From: Lynn McIntosh [faiml@uswest.net] Sent: Monday, February 07, 2000 2:12 AM To: FAIMLanon; FAIML Cc: faiml@miamiferret.org Subject: FAIML #385; Feb. 6, 2000 Ferret Adrenal/Insulinoma Mailing List (FAIML) #385; Feb. 6, 2000 1. What else can I do? 2. Blue Shoulders 3. patch update 4. 4-hour seizures 5. Reply: FAIML #384; Feb. 5, 2000 6. more on Lupron-vs-lysodren post. 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. What else can I do? From: KFor651676@aol.com Date sent: Sun, 6 Feb 2000 14:34:04 EST My 4yr old female Phoebe has has both her left and right adrenal removed on two seperate operations. The right had cancer and I was told that they removed the majority of it and that it would most likely not cause any problem. She did terrible after the second surgery. She did not have enough hormones to survive having both adrenals removed. They say that it does not affect most ferrets but it affected her and she nearly died until we spoke to Dr. Weiss and he prescribed shots of DOCP every month. That was about 1yr. ago and she has been doing well the shots are keeping her alive. I am not to clear on why but I know they are. I don't know of anyone else that does this type of therapy. if you do please e-mail me. Know poor Phoebe is loosing hair agian after only having it back for less than a year. We have been struggling with this adrenal thing since she was 1yr! Vets kept saying she was too young. Both of her adrenals are gone or mostly gone how could she be showing signs of adrenal problems again. She is also very itchy. She has never had a normal coat change I thought maybe this was it? We live in Albany, NY. My poor strange Phoebe. She always has some strange ailment. Please help if you can!? Kelly Foran & Phoebe, Molly, Sid and Ellie 2. Blue shoulders From: "Heidi Lepak" Date sent: Sun, 6 Feb 2000 21:24:13 -0400 I hope this post doesn't sound to weird, and also that I will be able to describe what I see and make it understandable. You all know Silveretta by now, my little girl who has most of her hair missing and had Lupron about three ago. So it is very easy to see her skin color. Ok here goes. Last night we noticed that while looking down at her, her front shoulders have a blue color. Almost a cyonotic blue. The color does not go across the shoulders as there is normal skin color there. When you turn her over (amidst her wigglies) the upper arm pit area also has this blue color. Though again, it does not continue across her chest. There is no change in her personality or her activity. The area is not cold, but the same temp as the rest of her body. The area does not bother her, so I don't think it is a bruise. Has anyone experienced anything like this?? This was the area where she had her Lupron shot, and I was aware that she might get a sterile abscess from the shot and not to be concerned about it, but this is not even a swollen area. It almost looks like someone took some blue coloing and painted her shoulders. We survived the Petsburgh Critique www.geocities.com/Petsburgh/Zoo/3133 http://communities.msn.com/Ferret ICQ# 33966544 Defending those who cannot defend themselves! http://www.geocities.com/Petsburgh/Haven/2303 3. patch update From: dagger4u@home.com Date sent: Sun, 06 Feb 2000 20:31:36 -0800 well, we took patch to the vet again. We did some more xrays and what showed up was alot of excess gas in his intestines. Most of his intestines were pushed to one side as well, however, there is no identifiable mass. The vet gave him an injection of metoclopramide which he said should hopefully calm things down, stop the nausea and maybe push out whatever was in there. This weekend he is a whole new ferret. He had 3 huge bowel movement within 8 hours of having the shot, his nausea is gone and he has been 100% better this whole weekend. It's now sunday. I think we almost have it under control. With careful watching, we might just lick this thing yet. Only time will tell if we have fixed the problem, but so far so good. He will be going for a check up within 2-3 weeks if all goes well. Cross your fingers. thanks for all the suggestions, they helped!!! KIM and the furry six 4. 4-hour seizures From: "Michael F. Janke" Date sent: Sun, 6 Feb 2000 08:17:10 -0500 > 1. Input needed ...please help!! > From: "Michele" > has a mass inside his pancreas he has infectious hepatitis I have never heard of a ferret with infectious hepatitis, but that doesn't mean much. As for ulcers... carafate works well to protect the stomach lining. Also consider Amoxicillin/metronidazole (and maybe bismuth?) treatment for helicobacter. > his insulinoma..he has been having seizures everyday since this > past Tuesday > even with increasing his meds..My vet told me there is nothing I > can to to make > him come out of his seizures which have lasted for over 4 > hours..all I can do is > watch him shake drool and pant and paw at his mouth.. This has to be the worst case(length and frequency of seizures)that I've ever heard of. Have you considered surgery? Something needs to be done for the poor little guy. An IV injection of dextrose solution would bring him out of the seizure very quickly I suspect, but is that something he should (or could) be subjected to every day. Is he at the maximum dosage of Pred and Proglycem? The max for pred is 2mg/kg, twice a day and for proglycem it's something like 60mg/kg a day. Are you feeding him frequently? At least four times a day? Michele, you have to start to consider whether or not you're doing the best thing for Bandit by trying to keep him going through this. I know euthanasia is not something you want to think about, but if you're doing all that can be done and he's having 4 hour seizures every day, it isn't a very good quality of life for him. For the ferrets, Mike * Michael F. Janke, mjanke@miamiferret.org * Secretary, South Florida Ferret Club & Rescue * A 501(c)3 not-for-profit corporation * * Shelter web site: http://www.miamiferret.org * Adrenal/Insulinoma web site: http://www.miamiferret.org/fhc 5. Reply: FAIML #384; Feb. 5, 2000 From: Melissa Date sent: Sun, 6 Feb 2000 01:10:59 -0500 >1. Input needed ...please help!! >From: "Michele" >Date sent: Sat, 5 Feb 2000 22:22:30 -0500 > >Hi I just came back from the vet today with my other ferret named Fatbert who >has stopped eating and drinking....His right adrenal is enlarged he has a mass >inside his pancreas he has infectious hepatitis he has most likely an ulcer he >might have insulinoma,but he wont know until Monday First of all, helicobacter (which can cause ulcers) can cause high liver enzymes. Not eating can cause hypoglycemic episodes w/out neccesarily having insulinoma. The most reliable blood test for insulinoma is an in house blood glucose test, not the ones they send out. Go to http://www.ferretcentral.org , go to the medical FAQs and read up on Helicobacter and ECE if you'd like to learn more about treating ulcers. Print copies for your vet too. >....one bandit who is not doing well with >his insulinoma..he has been having seizures everyday since this past Tuesday >even with increasing his meds.. What meds is he on and how much? 4 hours is too long for a ferret to have repeated seizures w/o adequate treatment. -Melissa >3. Weasel & Dr. Marx >From: hjdom@webtv.net (Holly Domanick) >Date sent: Fri, 4 Feb 2000 10:31:12 -0500 (EST) >I also have a male who drinks his pee. He doesn't when he is in his cage. When >he comes out to play he tries to drink as much as he can until I get to him. He >started doing this after he was really sick and almost died in March 99. He is >a healthy 3 1/2 lb.boy now. I have had blood work done twice and it comes out >ok. I guess it's just a bad habit. Have you tried putting some clean water out in a bowl for him when he's out of his cage? It could also be some kind of electrolyte or salt imbalance if this started after he got sick. But if the blood work comes back normal, it's hard to know what it is. Maybe a little pedialyte would help if he doesn't have bloodsugar problems? Just thinking out loud. -Melissa >7. Lupron/Dr. Weiss >Date sent: Fri, 04 Feb 2000 11:41:42 -0800 >From: Linda Knights > >RE: Dr Weiss - > >You said: Dr. Weiss has lots of Lupron info up on the web and is very >"visible" >so most internet ferret people consider him to be an expert on the >subject. Bear >in mind though that this is one vet's experience. > >Melissa - can you share the web address with us on this vet? I'm not >familiar >with it. > >Linda K >(and 14 fuzzy little friends)Send reply to: Hee hee! You want me to reply to Mike's email address? It's his site that I'm thinking of :) http://www.miamiferret.org/fhc . Dr Weiss also gets lots of positive press on the mailinglists and newsgroups. He also just started up his own site: http://www.ferretdoctor.com/ At this time, however, Mike's site still has more of his info. Most ferret owners on the internet think of Dr. Weiss as a ferret expert. Off the internet, he's not as well known. But that may change in time. -Melissa __________________________________ http://members.aol.com/NYCFerrets http://home.att.net/~The_Ferrets __________________________________ 6. more on Lupron-vs-lysodren post. From: AFERRETVET@cs.com Date sent: Sun, 6 Feb 2000 02:04:29 EST Hi again, Seems like I started a little debate on Lupron-vs-Lysodren. I'll give you a simple explanation. Lupron stops the stimulation to the adrenal glands which stops the production of the sex steroids and the androgens.[Remember it is the sex steroids and the androgens that cause the problems in ferrets. Cortisol is the problem in dogs and people.] Lysodren destroys the cortisol producing cells in the adrenal glands and some of the cells in the zone that makes the sex steroids and androgens. Unfortunately lower cortisol levels will lower the blood glucose levels which is a serious problem in ferrets, especially if they have an insulinoma! It does not stop the stimulation to the adrenal glands, and it does not work well on adrenal tumors. Thus it may do more harm than good. Someone commented that the Lupron info was based on dog/cat studies. That is not true. We do not use Lupron in dogs or cats. [We do use Lupron in chronic egg laying birds (especially cockatiels) This is a photoperiod related problem also.] The manufacturer of Lupron (Tap Pharmaceuticals) did alot of animal studies on rats, mice, dogs, rabbits, and monkeys, so we know it is safe. Again this is a human product and not one that we use on dogs and cats. Lysodren is the drug that we use on dogs and cats with cortisol excess from adrenal hyperplasia or tumors. Someone commented that Lupron works on the brain to correct some of the behavorial problems. That is about half true. It works at the hypothalamus level to stop the stimulation to the adrenal glands, but NO it is not a behavioral modification drug. For those of you who want more detailed info then read my next post. Jerry Murray, DVM Animal Clinic of Farmers Branch Dallas,TX. Hi Lynn, I’ll try to explain how and why Lupron works and how Lysodren works. However it takes alot of adrenal physiology, endocrinology, and pharmacology, so that is where I’ll start. ADRENAL PHYSIOLOGY: The adrenal gland is divided into 2 big sections: the cortex and the medulla. The adrenal cortex is the section where the majority of the problems arise from (hyperplasia, adenomas, and carcinomas). Tumors from the medulla are called pheochromocytomas and are rare in ferrets. The adrenal cortex is subdivided into 3 zones. The outer zone is the zona glomerulosa, and it secretes mineralocorticoid hormones (mainly aldosterone). The middle zone is the zona fasciculata (it comprises about 70% of the cortex), and it secretes the glucocorticoid hormones (mainly cortisol). The inner zone is the zona reticularis, and it secretes the sex steroids (estrogens, progestins, testosterone) and the androgens (DHEA,and Andro.). In people and dogs, adrenal hyperplasia and tumors overproduce cortisol (ie zona fasciculata) and are called Cushing’s disease or Cushing’s syndrome. In ferrets it is quite different. Ferret adrenal hyperplasia and tumors overproduce the sex steroids and the androgens (ie zona reticularis). In ferrets it is called hyperadrenocorticism, not Cushings. Now for the ENDOCRINOLOGY part: In dogs and people, the normal hypothalamic-pituitary-adrenal axis is straight forward. The hypothalamus secretes CRH which stimulates the pituitary to secrete ACTH which stimulates the adrenal glands to secrete cortisol. The cortisol has negative feedback to the hypothalamus and to the pituitary to stop the stimulation to the adrenal glands. In canine Cushings disease there is an adenoma or hyperplasia of the ACTH secreting cells in the pituitary gland. This over secretes ACTH which stimulates the adrenals and results in adrenal hyperplasia ( ie zona fasciculata)and cortisol being over secreted. This is called pituitary dependent hyperadrenocorticism and occurs in about 90% of the canine cases. Actual adrenal tumors (Cushing’s syndrome) are about 10% of the canine cases. Again these cases over secrete cortisol. In ferrets it is actually a modified hypothalamic-pituitary- gonadal axis (where the adrenal glands are acting like gonads due to early spay/neutering and the long day photoperiods) that is involved. The hypothalamus secretes GnRH which stimulates the pituitary to secrete LH and FSH which stimulates the adrenal glands (zona reticularis) to secrete the sex steroids (estrogens, progestins, testosterone) and the androgens (DHEA and Andro). In ferrets there is no pituitary tumor. It is the long day photoperiod and early spay/neuter that stimulates the hypothalamus to over secrete GnRH which stimulates the pituitary which stimulates the adrenal glands. This over stimulation leads to hyperplasia or tumors of the adrenal glands (zona reticularis) and the over production of the sex steroids and the androgens. Now for the PHARMACOLOGY part: LUPRON DEPOT is a synthetic analog of GnRH. It acts as a potent inhibitor of GnRH secretion. This results in decreased levels of LH and FSH. This results in decreased levels of the sex steroids and the androgens. These decreases occur within 2-4 weeks and have been demonstrated to last for more than 5 years with continuous use in people. Many animal studies were done by TAP Pharmaceuticals in rats, mice, dogs, monkeys, and rabbits. In humans it is used to treat endometriosis, uterine fibroids, mammary tumors, and prostatic tumors. In ferrets Lupron works by the same mode of action. It stops GnRH secretion by the hypothalamus, which stops LH and FSH secretion by the pituitary, which stops the stimulation to the adrenal glands, which stops the production of the sex steroids and adrogens by the adrenal glands (zona reticularis). The improvement in clinical signs is usually rapid and impressive. Typically the vulva will return to normal size in 1-2 weeks, and hair stops falling out in 2-3 weeks, and hair regrowth starts in 1-2 months. Completely normal haircoats take 2-5 months. The ferret I saw on Friday (2/4/00) was just 4 weeks since her first dose. The vulva was normal in size and new hair was already growing at the rump and base of the tail area. See MODERN FERRET (May/ June 1999) for an article by Dr Charles Weiss plus before and after photos. Lupron depot is safe. I have only seen 1 minor side effect (on only 1 ferret). It was purple striae on the caudal, ventral abdomen that resolved in a few days. Lupron does not lower cortisol levels or glucose levels. Unfor- tunately it does not work as well in cases of carcinomas, but it works well in hyperplasia and adenomas. To answer your questions about biopsy studies, and ultrasound studies: The only controlled study on Lupron in ferrets is on going through the University of Tennessee. Preliminary results verify a reduction in the sex steroids and androgen levels. To do a “biopsy” study would require surgery. This a drug for ferrets that are not good surgical cases or where owners object to surgery. Thus no biopsy studies have been done. Ultrasound is not an accurate enough test for adrenal gland disease. In a study at the Animal Medical Center in New York City (Dr Karen Rosenthal, etc.) only 50% of the diseased glands were diagnosed by ultrasound. In addition you would need a control group that was left untreated to compare adrenal gland size differences with. Thus the only studies are based on clinical signs and the most accurate test: hormone levels. Again the results have been good. LYSODREN is a chemical derived from the insecticide DDT. It has been used in dogs for the past 25 years. It works by destroying the cortisol producing cells (zona fasciculata) and some of the cells in the zona reticularis. It works well in canine adrenal hyperplasia because cortisol is being over secreted. Side effects of lysodren in dogs include GI irritation (vomiting and anorexia), CNS signs (ataxia, weakness, and seizures), hypoglycemia, and a moderate increase in a liver enzyme (alk phos). In dogs adrenal tumors are relatively resistant to Lysodren. In a histopath (“biopsy”) study in dogs, the zona fasciculata was destroyed in the hyperplasia group, but the tumor group contained a clear description of the tumor histology. Clinical response also shows that adrenal tumors are relatively resistant to lysodren. Lysodren in ferrets has 2 problems. It does not work well, and it produces low blood glucose (hypoglycemia). Dr Karen Rosenthal writes, “in my experience, mitotane (lysodren) does not reliably produce resolution of the clinical signs in ferrets..” “The primary danger associated with mitotane (lysodren) administration in ferrets is the possible development of severe hypoglycemia after several days of therapy in animals with concurrent insulinoma.” Dr Susan Brown does not recommend giving Lysodren if they also have an insulinoma. Dr Charles Weiss even goes farther by saying “..mitotane is not recommended for ferrets with hyperadrenocorticism.” In my opinion Lupron works better, is safer (no change in glucose level), and has little or no side effects. Dr Cathy Johnson- Delaney presented info on her clinical use of Lupron at the exotic pet medicine seminar at Texas A&M (Dec 97). I talked to her then and since then, and to Dr Weiss about Lupron. We all agree it works well and is safe. I hope you see how these 2 drugs work quite differently. Lupron stops the stimulation to the adrenal glands which stops the production of the sex steroids and the androgens. [Remember it is the sex steroids and the androgens that cause the problems in ferrets]. Lysodren destroys the cortisol producing cells in the adrenal glands and some of the cells in the zona reticularis. The lower cortisol level lowers the blood glucose level which is a serious problem in ferrets, especially if they have an insulinoma! It does not stop the stimulation to the adrenal glands, and it does not work well on adrenal tumors. Please note there have been no biopsy study, ultrasound study, or hormone study with lysodren in ferrets that I know of. If you have any other questions, just let me know. Thanks , Jerry Murray, DVM ----------------------- End of FAIML #385 -------------------------