LBAH Informational Articles

C-Section (Guinea Pig)

Hi, my name is Leonardo (I’m the cute brown guy in the picture), and this is the story of how me and my brother Luigi came to be in the summer of 1997. If Luigi looks a little sleepy its because we are only 30 minutes old.

C Section Guinea Pig

Our Story

My little mom was doing fine throughout most of her pregnancy, taking her daily 6 hour naps, watching Oprah, and eating plenty of pellets fortified with Vitamin C. She only had morning sickness for the first few days, of course when your gestation is only 62-75 days, a couple of days of morning sickness is significant.

When the magic moment came little mom was just too pooped out from all the excitement, so big Mom took us to see Dr. Ridgeway at the Long Beach Animal Hospital. He knew exactly what was going on and started making little mom feel better (which made big Mom feel better also).

Once little mom was resting comfortably and watching Oprah again, Dr. Ridgeway came in and told big Mom we would have to perform a C-Section because little mom did not have the energy to finish the job. I have to finish the story later because I am getting sleepy from the anesthesia they are giving little mom……

Show and Tell

Once Dr. R and big Mom decided little mom needed a C-Section, Dr. Palazzolo anesthetized little mom. I don’t remember exactly what he said next because I was getting groggy, but it was something to the effect “my god, she is so big she barely fits into the anesthetic mask”.

Anes

The following area contains graphic pictures of an actual surgical procedure performed at the hospital. It may not be suitable for some children (and some adults also!).

As soon as little mom was anesthetized Dr. P went to work. He made an incision in little moms bulging (she went from a size 5 to a 16!) tummy while me and Luigi were fast asleep. He rapidly cut through little moms tummy muscles and exposed the uterus because me and Luigi might not do to well if we stayed under anesthesia too long.

guinea pig csection

That’s me and Luigi still in little mom’s uterus. Dr. P made a quick incision in the uterus and next thing I know I am rudely awakened from my sleep and getting my bottom slapped-what an indignity!

guinea pig uterus

Dr. P made sure little mom was put back together real well, with as rough as me and Luigi play with her, that’s real important. Here is he sewing her muscle layers back together.

guinea pig c-section

Here is little mom’s bikini scar when the surgery is complete. Me and Luigi had dibs over which of little mom’s nipples we would get.

Guinea Pig C Section

Our first piggy back ride! Now if only Luigi would turn around I could see where we are going

gpig csection

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Rat Mammary Tumor

Rats are prone to tumors, commonly in the mammary glands and in the uterus. These tumors can be benign or malignant. Removing them as soon as they are noted makes for a much better prognosis.

This page has photos of an actual surgery to remove a mammary tumor. It was performed using the laser

Graphic photos to follow.

 

Appearance

In addition to the usual underside location of mammary tissue found in most mammals, rats have mammary tissue under the skin along the top and the sides of their bodies. If this extensive network of mammary tissue develops a tumor, the lump that is present can be found most anywhere on the trunk of the body. The following pictures show some of these locations:

This large tumor was almost inoperable.

 

Its hard to believe that someone would let a tumor get this large before they would bring their rat in for care.

 

This is a different rat from the one above. This rat is prepped for surgery to remove its large tumor.

 

 

Laser Mammary Surgery

This mammary tumor is in the armpit

Surgery-RatMammary

The carbon dioxide laser is used for this surgery

Surgery-RatMammary-2

There is no bleeding when making the skin incision

Surgery-RatMammary-3

There is almost no bleeding at the actual tumor, even though tumors tend to have an extensive blood supply

Surgery-RatMammary-4

The tissue that remains after the tumor is removed has no bleeding. This is important since small blood vessels that normally ooze blood and cause swelling when a scalpel and scissors is used are cauterized when using the laser. No blood means no hematoma and much greater patient comfort.

Surgery-RatMammary-5

This lack of bleeding extends to the skin incision also.

Surgery-RatMammary-6

Laser Surgery

Performing surgery with the carbon dioxide laser has obvious advantages for this and other surgeries. To learn more about the use of laser in surgery follow this link.

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Spay Ferret

If female ferrets go into heat and do not mate or are not spayed, they can develop a severe, and even life threatening anemia. This is because estrogen can cause the bone marrow to stop producing red blood cells. If your female ferret develops an enlarged vulva it should be brought in for an exam immediately to determine if it is in heat or possible has an adrenal gland problem.

This page contains graphic pictures of an actual surgical procedure performed at the hospital. 


Physiology

Female ferrets have a unique reproductive system. Most female mammals have a heat cycle the phase in and out of, whether they mate or not. Ferrets are induced ovulators, and will stay in heat until they mate. While in heat a female ferrets secrete high levels of estrogen. If this hormone stays in the blood for a prolonged period of time, as what occurs when the female does not mate, it will affect the bone marrow. The white blood cells are not produced in adequate numbers, and the ferret becomes much more susceptible to an infection. Also, a serious anemia will arise, and will be life threatening if not corrected. If your ferret is not being bred then it must be spayed or the problem of life threatening bone marrow suppression will present itself when it goes into heat.

Pre-Operative Preparation

Please take away all food and water the morning of surgery (do not fast a ferret for more than 4 hours) and bring your pet to the hospital between 7:30 AM and 9 AM the day of surgery. It will go home in the late afternoon the day of surgery. Please call our office at 4 PM for pickup time, you will be given post operative instructions then.

Anesthesia

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine. All of our spays receive a physical exam prior to surgery. After this exam will we draw a small amount of blood for an in-hospital pre-anesthetic test. When everything is to our satisfaction we will administer a sedative. This will calm the pet down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

This is a sterile abdominal surgery, and our surgeon starts the pre-surgical process by using special soap to clean his hands

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While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments. Our surgeon is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

OVH-rabbit-2

OVH-rabbit-3

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Surgery-Monitor

In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters

Rabbit-femurfx-9

Surgery

The first step in the surgical process requires an incision in the skin and muscles of the abdomen. There is a specific anatomical location where the incision in the muscle is made, called the linea alba. An incision here bleeds very little and gives us a strong tendon to hold sutures when we close the incision.

In this picture the skin incision has already been made and we are using a scalpel to incise the linea alba.

A scissors is used to extend the linea alba incision. Now we have access to the abdominal structures.

This incision gives us a full view of the abdomen and its structures. Before we can find the uterus we commonly encounter fat, intestines, spleen, and even urinary bladder.

The uterus needs to be exteriorized from the abdomen for the spay to proceed. In this view one horn of the uterus is exposed. The arrow points to the location of the ovary, buried in fat.

Sutures are placed around the ovary and it is removed form the abdominal cavity along with the rest of the uterine horn.

The same procedure is performed on the other ovary. The black arrows point to the ovaries that were just removed. The blue arrow to the right points to the location where the uterus will be removed from the body. Everything to the left of this blue arrow is removed during the procedure.

This is what remains at the cervix after it has been sutured and the rest of the uterus removed. This small amount of remaining uterus will be placed back into the abdomen.

It is very important that the linea alba is properly resutured. a hernia with actual spillage of abdominal organs can occur if the sutures aren’t placed properly.

When all of the sutures have been placed (in this case they are stainless steel) there is a solid seal in the linea alba. These sutures cause minimal tissue reaction and have tremendous holding ability. They will stay with this pet for the rest of its life, and will even show up on an x-ray of the abdomen.

Several different types of sutures can be put in the skin incision. This type, called subcuticular, makes is difficult for the ferret to chew them out because the sutures are under the skin surface. These sutures will dissolve by themselves, so there is no need to remove them.

At this point in the surgery a pain injection will be given and the patient allowed to wake up slowly. She will be ready to go home late in the afternoon, and by the next day, will resume her normal activity.

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Ferret Insulinoma

Tumors of the pancreas (insulinoma) can cause excess secretion of insulin, thus lowering the blood glucose (sugar) level to a point that a ferret can become ill. Unfortunately, this is a relatively common problem in middle aged and older ferrets.

Graphic photos on this page.

The end of this page has a short video on surgery to remove nodules from the pancreas.


Symptoms

Some ferrets do not show any symptoms, while others exhibit lethargy and weakness. There might be a decrease in appetite and weight loss. These symptoms might even come and go over a period of months. Some ferrets will have increased salivation and even a glazed appearance to the eyes, and might even collapse or have seizures.

FerretInsulinoma-Waking

Some ferrets are very weak due to their low blood sugar

Diagnosis

Some ferrets are diagnosed as having an insulinoma when an abdominal surgery is being performed for other reasons (adrenal gland diseasespayliver disease). This is especially true for the ferrets that are not showing any symptoms of this disease. For those ferrets that are symptomatic of insulinoma, the diagnosis is made based on history, examination findings, and diagnostic tests.

Our laboratory has a special blood panel for ferrets that are exhibiting signs of insulinoma.The diagnosis of insulinoma is verified by a low blood glucose (sugar) level.

FerretInsulinoma-Glucometer

We use a special instrument to check the blood glucose level that only requires a few drops of blood. If you have ever tried to get blood from a ferret you would understand the importance of being able to do this test with only a few drops of blood

Medical Treatment

Medical therapy can be effective at controlling symptoms, although it can not cure the disease. Food should be fed frequently, and should consist of cat food or ferret food. Stay away from high sugar foods that can stimulate the pancreas to secrete excess amounts of insulin and set the stage for a hypoglycemic (low blood sugar) episode.

Prednisone (cortisone) can be effective at controlling symptoms for several months to several years. It comes in a liquid or pill form, and is usually given twice each day, depending on what your veterinarian determines. It helps raise the blood glucose level without stimulating excess secretion of insulin like foods high in sugar.

Other medications can be used if prednisone is not effective. These drugs are more expensive and have the potential to cause vomiting and appetite loss. Your veterinarian will let you know if they are indicated in your situation.

If your pet has an episode of hypoglycemia it should be given Karo syrup, Nutrical, honey or other foods high in glucose to temporarily raise the blood glucose level. After giving a high sugar food feed it its normal diet to minimize excess secretion of insulin in the long run.

If your pet has collapsed and is unable to swallow, rub a small amount of honey or syrup on its gums. Only use just enough to wet the gums and take care not to be bitten if your ferret is having a seizure. When it regains consciousness feed it its normal diet and bring it to the hospital for an exam and blood glucose check.

Ferrets that are not eating well are also commonly fed Hill’s A/D.

Surgical Treatment

The following area contains graphic pictures of an actual surgical procedure performed at the hospital.

Younger ferrets or those that have adrenal gland disease simultaneously are candidates for surgery. Tumor nodules that are found on the pancreas are removed, helping to prolong survival time. In some cases we perform a partial pancreatectomy. In spite of the fact that surgery is performed some of these ferrets will need medical management. Survival time is variable after surgery, ranging from months to years.

Several pecautions must be taken when this surgery is performed. Ferrets can easily become hypothermic due to the anesthesia and the fact that their abdomen will be open during the procedure. They can also become hypoglycemic due to the stress of the procedure. Special precautions are taken to help mitigate these problems.

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This is a sterile abdominal surgery, and our surgeon starts the pre-surgical process by using special soap to clean his hands

OVH-rabbit-3

While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments.

OVH-rabbit-2

Our surgeon is ready to start before our patient is completely prepped. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

In ferret surgery pay particular attention to low body temperature (hypothermia) and low blood sugar (hypoglycemia). They are placed next to special hot water bottles throughout the procedure.

FerretInsulinoma-Temp

We keep a close tab on body temperature, before, during, and after surgery

Our patients are carefully monitored to detect any abnormality before it becomes a problem. This early warning system is important in such a small animal that is ill and undergoing anesthesia and major surgery.

Surgery-Monitor

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Rabbit-femurfx-9

Our surgeon and anesthetist work closely together

Rabbit-femurfx27

In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters. We use a special stethoscope (called an esophageal stethoscope) that is passed down the esophagus and can give us a clear sound of the heart.

FerretInsulinoma-Scrub

Our patient is carefully clipped and scrubbed

OVH-rabbit-4

Our surgeon does the all important draping after the final cleanse of the abdomen

FerretInsulinoma-Drape

 Under these drapes is a hot water blanket and also hot water bottles

FerretInsulinoma-Incision

When our surgeon is comfortable everything is in order he makes his skin incision 

FerretInsulinoma-Linea

There is a special location on the abdominal muscles called the linea alba.  You can see it as this white horizontal line between the muscles.

It is here that our surgeon cuts through the muscle and enters the abdominal cavity without cutting any abdominal muscles. This is a tendon that holds the abdominal muscles together, and is the area that has the best holding strength when we suture the area back together. If it did not have this strength, we would have an abdominal hernia.

FerretInsulinoma-LineaIncision

The scissors is used to make the cut through the linea alba into the abdomen

OLYMPUS DIGITAL CAMERA

 The pancreas is rapidly isolated and a insulinoma nodule is searched for visually and by palpation. Do you see the small nodule on the pancreas?

OLYMPUS DIGITAL CAMERA

The arrow will help you visualize the nodule

Many nodules are gently squeezed out

FerretInsulinoma-NoduleRemoved

This is a typical insulinoma nodule after removal from the pancreas

FerretHisto-Insulinoma

This is the report we receive from our pathologist confirming the diagnosis

FerretInsulinoma-Hemoclips

Sometimes these tumors need to be cut out. These are hemoclips, metal sutures that stop the bleeding of small vessels buried in the fat around the area.

FerretInsulinoma-Tumor

On occasion we encounter a pancreas that has a large tumor

FerretInsulinoma-LargeTumorArrow

The arrow points to the lower left edge of the tumor

After removal of any pancreatic tumors we check the rest of the abdominal organs for any problems. Ferrets are prone to many problems, and if we are doing surgery for a specific problem like insulinoma, we make sure to check the other internal organs.

FerretInsulinoma-Intestines

Our surgeon is carefully palpating the length of the intestines to feel for any abnormalities, especially foreign bodies and cancer.

FerretInsulinoma-Spleen

The spleen is assessed next in this patient. Even though it is large, it is not necessarily diseased. That nodule at the end is not significant.

FerretInsulinoma-LiverLobe

The liver is carefully assessed

Missy Miller 4/19/01

This one is cystic

A very important organ to check is the adrenal gland since adrenal gland disease is common in ferrets.

FerretInsulinoma-Kidney

This one is normal so it is difficult to visualize. It is the small pink circle of tissue that lies to the left of the dark brown kidney, which in this picture is surrounded by normal fat. Can you see it?

FerretInsulinoma-AdrenalArrow

The arrow helps identify it

After surgery our little patient is kept cozy warm, watched carefully for hypothermia and hypoglycemia, and monitored closely for pain.
FerretInsulinoma-FAce
This one is a little groggy, but feeling no pain
This short video goes through the important points of surgery to remove nodules from the pancreas and also remove an adrenal tumor. Notice how we use the laser to make the initial incision.

Prognosis

Insulinomas are malignant tumors that will decrease a ferrets life span and compromise its quality of life. This is a serious disease that does not lend itself to a cure or long term control. Longevity after diagnosis varies from weeks to years, and depends on the duration of the problem prior to diagnosis. The sooner we make the diagnosis, the more that can be done to treat the problem and increase a ferret’s quality of life and lifespan.

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Ferret Adrenal Disease

Tumors of the adrenal gland in ferrets can cause excess secretion of sex hormones, thus affecting many organs in the body. Unfortunately, this is a relatively common problem in middle aged and older ferrets. Even though most of these tumors are not malignant, they can cause significant disease if left untreated.

This disease goes by several names in addition to the one in the title of this page:

  • ADG- adrenal gland disease
  • AGN- adrenal gland neoplasia
  • ACD- adrenal cortical disease
  • AEE- adrenal associated endocrinopathy
  • FADC- ferret adrenal disease complex

FADC is probably the most accurate description, because as is the case with so many diseases, as we advance our knowledge over the decades, and develop more sophisticated diagnostic tools, we realize that most diseases are much more complex than originally envisioned. It is human nature to try to make things simple so they are easier to understand. This does not apply to most diseases we encounter in animals.

Dogs and cats get a problem similar to this, although it acts and is treated differently. In dogs and cats it is due to an excess secretion of cortisone, not sex hormones. In these species it is called Cushing’s disease.

At the very end of this page is a video of part of a surgery to remove cancerous adrenal glands and cancerous nodules on the pancreas.

The adrenal gland is small, so click on photos to enlarge them.

This page contains graphic photos from surgery and necropsy of deceased ferrets.

Physiology

This disease involves reproductive hormones. In a normal ferret, a hormone from the hypothalmus in the brain, called gonadotropin-releasing hormone (GnRH),  is released in larger amounts, usually due to an increase in daylight. This causes stimulation of luteinizing hormone (LH) and follicle stimulating hormone (FSH) from the pituitary gland.

These hormones stimulate the release of estrogen and testosterone from the gonads and adrenal glands (important point in neutered pets that have no gonads). A very sensitive negative feedback loop maintains just the right amount of estrogen and testosterone. This sensitive balance is upset in adrenal disease of ferrets.

In the medical treatment section we will discuss a drug called Lupron. This drug binds with receptors on the GnRH molecules and lessens its effects on the pituitary.

Cause

The exact reason this tumor arises is not completely known. It is seen more often in the U.S. than in Great Britain, where different breeding and husbandry practices are utilized. It is speculated that diet, exposure to sunlight, and neutering are all factors, with neutering being the most important one.

Ferrets breed seasonally, causing variation in melatonin release with varying daylight. Less daylight means more melatonin and a thick haircoat. This higher level of melatonin eventually exerts a negative feedback on the release of the sex hormones estrogen and testosterone. When ferrets are spayed and neutered the negative feedback is disrupted, more of these sex hormones are secreted than is normal, and clinical signs develop.

The three main types of adrenal lesion encountered are:

  • Benign nodular hyperplasia that occurs 56% of the time
  • Benign adrenocortical adenoma that occurs 16 % of the time
  • Malignant adrenocortical adenocarcinoma that occurs 26% of the time
  • A combination of the above

Anatomy

The adrenal glands are small glands located just in front of the kidneys. The left gland is embedded in fat just in front of the kidney, the right one is located deeper in the abdomen and under one of the liver lobes. The left adrenal gland is the one affected in almost all cases, which is advantageous surgically as you will learn.

Ferret-AdrenalFat

The arrow points to a normal left adrenal gland of a ferret. It is quite small and buried in fat in front of the kidneys. Click on the photo to enlarge.

Ferret-AdrenalCloseup

A close up to shows how tiny it can be when normal

Cushings-FerretAdrenal1

Here is another one at the top of the hemostat on the left. This one is inflamed, the with adrenal disease.

Rocky Walker 21218 Ferret Gastric tumor Blood supply to mildly inflamed left adrenal

The tip of this hemostat shows an inflamed adrenal gland. Note the large vein underneath it, called the adrenolumbar vein  This vessel makes this surgery intricate. You can see the adrenolulmbar vein (horizontal blue line) in this picture below the adrenal gland. This is what will be ligated when we show surgery pictures later.

Cushings-FerretAdrenal3

The adrenal gland to the right of the arrow is very inflamed

necropsy of Ash, the ferret with insulinoma kidney on right adrenal to left of kidney at cranial end

The adrenal gland to the right of the arrow is very inflamed

When a diseased left adrenal gland is not removed surgically it might eventually get extremely enlarged and cause substantial illness. Symptoms of adrenal disease would appear long before the gland gets this large.

The left 2/3 of this picture is a diseased adrenal gland. The right 1/3 of this picture is the kidney, showing just how large this adrenal gland became as this ferret aged. The adrenal gland is so diseased that it is literally rutpturing, as can be seen toward the top left of the gland.

Ferret-LiverCoveringAdrenal

The right adrenal gland is under the right lobe of the liver, adjacent or attached to the vena cava (VC). The vena cava is the major return of all the blood from the back of the body to the heart. The liver has to be pulled away to visualize the adrenal gland, which is why you cannot see the adrenal gland in this photo.

Ferret-AdrenalNormalRIghtVC

When you pull the liver lobe forward you can see the enlarged right adrenal gland to the right of the arrow. You can also see how the adrenal gland is adhered to the vena cava, which makes surgery to remove a diseased right adrenal gland problematic, to say the least.

Ferret-RightAdrenalVC

A different view of the right adrenal gland and its close association to the liver and vena cava (VC)

In this picture we have both right (on the bottom) and left (on the top) adrenal glands of the same ferret. The white arrow in the lower left of this picture points to a normal right adrenal gland. It is very small because it is normal. On the left, above this right adrenal gland, is a lobe of the liver (L) that has to be pulled forward during surgery in order to get access to the right adrenal gland. The posterior vena cava is the large blue vein running horizontally. The abnormal left adrenal gland can be visualized to the left of the arrow on the top right.

Ferret-LargeRtAdrenal6

Sometimes the tumor on the right side gets greatly enlarged. Here is is intertwined with the right kidney and the  vena cava (vertical blue line to the right of the tumor).

OLYMPUS DIGITAL CAMERA

Here is a different angle of this same tumor showing just how large it is

Physiology

These small but very important glands have numerous roles you can learn more about in our Cushing’s page. It gets very detailed, so be prepared to learn some anatomy and physiology before you return back here to learn about adrenal disease in ferrets.

The adrenal tissue in ferrets normally secretes several sex hormones. The important ones are:

  • 17 – OHP (17 alpha hydroxyprogesterone)
  • androstenedione
  • DHEa (dehydroepiandrosterone sulfate)

It is postulated that these hormones are secreted from the adrenal glands after chronic stimulation from follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. Indoor housing of ferrets, leading to more light than ferrets in the wild, is postulated to also stimulate release of LH, along with gonadotropin releasing hormone (GnRH) from the pituitary gland. The end result of this hormone imbalance is excess secretion of estrogen in females and testosterone in males. This causes the vulva to enlarge in females, and a return to male sexual behavior in the male. The enlarged vulva is easy to see, which might be the reason we diagnose this problem more often in female ferrets.

A special lab in Tennessee can check for excess amounts of these hormones on a blood panel, an important help in the diagnosis of this disease.  A ferret can have normal values on this test, yet still have adrenal gland disease. This is why we always follow the tenets of the diagnostic process.

Symptoms

Hair loss

The most common symptom of adrenal disease in ferrets is hair loss, sometimes with itchiness (pruritis). Itchiness due to adrenal disease an also be present with no hair loss. The most likely spots for hair loss are the tail area and rear legs. Hair loss in dogs and cats is almost always caused by a different problem. This hair loss occurs in over 80% of the ferrets with this disease.

Some ferrets with adrenal disease do not show any symptoms, while others exhibit varying degrees of hair loss and even enlarged vulvas in spayed females. The hair loss can be seasonal, can come and go, but eventually it progresses to almost complete baldness.  It has been observed that mast cell tumors in ferrets can also cause hair loss.

 

Hair -loss-tail-ferret

Hair loss can be anywhere on the body. This is typical of the hair loss that can occur at the tail

It can sometimes be more extreme as the seasons progress

Difficulty urinating (stranguria)

Male ferrets sometimes have difficulty urinating in addition to hair loss. Even if they are neutered there might be a return to normal sexual behavior. There might also be lethargy, a decrease in appetite and weight loss.

In male ferrets cysts can occur in the small amount of prostatic tissue they have. They can also get a bacterial prostatitis causing these symptoms. This can cause difficulty in urination, which can affect the kidneys if it progresses. On rare occasion this problem can progress to complete inability to urinate due to the enlarged prostatic tissue.  Inability to urinate is a medical emergency, and needs immediate attention to save the kidneys and prevent the bladder from rupturing.

distendedbladder

A urinary bladder that is so distended that a pet cannot urinate is diagnosed on palpation during a physical exam. It is confirmed with a radiograph, as in this cat that cannot urinate. If we run a blood panel on this animal we will see what is called post renal azotemia, a sign the kidneys are shutting down. Our kidney page has much more detail on this.

Ferret-DistendedBladderNecropsy

This is the necropsy picture of a severely distened bladder in a ferret that did not make it

Ferret-LateralRadCatheter

When a ferret is presented in this state we have to immediately catheterize them. You can see the tip of the catheter at the arrow as it is in the lumen of the urinary bladder. The catheter was placed through the tip of the penis, and gently pushed past the pelvic urethra and into the bladder. You can see all of this if you enlarge the photo.

Radiopaque dye was put into the urinary bladder to make sure there was no rupture

Ferret-Penis

Note also the unique shape of the tip of the penis in the ferret. It has a bone in it (just like the dog) called the os penis. The tip of the os penis in the ferret is curved, and the opening is very small, making catheterization difficult.

Stones in the urethra and bladder can also cause stranguria, so we cannot always assume adrenal disease is the cause of a ferret that is straining to urinate or cannot urinate.

Ferret-UrethralStones

These are what stones look like in a ferret urethra

Ferret-BladderStones

The same stones after removal from the urethra

Male ferrets with adrenal disease might also return to typical male sexual behavior or mounting, whether it is a female or a male they are mounting. Aggression can occur, and seems to occur more in ferrets with malignant adrenal disease (adenocarcinoma).

Swollen vulva

In years past, before all ferrets were routinely spayed, an enlarged vulva in a sick ferret was a sign of a ferret that did not mate when it was in heat. Being an induced ovulator, meaning jills would only release eggs from their ovaries when they mated, jills that did not mate would secrete an excess of estrogen for a long period of time.

This excess estrogen was toxic to the bone marrow, and would cause a severe life-threatening anemia that few would survive. The technical term was aplastic anemia. When we had a sick unspayed ferret with an enlarged vulva we would run a blood panel. The anemia would show up as  severely low RBC’s (red blood cells), HGB (hemoglobin) or HCT (hematocrit).

Ferret-SmallMammalProfile

Our lab runs a special blood panel for small mammals like ferrets

Ferret-AdrenalCBC

This ferret has a hematocrit (HCT) of 15.5 %, typical of a ferret with aplastic anemia. It should be at least 43% at this lab.

Now that all ferrets are spayed and neutered upon purchase in the United States, we no longer see this type of anemia. When we have a ferret with an enlarged vulva we know it is most likely due to adrenal disease, especially if hair loss is present also. Retained ovarian tissue form a spay can cause this on rare occasion.

The arrow points to an enlarged vulva typical in females with adrenal disease

Lethargy and muscle atrophy

Occasional symptoms might include lethargy and muscle atrophy. Abdominal muscle atrophy can also cause the pot-bellied appearance seen in Cushing’s disease of dogs.

Ferret-HairLossMuscleWasting

Sometimes the muscle atrophy is severe, and is also caused in conjunction with other common ferret diseases, notably cancer in the intestines or lymph nodes. The bulge on the left at the back end of this ferret is the right kidney.

Diagnosis

Signalment

This tends to be a disease of neutered male and female ferrets with an average age of 3 years. It be seen earlier and later than these age groups.

Symptoms

Although enlarged adrenal glands can be palpated during an examination, this is not usually the case. A large number of adrenal tumors are confirmed during routine exploratory surgery, especially if the ferret exhibits the typical pattern of hair loss and an enlarged vulva in the female, or straining to urinate in the male. Exploratory surgery is a common way to verify the diagnosis and correct the problem. During this surgery we routinely check other organs for problems, especially the pancreas for tumor nodules that might be an insulinoma.

Physical Exam

This might reveal pale gums and heart murmur if there is a significant anemia. If the adrenal gland is on the left (most cases), and it is large enough, it might be possible to feel it during abdominal palpation.

We perform a complete physical exam on all our patients. This is particularly important due to their propensity to get other diseases besides adrenal gland disease.

Ferret-EnlargedSubMandLN

This ferret has an enlarged submandibular lymph node. Unfortunately, in the case it was malignant cancer called lymphosarcoma. We have a detailed page that talks about lymph nodes.

Adrenal Panel

Sex hormone assays are very helpful in the diagnosis also, particularly to rule out other diseases. Pioneer work on these hormones was done at the University of Tennessee, and it is where we send all of our hormone tests on ferrets. You learned about these hormones in the physiology section above.

A special blood sample can be performed to check hormone levels. This test can be used if the typical symptoms of hair loss and enlarged vulva or urine straining are not particularly prevalent. This sample is sent to a special laboratory that takes several weeks to report their results.

Ferret-AdrenalPanelNormals

This is their results based on 3,000 ferrets  with confirmed adrenal disease, on how much of an increase (the abnormal column) is needed above the normal column to be considered positive for ferret adrenal disease. They also noted that all 3 tests need to be run because on occasion estradiol was normal in a ferret that has adrenal disease.

This is how they report a sample back to us

This adrenal panel needs to be interpreted with regard to time of the year in the northern hemisphere, because even neutered ferrets can have seasonal variations in these hormones. This emphasizes the importance of the diagnostic process in making a diagnosis of this disease, and using clinical signs along with ultrasound, surgery,  and biopsy findings, to confirm a diagnosis.

Radiology

Radiographs are usually unhelpful in this diagnosis since it is difficult to see the adrenal glands. On occasion, due to size or calcification, we can get an indication the adrenal glands are enlarged on a radiograph.

This normal radiograph shows two overlapping kidneys (K) in the middle of the abdomen. The adrenal glands are located just to the left of these glands. They are not routinely visible on radiographs.

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Can you see the the large whitish area on this radiograph that could indicate a greatly enlarged adrenal gland?

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It has been circled for easier visualization

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Can you see it on this view of the same ferret?

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The calcified right adrenal gland has been circled

Ultrasound

Ultrasound is what is needed to visualize the adrenal glands in ferrets, and also dogs and cats in most cases. Ferret adrenal glands can be tiny, which is why we always call our radiologist to perform this test.

Radiologist are specialists in this area, and perform many dozens of ultrasounds on a daily basis. Their skill is extraordinary. Our radiologist, Dr. Ann Reed, is very experienced with ferrets, and is the only one we trust to perform our ultrasounds.

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Brenda is gently holding this ferret still for an abdominal ultrasound

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This G.E. ultrasound gives us the detail we need to see a very small organ

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Most ferrets enjoy the attention and tummy rub as we gently move the probe on the abdomen

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With ultrasound we can measure the size of the adrenal gland and determine if it is enlarged

Surgical Treatment

These ferrets sometimes come in very ill, and need medical stabilizing before we can proceed further. At this point in the exam we do not know what an individual ferret has, so we correct basic problems like dehydration, hypothermia, negative nitrogen balance, nausea, and hypoglycemia before proceeding further.

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Most ill ferrets are treated with IV fluids to correct dehydration. The IV catheter also allows administration of medication without having to inject into the muscle.

The primary method of treating adrenal disease in ferrets is surgical removal of the gland. The problem can occur on either the right or left adrenal gland (or both). In the overwhelming number of cases the problem is in the left gland only. Eventually, both glands are commonly involved. After surgery to remove the affected gland vulvar swelling decreases and hair growth starts within 1-2 months and returns to normal at 6 months in most cases.

The left gland is much easier to work with because it is in a fat pad above the left kidney. The right gland is much more difficult to approach because it is under a lobe of the liver and is attached to the posterior vena cava, the main vein that returns blood from the back end of the body to the heart. You saw that in the pictures at the beginning of this page.

In most surgeries we remove the diseased left gland, leaving the right gland alone.  Complete removal of both glands can cause serious complications. Sometimes removal of only one of the glands can cause a problem if the remaining gland cannot make up for the loss. If that is the case we might cause something similar to a disease called hypoadrenocorticism.

We take the same precautions in ferret adrenal gland surgery as we do in all pets. First we perform a pre anesthetic blood panel to check the internal organs. If everything is in order we perform a pre-anesthetic physical exam, and then carefully go through our checklist prior to anesthetizing our patient.

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This is a sterile abdominal surgery, and our surgeon starts the pre-surgical process by using special soap to clean his hands

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While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments. He is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around, in order to minimize anesthetic time.

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Only when everything is in order does our surgeon start the procedure

 In ferret surgery we have to pay particular attention to low body temperature (hypothermia) and low blood sugar (hypoglycemia). They are placed next to special hot water bottles throughout the procedure.

Our patients are carefully monitored to detect any abnormality before it becomes a problem. This early warning system is important in such a small animal that is ill and undergoing anesthesia and major surgery.

Surgery-Monitor

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

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In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters. We use a special stethoscope (called an esophageal stethoscope) that is passed down the esophagus and can give us a clear sound of the heart.

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Once our patient is draped we are ready to proceed

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We make our incision in a particular location in the center of the abdomen, called the ventral midline. We use a special scalpel made for a small animal like a ferret

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The next layer is a special muscle/tendon layer, called the line albs. It is important that we go through this particular area because this is the area that will be able to hold the sutures we use to sew the muscles back together, and thus prevent a hernia.

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A special surgical scissors is used to extend the incision

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Ferrets are little guys, so their surgical anatomy is small. In some surgical cases we use magnifying loops to help identify structures.

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This picture is from an actual surgery. The inflamed left adrenal gland, buried in fat, is in the center of this picture

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It is at the tip of this forceps after it has been dissected out of the fat

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Special stainless steel clips, called hemoclips, are used to ligate the blood vessels as we remove the gland

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This is the 1 cm diseased adrenal gland after removal, with some fat still around it

We sometimes use the laser on the larger glands to aid in hemostasis (control of bleeding). This is of great important in such a small animal because large tumors like the can bleed excessively. Our laser has revolutionized some of the surgeries we perform on small animals like a ferret.

 

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Cutting Cauterizing Bloodless dissection

During the surgery, and immediately after, we monitor body temperature to prevent hypothermia

We also check the blood sugar level when the procedure is finished and before the ferret is completely awake. Their veins are small and difficult to find, so it is much easier to do it when the ferret is still groggy from the anesthesia.

We test the blood sugar level right in the surgical suite so we can plan our post operative care

Here is our little friend nice and cozy right after her surgery. She has been given a pain injection and is being monitored closely.

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We continue to monitor temperature and blood glucose as our patient recovers

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This ferret had surgery 12 hours earlier and is doing great. After a nigh of observation by our staff it will go home in the morning. 

Whenever we perform an exploratory surgery (called a laparotomy) on an animal we check other internal organs for disease. This is especially important in ferrets due to their propensity for having other diseases.

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This is a picture of an enlarged spleen found during a routine adrenal gland surgery

We knew there was an enlarged spleen in this ferret because we could palpate it during an examination. This enlarged spleen was verified by a radiograph.

The black arrows outline the enlarged spleen. A kidney (K) is also visible overlying the spleen

This spleen was biopsied to determine whether this was a normal enlargement, called hypersplenism, or whether it was cause by cancer.

This picture shows cautery of the spleen after a small biopsy was taken

We have a very detailed page on spleen disease if you want to learn more

Another very important organ to check in ferrets is the pancreas due to a disease called insulinoma. In this disease the pancreas secretes too much insulin, the opposite of sugar diabetes (diabetes mellitus).

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Our surgeon is carefully palpating the intestines to check for intestinal cancer, and also the pancreas (the peach colored semi-circular area in the center of the intestines) for nodules that could indicate insulinoma

This ferret had a cyst on one of its liver lobes

Now that you know how we perform this surgery lets look at an abbreviated video of a ferret with an adrenal gland tumor and an insulinoma. You will also get a chance to see how we make a bloodless incision with the laser.

Medical Treatment

Much of the information on medical therapy for animals is anecdotal, and ferrets are no exception. With the ready availability of information on the Internet, the number of ferret organizations, along with the propensity for people to sell you most anything, people with sick ferrets can be desperate to try anything and will use medications that are unproven, and sometimes can make a condition worse. Our first goal as veterinarians when treating any animal is “first do no harm”.

Lupron

One of the best medications used to treat this condition is called Lupron, originally used to treat testicular cancer in men and endometriosis in women.

Lupron (Leuprolide) is a GnRH analog (remember the physiology section above) that minimizes the secretion of the sex hormones from the adrenal gland. Lupron does this by suppressing the production of FSH and LH from the pituitary gland. This decreases levels of estrogen and testosterone, and symptoms diminish.  It will decrease symptoms but not the size of the tumor.

It is usually given as an injection that lasts several months at least, all depending on the dose. We titrate the dose based on symptoms, age, weight, blood results, body condition score, and client compliance. Some ferrets exhibit a swelling at the injection site. This is of no cause for alarm and will usually resolve.

We have maintained ferrets on Lupron successfully for many years, so it has become a mainstay of our medical management after the left adrenal gland is removed. Long term effects of the chronic use of this drug are unknown. In some cases we also use only medical therapy, particularly if a ferret is not a good surgical candidate due to age or other conditions that are so common in ferrets.

Adrenal tumors are so common in the United States that some veterinarians that work with large numbers of ferrets even use Lupron as a protective plan with the following criteria:

Indoor ferrets that are exposed to unnatural photoperiods- give 1 mg Lupron Depot 4-month every 6-8 months starting at 4-8 months of age.

Outdoor ferrets exposed to natural photoperiods- 1 mg Lupron Depot 4-month annual in Feb or March in North America starting at 4-8 months of age.

Viadur, a 1-year Leuprolide implant is planned for the future.

Miscellaneous drugs with potential

The following medications have been used with varying success on adrenal disease in ferrets. Much more work needs to be done before we can recommend them routinely. There is concern that long term use of them can cause damage to organs like the kidneys. No long terms studies have been performed. They should be used when Lupron is not working, and adrenal profile hormones and ultrasounds should be performed every 3 months to monitor their effects, both good and bad.

Mitotane

This is one of the primary drugs used to treat dogs with Cushing’s. It is sometimes in conjunction with Lupron. It seems to show variable success only with cortical adenomas, and does not help adenocarcinomas. Its seems to work by chemically reducing the size of the affected adrenal gland. If a ferret has insulinoma at the same time, which is not uncommon, mitotane can cause hypoglycemia (low blood sugar) and a ferret can become comatose.

It is sometime used as pulse therapy, and symptoms of hair loss sometimes return after stopping Mitotane. As general rules, this drug, or in combination with Lupron, is only used on older ferrets with both adrenal glands affected and also a poor candidate for surgery due to other diseases occurring at the same time.

Deslorelin

This drug is a synthetic GnRH analog, and is used currently to reduce testosterone in dogs as a contraceptive. When given as a injection it is slow release and has helped reduce the typical symptoms of ferret adrenal disease.

Melatonin

Melatonin inhibits the release of GnRH, suppressing the amount of LH and FSH released into the bloodstream. It theoretically helps regulate hormonal control in a ferrets normal circadian rhythm of light and dark. It is in the form of a long acting injection or daily oral medication.

Melatonin can be used to stimulate hair regrowth, it does not suppress the adrenal tumor. If used prior to a physical exam it can mask symptoms, and cause the adrenal gland to become even larger before surgical removal.

It can cause lethargy, and should not be used in smaller ferrets. Ferrets can develop a tolerance. It should be used as an adjunct to Lupron.

Casodex

This oral drug blocks binding sites to testosterone. It will help minimize symptoms of adrenal disease, especially straining in the male ferret. It needs to be used one week on, one week off, for life. More information is needed before we can recommend this drug.

Arimidex

This oral drugs interferes with the enzyme pathway that converts testosterone to estrogen. It should not be used with Casodex since the two drugs will negate each other.

Prognosis

Most ferrets that have this surgery regain hair growth and do well for years. Even though most adrenal tumors are benign, recurrence can occur. A tumor can appear in the adrenal gland that is not removed at the time of  surgery, and symptoms can recur.

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Ferret Liver Cancer

Ferret’s are highly prone to several serious diseases. In addition to insulinomas and adrenal gland disease, they are also prone to cancer. This page shows a ferret that has a liver cancer.

Symptoms

Some ferrets do not show any symptoms while others exhibit lethargy and weakness and a distended abdomen. There might be a decrease in appetite and weight loss. Symptoms alone are not enough to diagnose liver cancer.

Diagnosis

Like most diseases, the diagnosis of liver cancer is made based on history, examination findings, and diagnostic tests. In this specific case an exploratory surgery was performed to verify the diagnosis and determine the extent of the problem. an ultrasound could have been performed also. Since ferrets are prone to so many internal organ diseases, and since exploratory surgeries can be performed rapidly and yield a large amount of information, it is common to perform surgery instead of ultrasound. Some ferrets are diagnosed as having cancer when an abdominal surgery is being performed for other reasons (adrenal gland diseasespayinsulinoma). This is especially true for the ferrets that are not showing any symptoms of this disease.

Blood samples are an aid in the diagnosis and can also be helpful to rule out other important diseases that might be occurring simultaneously. Our laboratory specializes in working with ferrets, and has a special blood panel for them.

We are commonly asked how the heck do you get blood from a ferret. They are certainly one of the more difficult patients to obtain blood from. This is where the expertise of our nursing staff comes into play. a very small needle is used because the veins are so fragile. This ferret is having its blood taken from a vein on the side of its rear leg.

This test tube is filled with fluid that was taken from a ferret that had a distended abdomen due to liver cancer. analysis of this fluid in conjunction with other diagnostic tests gives us a clue as to its cause.

A useful tool as an aid in this diagnosis is radiography. It gives us a clue as to the presence of fluid along with abnormalities of the internal organs.This ferret is laying on its right side, and has a distended abdomen due to a large liver and fluid in its abdomen. It also has a large spleen. In addition, there are 3 metallic clips visible just under the kidney from a prior surgery for adrenal gland disease. The clips were used to stop bleeding when the diseased adrenal gland was removed. The identified organs are: Liver (L), Stomach (S), Kidney (K), Spleen (SP) and Bladder (B).

a view of this same ferret while it is on its back shows the large area of the liver and the large spleen. Look carefully at the spleen because it is folded over on itself in this picture and is larger than it first appears.

Whenever we suspect cancer we take a radiograph of the chest to look for evidence that the cancer has spread. We use the chest for this radiograph because the small blood vessels that are located around the lungs act as a filter to trip cancer cells that have spread. The black background of the lungs allows us to visualize these cells that are white in color.

In this same ferret as above we are looking at a side view of its chest with the head to the left. The windpipe (W) goes from left to right, the Heart (H) is in the very center, and the air filled Lungs (Lu) are above the heart. To the right of all of these structures you can see the large white area that denotes the large liver.

Surgical Treatment

The above information gave us reason to suspect a high probably of liver cancer, so an exploratory surgery was performed. The owner was aware of the poor prognosis in this case but wanted to know for sure what was going on.

Several precautions must be taken when this surgery is performed. Ferrets can easily become hypothermic due to the anesthesia and the fact that their abdomen will be open during the procedure. They can also become hypoglycemic due to the stress of the procedure. Special precautions are taken to help mitigate these problems.

The following area contains graphic pictures of an actual surgical procedure performed at the hospital. It may not be suitable for some children (and some adults also!). 

Brandi is a high risk anesthetic patient. In addition to the usual precautions we take for hypoglycemia and hypothermia, we have to be concerned with the induction of anesthesia. a special induction chamber is used for Brandi to breathe in the anesthetic gas and slowly go to sleep. You can see her doing what ferrets do best when they fall asleep-curl up.

Once she is relaxed enough a small tube is put into her windpipe to allow us to give her 100% oxygen along with precise amounts of anesthetic. In this view you can see her breathing tube on the left. She has been clipped for surgery and her final prep is about to begin. The distended abdomen is obvious. The pink bandage on her left front leg is where her intravenous catheter (IV) is placed so that we can accurately give her fluids.

We made a rapid entrance into her abdomen due to her anesthetic risk. What we encountered was a abdomen filled with blood. In this picture there are intestines visible on the left with abdominal fat on the right. Encountering this much hemmorhage at the start of the surgery is not a good sign.

The tissue was very delicate and bled easily when touched. In this picture we are using a laser beam to cauterize bleeding blood vessels.

When the bleeding was relatively under control we slowly exteriorized the severely diseased liver, seen here under Dr. P’s fingers. The spleen is starting to become visible under the surgeon’s hands (arrow).

A closeup of this liver lobe shows how enlarged and hemmorhagic it is. For comparison purposes, a normal liver is below this picture of a diseased liver.

Notice the tremendous difference in color and size in this normal liver lobe.

The liver was so delicate (the medical term is friable) that it bled significantly when touched. We were unable to get an adequate biopsy due to this problem We are using the laser beam again to control the bleeding we caused.

After we checked the liver we exteriorized the spleen. It is enlarged and hemmorhagic also. Go back up to the x-ray and now see if you can visualize the full size of the spleen.


A very important organ to check during and exploratory surgery is the adrenal gland since adrenal gland disease is common in ferrets. Brandi had her left adrenal gland removed previously. We know this because we did it and because of the hemoclips on the x-ray we showed you above.

Prognosis

Brandi survived the surgery (we are not sure her mother has recovered yet). Unfortunately, several months after this surgery we euthanized her because her problem had progressed significantly.

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Anesthesia

One of the most important tools available to veterinarians to thoroughly and painlessly treat pets is the advent of modern day anesthetics. These anesthetic agents allow us to sedate and anesthetize a wide variety of animals with negligible chance of serious side effects.

The lack of significant complications from anesthesia is due to a combination of expertise, thorough pre-anesthetic testing, and state of the art anesthetic and monitoring equipment. We are equipped to anesthetize any pet from a finch that weighs 15 grams (it takes 454 grams to make up one pound), to pets that weigh several hundred pounds. We are also particularly proficient in anesthetizing senior pets and pets with medical problems like liver and kidney disease.

The goals of anesthesia are to minimize anxiety and eliminate pain. In addition, from the surgical point of view, anesthesia allows profound muscle relaxation. This is helpful in every surgery because the procedure will go quicker and incisions can be made smaller when the muscles are relaxed. In certain types of surgery like fracture repair, this muscle relaxation is crucial for success.

It is normal for you to have concern if your pet is about to undergo a procedure that requires anesthesia. Because of this fact, we invite you to be a part of our anesthetic team. Your primary responsibility is to let us know of your concern. You will have access to your doctor to discuss any of your concerns and to set up a custom protocol for your pet, taking its specific needs into consideration. Only when you are comfortable with the situation will we proceed any further. Also, to alleviate your concern on the day of actual anesthesia, we will call you immediately after your pet wakes up, if you so desire. Please leave a number where we can reach you on the day of surgery.

We have a short video on monitoring pets during anesthesia. You will need QuickTIme from www.apple.com to be able to view it.

Precautions

One of the best precautions we take to minimize the risk of anesthesia it to perform pre-anesthetic diagnostic tests. A pet can pass its pre anesthetic physical exam and still have significant internal problems, so it is important that we perform more than just a physical exam. This is because animals cannot tell us of their problems, have high pain thresholds in comparison to people, and have defensive mechanisms allowing them to hide symptoms. Pre-anesthetic diagnostic tests are designed to alert us to internal problems that are occurring without any symptoms.

Those pets that have infections (especially tooth infections) are put on antibiotics ahead of time. They make pets feel better, and help support internal organs.

Older pets or those with medical problems are given intravenous (IV) fluids prior to and during the anesthetic procedure. Giving fluids prior to the surgery greatly reduces anesthetic risk. This is particularly important in older pets and those with kidney or liver disease. Most pets that have significant dental disease will also be given IV fluids.


Injectable Anesthesia

Injectable anesthetics are used for many purposes. One of their primary uses is to sedate pets before giving the actual anesthesia (called pre-anesthetic). By sedating ahead of time we dramatically minimize anxiety, cause a smoother recovery, and minimize how much anesthetic we need to administer during the actual procedure. In addition, some injectable anesthetics minimize vomiting, a common problem when waking up from anesthetic.

Little Bit is receiving an intravenous injection of an anesthetic before his teeth cleaning. It is being given through an I.V. catheter in the cephalic vein of the forearm.

Injectable anesthetics are also used to give complete anesthesia for short periods of time. This is used for C-sections and minor surgical procedures. Injectable anesthetics are ideal to sedate a pet for radiographs (x-rays).

As new anesthetic agents evolve, the trend is towards using injectable anesthetics more and more for complete surgical anesthesia. They are very effective, very safe, and allow for rapid recovery from anesthesia. They also protect the environment because there are no anesthetic gases vented into the atmosphere.

The primary anesthetic in this category is called Propofol. It induces anesthesia rapidly, and pets wake up almost immediately.

Gas Anesthesia

The mainstay for general anesthesia is gas anesthesia because it is very safe and highly controllable. We use the safest and most effective gas anesthesia available, called Isoflurane. It is so safe it can be used in creatures as small as tiny birds.

Gas anesthesia requires specialized equipment and training. Several precision components are used to administer and monitor anesthesia:

Oxygen

All pets put under gas anesthesia are given 100% oxygen from the moment they are anesthetized until they wake up, dramatically increasing the safety of the procedure.

We have a special machine in surgery that generates 100% oxygen

As a backup,  oxygen is stored in large tanks under high pressure. The oxygen in the tanks is delivered to the anesthetic machine via special piping throughout the hospital. This allows us to have anesthetic machines in several hospital locations. A pet can be brought into radiology after its surgery and still be kept under gas anesthesia while the surgeon reviews post operative radiographs to ensure everything is in order. This is especially helpful when orthopedic surgery is performed.

Endotracheal Tube

With rare exceptions, oxygen is delivered to your pet by a breathing tube (endotracheal tube) in its windpipe. It is the preferred method to administer oxygen because it is very efficient, will prevent any vomitus from entering the trachea (vomiting rarely happens because of fasting and pre-anesthetic sedation), and allows us to gently inflate the lungs during surgery so that work at maximum efficiency. Besides oxygen, the anesthetic gas (Isoflurane) is also administered through the endotracheal tube. Medications can even be administered via this special tube.

After Little Bit was given an injectable anesthetic a breathing tube was placed in his windpipe and Isoflurane was administered.

We can easily inflate your pet’s lungs by gently squeezing the bag connected to the tube and monitoring the amount of pressure we are exerting with a gauge on the anesthetic machine. Each size and species of pet requires a different sized endotracheal tube. The tube is not removed from your pet until it is literally waking up. This ensures that the swallowing reflex is present and your pet is now safely able to breathe on its own.

This x-ray shows the breathing tube (follow the arrow) as it passes over the tongue and down the trachea (windpipe).

"Chase Summerville" 2/2/98

Vaporizer

An instrument called a precision vaporizer is used to deliver the anesthetic gas within the oxygen. It is a very precise instrument allowing us to make fine adjustments in anesthetic level. Without this vaporizer we would not have the wide safety margin that we currently enjoy.

For most surgeries we administer the anesthetic at a setting of 1-2 %. This small percent of anesthetic, added to the oxygen the pet is breathing, is all that is needed to achieve complete surgical anesthesia. Before the surgical procedure is finished the anesthetic is lowered before it is turned off completely. As the surgeon is finishing the procedure your pet is in the beginning stages of waking up. This is another way we minimize anesthetic risk.

Monitoring

During the procedure your pet will be monitored in several ways. One of the best monitors is the surgeon because he is literally visualizing the blood in the circulatory system. Any change in the blood is readily noticed because pets that are breathing 100% oxygen should have bright red blood.

Also, we have an anesthetist nurse in the room monitoring anesthesia. She monitors oxygen flow and anesthetic settings on the precision vaporizer, along with heart rate and respiratory rate. She also uses several tools to aid her in keeping a close watch on important anesthetic parameters:

All of our patients, especially the smaller ones like this guinea pig, are kept on warm water water blankets to prevent hypothermia before during, and after any anesthetic procedure.

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Anesthetic Monitor

This highly accurate and sensitive monitor gives us detailed information on your pets physiologic status while under anesthesia.

It is calibrated prior to surgery to ensure accuracy

Esophageal Stethoscope

Our anesthetist technician can also use an esophageal stethoscope to listen to the heart. This sensitive instrument is passed into your pet’s esophagus while under anesthesia and placed right at the level of the heart, thus greatly enhancing our ability to hear the heart and detect any problems.

Pulse Oximeter

The portable pulse oximeter is an instrument that measures the oxygen saturation of you pet’s red blood cells (to be more specific, its hemoglobin). It is an extremely sensitive instrument that gives us an indication of problems that may be arising long before your pet suffers any ill effects. In addition to measuring oxygen saturation, it measures heart rate, pulse character, and respiration.

This instrument does its magic by measuring the hemoglobin that is oxygenated and comparing it to the hemoglobin that is not oxygenated. It does this by shining a light on an artery, and then measures how much of this light is absorbed. It gives us an answer in PaO2– the partial atmospheric pressure of oxygen

This pulse oximeter shows a pet with an oxygen saturation of 94%, a heart rate of 157. It is breathing 27 times per minute, and its heart rate is steady.

This is Little Bit having his teeth cleaned under general anesthesia. The pulse oximeter is attached to his rear leg.

The pulse oximeter has several different types of sensors that can be attached in various locations depending on the procedure being performed.The pulse oximeter can also be used on pets that are not anesthetized. It is useful for pets that are having difficulty breathing (dyspnea) from many different causes. It is also used to monitor pets that are in a state of shock. One of the most common reasons for pets to be presented to us in a state of shock is from trauma, especially being hit by a car (HBC).

The esophageal stethoscope and the pulse oximeter can be used simultaneously. In this dog, undergoing a neuter operation, Denise, our nurse anesthetist, is taking a reading with both instruments.

The blue tube on the anesthetic machine suctions exhaled gases from our patient and vents them outside the building. The white particles in the canister absorb exhaled carbon dioxide, and the round gauge measures the pressure at which oxygen is being introduced into the endotracheal tube when the technician inflates the bag.

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We have a short Quicktime movie showing a pulse oximeter in action on one of our volunteers. The top number is the oxygen saturation, the bottom number is the heart rate. The vertical bar gives us a clue as to the strength of the heart beat. Click on the link below.

Pulse Oximeter

Capillary Refill Time

To complement these high tech methods of monitoring, our anesthetist technician uses several hands-on techniques as a backup. One of the easiest of these is called capillary refill time (CRT). By pressing on the mucous membranes in the mouth, and noting how long it takes for the blanched area to turn pink again, we get a basic assessment of your pets cardiovascular status. A normal pet’s pink color returns within 2 seconds. This technique is used in other situations besides anesthetic monitoring. It is especially helpful when a pet is in shock or is dehydrated.

Blood Pressure Monitor

We also monitor the blood pressure when pets are under anesthesia for the longer surgical procedures. This is done with our anesthetic monitor. Our hypertension page has a video of the doppler blood pressure monitor in action when we use it in an exam room.

Pain Medication

We complete the anesthetic process by giving your pet a pain injection before it wakes up from the anesthetic. Since the gas anesthesia has a small amount of residual analgesia (ability to kill pain), the pain shot kicks in as the gas anesthetic is wearing off. This allows for a very smooth and pain free recovery. Those of us that have had even minor surgery know how important pain medication is after a procedure. This pain injection will keep your pet calm its first night home from any surgery.

Local Anesthesia

Another excellent way to prevent the pain encountered when your pet first wakes up is to use a long acting local anesthetic at the incision site. We administer it prior to completion of the surgery, and its affects last for 6 hours.

We use the long acting version of this drug which eliminates pain for up to 8 hours.

We even have a local anesthesia patch that is used in some cases to bring long term relief for several days if needed.

Pain Patch

We also use Duragesic patches for general pain control in the more serious cases. It is preferable to apply it 12 hours before the surgery for maximum effect postoperatively. It provides pain relief for 3 days. It is important to make sure that no children or other pets are allowed to contact the patch in any way. Bring your pet back to us for proper removal and disposal.

The patch is applied in different locations depending on the surgery. Wrapped around one of the legs and between the shoulder blades are common locations. One of our nurses is applying it in this picture using gloves to ensure she does not come into contact with the active ingredient.

If we put it on the leg it is covered with a bandage. We will commonly staple the patch to the skin if we put it between the shoulder blades. It will be bandaged for protection and to minimize the chance of contact with other pets and children. Please return in 3 days for us to remove it and dispose of it properly.

To ensure your pets complete safety, it will stay with us for at least several hours after it is awake. We will verify the pain medication is working and there are no ill effects from the anesthetic administered. It will also allow your pet to completely wake up and walk normally in a controlled environment where it cannot hurt itself. Our technical staff monitors your pet post operatively until we are certain it is ready to go home.

Long term pain control at home is also important during the next several days. We will routinely send you home with an anti-inflammatory medication or pain suspension for long term pain control. The two most common medications we use are Rimadyl and Torbutrol suspension.

Laser Surgery

Even though it is not an actual pain medication, using our carbon dioxide laser when indicated during a surgical procedure dramatically minimizes pain because it decreases inflammation, swelling, and cauterizes nerve endings. By using the laser and stopping the pain cascade before it even begins there is a dramatic influence on decreasing post operative pain.

Returning Home after anesthesia

When you bring your pet home after anesthesia it is helpful to follow some common sense suggestions:

Keep contact with other pets and children to a minimum for at least the first 12 hours. Confine it to an area where it cannot hurt itself  because it may not be steady on its feet for up to 24 hours. It might be groggy the first night due to the pain injection it was given.

Use pain medication as prescribed and keep your pet in a warm and quiet area. You can spend time giving unlimited TLC

Even though your pet has probably been fasted for the anesthesia, feed it only a small amount of food and water when first returning home. Give it more later if it eats well and does not vomit (emesis). Most pets return to a normal appetite within 24 hours. If your pet has not fully recovered from the anesthetic by the next day then please call our office.

Please call us in the evening if you have any questions when your pet returns home from surgery or any anesthetic procedure.

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Spay- Pot Bellied Pig

Spaying a pig has similarities to spaying dogs and cats, but not a lot! It is an interesting surgery because of the unique anatomy of the pot bellied pig. They have miles of intestines and a uterus that’s very long because of the large number of piglets that are born at one time.

Graphic surgery photos on this page.

On the day of surgery we need your pet in the hospital between 7:30 AM and 9 AM. Please take away all food and water when you go to bed the evening before surgery, and do not give your pig anything to eat or drink the morning of surgery. It will go home in the late afternoon the day of surgery. Please call our office at 4 PM for pickup time, you will be given post operative instructions then.

This is Elly, a young lady who will be our patient today.


Anesthesia

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine, because surgery is not an area to cut corners. All of our spays receive a physical exam prior to surgery. Only if they pass this exam will we draw a small amount of blood for an in-hospital pre-anesthetic test. When everything is to our satisfaction we will administer a sedative. This will calm the pet down and make the administration of the actual anesthetic, along with post operative recovery, much smoother.

Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

Pigs need to be monitored carefully for overheating during anesthesia, which is the opposite of most anesthetized animals. They produce more body heat relative to other animals because of their large muscle mass. Pigs do not sweat or pant, they need to be in contact with something cool to rid of excess body heat. Because of this we constantly monitor their temperature during and after the surgery.

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

Surgery-Monitor


Surgery

The following area contains graphic pictures of an actual surgical procedure performed at the hospital. It may not be suitable for some children (and some adults also!).

Every major surgery we perform begins with proper patient preparation. This will help prevent infection, which could be a serious complication in this surgery because during a spay we have an opening into the abdomen.


The surgeon makes an incision near the umbilicus and extends it 3-5 inches in the direction of the tail (the tail is at the left in this picture). We try to make our incisions as small as possible to minimize anesthetic time, decrease post operative discomfort, and minimize the healing time.

Our surgeon is using a #10 blade to start the incision


The tissue just underneath the skin is called the subcutaneous layer. It consists mostly of small blood vessels, and of course fat (this is a pig after all).


The final layer we need to cut before we are actually into the abdomen is called the linea alba. It is an area of muscle in the center of the abdomen that is covered by a tough layer of tissue. This is the most important layer resutured at the end of the surgery because it is the only layer strong enough to hold the abdominal muscles together to prevent a hernia.

In this picture the linea is being held up with a forceps, and a scalpel blade (held upside down) is being used to make the incision.


Scissors are commonly used to extend the linea incision and facilitate the removal of the uterus. Care has to be taken not to puncture internal organs like the bladder.

The scissors is sharp and all we have to do is slide it along the tissue for a proper cut


Buried within the abdominal organs and abdominal fat is the uterus. A special instrument called a spay hook is sometimes utilized to gently pull one of the uterine horns through the abdominal incision.

This hook allows us to keep the skin incision small


The uterine horn is traced into the body cavity until the ovary is found. It has to be gently teased from its location near the kidneys in order to be able to pull it out through the abdominal incision. In older pigs this part of the procedure is much more difficult.

This ovary (arrow) has several follices forming, which is the bumpy appearance.


The blood supply to the ovary is extensive, so a special technique is utilized to prevent hemorrhage. This technique involves the use of special clamps. The smaller arrow on the top points to the ovary, which will be removed along with the clamp. The 2 larger arrows on the bottom point to two sutures used to tie off (called ligation) the blood supply to the ovary.

This area is called the pedicle, and will be replaced back into the abdomen when the surgery is complete.


When both ovaries have been removed the body of the uterus is now ligated.

You can see the first suture being placed at the top of the screen.


Another ligature is placed around the body and the uterus is cut away


The linea alba is now securely resutured. Stainless steel sutures are sometimes used because they are very strong, cause minimal tissue reaction, and show up vividly on an x-ray of the abdomen .


The subcutaneous layer is now closed with a type of suture that dissolves over several months.


The last layer sutured is the skin. Sometimes we put the sutures on the outside, which means they have to be removed in 7-10 days. We call this a bikini scar.

It is at this point that we will give a pain injection, which might make this pig groggy for the evening.


Postoperative Care

Most pigs go home late in the afternoon on the day we perform the surgery. They might be groggy from the pain injection which is advantageous because they will remain calm and allow the healing process to start immediately. By the following morning the grogginess will have worn off.

When you first get home do not be in a big rush to feed. After 1 hour at home offer a small amount of food and water. If the appetite is good, offer more several hours later. Do not over do the feeding the first night because anesthesia can make them nauseous.

Keep contact with children and other pets to a minimum the first night, and restrict activity for several days to allow the incision to heal. Try not let your pig go outside until healing is complete.

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Neuter- Pot Bellied Pig

At the Long Beach Animal Hospital use of the laster is mandatory for all neuters.  The advantages of using the laser will be obvious.

Sometimes people get a jaded mindset when it comes to routine surgeries like neuters, that are performed by the thousands, especially at low cost spay and neuter clinics. It is a major surgery, and we treat it as such at the Long Beach Animal Hospital, which you will learn about in this page.

One of the more interesting surgeries we perform is a pig neuter, know medically as an orchectomy. It has similarities to neutering other animals, particularly dogs, yet it is not the same thing as a dog neuter. You should not try this surgery at home….

Several days prior to any surgery please bring in your pet for a preanesthetic exam and blood panel to confirm your pet is ready for anesthesia. At that time one of our doctors will go over any questions you have.

On the day of surgery we need your pet in the hospital between 7:30 AM and 8 AM. Please take away all food and water when you go to bed the evening before surgery, and do not give your pig anything to eat or drink the morning of surgery. It will go home in the late afternoon the day of surgery. Please call our office at 4 PM for pickup time, you will be given post operative instructions then.

Our surgeon will call you after the surgery is complete and your pig is awake. It can go home in the late afternoon the day of surgery unless instructed otherwise. Please call our office at 4 PM for pickup time, you will be given written post operative instructions then. We are open in the evening if you need to pick up later.

This is Bailey, our victim (oops, we mean patient). Isn’t he just cute enough to hug!

Anesthesia

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine. All of our neuters receive a pre-anesthetic test several days prior to surgery.

Bailey is a good patient and held still for his blood sample

When everything is in order we will give a sedative. This will calm Daisy down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

Pigs need to be monitored carefully for overheating during anesthesia, which is the opposite of most anesthetized animals. They produce more body heat relative to other animals because of their large muscle mass. Pigs do not sweat or pant, they need to be in contact with something cool to rid of excess body heat. Because of this we constantly monitor their temperature during and after the surgery.

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

Surgery-Monitor

Once our surgeon has scrubbed up and is  in sterile gown, gloves, and mask, the surgery begins

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Surgery

The following area contains graphic pictures of an actual surgical procedure performed at the hospital.

Bailey is being readied for surgery. His anesthesia has been given and we are ready for our surgical prep.


We make our skin incision just in front of the scrotum. We used the laser to make the incision because of its tremendous advantages.

There is no bleeding from the the skin incision when we use the laser. This is an advantage for the surgeon and the patient.

The testicle bulges out of the incision cover by its internal layers called tunics

The testicle is carefully exteriorized giving us access to the base where the blood vessels reside

Special suture is used to tie off the blood supply before we remove the testicle

The blood supply is so extensive we use more than one strong suture. These sutures will dissolve over the next several months.

The sutures we place in the skin are removed in 10 days.

Bailey is a little groggy right after the surgery, but at least he is feeling minimal pain. This is because we use the laser and we gave him post-operative medication for pain.

Postoperative Care

Most pigs go home late in the afternoon on the day we perform the surgery. They might be groggy from the pain injection which is advantageous because they will remain calm and allow the healing process to start immediately. By the following morning the grogginess will have worn off.

When you first get home do not be in a big rush to feed. After 1 hour at home offer a small amount of food and water. If the appetite is good, offer more several hours later. Do not over do the feeding the first night because anesthesia can make them nauseous.

Keep contact with children and other pets to a minimum the first night, and restrict activity for several days to allow the incision to heal. Try not let your pig go outside until healing is complete.

Laser Surgery

Using the laser has many advantages over using a scalpel blade. These include negligible bleeding during the procedure and post operative pain. Our Laser Page has detailed information on the use of the laser for various surgeries.

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Bird X-Rays

The first series of radiographs are before we had our digital radiography. As you scroll down and come to the rad’s taken by our digital machine you will see the increase in quality.

This first x-ray is from a normal cockatoo that is laying on its side, with the head towards the right. To see a diagram that labels these structures click here, then return for our x-ray tour of birds.

This is another normal cockatoo, this time it is laying on its back. The important organs have been labeled. Note the hourglass appearance of how the heart and liver connect.

These first two x-rays show a bird that has an abdomen filled with fluid. You cannot identify individual organs when the fluid is this extensive. Unfortunately, this is a serious condition.


This is an x-ray of a bird with an enlarged liver. The hourglass appearance between the heart and liver is not present.

This patient has lead toxicity (click here to learn more about lead toxicity). The arrow points to lead particles in the gizzard (stomach). Do you see the fractured leg also? The next x-ray shows the lead and fracture from a different view.

This same bird is now laying on its back, and emphasizes the importance of analyzing two views of an x-ray. The fracture (arrow) in the tibiotarsal (shin) bone is more apparent now. The other arrow points to the lead particles in the gizzard. Now go back and see if you can find the fracture in the view above (hint-it is in the leg to the left). This type of fracture can be handled with a splint.


Here is another bird with lead particles in the gizzard. You know how to recognize it now without an arrow.

The arrow is pointing to a metallic object that is in the bone marrow of the femur (thigh bone). Can you guess what this object is? The next x-ray shows you a side view of this object.

Birdrad-intraosseus

This is called an intraosseus (IO) catheter. It is used to give fluids, especially during an emergency. Birds have very thin walled veins and sometimes they do not hold up when we need to administer fluids. The IO catheter remedies this problem

The following radiographs are from our new digital radiography machine. You can click on them to enlarge.

Egg bound

Birdrad- egg

Fish hook in crop

Birdrad- fishook

OLYMPUS DIGITAL CAMERA

Barium in crop

OLYMPUS DIGITAL CAMERA

BB in skull

Birdrad-BB

Hawk with BB’s in wing

Birdrad-digitalhawkpellets

Detail of digital radiography in a normal bird

Birdrad-digitallateral

Birdrad-digitalvd

Fractured tibiotarsal (shin) bone

Pelican Fx

Fish hook in gizzard (ventriculus)

Birdrad-gizzardfishook

Heron neck

Birdrad-heronneck

Repair of fractured ulna in red tailed hawk. The metal object is an IM (intramdeullary) pin. The fuzziness around the pin is normal healing bone, called callus

Birdrad-impin

Egg bound bird with egg almost out (in the cloaca)

Birdrad-lateralegg

Fracture repair using external pins

Birdrad-pinrads

Birdrad-pins

 

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