From: Lynn McIntosh [faiml@uswest.net] Sent: Monday, July 12, 1999 9:06 PM To: FAIMLanon; FAIML Subject: FAIML #312; July 13, 1999 Ferret Adrenal/Insulinoma Mailing List (FAIML) #312; July 13, 1999 1. Brandy is showing signs of fur regrowth 2. insulinoma blood sugar testing 3. Insulinoma blood sugar testing 4. Gadzook; Petey (urgent case); Minnie 5. All About Lupronr TO POST: Write POST at the end of your subject heading (the more specific you can be in your subject heading, the better) and send to . URGENT POSTS: If you feel the message is urgent please mark it POST URGENT and I'll send it out to subscribers as soon as I can, then include the message in the next list. CALIFORNIA RESIDENTS: Please write POST ANONYMOUS after your subject heading if you don't want your address or last name published. SUBSCRIBE/UNSUBSCRIBE: Just use the one address for posts, subscription questions, requests, cancellations, comments, etc. The list is run by hand so just send me an e-mail. ADRENAL/INSULINOMA WEBSITE: FAIML ARCHIVES/PHOTOS: Past FAIMLs are being archived, with a search feature, on Michael Janke's adrenal/insulinoma web site: . Michael is also kindly posting pictures of FAIML subscribers and the ferrets at this site in the FAIML Album. Check out his site for more info. PAM GREENE's FERRET FAQs: I suggest people read (and reread) Pamela Greene's Disease FAQ's on Insulin and Adrenal diseases, as they offer a good background. I forward them to all new subscribers, and will gladly send them upon request. I also send the "Disease Package", a file that tells how to get all six of Pamela Greene's FAQs on ferret diseases. Pam also has excellent FAQ's about general ferret care as well, and a link to these may be found on the FERRET CENTRAL web site: . THE FERRET MAILING LIST (FML): The FML has 3,000+ ferret-loving subscribers and the topic is simply ferrets, ferrets, and more ferrets. Moderated by Mr. Bill Gruber, it's a good source of ferret entertainment and information. Visit FERRET CENTRAL on the web (see paragraph above) for more info on the FML. To subscribe to the FML, send email to its moderator, Bill Gruber, at and ask to be added. You can also try subscribing automatically by sending email to with the command SUBSCRIBE FERRET in the body of the email. 1. Subject: Brandy is showing signs of fur regrowth From: Vicki Eller Date: Sun, 11 Jul 1999 21:29:14 -0700 (PDT) Hi. I know I don't post very often, but I had to share this and am in desperate need of responses. Brandy went for surgery in late May. She had the left adrenal removed. The vet also said he felt a "nodule" on the right side that he thought was the same thing. Today, we noticed a significant amount of fur regrowth on her tail. It is becoming very dark brown again. No guard hairs, but lots of dark brown stuff growing. Her back is still bald along with the areas where the vet shaved her. Could this be a good sign that the "nodule" is something else, perhaps normal? Could we be seeing the beginnings of renewed health? Or has this just happened as a fluke for anyone? I don't want to get false hope, but I don't want to be pessimistic either. If anyone has any info, please share! Thank you :) === ---Vicki Eller v_eller@yahoo.com http://www.angelfire.com/pa2/vickieller.html ICQ# 39238225 2. Subject: insulinoma blood sugar testing From: LuAnn McCann Date: Sun, 11 Jul 1999 13:14:50 -0500 (CDT) Subject: insulinoma blood sugar testing From: Jack Brondwin Date: Wed, 07 Jul 1999 22:54:52 -0700 I am noticing that a lot of owners of diabetic cats and dogs are beginning to test their pets for blood sugar at home using a glucometer. One of my clients has a cat that is so frantic and upset that it is virtually impossible to test her in the office. The owner learned how to collect and test her blood at home making it so much less stressful for all of us. This would be a wonderful way to detect ferrets who are about to go into a low blood sugar crisis. I am wondering if there are any owners of ferrets with insulinomas who are testing blood sugar levels at home. Please share your experiences with us. If you wish to know more about blood sugar testing the following website http://www.petdiabetes.org/techniques_index.htm has some information from owners who are doing it. It's funny that you should bring this up. I'm hoping that you or anyone else on this list can help me out with something. Our little Fred was diagnosed w/Insulinoma a few months ago. So far we are able to control it with Pediapred, we're still thinking about surgery. When I took him in yesterday for a bg check our vet (whom I consider rather ferret knowledgable, he interned w/Susan Brown) said he couldn't get any blood from Fred to test, and didn't want to clip the quick and use a glucoe meter because they usually read low. Now, am I off my rocker or don't all ferret vets use this method? Please enlighten me to the difference between using a glucoe meter and the "big, expensive blood machines". Thanks for any info you can give me on this topic. LuAnn and the fablous four, Zoid, Cinder, Quedo and Fred +++++++++++++++++++++ 3. Subject: Insulinoma blood sugar testing From: WOO1953@aol.com Date: Sat, 10 Jul 1999 15:46:22 EDT Jack Browdin wrote about testing our ferrets blood sugar at home. Well, I'm trying to do that but so far I've had a problem getting blood from my ferret. If anyone knows a good place to get the blood from please let me know. So far I've tried the pads of her feet and once got a spec of blood from there but not enough for the test and I've also tried her ear with no luck. Someone told me to try clipping her nails a little short and get the blood from there but I just couldn't do that to her. While I'm here let me ask you all another question. My female ferret had surgery about six weeks ago and my vet removed part of her pancreas because of the insulinoma (Thank You Dr. Karen for your advise to my vet, Dr. Rockwell). She is also on .4'ss of Pred. twice a day. She acts wonderful, eats well and is ready to play whenever I am. The problem is her blood sugar is still in the 40's. Have any of you had a ferret with such a low blood sugar and have them act so well? I'm confused. I have gotten a recipe for an additional feeding for insulinoma ferrets but I haven't made it yet as my ferret is a VERY fussy eater. She doesn't even like duck soup. I've also tried chicken baby food and she won't touch it. All she'll willing eat is her dry food. Any help to these questions would be appreciated. Phyllis and Sammi... MODERATOR'S NOTE: This thread came up before, and I collected a few posts in a file, about people's preferences for blood tests and methods for taking blood that worked for them. Drop an e-mail to me if you'd like the file. Lynn 4. Subject: Gadzook and Petey (urgent case); Minnie From: Lynn McIntosh Date: Sat, 10 Jul 1999 15:46:22 EDT Hi. Thank you very, very much to those who wrote me asking how Gadzook's adrenal surgery went. I'll try to answer personally, but am overwhelmed by ferret illnesses, so if you don't here, know your message was very much appreciated. Gadzook had both adrenals taken out, and received a vena cava ligation, since the right tumor was growing into the vena cava; also a bit of the liver where the tumor had grown was taken out. This was Thursday afternoon. Monday, today, he's still chomping his teeth a bit at times (feeding expecially), showing he still has abdominal pain from the surgery. He acts as if he has insulinoma. Stopping and staring and collapsing (his pancreas looked fine and energy has been great). He drinks a little on his own, but hasn't started eating (he's getting plenty of turkey soup hand fed). He's six, so recovery is expected to take longer. Anyone else have a similar reaction to bi-adrenalectomy and how did it turn out (though they're all different). The pathology report says both adrenals were removed completely, and that the left was hyperplastic, the right adenoma, so non-malignant, which is good. Though perhaps bad in terms of the prospect of him ending up with enough adrenal tissue not to need medication for life. We gave him a little pred. tonight hoping that will help him perk up (replace adrenal function). As for Petey, sigh. All ferrets are sweet, but this is the sweetest soul I've ever met. He's in bad shape, and getting an ultrasound tomorrow. He's been on Lupron and probably needs adrenal growths removed, but he may need more (or there may be nothing that can be done). He's got a huge spleen and fluid in the abdomen and chest. He recently recovered from a bout of bronchitis (according to the x-ray), thanks to antibiotics. His lymph nodes are a bit large, too. He's been so miserable I've got him on turbutrol tonight and will give him some tomorrow morning. It's been a godsend to him. It's heartbreaking to see, but I hope we find something that can be fixed. Heart, of course, is a big concern. Possibly lymphoma. I hope it's right adrenal causing problems. We'll see, and hope for the best for the sweet little guy, only four. Our Minnie is a real wild and beautiful little soul. An albino, the runt, full of vim and vigor. She was born with a heart murmur, three on a scale of six, three meaning pre-symptoms. Something happened last night. I found her scratching away madly in a box, pawing at her mouth, put her down for a minute and she galloped off drunkenly and began scratching again. There was foam in her mouth. She was in extreme distress. Of course we thought insulinoma, and come to think of it she has stopped and stared off in space occaionally over the years, but is an incredibly energetic gal. She's maybe been slowing down a bit lately. I listened to her heart this afternoon and it sounded like Niagara Falls and a huge roaring heartbeat all together, or sort of like driving through a tunnel - LOUD, on the left side. I'll take her in tomorrow with Petey. Thoughts about any of these cases are welcome, and prayers and healing thoughts even more. Thanks you very much, Lynn and the Sweet Six 5. Subject: All About Lupronr From: MiskaBC@aol.com Date: Sun, 11 Jul 1999 21:06:09 EDT The following post is from Charles Weiss, DVM, to help the ferret community understand Lupron, a new medical treatment for adrenal tumors. If you have not yet requested his Lupron/Casodex/Arimidex protocol sheet for your veterinarian, just email me and I'll send it to you. Let me know if you want it in Word, WordPerfect, or copied and pasted in an email, please. I suggest you give this post to your veterinarians as well. If you like your documents pretty, I'd be glad to email you this post as a Word or WordPerfect document, or separate email as well. All the best - Beth + Miska the #1 Ferret + Pads + Gabby + Smudge + David ALL ABOUT LUPRONr I don't usually have time to write posts, but I felt it was important to clarify some confusion surrounding the different forms and dosages of Lupronr, and briefly discuss adrenal tumors. There have been some inaccuracies in some posts and emails that I've read about the forms in which Lupron comes. I have done extensive research in this area and will try to pass on some of the key information. The protocol information sheet for veterinarians that Beth Comarow (Miskabc@aol.com) is distributing for me is the result of treating more than 150 ferrets with the drug and not based upon hearsay or a few cases, so I think the information is accurate. I urge you to exercise caution before acting on unsubstantiated information or claims that you may read. Treatment of Adrenal Tumors in the Ferret The treatment of choice for this condition is surgical removal of the adrenal tumor. The adrenal tumor produces an excess of testosterone and/or estrogen which results in all of the symptoms we see, including but not limited to: hair loss, males straining to urinate, swollen vulva, lethargy and return-to-male sexual behavior or aggression. Approximately 25% of adrenal tumors are malignant; therefore, surgical removal is the best treatment. Medical treatment is reserved for ferrets who are not good surgical candidates - too weak or otherwise sick to tolerate surgery well, or when surgery cannot be done.. The medical treatment for this condition involves drugs that block and decrease the production of estrogen and testosterone. Therefore, these medical treatments are unlikely to affect the adrenal tumor(s) themselves, but they can reverse all of the symptoms. None of the new medical treatments are approved for ferrets, although they appear to be safe, and long term treatment results are not available. (I should point out that most drugs, from Amoxi-drops to Lysodren, have not been specifically studied and approved for the ferret either.) Lupronr: Lupron is available in several forms that last different amounts of time in the body. Lupron is available as an injection that lasts 24 hours, 1 month, 3 months and 4 months. Each is a different preparation that lasts for different amounts of time, so it's important to know which form you are using: 1-month, 3-month or 4-month. The reason we use the 4-month form is for convenience and cost. The monthly injection given 4 months in a row is more expensive that one 4-month shot. (No matter how high a dose you give of the 1-month shot, it will only last 1 month - so when you talk about what dosage you are giving you must say which form you are using.) Example: Two ferrets receive the same dosage of Lupron, but one gets the 4-month shot and one gets the 1-month shot. The ferret who gets the 1-month shot receives a 500 microgram (mcg) shot each month for 4 months. The ferret receiving the 4-month shot receives one shot of 2000/mcg (2 milligrams or mg). Therefore, both ferrets are receiving the same amount of the drug per month, but when you say one ferret got a 2000/mcg shot and one got a 500/mcg shot, it doesn't sound like the same dosage - but it is the same per month. I have found that at the same dosage, the 4-month shot is the less expensive form. (The Lupron in both cases is time released, called a "depot." In the 1-month shot the Lupron depot is released over the period of 1 month, and in the 4-month shot, over 4 months.) Premixing: The 24-hour form of Lupron comes in a pre-made liquid. Since it only lasts 24 hours in the ferret after being injected, it would have to be given every day to be effective, so is not worth discussing. The other forms (1-, 3- and 4-month) come in two vials - a liquid and a powder. They are mixed together, and then immediately injected. Stability after mixing has never been studied. I am looking at the stability of the solution once mixed and stored in a standard freezer. Why is this important to understand? Each human dose of Lupron is large enough to treat many ferrets. If a veterinarian who wants to treat one ferret is forced to buy a human-sized dose, storage can be a problem, since after the Lupron is mixed it should be injected immediately, or it could become ineffective very quickly. But the veterinarian may not have, for example, 15 ferrets who need the injection at the same time. So it can be cost prohibitive to be forced to buy a dose that could treat that many ferrets but only use it for one. The good news is that we recently found a pharmacy which, under sterile conditions, will separate the powder into individual ferret-sized dosages and ship directly to the veterinarian. A veterinarian can now call the pharmacy and buy one ferret-sized dose of the drug. The veterinarian mixes the liquid and powder together, and gives the injection immediately. I should mention that I receive no money from the pharmacy! I'm giving out their name because they are capable and willing to separate out the powder and liquid in a sterile environment for us. Dosage: Lupron is so new that no one yet knows the lowest dosage we can use to reverse all symptoms. The dosage I have found to be the most effective so far is 2000/mcg (2/mg) of the 4-month depot, or 500/mcg of the 1-month depot. This dosage is virtually 100% effective in reversing all symptoms. To date we have not seen any toxicity, although long-term studies have not yet been performed. In a small number of ferrets we have seen local reactions - a bump where the shot was given. The reactions can occur 2-4 weeks after the injection, and resolves without treatment in 4-6 weeks. If they are removed or biopsied, some or all of the Lupron will be removed, so they should be left alone. They do not seem to bother the ferret. There are lower dosages recommended by some. Although I have not used lower dosages, I have heard of approximately 20 cases and seen several for a second opinion, where lower dosages did not reverse symptoms. In cases where male ferrets have enlarged prostates and are straining to urinate, life threatening blockages can occur. (A word on urinary blockages: straining to urinate means that the adrenal tumor is secreting the hormone testosterone, which causes the prostate (not the tumor) to swell and block or partially block the urinary tract. Treating with a high enough dose of Lupron can stop the testosterone secretion, so the swelling of the prostrate is reduced.) I consider the treatment effective if all symptoms reverse (hair grows back, vulva goes down to normal size, no straining to urinate, no lethargy, reversal of male aggression, reversal of return-to-male sexual behavior, etc.). If your ferret is receiving Lupron and all of the symptoms do not completely reverse, then the dosage may be too low. In my experience the 4-month shot at the dosage we are using is very effective and lasts for 5-6 months with some ferrets symptom-free for 7 months. Again, you can have your veterinarian buy a 1-ferret dose of the 4-month Lupron depot from Professional Arts Pharmacy. Their number is 1-800-832-9285. There may be other pharmacies that offer this service but this is the one with which I've worked. It's critical that a pharmacy work in a sterile hood and understand the protocol. My wife is a pharmacist, and agrees that the varied forms of Lupron can be confusing. Also, Lupron is often administered in a hospital setting, so retail pharmacists don't frequently work with it. I've heard about mistakes such as using unapproved diluent (the liquid) or dispensing 24-hour Lupron as the 1-month depot. It's also easy to confuse 1- and 4-month Lupron depot and think that 2000/mcg (2/mg) of 1-month depot lasts 4 months. But remember, the 1- and 4-month depots are different forms, and 2000/mcg of the 1-month depot only lasts 1 month! I've spoken at length to all of the pharmacists at Professional Arts, provided them with my protocol, and they have been compounding and shipping it to veterinarians. If you would like a copy of the Lupron, Casodexr and Arimidexr protocols for your veterinarian, contact Beth Comarow at Miskabc@aol.com and request "Medical Treatment of Hyperadrenocorticism in the Ferret," or simply "the protocol sheet." Finally, I'd like to thank the ferret-owning community for their generosity and dedication, which has helped spark my enthusiasm to continue treating and searching for new treatments for this wonderful species. Charles Weiss, DVM Potomac Animal Hospital, Potomac, MD Note: This information sheet may only be copied or reprinted in its entirety, with credit given to the author. CW:bc 0799 ------------------- End of FAIML #312 ----------------------