From: Lynn McIntosh [faiml@uswest.net] Sent: Saturday, October 16, 1999 8:05 AM To: FAIMLanon; FAIML Subject: FAIML #342; Oct. 16, 1999 Ferret Adrenal/Insulinoma Mailing List (FAIML) #342; Oct. 16, 1999 1. New adrenal surgical technique 2. Very high blood sugar 3. bilatteral adrenal 4. Adrenal Surgery and Subsequent Treatment 5. prostate, etc 6. Update on Ferris; Misc. 7. Guss & Lissy Lou 8. Dr. Purcell re: failure to thrive on Right Adrenalectomies using ligation, other questions, etc. 9. Visit to the new vet..good news and bad...HELP/Advice needed from VETS..two vets hesitant to do adrenal surgery !! New Right Adrenalectomy Techinque, etc. The FERRET ADRENAL/INSULINOMA MAILING LIST (FAIML) is a group that's come together to share support and information about adrenal and insulinoma diseases. FAIML comes out in digest format three to six times per week, depending on the number of posts sent, and their urgency. FAIML information is the opinion, only, of subscribers, mostly ferret caretakers. It is not medical advice, comes with no guarantee of accuracy, and is not meant to replace the examination and medical oversight of a qualified veterinarian. If your ferret is sick or exhibiting signs of illness take your fur kid to the most ferret-experienced vet you can find! A ferret-experienced vet is one of the most important services you can provide to your ferret. 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 great 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. New adrenal surgical technique From: "Michael F. Janke" Date: Thu, 14 Oct 1999 20:34:42 -0400 Dr. Charles Weiss, one of the leaders in new techniques and solutions to treat ferrets for both adrenal disease and insulinoma, has given me the priviledge of being the first to publish his latest work. Dr. Weiss has used cryosurgery, a method using liquid nitrogen, to freeze adrenal tumors, making surgery, particularly on right adrenals, much safer. There are other benefits of course, but I won't detail the whole article here. If you're interested, see my signature below for the URL to the Adrenal/Insulinoma web site. Once on the home page, look for "Breakthrough in Ferret Surgery" in the "Breaking News" section, or "Adrenal Cryosurgery" in the list of links on the left side of the page. For the ferrets, Mike * Michael F. Janke, mjanke@miamiferret.org * Secretary, South Florida Ferret Club & Rescue * A 501(c)3 not-for-profit corporation * * Shelter web site: http://www.miamiferret.org * Adrenal/Insulinoma web site: http://www.miamiferret.org/fhc 2. Very high blood sugar From: "Karen O'Keefe" Date: Fri, 15 Oct 1999 23:02:47 +0100 My ferret Ben has been on Prednisolone since February this year for suspected Insulinoma, even on Prednisolone his sugars would not get up to normal but a few days ago he started drinking lots of water, he does not usually drink much water but he started drinking lots and I thought oh no this looks like a high blood sugar (I am diabetic and so know that drinking lots of fluid can mean a high blood sugar) so I tested his urine with my diastix which test the urine for sugar and I was shocked when it showed a huge amount of sugar :o( My vet reduced his dose of Preds to every other day instead of everyday and today he still had a large amount of sugar in his urine so my vet did a complete blood test, his liver is fine, his kidneys are on the highest side of normal but his blood glucose is just over 600mg/dl !! Can Preds cause this and will his sugar level go down now we have reduced his Preds even more??? and by the look of it he will come off them but my vet does not want to take him straight off she wants to reduce the dosage and get him off gradually. Has anyone had this happen to there ferrets that are on Preds??? If the Preds did cause Ben to now get a enormously high sugars will his sugar levels come down when he gets off the Preds or is the damage done??? He does not have any ketones in his urine at all by the way. Could there be another reason why this has happened, it seems that diabetes in ferrets is quite rare? I live in the UK as well by the way. Oh and Ben also has Cardiomyopathy and is on Enalapril and Frusemide for that. He is 6 1/2 years old. I would be so grateful for any help, Ben means the world to me. >From Karen,Ben,Glyndwr,James,Cian,Kealan,Tia and Ella. *Love and missing my darling Billy so much* 3. bilatteral adrenal From: "The Ferret Aid Society" Date: Wed, 13 Oct 1999 00:03:30 -0400 Hay everyone! I have a fur kid who had both his left and Right adrenals removed in 2 surgeries over 1.5 years. He grew all his hair back, but now is almost bald again. Any suggestions? Would Lupron help this? I'm still not so sure about that GnRH inhibitor. The Ferret Aid Society "For the love of our Fuzzy Friends" http://www.ferretaid.org http://www.igive.com/html/ssi.cfm?cid1383&mid43897 Use your mouse to raise funds for the shelter at no cost to you! Click here!! 4. Adrenal Surgery and Subsequent Treatment From: "Emily Moon" Date: Tue, 12 Oct 1999 23:40:45 PDT Hello! I thank the heavens above for Edward telling me about this list last week! One of our little guys is sick with adrenal disease and I have had nowhere to turn for help until now :) Thank you kindly. Oliver, who's 4, and I were at the vet all afternoon so he could have an ultrasound. He, and his 3 closest buddies, shed much of their coat every summer and, this year, Oli's kept going...He does not seem sick (eats, plays, etc.) but I knew that his excessive hair-loss was a problem. I have had one VERY bad vet in Seattle and was recommended to another, Dr. D. On our first visit she confirmed my research, adrenal disease... The ultrasound showed that the problem is on Oli's right side, right next to his vina kava (spelling?). The vet told me that we must operate so he's going in on the 22nd. She also said that, when removing the adrenal from the right side, she has sometimes only been able to remove part of it. I understand that this is a very delicate surgery but is it ok to only remove "part" of the disease? The doc said that this has led to a full recovery in the past... Dr. D never said anything about alternative treatments or any type of needed supplements for the hormones that Oli will, post-op, be making lees of. We have never even done a blood or fecal test on him for this. Please tell me what you suggest. I would love to hear from others out there with ferrets having RIGHT adrenal surgery and what happened. I would also like to hear from any other vets who also may think this strange. Lastly, if you are in Seattle and have had experience with a GREAT vet and adrenal surgery, I'd love to hear from you too. Kindly, Emily Moon, Hubby Jason, Bear, Oliver, Clepopatra, Puck and their fish friend Tommy Thompson. emilymoon@excite.com 5. prostate, etc From: "Karen Purcell, DVM" Date: Wed, 13 Oct 1999 00:09:18 +0000 Michaela, > and this list this past year. I am a second year vet student at > Ohio State University and have four gorgeous ferrets right now. > Unfortunately, one of my ferrets recently died of DIC/Sepsis > secondary to Suppurative Prostatitis (abscess) (short version). He > had all the signs and symptoms for a lil over a year and no less > than three vets didn't even consider his prostate. It was > supposedly 2x it's normal size on necropsy which leads me to my > first question since I can't find an answer anywhere, what is a > normal ferret's prostate size?? Ferrets don't actually have a distinct prostate, just tissue on either side of the urethra. However, in adrenal disease this tissue can become cystic, and appear to be similar to a distinct prostate gland. >SNIP>. Well, a subsequent surgery > elsewhere ended up with two surgeons and all the fancy glasses (like > microscopic) could find NO adrenal tissue anywhere, despite the fact > that Spikey had continues to lose hair to the point of baldness, had > horrible pruritis, was displaying male sexual behaviour and dysuria > (not blockage but not using the box anymore and urinating in > dribbles across the floor as opposed to one long void). The only > theory we could come up with at the time was that the adrenal tissue > had broken off and 'set up camp' elsewhere in his body (adrenal > tissue can 'live' elsewhere if need be) Ot it was ectopic to begin with - not an uncommon occurence, unfortunately. >SNIP> > > This leads me to my next questions. The most recent vet I have > seen has known that my two girls have adrenal disease for nearly a > year now. His reasoning for putting off surgery, as I understand it, > is that I am a rare client in having brought him ferrets with such > mild symptoms as he usually sees them for the first time in far more > advanced stages. He was concerned at that early a stage of being > able to find the adrenals. I know the old school thinking was to > wait till the adrenals enlarged but everything I have heard and read > till now says to go in immediately. I am concerned about two things. > The first is age. I read Karen Purcell (DVM) saying she doesn't > recommend surgery in ferrets over 6 years of age. Why is this? They have a higher incidence of mortality due to anesthetia after 6 years, in my experience. This is not a hard and fast rule, by the way - it depends on the ferret. What appears to > occur with ferrets over that age? Subclinical heart disease. My two girls will be 5 soon but that > isn't far from 6. Five doesn't seem to be as big an issue, but I would do a full CBC/chem profile and a whole body xray before anesthesia. I also read somewhere that ferrets with unilateral > adrenalectomies usually show signs of adrenal disease on the other > adrenal gland about a year postsurgery. Is this true? 3-12 months. How many is > 'many'? Oh, about half. Are these bilateral cases that were simply > overlooked/unrecognized or is removal of the first adrenal gland > somehow setting up conditions for hyperplasia of the remaining > adrenal (pathologic hyperplasia that is)? > I think it is the sudden removal of all the hormones with the first surgery, myself, but no one really knows. > Aside from the risks of prostatitis and blockage and aside from the > possibility of blowing a blood vessel, what other risks are there in > waiting? Increased stress on the body due to the hormone levels, and anemia (rare). Are there any other risks specific to females? Vaginitis and stump pyometra. -Dr. Karen drkaren@world.std.com 6. Update on Ferris; Misc. From: Celeste Jacob Date: Wed, 13 Oct 1999 16:20:46 -0700 Hi Lynn and All, First, to Gus & Lissy Lou's caregiver: My thoughts are with you, and my heart goes out to you. This is such a sad and difficult thing you must face. I pray that the Lord gives you the strength to help you through it, and that you have friends and family around to help and support you. The days ahead will not be easy, but try to remember that you are doing the best you can, and that you will see them again one day, happy, healthy, and playing, at the Bridge. As well, I hope you find some wisdom and comfort in Sarah's timely post. To Sarah: Thank you for the beautiful and insightful post about the ultimate act of compassion and letting go. You're so right! I'd forgotten about the fact that ferrets do have such a high tolerance for suffering, and how we can sometimes, understandably, mistake this for extraordinary endurance. I heard once that many animals in the wild camouflage their injury or weakness in an attempt to stave off predators. Although ferrets are now completely domesticated, they have retained this instinct. Nonetheless, I just wanted to say that I appreciate the gentle reminder that we must always do what it takes, regardless of how difficult or painful for us, to ensure the least amount of suffering for our much loved babies! (P.S. If you haven't posted this to the FML, you may want to consider it, as that list reaches alot of people - and their fuzzies - who I think would benefit greatly from it.) As for my little devil-child, Ferris! ;) As you may remember I wrote awhile back that I was FRUSTRATED with his chronic diarrhea, etc. To make a very long story short, in addition, he got a nasty bladder infection. I put him on Baytril, which helped that, but possibly (suspected) gave him an infection in his mouth with subsequent dehydration, loss of appetite, weight/muscle loss, a very high white cell count, anemia, and a protein deficiency. Basically, he was trying to fight a nasty infection and stopped eating and drinking water, which caused all these other problems. He was in the hosp. from Monday - Wednesday last week. They put him on an IV w/fluids and antibiotics and fed him a special high fat and protein wet food that he, fortunately, loved. He started gaining weight by Tuesday, and by Wednesday he was a new ferret, gaining a total of 4 ozs! AND . . . (drum roll please . . .) HIS STOOL RETURNED TO NORMAL!!! WOW!! And I mean *normal* -- like a ferret's should look, formed and about pinkie-sized! FINALLY! Yeeehaaaaa! I took him in yesterday for his check up, and no anemia, good cell count, hydrated, protein's good, all is well. She did another U/S on his bladder, which still reveals a smaller spot of some kind, but we don't want to do surgery now while he's doing so well. She wants to recheck him again in a few weeks or so. Or, if any symptoms return, we will revisit it then, as well. I wish I could tell you all what the secret was. Not even the vet knows, she's kinda puzzled, too. He simply made a quick and miraculous recovery. For now, I'll just keep an eye on those stools and count my blessings. (Hmmm!) ;) Many thanks to all who responded and gave me so many great suggestions. I printed them off and gave them all to my vet so it will be part of his record for future reference. For now, we're on the right track, and I'm just glad to have him back at home, where I can rock him in my arms, smother him with kisses, wipe the hand-fed food off his little chin each morning and evening, watch him terrorize Dusty, Daddy, and the dog, and otherwise cause as much trouble as he can possibly get away with. ;) Love and good wishes to all of you, and thanks again for being there! Celeste, Dusty & Ferris 7. Guss & Lissy Lou From: "Butts, Jennifer" Date: Wed, 13 Oct 1999 09:07:43 -0400 First off I wanted to say I that everyone's sick fuzzies are in my thoughts. My girl has also been battling a horrible cancer; squamous cell actually and that is why I am replying to this message. My girl, Daphne, developed squamous cell in her mouth as well and I was frantic and upset because I could not find hardly any information about this type of cancer in ferrets. I took her to my vet and she recommended me to a local oncologist, which pretty much told me there was nothing that could be done! But thankfully we have a wonderful veterinary hospital at a university in the state and he told me to go there because they have worked on a lot of ferrets and with cancer. There I met with one of the best exotic and wildlife surgeons in the country. He proposed a very radical surgery, which he assured me that he had preformed many times. I was horribly nervous, but I decided to do it because without it she would have degenerated very rapidly because this cancer is so aggressive (but thankfully in ferrets tends to stay localized). We have had a few set backs, but she has been so strong and is doing very well. The point of this is, if you want a chance to try to save your fuzzy that has squamous cell I would gladly tell you, or anyone, all that I have learned and what I, or rather Daphne, has been though, and even give you the number of the hospital where I took my baby, because it might be too far for you, but I am sure they would at least be willing to give a recommendation on maybe who to see in your area or advice to your vet. Please spread the word to any other fuzzy lovers you might know as well, because there are treatment options out there and I consider myself horribly lucky to have vets knowledgeable on the subject. I know it is pretty rare, but it does happen and I think people need to be more aware of their options. Sorry that this message didn't pertain to the diseases this list was meant for, but I think it is important...and maybe you could consider adding to the topics of discussion? Oh, I am also tying to create a website (my first one!) to tell Daphne's story and provide information about squamous cell, if you don't mind when I am done (could be awhile :P ) I would like to post it here. Also if you have anything you would like to contribute please let me know! :) Jenna jbutts01@harris.com 8. Dr. Purcell re: failure to thrive on Right Adrenalectomies using ligation, other questions, etc. From: "Michaela Maurice" Date: Wed, 13 Oct 1999 19:45:23 -0000 Hi again to everyone. Thanks for the responses. :) Lynn mentioned having done surgery to remove skin tumors using local anestetics - something that I was thinking last night might be a possibility with Bugsy. (Vets) If there is anything specific to the protocol, I would be glad to hear about it. And, along the lines of anestetic protocols, OSU has a unique protocol, the details of which I am not sure (will find out soon) that includes a cocktail of inhalants along with some pain med(s). When Spikey had his original surgery there a year ago, this protocol kept him knocked out for three days in ICU. I am curious as to what any vets might think about this. From everything I've read I gather that for ferrets, for the most part, it would be more draining to their system than recuperative. After Spikey's second surgery he was acting like he had just been to the park - all perky and happy (was damn odd! hehe). I would appreciate any opinions..to my personal email if you wish since it's not necessarily adrenal related. I had another question about adrenal surgeries for any vets. I don't think I asked this yet. I had heard by word of mouth that ferrets who had had right adrenalectomies via ligation of the vena cava (as opposed to just skimming the tissue) had problems post-surgically such as 'failure to thrive'. Does this indeed seem to be a pattern? Do any of you (vets) use ligation as a technique and if so, under what circumstances do you decide to use one technique over the other and why? Dr. Purcell, thanks for your quick response to my questions. Interesting idea that Spikey may have always had ectopic adrenal tissue. Didn't think about that possibility, particularly since we were unable to find the tissue that was supposed to be there from the first surgery (they only biopsied the glands). But definately a possibility. I know in general adrenal tissue can 'live' ectopically but am curious - have you seen many ferrets with ectopic tissue? Also, thanks for the tip on radiography and bloodwork. A few questions, ..I understand the radiograms will aid in finding any cardiomyopathy but is the bloodwork for general screening or is it to screen for anything in particular? Would you suggest the same bloodwork for five year old ferrets undergoing adrenalectomies or would a partial CBC be enough (and how old can the bloodwork be for it to still be a good indicator- recently a few of my guys had their teeth cleaned and I asked for a complete CBC etc..but they only did a mini..and it was a couple of months ago.) I personally thought that blood work that far back should be done again but the last vet I spoke with doesn't seem concerned. After my experiences with Spikey I am not taking any chances and THANK YOU LYNN. It is so wonderful to have this forum. And thank you Dr. Purcell for responding and thank you for all the wonderful people who share their ups and downs with their fuzzies..I am really feeling thankful this place exists. Okay..on that sappy note ..hehe..I'll sign off. Thanks Michaela Maurice College of Veterinary Medicine Ohio State University Class of 2002 9. Visit to the new vet..good news and bad...HELP/Advice needed from VETS..two vets hesitant to do adrenal surgery !! New Right Adrenalectomy Techinque, etc. From: "Michaela Maurice" Date: Thu, 14 Oct 1999 21:48:19 -0000 Hi again everyone, I went to this new vet tonight (thursday). Had to drive an hour each way but it was well worth it. I had a good feeling about the place from the minute I drove up and also when I entered. The vet is a terribly sweet man who shared his every thought with me about vet life and about the concerns I had regarding my ferrets and their care (past and present). He even took the lesions off Bugsy free of charge. That is something I never expect...a business is a business but he said he wouldn't take money from me being a student ..just that I should share the results of the path report with him (he hadn't seen those lesions before). I am taking the samples to school tomorrow and will have one of the pathologists take a look at them. One problem I am left with however is about the girls. They are the two who have adrenal disease. Neither is totally or even nearly bald but their hair loss is 'obviously' adrenal disease. One has had a swollen vulva with intermittent discharge in the past. Unfortunately, that one is cycling such that she has regrown her tail hair and some belly hair and her vulva while not normal, is enlarged though it's very small. The previous vet I had gone to has seen both girls with alopecia etc. since last November or so but has not been 'interested' in doing adrenalectomies on either of them. The last time I spoke to him he felt that I was bringing them to him much earlier than he normally sees them and under ideal conditions they can be difficult to find and/or know which is affected. He felt it would be better to wait till the disease had progressed. Well, this vet I saw this evening seems to feel similiarly and I am quite confused. Dr. Williams and others I have talked to say that one should do the surgery the moment they know it's adrenal disease. This new vet suggested doing an ultrasound and/or the adrenal panel since I am in a unique position in vet school and might be able to do these tests either for free or for a lower cost. He admits they won't exclude anything but I gather if they turned out positive it would make him more comfortable in doing the surgery. He said he would prefer to see Whitey's vulva more swollen than it is now before that sign concerned him. He questions the whole business of 'cycling' and how that relates to the hormonal effects on the ferret; In other words, if they are growing back their hair and previous signs are regressing, wouldn't that indicate that the glandular effects are not continuing to increase and hence, why operate if things are 'getting better'? This is my paraphrasing of course. He admits he is a very conservative about operating and that the decision really is about which is more of a problem and risk to the ferret: the hormones circulating in their bodies or an adrenalectomy with the inherent risks of surgery and the possibility that the other adrenal gland (assuming it's a unilateral adrenalectomy) will hyperproliferate soon after. I am at a loss. How hard is it to find the adrenal glands in ferrets in general and how does one assess the 'damage' being done by all the hormones being secreted. At what point does one decide to do surgery? How much hair needs to be lost? If a ferret comes to a vet at a point where the vulva has shrunken should the vet do surgery based on the present signs or the past ones? How does the cycling affect the hormonal affect on tissues? I am at a loss for how to determine what is best. I really need some concrete advice. I heard a sad story about another's girl who cycled and whose vulva decreased in size and that made a vet wait and she died of something adrenal related (can't recall what). I don't want to submit my ferrets to needless or premature surgeries but I don't want to wait if the risks the disease holds is greater than that of the surgery and their future with one less adrenal. I am going to see if someone at school might be 'interested :) in doing an ultrasound on them. I'm not sure there is much point, but if someone at school was interested and willing, it's non-invasive so it certainly can't hurt. Please advise. I am terribly confused. Btw, I just got an email from someone about a NEW technique in removing the tissue in right adrenalectomies - using cryosurgery (freezing the tissue) and it appears to be quite safe around the vena cava. If you haven't seen the info it's fantastic and here's the web site. It's a technique that Dr. Weiss has adapted from human medicine and it looks great! http://www.miamiferret.org/fhc/cryosurgery.htm I have one other question for Dr. Purcell and any other vets reading this-If there is anywhere that you would recommend a ferret-enthusiastic vet student work either summers or during a fourth year elective rotation, (clinical or research based work-private or univerisity), I'd love to hear from you.You could email me directly if you like since it's not totally relevant to the list. And, If anyone has any unique research ideas you are welcome to email me as well. I have a clinical research background and am thinking of applying for some grants for this summer but haven't narrowed my ideas yet. Ferret medicine is one of my top two areas :) (of course!) Michaela Maurice College of Veterinary Medicine Ohio State University Class of 2002 Subject: Add on Post HI, I meant to add to my last post that the vet did the skin biopsies/removals with a local anestesic and though Bugsy was busy with the nutrical for the first, he wasn't too pleased with the second. But, overall, it was quite simple and not that stressful on him. Subject: Add on Post I just didnt' read Dr. Purcell's email closely enough. In the recent post I sent today, I asked her if she recommends the full body xrays and full CBC on the girls who are five. She was recommending that specifically in the last email when I asked about them. (I was thinking about Bugsy at the time I read it) I wonder if you can edit it so she doesn't have to repeat herself..again..sorry I'm off to sleep NOW hehe nightnight..let you know how the visit with the vet goes tomorrow Subject: Add to POST please :) This is an add on to my original message. Regarding prostate size. What is the approximate size of the postate tissue in a ferret? Spikey had the typical metaplasia (for hyperadrenocorticism) along with a suppurative abscess. From what I recall (I was at the necropsy) it was about 2 cm wide and quite round. When you palpate a ferret can you typically feel the tissue and what shape does it normally take on? Is it round, flat? Thanks :) Michaela -------------------- End of FAIML #343 -----------