From:
sheziwa@gis.net
Date: 2004-03-21 17:48:01 UTC
Subject: 10 days post-op anorexia
To: ferrethealth@smartgroups.com
Message-ID: <107989099501@mx03.gis.net>
Spot is a 6yr old MF boy. During his first (left) adrenalectomy,
about 2 years ago, a large nodule was discovered on his pancreas
so he had partial pancreatectomy. Recovered well, although
several months later he had his right adrenal out. Recovered well.
During one of these surgeries cytology was done on a small renal
cyst. benign.
Last summer his insulinoma showed up--only clinical sign was
lethargy. We managed his BG with pred, although it took a while
to get the doseage (2mgs/bid). Around December, his adrenal
symptoms returned and his BG dropped. BG didn't respond to
slighter higher pred doses (prednisolone). Started diazoxide. no
response at lower doses and higher dose was impossible to get into
him. We discontinued, although thanks to that experience, he is
now extremely resistant to any sort of oral meds--even carafate,
which he used to love.
A few weeks ago, I upped his pred to 3mgs BID after reading on
this list about apparent safety of higher doses. Also invested in a
glucometer.
Spot's BG on Mar 9 was 72. yay. I was also hand feeding him his
soup 2-3 times a day. The next day, wed mar 10, his BG at 5 pm
was 76.
an hour later, I fed him his soup. immediately after eating, he
crawled out of my lap and went flat. trembling. he seemed dazed.
I though he was having a hypoglycemic episode. picked him up
and held him and he pooped without being aware of it. rubbed
nutrical on his gums and waited a bit. put him on the floor to see
if he could walk. he wobbled a feww steps, stood in a daze and
pooped--but he didn't seem to know it--he didn't "assume
the position", it just kinda came out. This made me feel sure he
was having some sort of seizure.
early the next morning(Thursday) I took him in to the vet. she
attributed his upset stomach and lack of appetite to the increased
pred, but agreed that nodulectomy was in order and I booked
Spot into the hospital.
Surgery was delayed til the following day (Friday)because his renal
values were a little high when they did presurg. bloodwork--
possibly due to slight dehydration, possibly early sign of chronic
renal failure.
he wsa unstable during surgery (a few pvc's) so pancreas was
dealt with and a liver biopsy was taken, but no GI biopsies.
He has been home since Sunday and while his ataxia has
improved and his incision is healing very very well, his appetite is
getting worse and worse and he seems very uncomfortable,
especially immediately after being fed.
Blood work is all within normal range except for slightly elevated
creatinine (I think it's ~1.1, normal for our lab is 0.8) He had been
very anaemic, but his PCV has risen from 23 to 36.
Urine sg is somewhat low 100.15
no fever
stools relatively normal--no melena
liver biopsy showed slight hepatic lipidosis
chest films showed slight pulmonary thickening possibly due to
aging.
At his recheck Friday, we did survey radiographs because I was
becoming convinced he had a foreign body obstruction. They
showed nothing. no gas, no physical abnormalites.
yesterday when he refused to eat even ferretone (!!!) I took him
back in. they did an ultrasound, which showed some "brightness"
of the abdominal fat possibly due to post-op inflammation, also
hepatic lipdosis seems increasing, but nothing else.
So I took him home. Am giving pepcid for his tummy, buprenex for
pain, and norm-r for hydration. also syringe feeding him every
few hours. the presumption is pancreatitis or hepatic lipidosis,
which one treats supportively.
Any ideas? On the one hand, the insulinoma has been resolved
with surgery and his BG is consistently normal. His red cells are
regenerating. the hind limb ataxia and 'knuckling' of back feet is
much improved.
On the other hand, his appetite is only getting worse, and his
urine is not well concentrated. He trembles after eating and
makes retching noises--I don't think he wants to vomit, I think it's
because *he* thinks he's getting nasty meds.
The vet worries that the other possibility we need to think about is
lymphoma (because he's a ferret, she says, and we know their
predilection for cancer).
The next step, she feels, would be to try to obtain gastric biopsies.
Endoscopy, or even another abdo. exploratory. and if Spot
continues anorexic, an esophageal feeding tube.
It's been 10 days and I would have thought any surgical
complications like pancreatitis or post-surg pain would be
resolving by now. Should I just be more patient? I don't want to
panic, but I don't want him to worsen just because I'm trying to be
patient.
Thanks,
Skyla