Insulinoma prognosis?

[tpup]

My 13 and 1/2 malamute/lab mix had a blood sugar drop Mon. evening. Our pet sitter found her unable to stand or walk. Emergency vet said her sugar was 22, and the fact that she has been having stiffness w/her hind legs for some time points to insulinoma. We are awaiting the blood test result. She is hospitalized and they are able to keep her blood sugar stable now with meals every 4 hrs, and a bit of prednisone. They did take the sugar drip/I.V. away and she is maintaining on the frequent meals and prednisone protocol.

Ultrasound revealed small mass on liver, and what looks like nodes on her pancreas. Based on the fact that she is holding her own without a sugar drip at this time, they feel the mass on the liver is probably not the culprit…that it is more likely the pancreas.

From what I’ve read, insulinoma is basically pancreatic cancer. Surgery is probably not an option due to her age and the complications. So we are looking at managing with frequent meals and prednisone.

She is able to walk now and doing well in the hospital. We are away until Sat. (which stinks all around!) so for now she is staying there, where they can feed her every 4 hours.

Any experience w/this disease, and prognosis? Having lost my Golden to cancer a year and a half ago, after trying weeks of chemo, I know we will let her go if we sense any pain and would not put her through endless treatments at 13 and a half. But hoping we can maintain the disease and keep her comfortable and with us for several more months.

[anel]

Surgery is typically the best option, but with likely metastasis to the liver and lymph nodes this may not be the case for your dog. You may want to look into streptozocin, diazoxide or palladia. All may be effective if prednisone fails. So sorry you are having to go through this.

[SquishTheBunny]

Surgery is basically curative on an older patient. Did one on a 14 year old lab last week, recovered very well. Age is not an anesthetic risk, referral hospitals are used to geriatrics and know safe anesthetic protocols for them, but completely understand if you dont want to invest the money into an older dog. Its sometimes a catch 22, you spend money fixing one issue and a few months later something else could pop up.

Our hospital has done 7 so far this year and all made a very uneventful recovery. Long term prognosis is excellent when normal glucose levels are achieved after their surgery. Post op monitoring is very important, moreso than the surgery itself.

Insulinomas generally dont met, but if they are going to, liver and lymph nodes are where they go. (Are the lymph nodes enlarged??) Also, remember that often benign hyperplasias hide in the liver looking like small masses. These are VERY common in older creatures and dont let them be a red herring if you do want to go ahead with further treatment. Also, lymphoma also can show up this way and is short term responsive to prednisone. Without biopsies, you wont know.

Jingles for your dog, never an easy decision. I still have regrets putting my dog down knowing I could have done more, but the prognosis was poor and I couldnt see him suffer through a third surgery. Sometimes they just tell you, and you have to listen to them.

[Lizrd]

Seems like everyone has had detailed information to share. I will tell you my experience with insulinoma was not terrific. If you don’t want to read a negative report just skip this posting. For me, as a pet owner, I want as much information on a disease as possible.

My 7 year old Boxer was diagnosed with it in November and was gone by January. We tried everything BUT surgery as we didn’t want to put him through it and thoughts were that his was a rather advanced case that had already impacted other areas of his body.

We learned he had insulinoma by waking up to him having a seizure from low glucose levels. They ran tests and it was definitive that this really small tumor was having a really large impact on his body. After he stabilized from the first episode (which took some real expertise) we were like hawks watching him. For the two months we had him we did everything to manage the disease. Frequent meals were done with an automatic timer feeding station. I found one that could be programed for every two hours to open up and give him the kibble inside. It was a relief to have that when we decided that we had to go back to work and had to leave him unattended for a few hours at a time. We monitored his blood sugar with a pet-specific glucose monitor and his sugars only crashed once between his diagnosis and his final crash. We were able to stabilize him at home.

While there were several chemo and drug options we elected to be part of a clinical trial on Palladia. It did not work for our dog. During his final episode of life-threateningly low blood sugar the emergency specialty clinic was unable to regulate his sugar even with very specialized methods and extensive efforts. While my beautiful boy was living his last two months he was happy, vibrant and LOVED getting fed every few hours. He looked at us with joy every time we woke up in the middle of the night to feed him again! I do not feel that he suffered during the two months we tried to manage his disease - in fact the hard part was he was so damn normal. We knew a repeat emergency visit was an eventuality but it always takes your breath away when it happens. For us it was at 10PM on New Years Eve 2009. We made the difficult choice in the end but for him it was the right one. The two months went way too quickly…

I am sorry you are struggling with this very ugly disease. Insulinoma is not something I ever want to encounter again. I urge you to love on your sweet girl and to make decisions as her care-taker that only you can do. There are many options for treatment and there are methods for management. You will do the right thing.

[Anne]

[QUOTE=SquishTheBunny;6487936]
Surgery is basically curative on an older patient. (snip) Insulinomas generally dont met, but if they are going to, liver and lymph nodes are where they go. [/QUOTE]

Squish, are you a veterinarian? I’m sorry but I have to contradict your information. The VAST majority of canine insulinomas are malignant, and over 50% of dogs have mets at the time of diagnosis. In those cases, surgical debulking can be done but is by no means curative. This is a yucky tumor type and in my practice experience has a bad prognosis.

[SquishTheBunny]

[QUOTE=Anne;6495258]
Squish, are you a veterinarian? I’m sorry but I have to contradict your information. The VAST majority of canine insulinomas are malignant, and over 50% of dogs have mets at the time of diagnosis. In those cases, surgical debulking can be done but is by no means curative. This is a yucky tumor type and in my practice experience has a bad prognosis.[/QUOTE]

Sorry Anne, I think you misunderstood what I was trying to type. They absolutley can met, which is why I stated in “older” dogs (the OP’s dog is 13 1/2) they are generally curative. Many don’t metastasize quick enough to cause the patient issues at age 13 1/2. However, each case is different and through diagnostics shoud be performed if one is to elect surgery as an option. I remember reading an artice stating that 51% of dogs have stage 1 (no mets) at time of surgery, and 49% are stage 2 and 3 (mets to liver, or mets to both liver and LNs). The article also mentioned that younger dogs have a more grave prognosis than older dogs (who generally present in stage 1). In the seven done at our hospital this year, zero had evidence of mets although owners are always informed that these could happen at any given time, or not at all. If the dog already had evidence of tumor in the lymph nodes or liver, that is obviously sign to NOT persue surgery. So yes, in the older patient most are curative practically speaking IF normal glucoses can be achieved post surgery. If normal glucoses are not achieved, the prognosis is much more guarded. ICU tech, who has looked after all 7 insulinoma patients this year

After saying all that, I likely would not do surgery on an older dog with an insulinoma…finances, the stress of post-surgery care, complications etc. just isnt something I could deal with. Many dog do well, but there are a significant number of dog who do not do well. I think surgery certainly gives them a better chance, but does not guarantee a long term fulfilled life.
I think some of the newer studies are basing a 1+ year average survival, which, for a 13 1/2 year old dog in my opinion is as close to curative as you can ask.