From:
Shelley Knudsen
Date: 2002-02-24 12:19:00 UTC
Subject: Relationship between AV node block and insulinoma - Vets??
(long)
Hello,
I have a curious question for the vets on this list (and
anyone else who may know about the subject). First the
question - could there be a relationship between AV node block
and insulinoma, and if so, how would that work? Second - the
background and reason I am asking.
Some of you may remember from previous posts my 6 year old M/C
ferret, Taz. Taz originally presented with insulinoma signs
of shaking last July, and a glucose check was 56. He was
started on pred by me at the time. In August, I brought him
down to school with me, and took him into the vet med teaching
hospital so that I could get a prescription for more pred.
During his physical, it was discovered that he had 3rd degree
AV node block, which was confirmed with ECG and echo. Over
the next few months, his insulinoma got worse while I tried to
assemble funds for a pacemaker implantation surgery. Taz was
also on 6 weeks of Clavamox during this time on the unlikely
chance that the AV node block was due to some kind of
bacterial infection from an adrenalectomy he had one year
prior. Also, we do not have a cardiologist here at K-State.
In October, he had an incident of either syncope or cardiac
arrest, I didn't stop to listen for a heart beat, just went
off of the limp body, white nose, and no observable breathing,
and initiated CPR, after which about 3-4 cycles of breaths and
compressions, he jerked back, and went into a full blown
hypoglycemic seizure. After this incident, for about a week,
he had a normal heartbeat, which then developed into 2nd
degree AV node block. On the advice of a cardiologist from
Vetheart in Florida that I e-mailed (Dr. Goodwin), we started
him on Theophylline, which worked wonderfully (other than one
nervewracking incident when I upped his dose to BID after 4
days as advised from the cardiologist) to bring his heart rate
to normal.
In December, as Taz was being put under anesthesia for
insulinoma surgery, it was discovered that he had lungs full
of fluid, and so surgery was aborted to take care of the
pneumonia. He was put on 4 weeks of Trimeth-sulfa, which
eliminated all noticeable symptoms such as sneezing, but 2
weeks after he came off of the Trimeth-sulfa, the sneezing
w/flem came back. 2 weeks of subsequent Cefadroxil had no
effect. However, Taz's glucose was steadily dropping and his
shaking was returning, so he was kind of running out of time
for surgery, so in spite of the risks, he went under for
surgery last Wednesday.
Also of note, a week before Taz went under for surgery,
radiographs (to check for pneumonia) showed that his heart,
which had previously been rather enlarged on original
radiographs, had shrunk to normal size. (And I keep hearing
that that just doesn't happen.) During the surgery, all went
well, his heart remained at a normal rate (he was still on the
Theophylline). After the surgery, his AV block returned for
about an hour or so, then his heart rate returned to normal,
followed by tachycardia (about 330-350) for several hours late
that night. Taz's respiratory rate also increased about this
time to 60-80. The theophylline was discontinued, and the AV
node block returned. Taz also developed full blown pneumonia,
with definite right sided alveolar pattern in a radiograph
taken on Friday.
Taz is currently on Baytril, and while he sounds absolutely
horrible breathing wise, and he is still breathing at about
70, he seems to be starting to try to hack the fluid up.
However, I listened to him last night, and for a long time
today while he was sleeping, and his heart rate is back to
normal (without theophylline), with only the occasional sinus
arrhythmia when he takes a deep breath. I am crossing my
fingers that this apparent return to a normal heartbeat stays.
Again, could there be a link between the insulinoma (which
now seems to be taken care of - glucoses so far are good) and
the AV node block? Also, a senior vet student on this list
(meesh meesh) also mentioned that when she asked the
cardiologists at her school about it, they noted that on the
few occasions that they had seen AV node block in a ferret,
insulinoma was often present, and they wondered if there was a
link.
I would be very interested in any ideas or theories on the
subject, as I am constantly trying to figure out how
everything is interrelated as I go through vet school,
especially with adrenal disease, insulinoma, and
cardiomyopathy, since those are the big 3 that ferrets get.
Also, has anyone else had experience with ferret hearts
seeming to fix themselves? A friend of mine here who is a
senior student has a ferret who has had adrenal disease and
insulinoma, and who was diagnosed with dilated cardiomyopathy
about 8 months ago by echo, ECG, and radiograph. The
cardiomyopathy now seems to have disappeared, which was
confirmed with echo.
If anyone has any ideas, I would really like to hear them. If
you could e-mail me directly at ferrets@kansas.net, and just
carbon copy the list if you want to share your ideas, I would
really appreciate it.
Thank you,
Shelley Knudsen
Class of 2004 KSU Veterinary College
ferrets@kansas.net sknudsen@vet.ksu.edu
http://www.tcgcs.com/~ferrets
785-565-9041 cel402-984-4217
"There ain't no limit in this life to how far you can get,
but if you're going all the way, you gotta break a sweat."
- Chad Brock