From: Lynn Mcintosh [mctosh@u.washington.edu] Sent: Wednesday, February 18, 1998 11:31 PM To: FAIML Subject: Adrenal List #06 Hi there. Welcome to new subscribers Dave, Jennifer M., and Dr. Tom McCabe, a ferret owner and vet since 1978. I see Dave and I may have already been discussing a case of yours, Dr. McCabe! I'm sure that, like most veterinarians, you're busy, so thank you for taking the time to subscribe. Sorry I appear such a blabber mouth in this issue. Dave and I, when he joined the list, had a short correspondence that seemed pertinent, so I included it. Sometimes that's the only way I get a chance to respond to members as the list keeps me pretty busy in terms of nuts and bolts of getting it out, and then I squeeze in some personal e-mail, and I'm still behind in e-mail and things. Keep those cross posts and biofile introductions coming! Lynn Adrenal List #6, dated May 3, 1997 1. Ferretwise Adrenal Work 2. Response to Ferretwise 3. Subject: Dr. Johnson-Delaney's clinical treatment for inoperable adrenal disease 4. To do surgery or not to do surgery 5. Response: To do surgery or not to do surgery post 6. Adrenal list/Bumpkins 7. Response: Adrenal list/Bumpkins 8. Adrenal list/Bumpkins 9. Response: Adrenal list/Bumpkins 10. Adrenal List/Intro Nancy & Ronnie 11. Sabre update 12. Adrenal (Ligation)/FML Post 13. Adrenals, food; Vets?: Adrenal Tumors... a mistake??/ FML Post 14. Leuprolide Acetate (Lupron) - help! 1.---------- Forwarded message ---------- Date: Wed, 30 Apr 1997 16:57:17 -0400 (EDT) From: ferretwise@top.monad.net Subject: Ferretwise Adrenal Work Hello Lynn, Please forward the biofile list for beginners. It is just something for me to pick at... The study program here concerns the adrenal disease in younger ferrets that is ferrets through age 4 1/2 yrs. You see in the past it was considered a geriatric malady and accepted as such... now the adrenals are affected in much younger ferrets. We are working with those who have premature-- adrenal disease manifestation. To date these are ONLY MF ferrets. I am interested in any other early alter or LATE alter ferrets who may have manifested adrenal disease at an early age. Alicia 2. ---------- Forwarded message ---------- Date: Wed, 30 Apr 1997 19:15:37 -0700 (PDT) From: Lynn Mcintosh To: ferretwise@top.monad.net Subject: Response: Ferretwise Adrenal Work On Wed, 30 Apr 1997 ferretwise@top.monad.net wrote: Hi Alicia. I'll send the biofile along. I'll post your message to the group and ask them to watch for younger cases and try and call them to your attention. I'll try and watch for the younger cases as well, though I haven't had time to really read the lists myself - except to edit a bit - or respond to the lists, but I hope to now that I've got the system of producing them down. I'm learning a lot, though, about adrenal disease. > The study program here concerns the adrenal disease in younger ferrets > that is ferrets through age 4 1/2 yrs. > > You see in the past it was considered a geriatric malady and accepted as > such... now the adrenals are affected in much younger ferrets. We are working > with those who have premature-- adrenal disease manifestation. To date these are > ONLY MF ferrets. I am interested in any other early alter or LATE alter ferrets > who may have manifested adrenal disease at an early age. > > Alicia My vet supports the theory that early neutering/spaying brings on the the disease for various reasons you're probably well familiar with. But what about other early-neuter ferrets? Perhaps other early-neuter breeders haven't been around long enough or supplied enough ferrets to show up yet. My vet mentioned today a breeder that he says is using a prod to close the anal glands in tiny kits, but leaving them intact and causing new anal gland problems; also is doing early neutering. So sad that some people traffic in animals... Take care, Alicia. I'm glad you're doing your good work and look forward to hearing more some time. Lynn 3. ---------- Forwarded message ---------- Date: Tue, 29 Apr 1997 00:54:52 EDT From: Michael T Delaney Subject: Dr. Johnson-Delaney's clinical treatment for inoperable adrenal disease Dear Lynn: You can rerun my ACD article that was done for VetRap (Seattle King Co Vet Med ASsoc) . Lysodren kills off adrenal tissue period. The difference in ferret adrenocortical disease vs dog/human is that the primary hormones secreted are usually sex steroids, instead of cortisol. However, cortisol may be slightly elevated in some ferrets as well. Lysodren seems to work better on adenomas than adenocarcinomas. There can be side effects, but various pulsing regimens can be used to minimize this. Deliver with some food seems to help as well. The Lupron Depot is a synthetic GNRH agonist that blocks sex steroidogenesis. It is leuprolide acetate, utilized primarily for endometriosis and as palliative treatment to shrink prostate tissue with many kinds of prostate cancer. Although theoretically it primarily acts to interrupt the feedback system from the pituitary to the adrenal/auxillary endocrine tissue, it essentially acts to block estradiol receptors. It is for this ability that we decided to try it in my ferret, whose prostate had totally occluded his pelvic canal, making urination and defecation almost impossible (and painful). He had his left adrenal totally removed in April of 95, along with one large insulinoma. In Aug of 96 he plugged. He started Lupron in September. I am happy to say he is now 5 days past 2 years from surgery (the right adrenal was determined to be too much of a surgery risk to even try). He is 13 months on lysodren (varying from 100 - 250 mg/week), and is 8 months on Lupron (100 mcg injection IM every 3 weeks). He will be six years and nine months on May 4, and is growing hair where none has grown for 2 years. He plays, has no problem urinating/defecating, climbs, and runs (he didn't do that for most of the time post surgery til when he started Lupron and I upped his lysodren). The insulinoma problems are more pressing - we have to closely monitor his eating and make sure he snacks frequently. I have started using a little prednisone (1-3 X a week) as needed because I think he's got very little natural cortisol (which helps keep blood sugar up). Bottom line: there's still a lot to be done out there. I do not think ligating the caudal vena cava is conducive with longevity. (painful as well). I have not heard of it being as successful as good medical management after you surgically debulk the tumor (remove left, as much of right as can safely be done without fatal hemorrhage). Those who have done it as a last resort to stop the hemorrhage during removal of the right adrenal - well, the ferret's haven't been around as long as those on good medical managment (longest I've heard is 3 or 4 months post op, and the ferret showed gradual hind quarter paresis and reluctance to move...)If the prostate continues to enlarge, Lupron is an option. I can add comments from time to time, but I really can't get involved in another bulletin board - can't keep up with the plain email! Good luck though - you might want to let the folks at Modern Ferret know about this. Cathy delaneymt@juno.com Michael and/or Cathy A Johnson-Delaney DVM 4. ---------- Forwarded message ---------- Date: Wed, 30 Apr 1997 20:04:17 -0400 From: "Michael F. Janke" Subject: to do surgery or not to do surgery > Date: Wed, 30 Apr 1997 00:14:22 +0000 > From: Beth > Subject: Slinky, Scamper, Bear, Sully, Sarah, Felix, Chuckles > > main concern now is Sully who has only recently lost his fur. Should I have > the surgery done or not??? Bear had the surgery & was rejected by the others > which was so sad to see. He appeared to recover from the surgery but was > never the same. I'm interested to hear if people have chosen surgery or not > & why. Any ideas on life span after surgery? Beth, I would definitely not do nothing. I personally don't care for lysodren's effects (nausea, etc.) and will avoid it at all costs. So surgery is the only other option I know of, unless you want to try the holistic approach. When Punky Doodle had his adrenal surgery, he never really recovered either, but he had a number of other problems and I relate his poor recovery to all the other things going on, which may or may not have been the long-term effects of the adrenal problem. Max, on the other hand, has recovered quite well and seems his ol' normal self, less than two months since surgery. The only problem with Max is that the vet elected to leave the somewhat enlarged right adrenal and only take the enlarged left. Now his coat is getting thinner and thinner and he's quite aggressive towards Beasley. As much as I hate to put them through surgery again, I feel that he will have to go back under the knife for the right adrenal. I'd sum up my feelings as... do the surgery while they're still relatively young and/or healthy. I could be wrong but I feel that if I had skipped the lysodren treatment and did the surgery right away on Punky Doodle, he might still be alive today. As a result of that experience, I didn't hesitate with Max. As soon as I saw his hair thinning on his back (he never really lost any) I got him into surgery. > Date: Sat, 12 Apr 1997 23:06:13 EDT > From: Cathy Johnson/Delaney, DVM > Subject: Cathy Johnson-Delaney, DVM: Current Adrenal Article to VetRap, > a publication of Seattle-King County Vet Medical Association Lynn, Would it be possible to get permission to reprint this in our shelter's newsletter? We're an official 501(c)3 not-for-profit organization, so it definitely wouldn't be used to make money. I'd be happy to send a copy of the newsletter to you and Dr. Johnson-Delaney if we used the article. 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 NOTE: I haven't heard back from Cathy but think it's safe to say she won't mind, Michael. I'd say go ahead and reprint it. 5. ---------- Forwarded message ---------- Date: Wed, 30 Apr 1997 20:11:48 -0700 (PDT) From: Lynn Mcintosh To: "Michael F. Janke" Subject: Response: To do surgery or not to do surgery On Wed, 30 Apr 1997, Michael F. Janke wrote: Hi there Michael. Thank you for your post. I will check with Cathy about this to make sure, but I think she'd be happy to have it reprinted. I'll pass on your request to her and get back to you as soon as I hear. I appreciated hearing your opinion on Lysodren. I'm am glad to be learning about these things prior to having a ferret with inoperable adrenal disease. It was in realizing how arbitrary adrenal surgery can be that I became concerned about this. When I began exploring options about Percy I felt like I'd come upon a big void and this list is helping me fill it with information. There may not be any solid answers out there now, but I feel better beginning to learn what is known and what isn't, and feeling I have a chance to make some intelligent guesses about treatment options for my baby, Percy. 6. ---------- Forwarded message ---------- Date: Wed, 30 Apr 1997 19:29:39 EDT From: dla7@juno.com Subject: Re: adrenal list/Bumpkins thanks for responding to my e. please send mail with enclosures to dadams@dzn.com since juno at present will not handle attachments. i am very interested in the meds for inoperable adrenal problems. i did look at compuserve as well as aol; both seem to have areas that could provide data althought the one i found that was open in compuserve only had data that i had seen months ago. no updates. I think that most of the information of this sort may be moving to groups such as the fml and as i gather the e mail listing u are establishing. this is one good thing that the internet et al can provide. I will try to keep u posted as to actions on Bumpkins( the one with the covered adrenal tumor). the present plan is to let him recover from this current spleenectomy and then send blood sample to the tenn. board for analysis; if result indicate adrenal tumor activity then we will look into current meds and other options such a ligating the vena cava etc. this does not seem to feasible since the aorta is also involved. thanks again and hope to hear from u again dave adams and bumpkins +13 more 7. ---------- Forwarded message ---------- Date: Wed, 30 Apr 1997 20:00:45 -0700 (PDT) From: Lynn Mcintosh To: dla7@juno.com Subject: Response: Adrenal list/Bumpkins Hi Dave. Thank you for writing, and for joining our group. Inoperable adrenal disease is one of the most pressing issues, medically, at hand, regarding adrenal disease, and one our group is very attuned to this issue! Thank you for the info on vet forums, and do please let us know how Bumpkins is doing. I'm surprized your vet is doing the Tennessee Adrenal Panel when an adrenal tumor is visibly present. I'm certainly not a vet, but from what I've read I would think obvious symptoms would be present indicating that excessive hormones are being secreted from the diseased adrenal, symptoms which would have prompted the second surgery. I'm curious why your vet is doing the Tennessee Adrenal Panel at this point. Could you shed some light? Take care and hugs to your many fuzzies! Lynn and the Gang of 8 Sweet Fuzzies 8. ---------- Forwarded message ---------- Date: Thu, 01 May 1997 08:57:40 EDT From: dla7@juno.com Subject: Re: Adrenal list/Bumpkin sorry about the mixup on the diagnoses of adrenal tumor. Dr Mcabe was able to feel something behind the aorta and vena cava but was not able to visualize it. He does not know if it is a tumor resulting from the remanants of the first surgery on the right side or fatty tissue or whateverbut is is between these veins and the back. The idea of the panel was mine since the idea of more surgery at this time looked bleak. If this is a bad idea please let me know since the chemical treatment of such ailments for me is unknown and i don't believe Dr Mcabe has treated any adrenal tumor problems this way. From what he says the treatment if terminated will result in the regrowth of the tumor so the treatment is forever. What sort of results have been had with chemical treatment in terms of longivity, quality of life, etc. The questions i have asked may be answered in the data u sent. I did not recieve any on juno and have not yet checked the dadams@dzn.com address. If u sent to the later address i will have if not please send it again. I will keep u posted on Bumpkins progress which is not too good at this time although he is up and giving some of the little girls a bad time. His eating is still soup style and his bowels are loose and again smelly. the smell is the concern and we are giving anitrobe to combat this type bacteria. thanks for ur responses and i hope the panel question is cleared. dave adams and all 9.---------- Forwarded message ---------- Date: Thu, 1 May 1997 08:39:58 -0700 (PDT) From: Lynn Mcintosh To: dla7@juno.com Subject: Response: Adrenal list/Bumpkin Hi there Dave, Thank you for writing. I'm sure the Tennessee Adrenal Panel won't hurt a bit, just that it's expensive and if you have obvious adrenal symptoms present my vet says it isn't always necessary. It can't hurt at all when diagnosis is unsure, and certainly sounds like a better idea than treating Bumpkin with serious chemo drugs if they may not be needed. So you're probably on the right track! Of course, Dr. McCabe can always consult another vet if he's willing. Dr. Kawasaki in Virginia has said he's more than happy to consult (doesn't even ask a fee bless his heart) with vets via phone and he says he's done more than a 1,000 adrenal surgeries. He talks to us regular folk, too. He's been working with ferrets for quite some time and is the vet with the pretty large sable in the video Ferrets Unmasked. Dr. Kawasaki isn't on the internet, but his phone number is 703-690-2580. >From what I've heard reactions to chemical treatment vary from success to a ferret not being able to tolerate chemo, sad but true. Our next list will have a success story about chemical treatment. I will try and get the list out Friday, but will forward the story to you right off, along with the Biofile and Lists #1-5. Our list is just getting started and we are all learning about this difficult illness together. Take Care Dave and give Bumpkin a gentle hug for me. That is such a cute name. Lynn PS. I hope you mean your messages for posting as they contain good info about Bumpkin's case. Let me know if it's not okay to post them. If you would like me to forward them to the group right away, let me know that too and I will. I'm happy to do that in pressing cases. You take care, Lynn PS. Yes, my understanding too is that once chemical treatment is started it is considered a lifetime treatment so the adrenal tissue won't regrow. I've been asking for stories about treatment used for bi-lateral adrenalectomy ferret patients, and they crop up on the FML, so we'll just have to watch for them. I have no personal experience of this myself. 10.---------- Forwarded message ---------- Date: Thu, 01 May 97 11:47:53 EST From: Jennifer_Morlanne@email.fpl.com Subject: Adrenal List/Intro Nancy & Ronnie Lynn- I saw your post on the FML about a dedicated list for Adrenal Cancer and I'd like you to please include me on it. I have 2 little ones with adrenal problems. One (Nancy 4yrs old) had both left and right surgery, but still has problems because the right could not be removed completely. My other (Ronnie 4 yrs old) had his left removed and seems to be doing well, but I'm watching him closely for signs. Both little ones had malignant tumors. Nancy has lost most of her hair and has a VERY swollen vulva. Her vet says there isn't much more we can do for her but I'd like to try some chemo, so I'm following this chemo thread closely. Any insight into helping Nancy and Ronnie would be greatly appreciated. Thanks, Jennifer 11.---------- Forwarded message ---------- Date: Fri, 2 May 1997 20:27:24 -0700 From: Gabby Subject: Sabre update Hi all, Sabre got her stitches out yesterday (Thursday) and is doing wonderful! She's zooming around the house and beating up on everyone else once again. She's eating and drinking completly on her own since the 3rd day home and is feeling better now than she has in months! She'll be back to alpha ferret in no time flat. The biopsy came back, and it was a malignant tumor, so we will have to hope it has not spread. Give all the adrenal fuzzies hugs, Christina. 12.---------- Forwarded message ---------- Date: Sat, 3 May 1997 15:35:42 -0700 (PDT) From: Lynn Mcintosh To: ferret fml Subject: Re: Adrenal (Ligation)/FML Post > On Fri, 2 May 1997, Automatic digest processor wrote: > > > From: MS MARY M MCCARTHY > > Subject: Adrenal(Ligation) > > > >Just wanted to mention that where I work,- Dr.Edwards has done a rightsided > > adrenal removal and vena cava ligation on a ferret that we would have > > normally just "closed back up" after seeing the tumor totally wrapped around > > the blood vessel the way it was......But Dr.Williams said "there is no such > > thing as a non-removalable adrenal gland because the vena-cava can handle > > being ligated." ("enough other little vessels to make up for the big one > > being ligated".) So we did our first ligation about a month ago and just > > wanted to comment that she is doing very well (and once again as always you > > were right Bruce :) and will be doing another one in a couple weeks on a > > ferret that we did sew back up after seeing how invasive her right tumor > > was. Will let you know how she makes out. Hi there Mary. Our adrenal group is following vena cava ligations with interest and hope. Please do post again to the FML and let us know how the ferret(s) does post sugery? I would like to post your info to the Adrenal List if you don't mind, this message and following messages about your vet's work. Please let me know if that isn't okay. Also, would your vet be willing to post or send some written information about vena cava ligations? Such as how it's done, how many have been done, and prognosis for ferrets who have had this procedure done? I've posted information about the Adrenal List in another message in this FML about adrenal issues, so if anyone is interested please see that message. Thank You, Lynn 13.---------- Forwarded message ---------- Date: Sat, 3 May 1997 15:36:09 -0700 (PDT) From: Lynn Mcintosh To: ferret fml Subject: Re: Adrenals, food; Vets?: Adrenal Tumors... a mistake??/ FML Post > On Sat, 3 May 1997, Automatic digest processor wrote: > > > From: Lisa Leidig > > Subject: Adrenals;food > > CLIP...> > Adrenal ferrets: Kyle, the amazing Albino who had both of his adrenal glands > > removed in February, is doing very well, considering all of his other > > problems. For a 3 year old ferret, he is sort of a mess, but he will stay > > with me for the rest of his life. His ear being sewed shut has proved to be > > no problem for him hearing (he hears the food lid being opened VERY well) > > but some liver values and blood chemistry results show he has a lot of other > > problems, they just are vague enough to not pinpoint the problem. CLIP...> > The only thing about Kyle that I noticed that is different > > is that his coat grew back with a definite orange tint to it! I assume it > > must have to do with the regrowth after adrenals, and possibly due to the > > complete removal of the glands, but it doesnt bother him, and I think it > > makes him even more unique! Just remember, if ya ever come to visit me and > > I ask you to clean the albino ferrets ear, hold him over the sink!!! > > > > Lisa Hi Lisa. I'm curious if or how Kyle is being treated medically since the removal of his adrenal glands? I am part of an adrenal group list and one of our strong concerns is care - what meds and to what detriment and/or success - for bi-lateral adrenalectomy patients. Is Kyle on any medication and if so what, and how long has he been on the meds? He certainly does sound like a clever guy :D Also, unless you say otherwise, I'd like to print your answer in the Adrenal List. The Adrenal List is open to everyone and comes 2-3 times per week depending on subscribers (most adrenal patient(s) moms and dads) posts and my schedule. Of course urgent posts are sent out to the list immediately. For more information or to be a part of the list write me.. > > From: Patricia Curtis > > Subject: Adrenal tumors...a mistake?? > > > > Someone wrote: > > >I was a little curious since she had said his adrenals were OK 2 months ago, > > >but people make mistakes and maybe she had just missed seeing something. > > > > It is quite likely that this vet did NOT make a mistake the first time. > > Adrenal tumors can advance quite rapidly. I've seen a little girl here > > examined for adrenal tumors and pronounced "no tumors", then 6 weeks later > > go in for adrenal surgery because symptoms worsened and it was found that a > > tumor now exists and in fact, has grown so rapidly (a cancerous tumor) that > > all of it could not be removed. > > > > It is also quite possible for adrenal glands to show *no* abnormalities, yet > > contain a tumor inside of the gland. This is very important to know. Age > > is not necessarily a factor either. A few weeks ago a pre-cancerous adrenal > > gland was removed from a *one-year-old* here! > > Trish > > Director, Ferrets First Rescue & Shelter For vets or others. How common are quick growing tumors, or tumors contained inside of a gland? Our Percy's glands appeared quite normal last November, but he is still showing signs of adrenal problems. Any answers will be posted to the Adrenal List unless I'm requested that they not be posted there. Thank you very much! Lynn and the Gang of 8 grand fuzzies. 14.---------- Forwarded message ---------- Date: Sat, 3 May 1997 19:56:32 -0700 (PDT) From: Lynn Mcintosh Subject: Leuprolide Acetate (Lupron) - help! Help! My vet is suggesting Leuprolide Acetate (Lupron) for Percy's frequent urination and spotting, and for his manyly behavior. I would like to try it. But my vet has only found it, so far, for from $300-500 per milligram (though Percy only needs one shot of 100 micrograms every three weeks). This is more expensive than exploratory surgery, as I would have to get the whole milligram! Percy had adrenal exploratory surgery last November so the vet doesn't think it's time to try it again. Part of the right - which was very small and normal looking though a bit bigger than the left, which was very tiny, like a black pepper or smaller - was removed and was found to have hyperplasia and a little adenoma tissue. I work with drug companies and doctors so may be able to find a cheaper source. 1) Who makes it? 2) Does anybody know where to get it less expensively? I've got a call in to a psychiatrist( a doc I work with knows) who has found a cheaper source in England. And, once I find who makes it (my vet's closed tomorrow) I'll see if I can get a sample from the drug company. Please e-mail me privately but to post to the group, as others may need this info in the future. Thank you very much! Lynn McIntosh & the gang of 8 sweet fuzzies -------------------------------End of LIst #6---------------------------