From:
Diane Burman
Date: 2001-03-29 13:07:00 UTC
Subject: Re: [Ferret-Health-list] Re: Cody - elderly male urinary
problem?
Dr. Williams -
Thank you so much for your input regarding Cody.
#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!
Your point is well taken, since no biopsy was done, a
definitive diagnosis could not be made. Since he was an older
ferret (already 6+) and in a shelter, the shelter made the
decision not to spend the money on a biopsy.
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.
Thank you for clarifying this for me. Hopefully I won't be
confronting with lipemia again but if I am, I will know to ask
about dilution of the blood sample. I felt so badly for Cody
because I felt that I had fasted an elderly insulinomic ferret
for 4 hours for nothing. It was also puzzling to me that this
happened despite fasting but maybe it was because right before
fasting his meal was mush made of A/D and IAMS canned kitten
food.
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.
Thank you so much for pointing this out to me. I *knew* about
the excessive urination and pred yet for some silly reason I
never made that connection with Cody. I am really relieved to
know that this is probably simply a side effect of the pred
and not some symptom of a dire problem.
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?
Good questions that I should have thought to ask. All he said
to me, after pointing out the very visible "floaters" in the
bladder on the ultrasound, was that it was probably indication
of an irritation in the bladder and that this irritation might
be caused by an infection. I believe he also said he saw no
indication of stones. He did take a urine specimen (and used
some of that to check the specific gravity - which was within
normal limits). When I return to his office tomorrow I will
have to ask if a urinalysis was done. I'm bringing Meg & Mo
back in. Maybe I should bring Cody along too and request a
urinalysis if one wasn't run.
> 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.
Cody is certainly doesn't appear to have any difficulty
urinating nor was there apparently any other obvious evidence
of prostatic disease. I asked the vet when he did the
ultrasound if he saw an enlarged prostate and he said no.
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.
Again, thank you for clearing up for me what some of the
benefits of Lupron are. It sounds as if Lupron might not be
indicated for Cody unless he is either diagnosed with
prostatic disease or we wish him to re-grow his coat (which
might not be such a bad thing).
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.
When I see the vet tomorrow I will ask more questions
regarding ruling in or out a urinary tract infection and/or
adrenal disease. Am I correct in my understanding that the
only way to determine adrenal disease is by either 1) running
the University of Tennessee Endocrine panel or 2) surgery to
remove & biopsy the adrenal gland? If that's the case, it
sounds like I should request the U of TN panel be run since
Cody isn't a good surgical candidate.
My most sincere thanks for your time and advice!
Diane & the gang