Dear Liz:
 
>About 4 months ago, Inara's stomach started bloating up, and we had x-rays
>that showed it had pretty much taken over her body cavity it was so
>swollen.  We had a round of amoxicillan for 2 weeks & some pepto bismol,
>which definitely seemed to make her more comfortable, but did not help
>the bloating.  We had exploratory surgery done to check for a blockage,
>bloodwork for other diseases, etc.  Nothing, except that the lining of
>her stomach was slightly inflamed, however, there was no bacteria which
>would indicate heliobacter problems.
>
>After surgery, she spent more time on amoxicillan and did very well, I
>also had her on duck soup for a few days.  I think I was also giving her
>one dose of pepto a day.  After she went off the amoxi & pepto, the poor
>fert started heaving and throwing up, you could tell she was in serious
>pain.  Throughout all of this, she has had regular bowel movements, no
>strange colors, etc.
 
Im afraid I don't have any definitive answers at this time, only a few
more questions and observations.  Was the biopsy taken from the lower part
of the stomach - the part of the stomach where the intestine joins the
stomach, also known as the pylorus is where the bacteria are concentrated.
Also it is where you normally find the most inflammation, as well as
ulcers.
 
My experience is that when areas other than the pylorus are biopsied,
you don't get all of the available information - and a diagnosis of
Helicobacter is often missed.  Additionally, when you have inflammation
of the stomach lining, Helicobacter is the cause until proven otherwise.
I have seen many labs miss the bacteria either because the wrong area of
the stomach was biopsied, or because their labs don't do the proper type
of special stain to identify the organisms.  They are best identified
with silver stains, and our lab has been expecially good over the years.
I occasionally get requests from other labs to run our stains to find
organisms.  I generally do it only if the biopsy is from the pylorus, so
as not to waste the time and efforts of everyone involved chasing bacteria
that probably are lurking elsewhere.
 
Another problem is that the treatment for Helicobacter generally includes
either clarithromycin or flagyl and should be continued for two weeks
(clarithromycin) of flagyl (8 weeks - yuk!).  But going on and off of this
treatment won't do anything to Helicobacter - it takes weeks of diligent
administration to make a dent.
 
What I am saying is I am not sure if Helicobacter, the most common stomach
problem in ferrets has been ruled out yet.  Also, have you seen any
grinidng of teeth while eating - which would suggest gastric ulcers - you
mention that the stools are normal, but the stools are only back when there
is significant bleeding - ferrets can have ulcers without tarry stools -
so we look carefully for other signs of gastric pain.
 
My suggestion would be to go on a whole-hog Helicobacter treatment and a
bland diet and see how it progresses.
 
With kindest regards,
Bruce Williams, DVM
[Posted in FML issue 3281]