Message Number: YG5158 | New FHL Archives Search
From: Karen Purcell, DVM
Date: 2001-07-04 18:07:00 UTC
Subject: Re: Vets: Need advice on difficult adrenal


You wrote:
> One of my ferrets, Florian, is an altered male silver-mitt who just turned
> 3. Since about December 2000, my husband and I have suspected an adrenal
> problem, due to a tiny bit of hair loss at the tip of his tail (no other
> symptoms). After 3 trips to our veterinarian (and 5 normal glucose
> levels), an adrenal panel indicated that our suspicions were
> well-founded. On Monday (7/2/01), Florian went in for what we thought
> would be an adrenalectomy. While in surgery, the vet called me to let me
> know that Florian has a tumor in a very precarious place on the right
> adrenal (nothing on the left and no insulinoma that we know
> of). Apparently, the tumor is wrapped around his vena cava and may even be
> invading it. The vet offered me 3 choices. He could:
> 1. attempt to remove the entire tumor (he suggested a very high risk of
> hemorrhage and/or death).
> 2. de-bulk the tumor (he suggested a high risk of hemorrhage/death even
> with this option).
> 3. biopsy the tumor and refer Florian to a vascular microsurgeon.
> Our vet suggested that the safest and best chance for Florian was option
> #3, so this is what we chose to do. In the end, our vet was not even able
> to biopsy the tumor, as he thought it too risky to even attempt since the
> tumor is buried under the adrenal, wrapped around the vena cava, and all
> *approachable* tissue appeared normal.
> So... after an exhausting and painful surgery (Florian's on .04 cc's
> torbutrol/pettinic every 8 hours), nothing was accomplished, and my ferret
> was closed back up. This is quite frustrating to us, since we've been
> trying to get this fixed for about 6 months and have spent $700-800 in the
> process (although money is not the issue, as my husband and I are both firm
> believers that the responsibility of adopting animals requires that one
> also adopt the financial and emotional responsibility of caring for them
> exhaustively).
> Now, our vet is referring Florian to another vet (who, I'm assuming, has
> experience in vascular microsurgery) at the 24-hours clinic that his
> veterinary hospital uses for after-hours care. I've been researching
> Florian's situation, however, and am wondering a few things. I suppose my
> questions are these:
> 1. Is traditional vascular surgery the best/safest route, or should we
> pursue someone who might be able to perform a caval ligation, cryosurgery,
> or some other procedure?

I'd recommend vena caval ligation or cryosurgery, at this point.
Your best bet is to find a vet that does both.

> 2. I understand that caval ligation is only possible if collateral
> circulation has been established, so we would need to find a veterinarian
> in our area (Austin, Texas) who is experienced in identifying whether this
> has happened. Any ideas on how to go about doing that? Would it ever be
> the case that we should *wait* for collateral circulation to develop before
> attempting surgery?

Actually, many ferrets seem to develop the collateral circulation
post-op. There is a vet in Texas, not sure how close to you (big
state) -that presented at the International Conference on Exotics -
knows her stuff. Her name is Dr. Natalie Antinoff, contact info:
1111 West Loop South, Houston, TX 77027. If you can't get to her,
she may be able to refer you to someone closer.

> 3. How accepted a procedure is cryosurgery? If we decided to go that
> route, what are our chances of finding an experienced cryosurgeon in our
> area? And how would we go about finding one?

See above.

> 4. Is anyone aware of any other medical/surgical options that would give
> Florian a good chance for life? We're open to absolutely *any*
> suggestions, and we'd love to hear as many perspectives as possible (either
> on- or off-list).

Medical treatment with lupron, among others is an option. However,
any tumor that invasive of the vena cava could cause a major bleedout
at any time. Surgery is the best option, in my opinion, but all the
options are risky in this case.
-Dr. Karen

This e-mail is provided for general informational purposes only. It is in
no way intended as a replacement for a consultation with a qualified
licensed veterinarian. If you are concerned about your pet's health, you
should seek the advice of your regular veterinarian as soon as possible.