From:
"Diane Burman"
Date: 2003-01-05 17:17:14 UTC
Subject: Elevated Bilirubin
To: <ferrethealth@smartgroups.com>
Message-ID: <016e01c2b4de$4abe4c80$6401a8c0@dell>
I have a ferret with a possible liver problem and when doing a search for
"liver disease" in the archives I came across a post from Dr. Williams where
he mentioned that the bilirubin level can be elevated by things other than
liver disease. What are some of the other things that might elevate the
bilirubin count?
Here's a brief summary....
The ferret today is approx 6-7yo (rescue) sprite. Weight has dropped from a
normal of 1-3/4 to 2 pounds down to 1 pound over the past year. Nearly 2
years ago she was suddenly on death's door and extremely jaundiced.
Ultrasound, biopsy and blood work all pointed to liver disease.
Unfortunately I don't remember the exact diagnosis from the biopsy but I do
remember that her total bilirubin was 14 at one time. At one point my vet
didn't think she would make it through the night but with supportive care,
sub-cu fluids, actigal, aluminum hydroxide, pet tinic, pepcid a/c, pred &
baytril she pulled through.
For about the next year she was the picture of health. Then in Dec. of '01
she developed symptoms of insulinoma and was put on pred. The vet was
reluctant to do surgery because of her liver disease history. This past
spring her vulva swelled noticeably and she was given a Lupron shot with no
apparent response. Another Lupron shot was given in August and she appeared
to respond in that the swelling went away but her coat continued to thin. By
fall her weight had dropped significantly (down to nearly 1 pound from a
high of 2lb) and despite increasing doses of pred and the addition of
proglycem her glucose continued to drop. While she still tried to be active
and playful she had frequent starring episode, stumbling and tremors. By
December her pred dose was 0.3ml 2x/day and the proglycem was 0.2ml 2x/day.
A vet visit at that time showed her glucose level to still be in the low
40's. The decision was made to go ahead with surgery (despite that fact that
she was felt to be a poor candidate a year earlier) because it was believed
that at this point her time left was very limited without surgery.
Surgery was done 12/20/02 and at that time the right adrenal was removed (it
was completely encapsulated & "popped" right out - about the size of a small
pea) and a small portion of her pancreas was removed with 3 nodules. My vet
also noted that her liver had numerous spots (if I remember correctly he
described them as small & yellowish) which he had wanted to biopsy but he
was concerned about how long she had already been under anesthesia and how
much her body had already been subjected to. The rest of her internal organs
looked fine. We had been concerned that she might not make it through the
surgery but she did fine. The first several days of recovery were very rough
but by the 4th day she was eating well and seemed well on the road to
recovery. My vet had me maintain her medications at the pre-surgery level
(0.3ml pred 2x/day and 0.2ml proglycem 2x/day) with the addition of
Clavamox. For several days following surgery she had *significant* and
extensive bruising that was very dark and went way up her chest to her neck.
I was initially alarmed but was told it was due to the long-standing adrenal
condition which resulting in poor clotting. By the fourth day the bruising
was begining to fade. At some point in the first week or 10 days it was
suggested that I drop her proglycem from 0.2ml 2x/ day down to 0.1ml 2x day.
This I did.
At about 12 days post op I noticed that she seemed a little "off". She
seemed to be sleeping a little more than she had been and eating less (and
therefore "output" was decreased). Since she seemed to hate the Clavamox I
thought that might be the cause. Even though each time I fed her some mush
before giving the Clavamox I thought it might be upsetting her stomach. But
I also thought she didn't look quite as pink as she should but possibly a
hint of yellow to her coloring. All of these changes were subtle so I wasn't
sure if I was imagining it. On day 13 we returned to the vet. At that time I
was becoming increasingly concerned that my observations were accurate.
At that time she was a bit dehydrated though her weight was unchanged (thank
goodness!) and it was agreed that she was a bit yellow so a blood was drawn
(and sent out) for weak ferret profile. At that time her glucose level was
in the 70's despite not having her meds for about 14 hours. I was told to
give supportive care (sub-cu fluids and mush 3/day), cut out the proglycem,
drop the pred to 0.1ml 2x/day and put her back on pepcid and Actigal. The
next day I was called when the blood results were in. I wasn't given
everything over the phone but I was told her bilirubin was 11 and her liver
enzymes were elevated. I was also told that everything else was normal (I
specifically asked about kidney function because of the dehydration). She is
still "off" her food but does continue to eat a little kibble (Totally
Ferret & The Ferret Store kibble) thoughout the day. She does willingly take
some supplimental "mush" several times/day (though not a lot) but not unless
it is *really* watered down. I was told to give her lots of Nutrical because
the liver needed lots of glucose (she won't eat it "straight" so it's in her
mush along with Dyne & Clinicare, chicken baby food & IAMS canned kitten
food & prozyme). I was also told to add back the aluminum hydroxide to her
meds. Even though her bilirubin level is nearly as high as it was when she
was at death's door 2 years ago, she seems nowhere near as ill. She does eat
some on her own, she is alert, her coloring is only slightly yellow and when
out of the cage she is fairly active - she even tried to war dance this
morning for the first time since surgery. Two years ago she was dark orange
in color, she didn't eat on her own at all, she wouldn't even eat mush
willingly from a syring and she was very lethargic.
So...I'm sorry to be long winded but I guess I just want to find out what
you think is going on. I'm hoping what Meg is experiencing is normal
post-operative recovery and that the jaundice (and elevated bilirubin &
liver enzymes) is the result of the extensive bruising she had or from being
a bit off her food because of surgery. The spots on her liver that my vet
observed sounds like what Dr. Williams described (if I remember correctly)
as fat deposits commonly seen in older ferrets and not something to be
concerned about. Is that likely correct? I really hope we haven't reawakened
a serious liver problem.
Meg and I both thank you all for your input,
Diane & the gang
Note: I opted not to have the adrenal or the pancreas nodule sent out for
pathology because funds were very tight for us. In hindsight I guess that
was a mistake.