From: Lynn McIntosh [faiml@uswest.net] Sent: Saturday, October 14, 2000 3:57 PM To: FAIMLanon; FAIML Cc: faiml@uswest.net Subject: FAIML #471; Oct. 14, 2000 Ferret Adrenal/Insulinoma Mailing List (FAIML) #471; Oct. 14, 2000 MODERATOR'S NOTE: Hi! Just a couple things. FORMAT: Has anyone seen squares appearing in their FAIML's? Or other strange formatting? If so *please let me know* what you've seen. VET POSTS; BREWERS YEAST and CHROMIUM: I'm putting a file together of FAIML posts (and the dates posted) about this subject so when the question comes up I can send it to the poster. The file will contain Dr. Murray's posts, a message about this from Dr. Purcell, who came to agree with Dr. Murray after doing some research, and other folks' points of view as well. Many of you have commented and there are still differing views on the issue, which will be represented in the file, but papers have been referenced and those references will be included so people can go to the source if they desire. I've been meaning to do this and Dr. Murray, in the meantime, has been wonderfully patient in reposting answers about this. Thank you for your invaluable contributions Dr. Murray! It is so wonderful to have vets dedicated to ferrets on the list. To those other vets who post, including, of course, the also "FAIML faithful", dedicated and talented Dr. Karen, thank you, too!! Lynn There are ten messages in today's list: Surgery for elderly ferret with insulinoma? female adrenal lymph nodes Flash's Insulinoma and Mom's Confusion Undiagnosed! preventing insulinomic attacks pred dosages/nutrical/feeding Brewer's Yeast brewer's yeast High protein diet FERRET ADRENAL/INSULINOMA MAILING LIST (FAIML) is a list featuring support and information about adrenal and insulinoma diseases. It comes out in digest format three to six times per week, depending on the urgency and number of posts. It is the opinion, only, of subscribers, and is not intended as 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 exhibiting signs of illness please take him or her to the most ferret-experienced vet you can. A ferret-experienced vet is one of the most important services you can provide for 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 and FAIML ARCHIVES/PHOTOS: For more info, check out Michael Janke's adrenal/insulinoma web site: . Past FAIMLs are archived there, with a search feature, and there is a FAIML album featuring pictures of FAIML subscribers and their ferrets. FERRET CENTRAL WEBSITE and PAM GREENE's FERRET FAQs: Ferret Central Website is the grand intersection of ferret websites, at . You can also find the Ferret FAQs there, which include invaluable FAQs on insulinoma and adrenal diseases. I forward these two FAQs 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. 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. Date: Fri, 13 Oct 2000 10:40:52 -0400 From: "Katelyn McKenna" Surgery for elderly ferret with insulinoma? Hi, Some of you may remember my mom, Lynne and her ferret Dustie. Lynne's computer has been broken and so I am writing on her behalf. Dustie has been doing well although he is getting some bad hind-end weakness. His insulinoma has returned and he has a large non-malignent carcinoma on his tail that frequently bleeds and occasionally pieces get scraped off of it when he crawls and plays (he doesn't play actively very much anymore but rather explores a little and sleeps a great deal). Her vet wants to do surgery and remove the carcinoma but that entails putting him under total sedation. Do any of you know how safe or dangerous this might be? He is about 9 or perhaps even 10 years old. We are worried about putting him under with the insulinoma and worried that the surgery might stress his little body out too much. On the other hand, that carcinoma is making it difficult for him to move about easily. Any advice that any of you could offer would be much much appreciated!! all best, Katie on behalf of little Dustie Date: Thu, 12 Oct 2000 19:47:49 -0400 (EDT) From: "Catherine Roebuck" female adrenal How long does it take the vulva swelling to go away after surgery? It has been almost three weeks since Midget had her leftadrenal gland removed.She is doing well, but her behavior is no different. She jumps all the boys, and then gets frustrated. Will she ever realize that the men can't help her? She is funny, but the poor guys get tired of her bugging them, and they let her have it, and she comes back for more. Has anyone else experienced this with their adrenal girls? Cathy I Love Ferrets Date: Fri, 13 Oct 2000 20:19:57 -0400 From: "Celia C." lymph nodes I was also going to say that Cokie has fat around her lymph nodes too--all down her body. No evidence of lymphosarcoma. My vet said in the vast majority of cases, it was fat (and she was fat). (Her ultrasound also found no evidence of lympho, but I don't know exactly howdecisive that is) This was another reason we decreased her pred--to get her to lose weight. So far she weighs the same, but she doesn't look as bloated. Still has the big lymph nodes, though.  Celia Date: Wed, 11 Oct 2000 15:22:35 EDT From: Kgsalimy@aol.com Flash's Insulinoma and Mom's Confusion Hi Everyone, First of all, thank you to all who have responded to my posts concerning Flash's insulinoma and my questions about Brewer's Yeast. Unfortunately, I am now totally confused and have no idea what I should be doing (or not doing) for him and am even beginning to wonder if this might actually be something other than insulinoma. Because of my uncertainty, I thought I should post a little more detail about Flash's illness and diagnosis with the hope that someone here can help me decide what to do about my little guy. I must apologize in advance ... I know this post will be quite lengthy. In July of this year, just two months after he turned three years old, I noticed that Flash was very lethargic, sleeping more than usual and just seemingly not feeling his normal "Flashy" self. He would frequently stop in the middle of his playing and lie down for a rest wherever he happened to be, sometimes dozing off for a few minutes. This was totally un-Flash-like ... he's never before slept out in the open like that, always seeking shelter and privacy under furniture or a blanket. He would only remain active for a very short time without needing one of these little rest breaks, but this was the only symptom I noticed. His appetite was still good at this time. I immediately suspected insulinoma and took him in for a blood test ... his blood glucose level was 86, not low enough for a diagnosis of insulinoma. This behavior continued and, on September 5, I took him for another blood test ... this time his BG was 68 and my vet diagnosed insulinoma. My vet mentioned that we might want to consider surgery "later down the road". Flash was put on prednisolone, 0.5cc twice daily, along with 2 ounces of Insulinoma Elixir twice daily. The ingredients in this elixir are as follows: 6 - Papaya Enzyme Tablets 1 - Vitamin K-1 100 mcg tablet 1 heaping teaspoon Probalance for Cats 1/2 teaspoon Brewer's Yeast powder 1 - Dry Vitamin E 400 I.U. capsule 1 cc Pet-Tinic Elixir 1 - Chromium Picolinate 400 mcg tablet 1 teaspoon Lecithin granules 1 can Nature's Recipe Rabbit and Rice Feline Diet 1 - 2 oz jar Gerber Blue Label Chicken, Turkey or Lamb Baby Food (I use chicken) 1 cc honey or Dextrose Powder (I use honey) 3/4 cup homemade low salt chicken broth (I use no salt when making it) 1 teaspoon heavily ground clams added once a week for added Taurine This recipe makes about 14 ounces, I feed 2 ounces twice daily. We went for another blood test six days later on September 11, Flash's BG was 92. After another two weeks or so, because of a misunderstanding on my part, I decreased Flash's pred dosage to 0.25 cc, still twice daily. When we went back for another blood test about ten days later on September 28, his BG was 94 so we kept him on the lower dosage of 0.25 cc ... which he still takes. When we first put Flash on the pred, he seemed to feel even worse than before we began the treatment. He was even more lethargic, slept all the time, never played any more with his ten brothers and sisters and quit eating his kibble. After lowering his dosage, he seemed to feel a little better but still not good and still not eating his kibble. One of my biggest concerns is the rapid development of his HUGE belly. I've often read of "pred-belly" and knew this would happen, but I had no idea it could happen so quickly. Flash's increase in girth was apparent within probably ten days ... maybe two weeks. Does this sound normal? Someone suggested the high calorie content of the baby food might be causing weight gain, but this is not normal weight gain. According to the scales, he's gained only a few grams, but he's losing muscle mass ... his face, shoulders and hip regions have become quite boney while at the same time, he's grown this very large belly. His belly is not soft and "gushy" like fat usually feels ... it's quite firm and even hard. He feels like he could explode. Is there anything else that could cause a BG level of 68, followed by these other symptoms? I guess what I'm asking is could something besides the pred be causing what seems to be fluid retention in his belly that would also exhibit low blood sugar as a symptom? Any ideas on this would be greatly appreciated ... I'm at a complete loss here. I'm thinking of having an x-ray done of his heart when we go back in, but don't know what else to have him checked for. If the pred is causing all this and Flash has to feel this bad for the rest of his life, I'm not sure I want to extend that life. My poor little guy looks and feels awful. I'm trying again with the chicken gravy ... I'll be more persistent this time, since he wasn't sick when I tried him on it before. My sincere thanks to all who are trying to help us. Kathy <>< Mom to Sparkle, Flash, JoJo, Sunny, Fox, Valentine, Bouncer, Cosmo, Grace, Simon and Chance (always remembering Skitty and Scat, the first silly weasels to steal my heart). See them all at: http://albums.photopoint.com/j/AlbumList?u=1251123 Date: Fri, 13 Oct 2000 20:12:44 -0400 From: "Celia C." Undiagnosed! It seems Cokie's heart disease has cured her insulinoma! Well, not exactly: She has been treated for insulinoma for several months now, after having several blood glucose readings in the 60s and then one at 41, and one at 79 after treatment with prednisone. Turns out the 41 was a mistake! The in-house glucose machine was miscalibrated. But we didn't know this untilseveral weeks ago, when, after increasing her pred, her glucose went from 79 to 64. But this blood was also sent out to be tested, and their results said 95. The machine was then calibrated correctly, and her bg was 150 a weekago. Today it was 126 after lowering her prednisone. (on a separate well-calibrated machine) So we put 2 and 2 together--finally! We are going to lower it again and retest her. Probably some of her symptoms (lethargy, hind end weakness, occasional spaciness), were due to the cardiomyopathy. She is being treated for that and is improving. Of all the things she has (no adrenals, chronic kidney disease, insulinoma, cardiomyopathy), insulinoma was the worst, so I am very pleased! (take heed, ye fates of the jinx--I am still worried!) At the very least, the insulinomashould be well controlled with a smaller dose of prednisone!  Celia Date: Tue, 10 Oct 2000 14:12:34 -0400 From: "Linda Iroff" preventing insulinomic attacks It is hard to say what dose of prednisone will prevent insulinomic attacks, or how fast you will have to increase it. Sometimes the pred just won't help anymore and you have to go to Proglycem, which is expensive and yucky tasting. My own Caruso had 1/3 of his pancreas removed less than 2 months ago, and in the last couple weeks I have had to start increasing his pediapred, so far from .5 to .7 cc (6.75mg/5ml) twice a day. He had been up to 1cc pre-surgery. Caruso has started having the pawing at mouth and drooling episodes. Strangely, they seem to occur just minutes after eating kibble, usually in the morning. He won't take honey or ferretvite when he is having these attacks, but will stop hiding under the furniture gagging and will lap up watered down chicken gravy. I give him a little to stop the attack, and then a few minutes later after he has calmed down, give him more. I don't know why the kibble seems to bring on the attack, or in Reggie's case the Ultrablend. I would be concerned that the amount of protein in the Ultrablend isn't high enough--yes it's better than kibble, but still not great. You may want to try mixing a little chicken baby food in with the Ultrablend to bring the protein level up. Mix just a little at a time until he gets used to it. I've just started giving Caruso 3 meals a day instead of 2 to see if that helps him. I think the problem is that he doesn't eat anything at night, and when the food first hits his stomach, the pancreas reacts immediately and pumps out the insulin which makes the blood sugar plummit before the food has a change to get into his system. Not sure if this will help you any, but at least you know someone else is going through the same thing! Linda Iroff Oberlin OH Date: Tue, 10 Oct 2000 20:03:45 -0400 From: "Michael F. Janke" pred dosages/nutrical/feeding > From: "Erin E. Shepherd" > Reggie, Preventing Attacks - URGENT POST > Doc had me adjust the pred again to .35 mg twice/day. I feel like we're > increasing the dosage at too fast a rate - i know it probably varies from > case to case, but do you have any idea how long should it take for Reggie to > stabilize and reach his "clinical threshold"? what is a safe rate to increase > the pred? I'm not a vet, so keep that in mind. With that said... I do know that one can't suddenly stop taking pred but instead they should be slowly weaned off (or down), but I don't believe there's a prescribed rate at which it is increased. I think one could just as easily start out at 0.5mg, twice a day as safely as one could start at say, 0.18mg twice a day. But I'm open to correction by any of the vets out there. I also know of some, what I consider, very ferret knowledgeable vets that feel one shouldn't hold back on giving enough pred to effect an improvement. I don't know how much Reggie weighs, but I'd say a total of 0.7mg a day is not a lot for an average sized male. If that's what it takes to bring about an improvement, I wouldn't hesitate. Beasley gets two milligrams a day, but I have to add that he weighs four pounds. It sounds like Reggie might need even more than 0.35mg BID if he's not responding, but speak to your vet about that. I see no reason why he shouldn't be given whatever he needs to avoid the constant attacks. Funny you should mention the fact that Reggie has had attacks after eating because Beasley's hypoglycemic episodes have also seem to follow a meal. I can see it immediately following a meal, since it must take some time for the body to process the protein that is fed, but I've seen it an hour or so after a meal AND a dose of pred. I would think by that time, the body had begun to process the food, considering how fast it moves through a ferret, and the pred. I know that a lot of people say not to give Nutrical to a ferret with Insulinoma, but I got just the opposite information from Dr. Kemmerer, a very highly respected ferret vet. If I recall correctly, Dr. K told me that she recommends (not just approves) a one inch ribbon of Nutrical twice a day for ferrets with insulinoma. I stopped giving Beasley Nutrical a while back, but as his hypoglycemic episodes came back recently, I've been giving him a little Nutrical right off my finger after every meal. I don't recall Dr. K's exact reasoning, but I believe it had to do with the more basic form of sugar that's in Nutrical. It's not as if one was giving them candy or something similar. In any case, I have not seen the rebound effect from Nutrical that one would normally associate with sugar given to hypoglycemic ferrets. As an added measure of safety, I only give it to him right after or with his meal. If the pred is not working, and your vet doesn't want to increase it over 0.35mg BID, you might want to talk to him about Proglycem. For whatever reason, It didn't work well for Beasley and I stopped its use, but quite a few ferrets with hypoglycemia respond well to Diazoxide and it might be what Reggie needs. Unfortunately, it's very expensive stuff. Depending on where you buy it, you can figure on spending at least $100 a month and maybe as much as $130 a month. So, I would talk to your vet about increasing Reggie's pred even more if 0.35mg doesn't help, adding proglycem and also his opinion on using Nutrical. For the ferrets, Mike * Michael F. Janke, mjanke@miamiferret.org * South Florida Ferret Help Line, 305-752-7040 * * Website: http://www.miamiferret.org * Adrenal/Insulinoma web site: http://www.miamiferret.org/fhc Date: Thu, 12 Oct 2000 00:36:06 EDT From: AFERRETVET@cs.com Brewer's Yeast Sorry that I have been to busy lately to respond to the recent posts. Kathy asked about using chromium or brewer's yeast for insulinoma ferrets. Chromium helps to LOWER high blood glucose levels. This is where the phrase "helps to regulate blood glucose levels" comes from. It is a good supplement for diabetics because they have a high glucose problem. However it does make sense to give something to lower blood glucose levels to an insulinoma ferret since their blood glucose level is already too low. Chromium also has some insulin like properties. But it does not make sense to give chromium (that has insulin like properties) when there is already too much insulin being produced by the insulinoma. When should you give chromium? IF after insulinoma surgery, your ferret develops a high blood glucose level problem (i.e., becomes a diabetic), but this a rare problem! For more on insulinoma treatment see the next Modern Ferret magazine that should be out in November. Jerry Murray, DVM Date: Tue, 10 Oct 2000 13:58:15 -0400 From: "Linda Iroff" brewer's yeast Recent research suggests that chromium and brewer's yeast (which contains chromium) do not "regulate" the blood sugar levels, but simply lowers it. Most testing had been done for diabetics (people and animals) so "regulating" is lowering. Recent studies in healthy dogs and cats show chromium lowers blood sugar levels BELOW the normal level. Drs Jerry Murray and Karen Purcell have both posted to this list saying chromium and brewer's yeast are NOT recommended for insulinomic ferrets. I have also spoken to Dr Karen personally about this, and she verified this info. This is a case where new studies and information has not yet made its way into popular practice, either by vets or ferret owners. Linda Iroff Oberlin OH Date: Tue, 10 Oct 2000 20:03:36 -0400 From: "Michael F. Janke" High protein diet >Mike, I copied part of your post at the beginning because you mentioned that >you feed Beasley a high protein meal four times a day ... may I ask what it is >you feed him? It's no super secret recipe, that's for sure! :-) Simply chicken baby food mixed with a bit of A/D. The baby food is nearly 50% protein, which I believe is about as high as one is going to find... at least in a form that a ferret will eat. If anyone knows of anything better, I'd love to hear about it. For the ferrets, Mike * Michael F. Janke, mjanke@miamiferret.org * South Florida Ferret Help Line, 305-752-7040 * * Website: http://www.miamiferret.org * Adrenal/Insulinoma web site: http://www.miamiferret.org/fhc ----------------------- End of FAIML #471 ------------------------