>From:    Meesh Meesh <[log in to unmask]>
>Subject: bilateral adrenalectomy question
 
You'll probably get a lot of responses, and I just wanted to throw
something else (2 something elses, actually) in the hopper.
 
Success with bilaterals depends so much on the experience and skill of
the veterinarian, so even if a 75 people out of 100 said they did not get
complete hair growth, or in 5 months the ferret showed symptoms, or it
"didn't work," or whatever is reported, the focus really has to be the
individual vet to know how likely it will be that bilateral adrenalectomies
"work." Bilateral or right adrenalectomies can be difficult, even for
highly skilled surgeons.  Other factors (correct anesthetic - isoflurine,
speed of surgery - ideally 30 minutes or less, etc.) contribute
tremendously.  This surgery gets a real bad rap sometimes.
 
Lots of really good veterinarians won't even do them (and they deserve
respect for not jeopardizing their patients).  Lots aren't able to get all
or most of the adrenal tissue.  (If they do get all, the ferrets should be
put on pediapred and flurinef [or DOCP] for a time afterwards or they can
do very well and then crash after about 4-6 days).  The vast majority of
our vet's bilateral adrenal patients do great for up to years.  (And
despite the numbers, even he does not love this surgery.)  But he's made
adrenal disease a specialty, and has done hundreds.  If a vet hasn't done a
pretty large number of bilateral or right adrenalectomies successfully,
(25? 30? 40?)  I truly believe the odds go down.
 
In Dr. Weiss journal article, "Surgical treatment and long-term outcome of
ferrets with bilateral adrenal tumors or adrenal hyperplasia: 56 cases,"
recurrence was 15% with a mean long-term follow-up period of 30 months.  I
believe he left a very small amount of right adrenal tissue in (thus no
need for pred or DOCP).  Note that the ferrets in the study were before he
began using cryosurgery.  The study was completed in 1997, and is in the
Journal of the American Veterinary Medical Association, Vol. 215, No. 6,
Pages 820-823, September 15, 1999.
 
People should talk to their vets and ask them a few questions: how many
have they done - how many were successful - and what success means.  (And
what anesthesia they use, typical length of time of surgery, etc. etc.)
It can be done nicely, and if the vet really resents the questions, well
that's good information too.  It broke my heart the other day when I read
about someone whose ferret did not make it through surgery - and neither
did her last 2 - with the same surgery - and the same vet.  Where those
questions asked beforehand?
 
If your vet likes input from clients, you might want to touch base with
him/her about the new cryo surgery.  It's much easier for the vet and the
ferret.  Apparently it's easy to learn too.  All things being equal,
recovery time is often about twice as fast as with regular adrenalectomies.
A couple of Dr. Weiss' clients told me that their ferrets acted like they
did not have surgery.  The biggest problem was keeping them quiet (no
stairs, ramps, wrestling) for 4 or 5 days.  As long as a vet can find the
tumor, the cryo can be done.  The piece of medical equipment is not
expensive (about $900.00?) compared to other equipment, given all it can
do - for other species as well.  A few weeks ago Dr. Weiss "cryo'ed" a
tumor deep in a cat's ear in just a few seconds that could have been a
whole different story with regular surgery.  (With cryo surgery, the
surgeon just touches a tumor with the probe and the cells of the tumor
freeze and die.  For some strange reason this does not affect the vena cava
or blood flow through it, for right-sided adrenal cases.) And forgive my
amateurish descriptions - I'm not in the medical field, have just been
struggling to learn for the last few years and have some great tutors,
including Dr. Weiss.  So people may disagree with me, and that's fine too.
 
In case you haven't seen it, I'll send you the post for your vet about the
video that shows cryosurgery for bilateral adrenal tumors and bilateral
adrenalectomies, among other surgeries.
 
Anyway, good luck in your surgeries, and don't worry about the generalities
about adrenal surgery if you have an experienced adrenal surgeon and good
surgical candidates in your beloved girls.  I'm a nervous wreck before
surgery, and my heart goes out to you -
 
All the best -
Beth + Miska the #1 Ferret + Pads the Man! + Gabby (in our hearts forever) +
Smudgey + David
[Posted in FML issue 2858]