From: Lynn McIntosh [faiml@uswest.net] Sent: Friday, March 24, 2000 3:12 AM To: FAIMLanon; FAIML Subject: FAIML #402; March 24, 2000 Ferret Adrenal/Insulinoma Mailing List (FAIML) #402; March 24, 2000 1. Adrenal surgery question 2. spring hair regrowth 3. Introduction 4. URINE TEST 5. Prostate enlargement and medical options. 6. Proglyceme 7. Insulinoma info 9. NY vet list attached 10. FAIML #401; March 18, 2000 and March 21, 2000 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. Adrenal surgery question From: "Nancy Patterson" Date sent: Thu, 23 Mar 2000 09:21:54 -0800 (PST) Foxy is a 3and a half year old male. He had adrenal surgery on 3-13-00 (it was the left; benign). How long does it take before he stops being "sexually aggressive" to the others? He is still driving the other 3 crazy... Also what about hair coming back? if it comes back... Other than that, he's doing great. Thanks, Nancy &Fur Kids 2. spring hair regrowth From: "Jason Neuman" Date sent: Sun, 19 Mar 2000 14:12:07 -0000 Hello everyone, I was wondering about the hair regrowth also. Hobbes had his bi-lateral adrenal surgery in April 1999 and since then he has continued to lose the hair on his back and bottom. His tail went completely bald as well. I kept asking about his hair growing back but his vet (Dr. B.) had moved and the new vets didn't seem interested. As soon as I took him to Dr. B. in his new clinic, he immediately expressed concern. In October Hobbes went through a terrible bout with bleeding ulcers and would have died without Dr. B's intervention. At this point Dr. B. said that he could give Hobbes medicine to grow the hair back, but a healthy, bald ferret was better than a sickly, medicated one with hair. I totally agreed, but within 4 weeks of his treatment from the ulcers his tail was twice as thick as before. He has now begun growing hair on his back and bottom. It is growing extremely fast and thick. In the past 2 weeks he has really gotten a bunch of hair back. In light of all I know with his history (especially the ulcers) I plan to get him into Dr. B's to get a re-check. Thanks for the advice Lisa - sorry about Gabby. Honks to all! Nikki & HOBBES 2. Introduction From: Jmike46107@aol.com Date sent: Thu, 23 Mar 2000 21:21:45 EST Dear Lynn & gang, I wanted to take few minutes and introduce myself. My name is Mike Witsken and I am Shelby's dad. She is 6 years old and has never had any health problems (or so I thought). Since she is the only ferret I have ever owned, I thought I was taking good care of her, yet I have to admit ignorance to ferret health issues. After noticing a couple of problems I made an appointment with my vet, then began researching on the net, which is of course how I found you all. I began to get panicky waiting for the appointment, as I literally "discovered" that insulinomas are common with ferrets. I have been in shock about this for days. When I took her in her sugar was 60. The vet put her on prednisone, which has helped the symptoms some, however she still is not herself. She had her second visit this morning for a fasting sugar- only 47! I literally do not know what to do. I have scoured over every written word I can find on the subject to educate myself, but now am to the point where my head is so clouded that I am hoping someone will post a response the help me. Here is the deal as I see it: The surgery is invasive, and traumatizing I am sure, never mind that she is already not feeling well. I could try the surgery anyway, but it seems with sugars this low the outcome could be bad, or complications could arise. I also get a sense that with sugars this low perhaps it might already be too late (??? can someone advise?) I have thought about trying my best to alter her diet, as I have seen a lot of mention in this regard, however it seems to be very costly on top of the already-costly drugs, not to mention time-consuming. Shelby is so finicky she will starve herself before eating anything except her dry food. I have tried repeatedly to get her on something else, but she only will eat 9 lives (BLUE BAG!, no others). No other brands, no ferret foods, nothing. The only treats she will eat is raisins (is this a no-no now?) and an occasional cat treat (pounce-type). The prednisone does seem to be helping some, but for how long I am not sure. I have wrestled with the surgery option for almost a week now, and I am leaning toward just trying to keep her comfortable until the inevitable. I would still consider the surgery, but only if I thought it would really improve and extend her life a great deal. (Again, I have my doubts with the sugar levels). Sorry, guess I am rambling....Anyway, does anyone have any advice? Thanks a bunch...Mike 4. URINE TEST From: AFERRETVET@cs.com Date sent: Sun, 19 Mar 2000 18:15:32 EST There has been some recent questions about an urine test for adrenal gland disease. The test is called an Urine Cortisol:Creatinine ratio. It was first reported as a useful test for ferrets in a 1995 article in JAVMA. Currently there is research project that is on going at Texas A&M to compare hormone testing, ultrasound testing, and urine cortisol:creatinine testing. They do all 3 test. Then they do surgery and have a pathologist determine the tumor type (hyperplasia, adenoma, or carcinoma). So far they report the urine test to be very accurate (and a lot less expensive ). Please remember that testing (blood hormones, urine cortisol to creatinine, or ultrasound) is not needed to make the diagnosis if the common clinical signs (hair loss, swollen vulva, swollen prostate, return of sexual behavior, itchy skin, etc.) are present. It is better to spend your money on treatment (surgery or Lupron) instead of verifying the obvious in my opinion. Jerry Murray,DVM. 5. Prostate enlargement and medical options. Date sent: Sun, 19 Mar 2000 17:50:13 EST From: AFERRETVET@cs.com There was a recent post about a male ferret with adrenal gland disease and prostatic enlargement. I do not want to second guess your vet, so I suspect there was a reason your vet decided that surgery was to risky. In a polite manner simply ask your vet for the reason why medical treatment was chosen instead of surgery. Perhaps they heard a heart murmur and suspect a heart problem or felt an enlarged spleen or liver and suspect lymphoma, or the blood glucose was low and they want to stablize glucose levels (insulinoma) before doing surgery, etc. etc. Again in a friendly way simply ask your vet to explain the reason for medical treatment instead of surgery. Now assuming there was a good reason for not doing surgery there are 2 medicines that can be used with Lupron for the prostate problem: PROPECIA and CASODEX. PROPECIA (finasteride) is an enzyme inhibitor that prevents testosterone from being metabolized into DHT (its active metabolite) in the prostate gland, liver, and skin. As a result the prostate becomes smaller, urinary flow increases, and hair regrows. Finasteride comes in a 1mg. tablet (PROPECIA) and also in a 5 mg tablet (called PROSCAR). A recommended dose is 0.1mg/kg orally once a day. A compounding pharmacy can make it into a flavored liquid. CASODEX is an androgen antagonist that blocks the androgen receptors on the prostate gland. This causes the prostate to become smaller and urine flow to increase. Casodex comes in a 50mg. tablet, and it is used at a dose of 5mg/kg orally once a day. Again a compounding pharmacy can make it into a flavored liquid. I usually use PROPECIA for the first 30 days or longer if the signs of prostatic enlargement are still present. I would also suggest using an antibiotic such as Baytril or Bactrim to rule out a prostate infection. Jerry Murray, DVM 6. Proglyceme From: "alice depass" Date sent: Sun, 19 Mar 2000 21:41:13 +0000 Will someone please explain what Proglyceme is and why it is so expensive? Thanks. Ali and the Tribe 7. Insulinoma info From: AFERRETVET@cs.com Date sent: Sun, 19 Mar 2000 17:12:28 EST There seems to be alot of insulinoma questions lately, so I will attach my client handout on insulinoma . It covers diet, pediapred, proglycem, chromium, how to treat hypoglycemic episodes at home, and comments about how to treat other concurrent problems at the same time. Jerry Murray, DVM INSULINOMA Insulinomas are tumors (malignant cancer) of the insulin producing cells (beta cells) in the pancreas. This is one of the most common tumors in middle-aged to older ferrets (3-7 years old). The tumors produce an excessive amount of insulin which causes low blood sugar (hypoglycemia). It is the low blood sugar (low glucose) that causes the problem. The exact cause of this disease is unknown, but it is probably related to the diet (too high in carbohydrates, especially rice) and possibly to genetics. It is rare in dogs and very rare in cats. It is basically the opposite of diabetes (high blood glucose). SIGNS The typical signs include a gradual rear leg weakness and lethargy. These signs are often intermittent over weeks to months. With time this progresses to episodes of severe weakness and collapse. Other common signs include nausea, pawing at the mouth, grinding of the teeth, salivation, anorexia, vocalizing, mental dullness and confusion, stareing blankly into space with a glassy eyed appearance, cataracts, seizures, coma, and death. DIAGNOSIS Diagnosis is based on clinical signs and a low blood glucose level (lower than 70). If glucose levels are higher than 70 and signs are present, then a fasting blood glucose (4-5 hours without food) test is done. A fasting glucose level of 70 or lower is diagnostic of insulinoma (normal fasting glucose 80-120). Insulinomas are usually too small to show up on radiographs, or on ultrasound. TREATMENT Treatment is both surgical and medical. Unfortunately surgery is usually not a cure, even though we remove as much of the cancer as possible. However surgery may stop or slow the progression of the cancer, and it may prolong the life span of the ferret. In addition, surgery allows us to check the abdomen (liver, spleen, lymph nodes) for metastasis and to check the adrenal glands for cancer. Surgery is the recommended first choice of treatment in healthy ferrets under the age of 6. Most ferrets, even after surgery, will eventually require medical management. The goal of medical therapy is to keep the blood sugar levels high enough to prevent or limit clinical signs. It is not a cure, nor does it stop the progression of the cancer. Medical management is usually effective for 6-18 months. Medical therapy is a combination of three things: DIET, PEDIAPRED (prednisolone), and PROGLYCEM (diazoxide). DIET The diet needs to be a meat-based, high protein ferret food (such as Marshall Premium Ferret food or Totally Ferret food) or kitten food (such as Eukanuba kitten food or Iams kitten food). Have the food available at all times, so they can eat every 3-4 hours. Cooked meats, cooked eggs, strained baby foods, and Hills A/D can be used as treats and when the pet is anorectic. A/D and baby foods can be syringe fed when needed. AVOID high sugar or high carbohydrate foods or treats (such as cookies, candy, chocolate, fruits, cereals, honey, etc.) ! PEDIAPRED Pediapred is a raspberry flavored liquid form of prednisolone (pred or “cortisone”). Pediapred promotes gluconeogenesis (makes glucose), inhibits utilization of glucose (keeps it in the bloodstream), and it has some antiinsulin activity. Thus it helps to elevate and maintain higher blood glucose levels. The initial dose is 0.25mg to 0.5 mg/kg twice a day. The dose is increased as signs get worse up to 2-4 mg/kg twice a day. With time tolerance to pediapred can occur. Pediapred is a low cost medication, and ferrets generally like the taste. AVOID generic preds; because, most contain alcohol. The liquid form is also more effective than the tablet form. PROGLYCEM Proglycem is a chocolate-mint flavored liquid to help elevate blood glucose levels. Proglycem works by inhibiting insulin secretion. Proglycem can be used with Pediapred. It can be added early or late in the treatment plan. I usually add Proglycem when Pediapred can no longer control the clinical signs of low blood glucose. The initial dose is 5mg/kg 2-3 times a day. As with Pediapred, the dose is increased, up to 30mg/kg, as the insulinoma progresses and signs get worse. When Proglycem is added the dosage of Pediapred can often be lowered to 1mg/kg twice a day. Proglycem is expensive (cost about $1+ a day), and ferrets dislike the taste! As you can see both medications need to be adjusted based on signs and blood glucose levels. Blood glucose levels should be routinely checked at 3 month intervals. Glucose levels should be checked more frequently (weekly to monthly) if signs of low blood sugar are still present. CHROMIUM The mineral chromium (brewer’s yeast) appears to improve glucose metabolism by increasing insulin’s action. Chromium supple- mentation improves glucose tolerance (high levels) in diabetic people and dogs. In dogs, chromium increases glucose clearance from the bloodstream without a change in insulin concentration. Basically it lowers blood sugar levels after a meal to prevent stimulation of the pancreas or insulinoma. Some vets report adding brewers yeast (1/4 teaspoon) or chromium picolinate (10-20mcg) to the food helps increase energy levels. On the other hand, animal nutritionist at Iams and Hills (science diet) do not recommend adding chromium; because, it does LOWER blood sugar levels! I do not recommend chromium supplementation; because, it may do more harm than good. HYPOGLYCEMIC EPISODES Mild to moderate low glucose episodes can be treated at home. Honey, Karo corn syrup, pancake syrup, nutrical,or sugar in water can all be given orally with a syringe. If the ferret has collapsed or is having seizures then honey, Karo syrup, or nutrical can be rubbed on the gums. The ferret should improve in 5- 10 minutes. Once the pet improves feed the ferret its regular food. Ferrets that do not respond to sugar products or ones that continue to have seizures require treatment at your animal’s hospital or emergency clinic. For the ones that do respond let your vet know of the episode as it may be time to adjust the medication(s). OTHER CONCURRENT PROBLEMS Adrenal gland disease is commonly seen with insulinomas (both cancers at the same time). Lysodren (mitotane) is one of the drugs that is used by some vets to treat adrenal gland disease. One of the problems with Lysodren is development of severe low glucose levels. Lysodren destroys the cortisol producing cells in the adrenal glands. Lowering cortisol(“natural pred”) levels will also lower glucose levels. LUPRON DEPOT (leuprolide acetate) is a safer and more effective product for adrenal gland disease. Heart disease is also a common problem in middle-aged to older ferrets. The most common problem is dilated cardiomyopathy. Pediapred causes sodium and fluid retention, and hypertension. Both can make congestive heart failure worse. Lasix may be used to control the fluid retention. Proglycem can cause hypotension. Lymphoma is also a common problem in older ferrets. Using Pediapred may make the lymphoma patient drug resistant to other chemotherapy in the future. On the other hand, Pediapred by itself can be used to alleviate some of the signs of lymphoma by reducing the size of the spleen and tumors, and by temporarily perking the ferret up. Jerry Murray,DVM Animal Clinic of Farmers Branch Dallas, Texas. 8. NY vet list attached From: STARFerret@aol.com Date sent: Mon, 20 Mar 2000 17:10:42 EST From: Ferret Friends Subject: New York Vet? and From: Lynn McIntosh Subject: NY Vet Referral Needed ASAP NY list attached To receive a nicely printed listing of ferret shelters, contacts, vets, suppliers, breeders, clubs, etc., in your state by mail, send a LONG self addressed stamped envelope to: STAR* Ferrets PO Box 1832 Springfield, VA 22151-0832 To review the ENTIRE listing (information might be dated), visit Ferret Central at http://www.ferretcentral.org/ Also visit http://www.netfopets.com/ptff.html E-mail questions, corrections, or additions to: STARFerret@aol.com. Subscription is $12.00 US ($15.00 for Canada and Mexico, $17.50 overseas) and you will receive a quarterly newsletter plus inserts, and for an extra $5.00 you can receive the book _FERRET CARE and RESCUE_, and forms for caring for ferrets. Checks or money orders must be from a US bank and in US funds. Pamela E. Troutman, Director Shelters That Adopt & Rescue Ferrets MODERATOR'S NOTE: If you'd like a copy of the NY list Pam sent just drop me an e-mail. Lynn Mc. 9. FAIML #401; March 18, 2000 and March 21, 2000 From: "Edward Lipinski" Date sent: Tue, 21 Mar 2000 02:30:14 -0800 This is Edward Lipinski at Ferrets NorthWest FNW Shelter on Mercer Island, WA. I've been working with ferrets, skunks and several mink since 1981 and have come to the following conclusion concerning the ultra-high apparent incidence of cancers in ferrets; that is, ferrets that are sourced from pet stores around the country. There are undisputably pre-hormonal juvenile estrogens secreted by the immature gonads in both the female and male ferret. It is unknown that these juvenile pre-estrogens play a significant role in the healthy development of the complexities of the immune system, but hypothesis lends credence to the supposition that these pre-estrogens do contribute to the development and maturation of the immune system. Prepubertic removal of the gonads, the very early, infantile spaying and neutering of the ferret obviously denys the ferret's endocrine system of these very important pre-estrogen secretions, even though they may be but infinitesimal in quantity in terms related to the quantities secreted later in the ferret's growth before, during and following puberty. It doesn't take a rocket scientist to conclude that the SOP of the ferret mills in characteristically neutering and spaying infant ferrets without a doubt in the world robs those immature young bodies of those so very important pre-estrogenic secretions that would otherwise be available to the base-line development of the immune system. Now if you add to this conditional development the most grevious of all faults, that of inbreeding of ferrets that is suspected of the commercial ferret breeders, additively speaking and compounding the lack of the development of the ferret's immune system, the genetic dispostion toward congenital birth defects inherent in such husbandry practices, you have what seems to me a powerful component that may surely lead to the ultra-high incidence of cancer in the ferret. Simply stated, the two factors of prepubertic butchery of infantile ferrets and the profit-driven motive to produce the greatest number of ferrets per unit time - inbreeding - seems, without a doubt, the two causitive agencies in the growth of cancers, and, as has been reported by unidentified sources, the generalization that some 70 percent of pet store ferrets will develop lethal cancers within their first four years of life, does not lie outside the realm of reason. What to do about this? For one, stop the purchase of pet store ferrets internationally and for a time until it will be learned what improvements in ferret longevity and health can be achieved by rescheduling the neutering and spaying of ferrets until later in their development; and for two, do not purchase any ferret whose lineage cannot be proven free from inbreeding. Thank you for your thoughtful consideration of this hypothesis from a dedicated ferreter, Edward Lipinski at Ferret Endowment for Research, Rehabilitation, Education & Training Society, North West, aka F.E.R.R.E.T.S., NW, or more simply, FNW., est 1981. Fuehrer Frettchen Verein Mercer Insel, WA [G.] Leader of the Ferret Society on Mercer Island, Washington. ----------------------- End of FAIML #402 -------------------------