From:
"Sue Liszewski"
Date: 2004-03-22 05:17:15 UTC
Subject: RE: [ferrethealth] 10 days post-op anorexia
To: ferrethealth@smartgroups.com
Message-ID: <BAY15-F120hIJPl2x0X0007eddf@hotmail.com>
I think a feeding tube is not a bad idea before surgery. This way you can
be patient, still get food into him to treat the fatty liver disease, and
you can give him meds via the tube and decrease stress. Many times we find
similar things in cats and never get an answer, but place a feeding tube to
keep them nourished, and one day they just start eating again. I would
probably use pred good for lymphoma and may help with fatty liver, SAMe is
good as is Milk Thistle just tastes nasty. It can be very frustrating but
not good for him to not eat as it worsens the fatty liver. Good luck in
finding the answers you need.
Dr. Sue
>From: sheziwa@gis.net
>Reply-To: ferrethealth@smartgroups.com
>To: ferrethealth@smartgroups.com
>Subject: [ferrethealth] 10 days post-op anorexia
>Date: Sun, 21 Mar 2004 12:48:01 -0500
>
>
>
>
>
> 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
>
>
>
>
>
>--
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>
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