From: Lynn McIntosh [faiml@uswest.net] Sent: Sunday, October 31, 1999 9:06 PM To: FAIMLanon; FAIML Cc: faiml Subject: FAIML #347; Oct. 31, 1999 Ferret Adrenal/Insulinoma Mailing List (FAIML) #347; Oct. 31, 1999 1. Molly's insulinoma 2. Liver problems 3. Scamper's ulcers and thanks; JCP pet insurance 4. Daisy adrenal disease 5. FAIML,10/26/99 (options for adrenal gland , disease) 6. FAIML,10/26/99 (options for adrenal gland , disease) 7. Reply to FAIML,10/26/99 (options for adrenal gland , disease) 8. Food Survey 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 surgency. 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 email. 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. Molly's insulinoma From: "Donald Dittman" Date sent: Sun, 31 Oct 1999 18:11:36 -0800 I have a little ferret that I adopted in June. She has had a hard life. I saw an ad in the paper about a found ferret and called to make sure they knew how to take care of it since ferrets are rare around here. The man had fed her on carrots and grapes for four days and thought she was a male. She had encountered a porcupine too, and was covered in fleas. I adopted her, took her to a vet where she was found to have heart arrhythmia from an advanced adrenal tumor. She had severe malnutrition, but had to have surgery because the tumor was putting a strain on her heart. It was a huge tumor but I did not have it biopsied. Soon she was hale and hearty, recovering well and on solid food. A week ago she started staggering and falling. I rushed her to the vet and she was diagnosed with insulinoma with a level of 54. She dropped weight rapidly and is big boned but only weighs one pound 2 ounces. I'm giving her duck soup and prednisone because the vet says her heart is acting up again and she can't have surgery. She is still incredibly weak and I hate force feeding her. It is so pitiful that I sit and cry as I do it because I hate it as much as she does. I'm sorry I'm writing so much but I need to know if she is always going to sleep and be so weak even on the pred. I can't see that she has any quality of life now but I would do whatever I could to help her before I take the final step. Please feel free to email me, Molly and I desperately need help. ddittman@csonline.net 2. Liver problems From: Buetow Date sent: Thu, 28 Oct 1999 19:02:48 -0500 (CDT) Hi everybody, AD, my insulinomic boy, is having some liver problems. His liver enzymes are very elevated, as is his white cell count. He has been eating quite a bit, but has lost weight. If anybody has any words of advice, I would appreciate it. He's my easy-going little guy and I just hate to see him feeling so bad. The vet has prescribed amoxi and I have him on milk thistle (with mushroom added) and other herbals. I feel like he's fading and I don't know what to do. Buddy also has elevated liver enzymes, but not nearly as bad as AD and she is acting okay. Xan is holding steady as far as I can see, but she hasn't returned to her old self since her surgery and bout with ECE in the spring. She's entirely too quiet and untroublesome for Xan. Thanks for helping and listening! Chris and the Sunshine Gang buetowc@sls.lib.il.us 3. Scamper's ulcers and thanks; JCP pet insurance From: "Steve McMall" Date sent: Sat, 30 Oct 1999 04:25:51 -0500 Thank you to everyone once again for your quick responses to the last post about Scamper and what I called "prednisone poopies". They had looked so different from the tiny little dark, tarry poops I had seen on occasion before that it didn't sink in that the ulcers were being upset. Dr. K forgot to mention to give the prednisone with food. I gather that many vets do forget that caution. Lynn sent me some copies of past posts on ulcers that were very helpful. Thanks, Lynn. In one, Troy Lynn Eckart mentioned that she had taken flagyl (metronidazole) before and what a metallic taste it has, but more importantly, that it put blisters on the roof of her mouth. I had already noticed Scamper had a burned looking scrape on the roof of hers. I am going for a prescription for Biaxin, instead. Based on that, and on her and Linda Iroff's "recipes" for dealing with ulcers. I figure that it has to hurt and why put her through more stress, just upsetting the ulcers even more. I also got some carafate (I could go into a one-sided debate on whether I am breaking doctor/patient trust, respect, ect, but I won't) today and it already seems to be helping. If anyone would like me to forward the info I have received on ulcers, please drop me a quick line. If you are like me, when reading lists, you may skim over info that doesn't apply at the time. I often see posts about people asking about pet insurance. I received junk mail the other day from JCPenney Pet Club. The offer some vet discounts , two free vaccinations, coupons for "grooming, accessories, nutrition and more", and a few other things. At 8.95 a month per pet, I don't think it would be worth it to me (or affordable, with six ferrets and a cat) but if you want to check it out, the site is www.jcpenneypetclub.com . I will give things a few days with Scamper and try to post an update. Becky MODERATOR'S NOTE: I have the file of ulcer posts available again, if anyone would like it. It's great info. Lynn Mc. 4. Daisy adrenal disease From: Robert Dejournett Date sent: Thu, 28 Oct 1999 20:25:59 -0500 (CDT) Hi all, A big thanks to Dr. Murray, such excellent information! Maybe some of this could go on the adrenal web site. An update to her condition. Daisy, a 5 yr old jill, has had adrenal surgury twice, removing the left and most of the right. Recently she has been showing vaginal discharge and more lethargy than usual. I took her into her vet, Dr. Jordan, and we did a blood workup and ultrasound on her. The left one was gone, (good!), the right one was suspicious, about 7-8mm. Dr. Jordan recommended doing a third surgury. I balked, given her history of two previous and no major effect (her symptoms got worse), and how poorly she did after surgury - the first almost killed her b/c of a undetected GI infection they found when they did the surgury. We agreed to try lupron depot. He thought the vulva discharge (a whitish goo resembling pus) was a sign of infection, i tended to disagree since I didn't see any inflammation, and given her adrenal history (but freely admit I could be wrong). BTW, her tail is completely bald and covered with blackheads, and is cold to touch. From her bloodwork I got back today, her blood glucose is 108 mg/dl, rest of blood workup is mostly normal, her BUN is normal, WBC is normal, Na+ normal, however Hemoglobin is low (14.8 g/dl) and her bilirubin is low (0.1 mg/dl). Slightly anemic?? RBC is okay (9.0e6/mcl). But at least she's hydrated and her renal function is okay. I'm slightly concerned about her eosinophyll count (4%), I feel this is high. I study pulmonary disease and I know that in humans or mice one hallmark of some pulmonary disease is high (4%) eosinophyll count (eosinophylia). Is this an indication of inflammation? WBC is 4.2e3/mcl. Anyway I'm going to try lupron depot, i guess the monthly form is slightly cheaper, I wonder if the daily form is cheaper. I don't mind injecting her, if she doesn't mind. ;) I am continuing her herbal therapy, after about a week she seems more active and the discharge is less, but not completely gone. Thanks to all! Rob -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- Robert Dejournett rdej@gsbs3.gs.uth.tmc.edu Graduate Student Graduate School of Biomedical Science University of Texas Houston 5. FAIML,10/26/99 (options for adrenal gland , disease) From: Robert Dejournett Date sent: Thu, 28 Oct 1999 20:07:42 -0500 (CDT) Hi Dr. Murray, Another question. How much is the lupron monthly therapy vs the 4-month therapy? You mentioned pricing per bottle, how many ferrets can that treat? (So expensive!) I found out that the human version of lupron depot is even more expensive. Oh well. Thanks much! Rob -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- Robert Dejournett rdej@gsbs3.gs.uth.tmc.edu Graduate Student Graduate School of Biomedical Science University of Texas Houston 6. FAIML,10/26/99 (options for adrenal gland, disease) From: Robert Dejournett Date sent: Thu, 28 Oct 1999 17:19:10 -0500 (CDT) Hi Dr. Murray, Thanks so much for your very informative message. Firstly, a big question for you. You are right, Daisy had her left adrenal removed and part of her right. Now he (Dr. Jordan, my vet, very ferret knowledgable IMHO) wants to to a complete right adrenalectomy. The question is, can she survive without any adrenal hormones? My understanding is that they can not survive without the cortisol, epinephrin, and sex hormones. He now has a new laser surgury machine which allows very fine operation next to the vena cava. So, I'm frustrated but willing to try it again if we can be very sure of some result. So far, after two, she just gets worse, and its so hard on her, she almost succumed after the first because of a concurrent GI infection. Second question, should I artificially change the photoperiod in their environment? During the day I'm gone and they are caged, in a closet with the door open, and a hall light shining in. Since I know they are not fond of light, I turn the closet light off. Should i move the cage out to a window? Thirdly, regarding the two herbal products, since I study science and have been raised to have great faith in medicine I am very skeptical of quacks and fake 'cures'. However a search using medline revealed two herbs which were proven to have specific molecular effects. I am neither a propotent or nay-sayer. After a week of treatment I can say that she is more alert and active, but this is not a clinical trial. On the other hand, who would really be willing to do a double blind trial of herbal products? They don't do it for humans, I doubt it will be done in ferrets...so a potential avenue for symptom relief or cure is not explored. Finally, do you have any ideas why adrenal tumors are so common in ferrets? Why do they grow? Is there a growth factor? Is estrogen the growth factor? I have been lead to believe that tumors arise from abarrent signaling, such as overexpression of growth factors. I think adrenal tumors is the major health threat in ferrets, as obesity is in humans :) Anyway thanks for your efforts. Rob -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- Robert Dejournett rdej@gsbs3.gs.uth.tmc.edu Graduate Student Graduate School of Biomedical Science University of Texas Houston 7. Reply to Robert:FAIML,10/26/99 (options for adrenal gland , disease) From: AFERRETVET@cs.com Date sent: Sat, 30 Oct 1999 19:32:07 EDT Hello again Robert, Well it looks like you have 5 new questions. I.Adrenal hormones: Yes if both adrenal glands are completely removed then hormone supplements are usually needed. The 2 big adrenal hormones are glucocorticoid steroids and mineralocorticoid steroids. The natural glucocorticoid is cortisol. This is replaced by giving prednisolone (Pediapred). Pediapred is a raspberry flavored liquid that is easy to give and is a low cost medication. The dose is 0.1mg to 0.5 mg/kg twice a day. The natural mineralocorticoid is aldosterone. This may have to replaced by giving either Percorten-V injections (desoxycorticosterone pivalate- DOCP) or Florinef tablets (fludrocortisone). Percorten-V is giving at a dose of 2.2 mg/kg IM every 25 days. Florinef tablets are giving at a dose of 0.01mg/kg twice a day. The third supplement is salt. Normal saline (0.9%) can be used for the drinking water . Likewise normal saline (0.9%) should be given IV or SQ during the post-op peroid. Pred and saline are usually the only supplements needed. II. Yes keeping them by a window is fine, but you will need to keep that room dark for about 15 hours a day. Also be careful during the summer months, so they do not over- heat by the window. III. Again I can not recommend herbal products until there are valid studies (yes including double blinded, controlled studies) in either lab animals or humans to prove they are both safe and effective. If you want a natural product, then use Melatonin. There are alot of studies of Melatonin in ferrets! IV. Yes early spay/neuter and long photoperiods are causing the problem. Most pet ferrets are spayed or neutered at 4-6 weeks of age. Studies have shown that mice that undergo early gonadectomy develop adrenal tumors.Early gonadectomy would remove the normal negative feedback that the gonads would have on the hypothalamic-pituitary-gonadal axis and on the adrenal glands.Plus it is quite possible to have "ectopic gondal cells" in the adrenal glands . In addition gonadotropin hormones are higher in spayed animals than in intact animals. In one study follicle stimulating hormone (FSH) was 3-5 times higher in spayed ferrets when compared to intact females. Since the gonads have been removed,the cells of the adrenal glands (zona reticularis) would respond to this stimulation. This combination of overstimulation and lack of inhibition can lead to adrenal hyperplasia and to adrenal tumor formation. Photoperiod: The female ferret is seasonally polyestrous, and the male is also seasonally "in heat". The natural breeding season is based on the increasing photoperiod, and it typically starts in the early spring and last until late summer. Female ferrets are also induced ovulators, so they can remain in heat for up to 6 months if not bred. During the long day photoperiod (12 plus hours of light), the duration of melatonin secretion is shortened. This stimulates the release of GnRH which stimulates the release of FSH and/or LH. In females estrogen no longer inhibits LH, and in males testosterone no longer inhibits LH. Thus the inhibition of the hypothalamic-pituitary-gonadal axis is lost during the long day photoperiod. Again since the gonads have been removed, the cells of the adrenal glands would respond to this stimulation. Again the combination of overstimulation and lack of inhibition can lead to adrenal hyperplasia and to adrenal tumor formation. As you know most pet ferrets are spayed or neutered at an early age, are kept indoors,and are exposed to artifical light for 12 plus hours a day,year round. Thus both problems are causing the "abarrent signaling" that leads to adrenal gland disease! V. Lupron depot. That is the actual cost of the HUMAN product (there is no veterinary product)! The monthly lupron depot is 7.5mg, so you can get 20 to 75 doses depending on the weight (bigger males require more ) and the dosage (100 or 200mcg/kg). The 4 month version is 30 mg ,so you can only get 15 to 10 doses at 2- mg/ ferret. Again if cost is the major factor:go with the melatonin tablets (1mg given around 8-9 hours after sunrise), and change the photoperiod to 9 hours of light with 15 hours of darkness. JERRY MURRAY,DVM Animal Clinic of Farmers Branch Dallas, Tx. 8. Food Survey From: Saracecili@aol.com Date sent: Fri, 29 Oct 1999 13:04:50 EDT I would like to run a small survey/study of my own to check out a hunch of mine: that the diet we feed our ferrets has a lot to do with whether or not they develop Insulinoma/Adrenal disease. For those of you with ferrets with these diseases (one or both,) please let me know what type of food your ferret eats, whether or not you supplement and/or provide treats/human foods to them, and how old your ferret was when diagnosed with the disease(s). Thanks, Sarah ------------------ End of FAIML #347 ---------------------