilet or on the floor, she'd do the splits with her back legs and she was too weak to stand up so she'd fall forwards and lie in her pee and get poo on her as well. I cleaned her up every time I saw her go to the loo or run around, I washed her once or twice a day. But still nothing helped heal her bum and it was very painful to see her the way she was. But the time didn't seem right to have her put to sleep because twice a day she had a run through the house which she enjoyed. Until early this week. She didn't have a run anymore but just went to bed when I let her out. The only thing she enjoyed was her meat. But last night she stopped eating. She was very lethargic and depressed and seemed to be in pain. So I just left her alone. This morning I woke up very early (around 4.45 a.m.) I stayed in bed but couldn't sleep so got up about an hour later. I was sooo worried about Jilly, I thought she might have died but she was still alive. Very weak, she was just a floppy bundle, like she hardly had any muscle left at all... I put her into a clean sleep sack and into the carrier, ready for the vets. Did the ferret cleaning and just after 8.00 we left for the vets, Louise saw us pretty soon after she came in and at 9.00, Jilly was put to sleep. Jilly was in pain when Louise felt her abdomen so this suggested that something else was going on inside her, not just the insulinoma. Louise injected the lethal drug into Jilly's kidneys but Jilly wouldn't die. So Louise anaesthetised her and injected her into the heart. Jilly soon died but was still moving and twitching when she was dead, her little legs and feet were moving like she was still alive...
We went back to the vets about 5.00 p.m. to observe the post mortem (and take pictures). Jilly had a huge tumour on her pancreas, the liver had loads of (8+) tumours on it and the spleen was mottled. The kidneys had loads of fat around them and with the fat they were probably 2" in diameter. Which explained why Jilly wouldn't die when Louise injected her in the kidney because the drug must have gone into the fat, missing the kidney... There was a cyst on the right kidney which burst when Louise opened the fat padding up. Louise has sent a lot of tissue samples off to be tested so we should get results soon.
I'm obviously not feeling happy right now, it's just been 5 days since we lost Spike. I was glad first when Jilly was put to sleep, her suffering finally stopped. She's been ill for more than 2 1/2 years and I couldn't even remember what she was like when she was healthy... But then a picture went through my head when I had a lie down, Jilly and Angel playing and war dancing and with it came such a tremendous pain in my chest that it left me gasping for air and in tears...
Jilly never had symptoms of insulinoma that other ferrets have, she never had seizures or screamed, she just became very weak with a low sugar and would drag herself around the room in a disorientated manner. She wouldn't rest but just keep crawling around. She did become unconscious a few times but not in recent months.
This is Jilly's histopathology report:
History Suspect insulinoma for several years. Ataxia, lethargy etc. Been on Preds for several months. Euthanasia.
Diagnosis Pancreatic Islet Cell Tumour
The submission consists of fixed necropsy samples of the pancreas, liver, spleen and kidney from a 6 year-old, neutered female ferret. (Jilly was actually 7 years old.)
PANCREAS: the section contains a large, reasonably well circumscribed neoplasm. This is composed of moderately well differentiated, predominantly cuboidal or columnar cells arranged chiefly as nests and cords. There is little nuclear atypia and mitoses are not particularly frequent. Patches of necrosis are present throughout the mass. The histopathology is consistent with a pancreatic islet cell tumour (insulinoma), confirming your clinical diagnosis.
LIVER: at one end of the sample submitted is a large, multilobular tumour histologically similar to that present in the pancreas and doubtless representing metastasis from the pancreatic tumour, confirming it was a malignant insulinoma.
SPLEEN: the parenchyma is moderately congested and hypercellular, but there is no evidence of metastasis in the section.
KIDNEY: there is mild, multifocal interstitial fibrosis, moderate tubular dilatation, with occasional small cortical cysts, occasional basophilic tubules, a few small foci of lymphocytic infiltration and the odd sclerosed glomerulus. These are all moderately common incidental findings in the kidneys of older ferrets. Whether any of them have any association with the effects of the insulinoma is uncertain.
According to most sources, pancreatic islet cell tumours are the commonest neoplasms of ferrets. They arise mostly from the beta cells and secrete insulin, hence their popular name of "insulinoma". Clinical signs are referrable to hypoglycaemia. Adenomas are generally small, well circumscribed and may be cured by excision, but carcinomas tend to be infiltrative, sometimes multiple and eventually metastasise to the draining lymph nodes, liver and sometimes other abdominal viscera. Peak prevalence of these tumours is between 4 and 7 years old and there is no sex predilection, although there is a suggestion that neutered animals are more frequently affected than intact ones.
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