From:
Bruce Williams, DVM
Date: 2001-03-28 01:03:00 UTC
Subject: Re: Cody - elderly male urinary problem?
--- In Ferret-Health-list@y..., "Diane Burman" <dmburman@r...> wrote:
Guess there's just a lot about the workup that I am not really crazy
about here.
> Cody is a rescue I adopted at about 6 or 7yo. He is now about 9 or
10yo. When I adopted him he had just had adrenal surgery. I don't
remember which side was taken out. At that time no biopsy was done
but I was told it looked like adrenal carcinoma and that he probably
didn't have much longer.
#1 - no vet can look at an adrenal tumor and say what type it is.
Yes, it is true that if the adrenal neoplasm is greater than 1 cm in
diameter, it is likely to be a carcinoma, but other than that, they
all look alike. Look at the tumor at the front of the site. Can you
tell what it is grossly - I can't. I give four ruleouts, but I still
need to section it an examine it microscopically. So the vet said it
was a malignancy and lo and behold - the ferret does great!
> The next 2 years he did fine until about a year ago when he was
diagnosed with insulinoma. He is now on 1/4 of a 5mg tablet of Pred
2x/day. Last week when blood work was done his glucose was 161. Last
summer his coat began to thin so I figured the other adrenal gland
was acting up. At his age he wasn't a good surgical candidate. Last
December he was examined because he seemed to be losing a bit of
weight and was a little dehydrated. At that time they were unable to
do blood work even though he had been fasted because there was too
much fat in his blood.
While excess fat can make determination of some blood values
difficult, and require dilution of the sample at the lab, lipemia
does not preclude running a blood sample.
>The vet felt though that he was in renal failure because his urine
was very dilute. I was instructed to keep up the Pred dosage and to
supplement his diet with very watery mush to increase his fluid
intact. Also, to add .25cc of Pet Tinic to his mush 2x/day.
Renal failure should not be considered when appropriate tests are not
available. A random urine sample is no way to make this diagnosis.
You need to demostrate elevated levels of BUN in the presence of a
urine sample of low specific gravity - without that data, diagnosing
renal failure is inappropriate. Additionally, prednisone's action
ont he tubule to impair the secretion of anti-diuretic hormone (ADH)
promotes dilute urine. Anyone who has given their dog high doses of
steroids for allergies will tell you - they pee all the time, and
voluminously.
>
> He was re-examined last week where we were able to run the blood
work. Surprise, surprise, he is concentrating his urine just fine and
his BUN and Creatinine were fine (17 and .6 respectively).
Not surprising at all.
>As mentioned earlier, his glucose was 161. Everything else looked
fine. An ultrasound was done of his heart and abdomen. His heart
looked great. The ultrasound of his bladder showed little specks
floating around. My vet explained that is was probably an irritation
in his bladder such as an infection. If I read my vet's handwriting
correctly, Cody has been put on Orbanos, 1 tablet 1x/day for 10 days.
BTW, Cody urinates a fairly large amount each time he goes and there
seems to be no evidence of straining.
Im no expert on ultrasound, but I would wonder what those specks are -
bacteria are too small to show up, and clots would easily show up in
the urine. Was a urinalysis done to document the presence of white
blood cells, blood, or bacteria?
Orbanos, I suspect is Orbax, a broad-spectrum antibiotic for dogs and
cats that can be used in ferrets for urinary tract infections.
>
> Could this apparent urinary tract infection be caused by the
apparent resumption of his adrenal disease? Even though he seems to
urinate freely, could this be a sign that his prostate is impeding
flow? My vet did not see an enlarged prostate when he did the
ultrasound.
Apparent is the operative word here. I'm not convinced there is one -
at least you don't mention how one was definitively diagnosed.
while a bacterial tract infection may be associated with adrenal
disease and prostatic disease, prostate disease of significance is
usually heralded by difficult in urination.
>
> I'm just wondering what are Cody's alternatives for treatment given
his age. I'd hate to think he might suffer recurrent urinary
infections due to the adrenal problem. Would Lupron help here? I'd
asked about Lupron at my vet's office last fall but was told all it
might do is allow Cody to regrow his coat so I shouldn't do it. After
reading about Lupron on this list it seems that Lupron can do quite a
bit more than that.
While Lupron would help with prostate disease (especially in concert
with some of the other drugs), once again I've got to caution that
prostatic disease has not been identified in this ferret. It is true
that Lupron's effectiveness is limited to blocking the effects of
estrogen, and is best used to regrow hair, it's combination with some
of hte other commonly used drugs, such as Casodex or Propecia seems
to have a synergistic effect in relieving dysuria associated with
adrenal disease.
While I hate to second guess other vets, and there is always the
possibility that some tests were run and not mentioned in your post,
there seems to be several diagnostic leaps of faith in this case
which are not supported by objective clinical data. I am hesitant to
make more comments about possible therapeutic options without better
assurances that this ferret has urinary tract infection or adrenal
disease.
With kindest regards,
Bruce H. Williams, DVM, DACVP
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