Dear Ulrike:
 
>My Igor has bad ascites, during July we noticed that his tummy was getting
>bigger and in August we went to the vets to have him checked and the vet
>did an aspirate and got fluid from his tummy, the fluid was mixed with
>blood as well.  Another vet felt his tummy and Igor's liver is enlarged.
>The vets suspect abdominal cancer.  We haven't done anything but give him
>diuretics.  But they don't seem to be working, Igor's tummy is just getting
>bigger and bigger.  Igor now has 350-400g of fluid in his tummy and he only
>weighed around 950g to begin with so it is a lot for him.
 
I am somewhat concerned in that your vet hasn't recommended any diagnostic
tests and simply has prescribed diuretics in this case.  Heart disease is
by far the most common cause of ascites in ferrets, far more than abdominal
tumors.  A chest X-ray often can be diagnostic in cases of heart disease
which result in significant ascites.
 
A number of reasons could result in the diuretics being ineffective, but
the one I fear the most is that Igor may have undiagnosed heart disease
which would require other drugs concomitantly to control the ascites.
Ascites from heart faillure, by the way, commonly have a background of red
blood cells.  I do not often see this with tumors - did your vet identify
any tumor cells in the ascites?
 
But I was wondering whether diuretics are helpful at all?  When my Angel
was dying, she had a lot of fluid in her abdomen due to abdominal cancer.
Back then I asked the vets whether they can't draw some fluid out with a
syringe, you know, a bit at a time and do that a few times.  The vets said
back then that the body would quickly replace the fluid.  So what if the
diuretics get rid of some fluid, will the body just replace that as well?
Does the body maybe produce more fluid if the diuretics get rid of some?
Could the diuretics be more harmful than helpful?  He is on frusemide, he
staretd on 2.5mg twice a day but is now getting it 3 times a day.  Should
I continue with the frusemide or better stop it?
 
Diuretics do work to mobilize ascites, but I usually recommend aspirating a
lot of it out at the beginning of therapy.  Diuretics work much better to
control small amounts of ascites than to mobilize tremendous amounts.  The
trick is to find the appropriate dose, but when you are giving it blindly,
as in this case, you are really shooting in the dark.
 
Did Angel ever have a definitive diagnosis - I get a somewhat suspicious
feeling from your message that your vet may have a standard protocol of
using diuretics and ascribing the diagnosis of abdominal cancer in cases of
ascites.  Perhaps it is just a lack of information in your email - but I
would be interested in knowing if an autopsy was performed on Angel and if
it was supportive of your vets diagnosis and treatment....
 
AT this point, it does no good to stop the diuretics - however, I think a
definitive diagnosis would be in order to justify its use....
 
With kindest regards,
Bruce Williams, DVM
[Posted in FML issue 3193]