This post is in response to Julie's post on yesterday's FML; To clarify
some things I said earlier.
 
I stated in my last post that for the most part, adrenal surgeries are
the equivalent of exploratories.  I said this because of the fact that
ultrasounds, in the most skilled of hands, only show enlarged adrenals
50% of the time and that the Tennessee panel is not near 100% effective
in diagnosing adrenal disease.  I have read alot of literature and been
speaking with ferret vets who do hundreds of such surgeries a year as
well as shelter workers who have alot of experience in this area, and the
overwhelming consensus is that the most reliable indicators of adrenal
disease are clinical signs and symptoms, the severity of which do not
correlate to the severity of the lesion/disease.  Negative results on
ultrasound and the adrenal panel do NOT rule out adrenal disease.  Many
vets will go in despite negative results and find (and confirm with
histopath) adrenal disease present in the animal.
 
You also stated that you would not want to go into a six year old ferret
without 100% positive proof of why you were going in.  There are two issues
here.  One is that there is an increased risk with surgery after age 6.  I
would also be very hesitant to do surgery at that age.  However, my girls
are not yet five.  The other issue is that rarely in medicine do we have
definitive proof beforehand.  An unfortunate but true statement.  Most, if
not nearly all, of medicine is the balancing of probabilities.
 
In terms of my ferrets, they have had significant clinical signs for over
a year and while I was not 'against' doing other tests, I did not feel it
necessary to make a diagnosis or decide on appropriate treatment.  The
truth is the vets I saw DID NOT disagree that the girls have adrenal
disease.  They simply preferred to leave the disease to progress and saw no
inherent problem in doing so.  This was my frustration.  Understanding why
it was they felt this way DESPITE everything I had read and heard from
those with the most experience with this disease (those who are considered
by this list, the FML, to be the "experts" in the field).
 
The other issue you brought up - about questioning the competency of a vet.
Firstly, the way I stated one question..  I followed it by saying that I
was not truly expecting an answer.  That it was more an expression of
frustration and a feeling of a lack of control.  I regret that that may not
have been clear.  Aside from that, I am not sure what you are upset with in
terms of my questioning a vet's competency.  I have been a consumer of the
health industry for 33 years now and I will soon be a provider.  I don't
see anything wrong with questioning care being provided.  In the past, much
medical care was dispensed in a paternalistic manner and some cultures
still feel that any doctor who asks the patients what s/he would like to do
is a quack.  For most of us, however, being in control of decision-making
is a part of the autonomy we value in this society.  I, sadly have too much
experience in human medicine to know that while you must at some point,
give over your trust to the professionals, you must never do so blindly.
 
You say that if I question the vets, I should go elsewhere and get my pets
'out'.  Perhaps you had not seen my previous emails.  This *was* elsewhere.
I have been to a total of four vets and they are all the recommended vets
in the area.  This was again part of my frustration: Finding a vet who
treats ferrets and is current on literature.
 
The last issue you mention was about *not* bringing 'outside' information
to vets and *not* looking to the mailing list for answers.  I have looked
*specifically* to this and the FAIML for answers and have found more than I
could possibly have hoped for.  I consider this forum to be one of the most
educational and effective resources I have at my disposal.  As for bringing
new information to vets, I would challenge your disapproval for a number of
reasons.  One is a problem I brought up that others have emailed me about:
that there is a *real* problem in getting new information about ferret
medicine out to vets who are treating ferrets.  It is an area of ongoing
research in human medicine and an area I have developed an interest in.
Most of what vets learn comes AFTER graduation.  It is difficult to keep
current on one or two species never mind if you treat all sorts of 'pocket
pets'.  Many vets know that most breeders know more about their particular
animals than the vets themselves.  That doesn't mean that the breeders are
qualified to treat the pets.  Being a vet is not simply what you know, it's
how you incorporate and apply new material.  In human medicine, many
patients with serious illnesses know more about them than most doctos and
are often the ones bringing the experts cutting edge pieces of literature
(I have personal experience in clinical research-experimental research-in
patients doing this).  IMHO, any health professional worth his/her salt
will not take offense to someone who respectfully brings them new
information and such a professional will respectfully evaluate the material
and weigh the pros and cons in relation to the case at hand.  It also
presents an extraordinary opportunity to educate clients.  Education can go
further than most lab tests, surgeries, etc.
 
Your challenge for me to "take responsibility for my ferrets' does hit a
sensitive spot.  I want nothing but the best for my babies and I have spent
much of my "free" time doing just that: taking responsibility.  I may be a
vet student but I go through many of the same emotions all of you do when
it comes to being a guardian and 'mother' to my fuzzies.  I just hope my
personal experiences allow me to be respectful and sensitive when clients
come to me in the future with their own similar or (dissimilar) worries and
stresses.
 
I hope I have clarified what I think may simply have been a regretable
misunderstanding.  If I haven't addressed your comments appropriately feel
free to email me, personally if you wish.
 
BTW, see my other post for great news about finding someone to do the
surgeries :).
 
Michaela Maurice
College of Veterinary Medicine
Ohio State University
Class of 2002
[Posted in FML issue 2842]