Hi, everyone.  I just got home from taking Lucky Charm to Colorado State
University for a right adrenalectomy.  Her case was managed by Dr. Jeffrey
Wimsatt.
 
I opted to take Lucky Charm to CSU because their approach was to debulk the
right adrenal gland rather than ligate the vena cava.  Other vets who had
conducted the ligation were frank about losing roughly 1 in 4 ferrets who
undergo the procedure, and a couple of ferret owners shared their
experience of losing ferrets after two days of intense pain.  My gut was
screaming at me not to take the risk.  I figured Lucky Charm had a good
chance of surviving a conventional debulking procedure, even though it
would not result in a cure.
 
As it turned out, the right adrenal had invaded her vena cava.  While I was
in the waiting room, Dr. Wimsatt informed me that with my permission, the
veterinary cardiologist conducting the surgery was prepared to use a
procedure developed recently in Florida, in which he would cut into the
vena cava, remove the adrenal tissue, and stitch the artery back together.
He estimated he would be able to restore 60 percent of the blood flow
through the vena cava.  Lucky Charm's blood pressure was holding and the
hospital had a donor ferret ready to donate blood for a transfusion.  I
authorized the procedure.
 
A little while later, Dr. Wimsatt informed me that Lucky Charm's blood
pressure had dropped precipitously and her heart had nearly stopped.
Fortunately, they were able to revive her immediately.  I cried a fair
amount after hearing the news, afraid that I would lose her.
 
When I visited Lucky Charm that evening, she was still pretty much out of
it.  By the following morning, 24 hours after surgery, her condition had
stabilized.  I requested they keep Lucky Charm in the critical care unit
an extra day, even though it would cost more.
 
The tissue removed during surgery turned out to be a carcinoma and there
was not a clear differentiation between neoplastic and normal cells, which
means the surgeon probably wasn't able to remove all of the cancer cells.
The good news is that Lucky Charm did not appear to have concurrent
insulinoma, her blood test also showed her glucose levels to be normal,
and her sutures are healing nicely.  She's eating, her stools are normal,
and the swelling in her vulva is going down.
 
In March, when Lucky Charm's left adrenal was removed, it was analyzed as
hyperplastic -- not yet cancerous.  Either the right adrenal gland was
already involved at the time or it became more aggressive after the left
adrenal gland was removed.
 
I am happy to report that Lucky Charm is doing well.  She is taking
Florinef and Prednisone to maintain her electrolyte levels and Amoxicillin,
Metronidazole, and Omeprazole to prevent potentially fatal ulcers caused by
Helicobacter and stress.
 
I arrived at CSU with a stack of veterinary information provided by people
on this list.  It turned out Dr. Wimsatt already knew about the various
surgical approaches, the papers by Drs.  Weiss and Williams, the need to
conduct a partial pancreatectomy if insulinoma nodules were present,
medication to prevent ulcers as well as Florinef and Prednisone to prevent
the ferret from crashing, treatment with Lupron if symptoms recur, and the
possibility that hidden adrenal tissue could cause symptoms to return.  It
was a relief to know the vet already knew about these things.  He also
mentioned a couple of pioneering approaches CSU is considering, such as
using shunts to gradually close off the vena cava and cryosurgery to kill
right adrenal tissue.
 
Lucky Charm and I are grateful to the many ferret owners and vets on this
list who shared their knowledge with us.
 
Linda and Lucky Charm
[Posted in FML issue 2768]