From: Lynn McIntosh [faiml@uswest.net] Sent: Sunday, March 14, 1999 9:41 AM To: faiml; mjanke@miamiferret.org Subject: Adrenal List #04 Hi there. Hope all is well. I've been pretty much off my feet and in bed for a couple days with a flu (aren't those things only supposed to hit in winter?!), but wanted to get messages out to you over the weekend. To post, remember, just write "post" somewhere in the subject line and send to faiml@sttl.uswest.net. Same address for other questions, comments you don't want posted. As usual, feedback is welcome on the list format. A couple people said they liked it! If something is really urgent than post straight through to the group, whatever is best for the fuzzies! Take Care, Lynn Mc. PS. I'll keep the biofiles in List #1, and the first group of messages we all sent in List #2. Let me know if you'd like to receive either of those Lists. Thanks! LMc. ----------Adrenal List #4, dated April 26, 1997-------------- 1. Introduction 2. Nickodemus Biofile 3. Lysodren 4. English Ferrets 5. adrenal, Introduction 6. Vena Cava Ligation ---------- Forwarded message ---------- Date: Fri, 25 Apr 1997 09:23:15 -0700 From: Gabby Subject: Introduction Hello everyone :) Just wanted to share our adrenal story with everyone. In January of this year, Sabre had her spring shed. There was something different about it (although now looking back I can't pinpoint what it was...) and we decided kept a close eye on her hoping nothing would come of it. Late January/early Feb. she started losing fur at the base of her tail. It progressed downwards until about 2" was bald. Her tail was a bit gunky at the time, so we gave her special tail baths. Then the fur over the rest of her body started to thin, with it being the thinnest at her rear. We hoped it wouldn't be adrenal problems. We took her to the vet, and he mentioned the possibility of adrenal, but since her skin looked irritated he wanted to see/rule out if it was a skin allergy first. She was treated for that for 3 weeks, and her skin became less irrated, but she was still losing fur. By this time she had started to bald in the rear. Along the way other problems started to develop. Her tail went ice cold along the whole length. People said it was just because she had no fur on her tail, but the last few inches of tail had fur, and that part was just as cold. She also partially lost control of her bowels. She would be walking along and pooping and not even realize it. She also lost a lot of weight and a good friend suggested heavy whipping cream and it helped her gain some back. She was very lethargic, and most mornings I would have to get her out of the cage. Even then she would just go curl up somewhere and go back to sleep, or curl up in my lap for cuddling (which is not her...she is miss anti-cuddle). She had surgery this Tuesday. The vet removed the left adrenal gland which was very enlarged and misshapen. She was doing well enough she came home on Tue. for which we were very relieved for several reasons. Already she is doing better than she has in months. She is playing, back to being very stubborn and independant, not wanting to cuddle. The changes are amazing! The pre-January Sabre is back :) She still isn't drinking or eating enough on her own, but does take what we offer to supplement her very well. Hope all the other adrenal fuzzies out there are doing well. Christina. 2. ---------- Forwarded message ---------- Date: 25 Apr 1997 19:35:58 -0000 From: dervish@scrye.com Subject: Nickodemus Biofile Hello Adrenal momUs and dadUs This is my first try at a complete (and completely long) biofile on Nickodemus, a post Adrenal martial farms male who at surgery was about 5 years old. Nickodemus is a sable boy who is one of my two original babies. I now have four babies. Prior to his Adrenal tumor the only health problems my family had had was when his sister Missy tore some ligaments in her elbow when under ayear old. She had a little surgery done and has had a complete recovery. This is when I learned about the care of post-surgery care. Last year is late summer 8/96 ish I noticed that Nickodemus had a rash on his stomach and his tail was losing hair and was blue with black spots on it. I quickly brought him to my vet. The vet gave me antibiotics for the rash said it was probably a staff infection(canUt remember which one - pink stuff I call it). He told me not to worry about the tail and that it was simply seasonal alopecia of the tail and that the hair would grow back. The antibiotics took care of the rash and I didnUt worry about the tail, until... We moved thousands of miles away and I had to temporarily have my mom & dad watch my babies while dad & I found a place to call home. I got regular reports and provided extra travel cages so dad could lock them up separately when cleaning the main cage. I got a report from him about how (the big one) that would be Nickodemus was chewing on the little ones ears (that would be Mason), and that he locked up the little one separately. I figured he was just frustrated because he wasnUt with his mom & dad and wasnUt getting enough playtime. November I get my babies back after two weeks with my parents. Mason has a scab on the back of one of her ears but looks no worse for wear. NickodemusUs coat looks thin and when I push it the wrong way I can see his skin not the undercoat. Tail is still bear. We settle into our new home. Nickodemus is harassing Mason all the time now and has to be caged separately because if we donUt in the middle of the night whimpering sound will awake us and we would find Nickodemus clamped onto MasonUs ear. December- January. Nickodemus is still treating Mason this way and is steadily losing hair. January mom gets real worried because heUs now our naked boy except for head neck and legs which have fur. I do my first www search for ferrets and find out very quickly that Nickodemus is very likely to be dying from an Adrenal tumor. Thanks to Ferret Central. The blood runs from my face as I realize that 1) I should have done something sooner & 2) the cost of moving made us broke and weUd have to save for the surgery. I called NickodemusUs dad who was at home and he instantly took him to a vet who ran a useless blood test which turned up inconclusive. I found a experienced vet in my area that had done many adrenal surgeryUs (actually an hour away - no biggy though because for MissyUs surgery I traveled across state lines and drove just as far for an experienced vet). Dad & I started setting aside money for the procedure. February- IUm watching NickodemusUs closely. I let him out to play on a Sunday and he jumps into the litter pan, doesnUt produce, and jumps out, then repeats. Finally he urinates a little. He was wet down there, drippy. Also therewas this mucous discharge near his penis. I get panicky. Monday I set up an appointment with the vet for Tuesday afternoon and have Nickodemus put onhis surgery list for Wednesday morning. Tuesday last week in February. I see the wonderful vet and he takes one look at Nickodemus and says -boy am I glad to see you!- He told me everything I had read about Adrenal tumors and asked me to decide what to do if it is the right adrenal that had the tumor. I told him to -remove as much of the tumor as you can-. I kissed Nickodemus good night and he stayed with the vet overnight. Having his blood work done. At noon the next day I get the call from the vet. First, he was ok and recovering. Second, it was the right adrenal that was 10 times the size it should be. He removed as much as he could and in the process nicked the vena cava but fortunately got the bleeding under control. Third, NickodemusUs prostate was inspected at surgery and had a large cyst in it which was drained of 3cc of milky yellow-green stuff. forth, his blood suger was alittle low.. His abdominal cavity was filled with antibiotic fluid and he was to stay at the vet in the bio-cube for at least a day. That night dad & I went to visit. He was only eating Nutrical and drinking ok. Potty was ok, no straining. The vet wanted us to keep a close eye on the potty situation, and we have for over 2 months now. Friday night Nickodemus got to come home. : ) He wouldnUt eat for more than a week and lived on Nutrical. Slowly he started eating his kibble (Iams) again. No dripiness and no discharges. Two weeks of antibiotics (Cefa-Drops Cefadroxil) come and go. His sutures are removed and heUs doing much better. Still toointerested in Mason but the vet says wait and see as it takes time for the bad hormones to get flushed from his system. We pray for fur. Three weeks after surgery his skin looks all blue along his sides. ItUs fur growing in. Shortly after that I started noticing this white mucous drop at the opening of his urethra. I took him back to the vet and he squeezed several drops of this stuff from him and had it analyzed. Mostly white blood cells some red. Back onto the same antibiotics (Cefa-Drops Cefadroxil). Two weeks later there is no real improvement in the quantity of mucous but his dripiness of urine went away. Back to the Vet. Takes another sample of the stuff and has it cultured. Feels the cyst and says itUs much smallerand I should aspirate as much as I can of the stuff. Theinfection turns out to be E-Coli and we switch to a better antibiotic(amoxicillin trihydrate/ Clavulanate Potassium). We have been using the it for more than a week and have had good results. I have not been able to aspirate hardly any of the mucous. General condition 4/25/97. Nickodemus is still periodically harassing his sisters, especially Mason. Nickodemus has most of his fur back with the exception of a triangle shape near his tail and the tail is still mostly bare but for a flag of fur near the tip. He is always the first to crash out at play time. He really really hates the taste of his new medicine. We are switching to the pediatric form of this medicine when this bottle runs out, and because of potency he will be taking nearly twice as much. IUm really not looking forward to the switch because as it is I have to bribe him to take the dose heUs getting now. -Dixie Carter 3.---------- Forwarded message ---------- Date: Fri, 25 Apr 1997 09:12:47 -0400 From: "Michael F. Janke" Subject: post on lysodren This is something I've saved for quite some time. It was originally posted to the FML by a vet, though I don't recall the name (Dr. Dutton?). I usually send this out when I get email or feedback from our web site and the person asks about hair loss or adrenal problems. There are some comments in this about Lysodren, which seems to be a current topic here. Nothing about ligating the vena cava though! NOTE: Lynn here. Coincidentally, I sent this out to the group pre-list times (all of a week ago :), but since it hasn't been incorporated into a list this is a good spot. It is Dr. Dutton and was posted in the FML. Gee Michael, good choice ;) Oh, I added in the first question and last sentence of Dr. Dutton's post. LMc --------- >From: Maria DeCicco >Subject: Adrenal Surgery >I wrote a few weeks ago about my ferret Ginger who was not eating well and >who continue to have soft poops and the lost of hair on her tail. I >returned to the vet and he took a blood test. Everything showed up OK. >The lose of hair seems to be going up the trunk of her body. > >From: Stacy Patchel >Scooter, my 2.5 year old ferret, was diagnosed with an adrenal tumor today >from an ultrasound. My vet has never done the surgery. She called several >area vets & none of them do the surgery. ... I thought I would answer these two questions together. A little background on the disease (there is more information on the FAQ).. Adrenal disease is caused by a tumor or growth in the adrenal gland. These growths can be malignant tumors, benign tumors, or something called hyperplastic tissue (bigger than normal cells but not quite fitting the definition of cancer). These cells no longer follow the normal negative feedback loop . That is, when levels of hormones or steroids that the adrenal normally secretes gets too high, the adrenal stops secreting them until they are back in the normal range. These tumors just keep pumping out the hormones and steroids. Depending on what hormones and/or steroids get pumped out results in the symptoms the ferret exhibits (aggression, swollen vulva, hair loss, prostate enlargements, etc.) Statistically, 85-90% of the ferrets have adrenal tumor ONLY in the left gland. 75% are female. The last piece of information is that the adrenal gland has a high regeneration capacity. You cut out half of one and it will regrow over a relatively short period of time. Now comes Lysodren. Lysodren is a medication that destroys adrenal tissue. The goal of administering Lysodren is to destroy a percentage of the gland while the rest of the gland regenerates new adrenal tissue. You are trying to reduce the functional mass so less hormones/steroids can be produced (i.e., the factory is smaller for manufacturing). Disadvantages of Lysodren: 1) some ferret become nauseous (vomit, diarrhea, anorexia, etc.), 2) does work in some ferrets, 3) lifelong medication (since the adrenal gland regenerates), 4) lifelong expense can equal or surpass the surgery cost, 5) can cause profound hypoglycemia (not to be used in an insulinoma ferret). Advantage of Lysodren: 1) don t need to do surgery if Lysodren works. Surgery disadvantage: 1) cost, 2) higher technical skill required by veterinarian. Advantage: 1) 85-90% of the time you can CURE ferret lifelong (just be removing the left adrenal gland. In my experience at least one gland will look abnormal on the surgery and that is the one I remove. Based on biopsy reports, I have been wrong two times in about 200 surgeries. One of those two ferrets got better and has remained symptom free so far.) A big problem with the surgery approach is when the ferret has bi-lateral adrenal disease (in both glands). These ferret, after having an adrenal gland removed, may need to be put on Lysodren or have 1/2 of their other adrenal gland removed (but remember it regenerates!). As for the cost of the surgery, it widely varies just like human surgery prices do. A lot has to do with the local economy (overhead is more in the NorthEast versus the SouthEast), veterinary pricing structure and equipment. Ironically, the more ferret work a vet does, the more he/she usually has invested in equipment to do ferret work. For example, my small animal incubator that the ferret recover in costs $1200. A lot of vets who do sporadic ferret work probably won t invest in this because they cannot see a return on their investment. The result is better medicine for the pet but with a corresponding higher cost. The same is true with anesthetics. The recommendation is to use isoflurane gas anesthesia. Some vets still use injectables (cost less but you have less fine control of the depth of anesthesia). That s the long answer for the short questions. ----------------------- For the ferrets, Mike * Michael F. Janke - mjanke@bridge.net * Member, South Florida Ferret Club & Rescue * * Shelter Home Page - http://www.bridge.net/~mjanke 4. ---------- Forwarded message ---------- Date: Sat, 26 Apr 1997 08:07:03 -0400 From: "Michael F. Janke" Subject: English ferrets I have conversed off and on via E-mail with Sheila Compton, who is the newsletter editor for the National Ferret Welfare Society of the UK and runs the Bolton Ferret Welfare. She mentioned in an E-mail to me today, and rather off-handedly I might add as if it were not unusual, that she had just seen her FIRST adrenal ferret the other day! How lucky they are over there. I don't think they have E.C.E. there either. I don't know if that means it's hereditary in our stock over here, probably largely being MF stock, or if it's because of early neutering. For the ferrets, Mike * Michael F. Janke - mjanke@bridge.net * Member, South Florida Ferret Club & Rescue * Shelter Home Page - http://www.bridge.net/~mjanke * * Opinions expressed are my own and not necessarily * those of the South Florida Ferret Club & Rescue 5. ---------- Forwarded message ---------- Date: Sat, 26 Apr 1997 17:56:39 -0700 (PDT) From: Lynn Mcintosh To: adrenal (Deana), Introduction (Michael) > From: Deana Beek > Subject: adrenal > > How do you tell which adrenal is affected if the tumor is really small...in > early stages??? > -Deana- Hi Deana. Congratualations on the successful surgery (you mentioned in a later post)! I couldn't believe it when my vet drew a picture of the left adrenal (the size of a small black pepper) and the right one of Percy's (following exploratory) which had only been slightly bigger!. This was a burning question for me prior to Percy's surgery. Some vets do an ultrasound to determine which adrenal is affected, but in the Adrenal Disease FAQ Dr. Dutton writes: "Karen Rosenthal from Animal Medical Center in New York City. She does tons of ferrets. The ultrasound technician they use has been doing this for 17 years and she feels is one of the best animal ultrasound people. In the technician's experience, he detects less than 50% of adrenal tumors." Dr. Williams writes in sthe same FAQ: "In most cases, one gland is noticeably larger than the other and is removed..." Dr. Williams later writes "If a vet goes in on an amimal with classic signs of adrenal disease he shouldn't come out empty-handed. If you can't tell, then take the left one." Following that quote is one saying: "Just because both of the adrenals are enlarged doesn't necssarily mean that both are involved. I commonly see cysts in the right adrenal, which don't cause any problem at all, but just make the adrenal larger." YIKES. So the right one can look big and just have cysts? He has also said to me that he thinks the reason so many left adrenals are removed is because of the difficulty of removing the right. Some vets say it's usually pretty obvious, but what if it's not? In Percy's case it wasn't and only half the right adrenal, which appeared slightly larger, was removed. I noticed just yesterday that Percy is losing hair on his rump, right above his tail :( Of the vets I called, some advised ultrasound and the Tennessee adrenal panel to diagnose adrenal disease prior to any exploratory surgery; others (including Dr. Williams and Dr. Kawasaki, who's done multiple surgeries) advised exploratory surgery as diagnosis and possible cure, in cases exhibiting classic adrenal symptoms. I'm glad that in your ferrets case one adrenal, the left, was notably larger with nodules and was removed. I think your fur kid has a good chance of full recovery! > From: "Michael F. Janke" > Subject: Introduction Thanks for your intro Michael. Your story about Punky Doodle was very moving. I have little girl with a heart murmur (congenital) who is currently symptom free, but I always keep my fingers crossed for her, knowing that one day I may hear that telltale cough. > As Jackie Hawley, who is in this group, will attest, this vet is pretty > ferret knowledgeable and is our shelter's "medical advisor" but apparently > not good enough to be comfortable with removing that right adrenal so close > to the vena cava. And I'm upset that I will probably have to put Max > through surgery again real soon. Our vet said, though Percy's right adrenal was enlarged, it was too small to remove! ?? I had a sinking feeling when he told me the results of surgery. And Percy went has since shown manly behavior, urinatry tract infections, and now the balding rump :* > So who has had experience with having a ferret that has no adrenal glands? Hopefully we can round some people up, because this seems like an inevitable situation for some of us, or is the better route to leave a partial adrenal and treat with Lysodren? Back to the "more questions than answers, more opinions than questions" quote from my vet - sigh... Lynn Mc and the Gang of 8 leaping lizards 6. ---------- Forwarded message ---------- Date: Tue, 15 Apr 1997 14:37:37 -0700 (PDT) From: Lynn Mcintosh Subject: Vena Cava Ligation Hi Barbara. You asked about ligating the vena cava. Here are the two posts I've read recently in the FML on ligating the vena cava. Has anyone seen an article on this? My vet was less than positive when asked about the procedure, but these two posts make it sound promising! On Tue, 15 Apr 1997, Automatic digest processor wrote: > Date: Mon, 14 Apr 1997 19:04:06 -0400 > From: Janet Lachowsky > Subject: Re: Pouka a adrenlectomy sucess story > > I really enjoy the ferret journal and I wanted to let all the people who > helped me when we were looking for information on adrenal gland tumor know > the results of the surgery. Thanks---Ernestvet---. Anyway for those who > don't know the story. Pouka is my male ferret who is just a little over 6 > years old. In December 96 he started losing his hair, first around his > tail, then up his back and last in round patches on his sides. He also > scratched all the time. Our vet first thought it might be allergies so we > tried a antihistime. Not much good. Then the next vet said it must be a > adrenal gland tumor and pancreatic tumor. They did the first test but did > not freeze the sample so the cells ate up the insulin causing a false > reading. Next one of them said that they could do exploratory surgery. > When asked how many he had done he said 3. Not much encouragement there. > So, I asked for a referral to a University Program about 2 hours away and > got the name of this wonderful vet. I will write later with his OK. And > tell you his name. > > This was the saving grace. He said he had frequently done this kind of > surgery he also said that most of the tumors were on the left and not much > problem to remove. Occasionally some were on the right and attached to the > vena cava. This could be bad. As it turned out Pouka had a bad one 1.1 cm > attached to the vena cava and the liver. This vet said that he had heard > that ferrets had enough alternate blood supply that you could shut off the > vena cava (main vain to return blood to the heart) and they could still live > a active life, but he had never had to try it. Well guess what > friends......he had to as well as take out part of his liver. It is one > month after surgery and we still have pink toes and no swelling. Pouka gave > us one heart failure by developing odd blue patches over the muscles on all > four legs. But a few days later out of those patches popped thick shiny > guard hairs. All of his hair is growing back so quickly. Pouka is happy > and active. He plays daily with his girlfriend Smokey who by the way was > allowed to stay with him when he recouped at the vets for a week after > surgery. So there is hope folks!!!!!! Thanks again to this most wonderful > vet in NC. Subject: Re: FERRET Digest - 21 Apr 1997 to 22 Apr 1997 > Date: Mon, 21 Apr 1997 14:13:20 -0400 > From: Shari Diane > Subject: Vena Cava Ligation in Rt Gland > > Rogue (a 3yo female) went *back* under the knife last Thursday. The first > surgery in March found the tumor in the right gland, and the vet decided it > was inoperable. The owner was able to get the vet to research information > and consult with other nationally-known ferret vets on de-bulking and/or > ligating (tie-off) the vena cava in the right gland. The vet was a bit > tentative on ligating the vena cava, so a different local vet, with one > recent successful operation of ligation, did the surgery. > > The vena cava was ligated successfully. Her owner says Rogue is doing fine, > and has abundant energy. Thanks goes to Dr. Bruce Williams for reporting in > the FML Adrenal Gland FAQ that this type of surgery *can* be done! Now, we > need to convince Dr. Karen Rosenthal in NYC. > > Why is there opposite medical opinions in the FML Adrenal Gland FAQ on the > effectiveness of Lysodren? > > Shari Gunter -----------------------End of Adrenal List #4-----------------------------