>I apologize in advance if emailing you directly is intrusive.  I plan to
>post to the list as well, but since time may be critical I didn't want
>to risk delay if you can help us.  I hope this is okay.  I'll make this
>as brief as possible: Bandit is our 8 year old neutered male, who had
>insulinoma surgery three years ago.  We've managed him medically for the
>last couple years fairly successfully, however in recent months his quality
>of life has been declining.  He had maxed out on his doses of pred and
>diazoxide, so we decided to try surgery again.  An exploratory was done on
>10/30/00, at which time a very large mass was found and removed.  My vet,
>Dr. Wellborn described it as the size of a golf ball.  The path report
>showed that the entire mass was adrenal tumor, benign with precancerous
>indications.  His recovery has been slow, but he took a significant turn
>for the worse on Sunday when he appeared to have increasing difficulty
>urinating.  I took him in on Mon day and his bladder was absolutely huge.
>I saw the xray and it appeared to fill his whole abdominal cavity -- it
>was even displacing his spleen, creating a lump on his side.  His bladder
>was flushed and he is on antibiotics for a severe UTI.  Unfortunatey his
>kidney function is seriously impaired.  His BUN on Monday was 231 and
>creatinine was 9.  He has been on IV and antibiotics since then and his
>bladder is being manually expressed.  The bloodwork yesterday showed the
>creatinine had dropped some, to 6 something.  His BUN was still over 140,
>which is as high as the clinic's scale goes (the initial bloodwork had
>been sent out to a lab).  Bandit is spending his days at our regular
>clinic and nights at the emergency clinic to be monitored and cared for
>around the clock.  We do see him, as we transport him and bring him by
>home to give him his regular meds and to syringe feed him (they do feed
>him at the clinics as well every 4 hours).
>
>Can you think of anything else we can be doing to help him through this?
>And do you have any idea of whether we should reasonably expect him to
>come through this and how long it could take to see improvement?  I have
>no intention at all of giving up on him as long as there is a possiblity
>of improvement, but at the same time he appears pretty miserable and I
>don't want him to suffer unnecessarily.
>
>I'm sorry this ended up being so long; I didn't want to leave out anything
>that might have been important.  Any suggestions or thoughts you may have
>would be most appreciated.
>
>Many thanks, Lucie
 
Dear Lucie:
 
I am cross-posting this reply to the FML, to save you a bit of time.
 
Once again, we are dealing with a dysuric male ferret with adrenal disease.
In males, the estrogen levels associated with the adrenal lesion may result
in changes in the prostate which impinge on the urethra and render the
animals unable to voluntarily urinate.  The bladder of these animals is
easily expressed, though.  In this case, we know there is an outflow
problem - kindey problems don't cause problems urinating, but either too
much, or not enough urine.  But the urine goes out well.  With obstruction,
the animal can't urinate, and the bladder gets progressively enlarged.
 
The most common causes of outflow obstruction in ferrets is adrenal-related
prostatic disease and urolithiasis.  Of course, prostatic disease is
exclusive to male ferrets.  Urolithiasis is generally diagnosed either
by radiographs, or by obtaining crystals or small stones during
catheterization.  Uroliths make catheterization difficult, as they are
actually plugging up the urethra; adrenal ferrets are catherized without
difficulty.  Without the ability to urinate, blood levels of substances
normally excreted by the kidney begin to rise, including BUN and
creatinine, as is seen in this case.
 
OK - so what do we do here.  First we keep the animal on fluids and try
to restore the BUN and creatinine to a normal level (assuming that it was
normal prior to the urine outflow problem.  Then I would take a good look
at the prostate - this is where ultrasound may help - look closely in the
area of the prostate.  As the source of estrogen has now been removed, we
have taken a good step towards treatment (hopefully it is not too late at
this point.) If the prostate proves to be enlarged, then we can either try
drainage of the largest of the cysts surgically, with hopes of restoring
normal outflow, or we can try bicalutamide, an estrogen blocker than may
have some effect on dysuric males.  (Probably at the age of this ferret,
with the current renal problems, bicalutamide would be a more appropriate
first step.) More info on bicalutamide is available at Charlie Weiss's web
site: http://www.ferretdoctor.com
 
With kindest regards,
Bruce Williams, dVM
[Posted in FML issue 3231]