Long Beach Animal Hospital 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

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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

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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.

FerretInsulinoma-Scrub

Our patient is carefully clipped and scrubbed

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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.

Return to Ferret Adrenal Diseases Page

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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.

This page will show surgical and medical treatment.

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).

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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 hair loss can be seasonal, can come and go, but eventually it progresses to almost complete baldness. 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.

Do you see the hair loss at the back end of this ferret?

This view gives you a better idea of the extent of the hair loss

She even has a bare tummy

At least she is not as bad as this ferret

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

Hair -loss-tail-ferret

Some times we are not sure if we are treating a ferret or a rat!

Sometimes we see enlarged vulvas in spayed females.

This one is slightly swollen. It should not be swollen at all since she is spayed.

This one has more enlargement. Notice the hair loss?

It has been observed that mast cell tumors in ferrets can also cause hair loss.

This is what a mast cell looks like on the neck of a ferret that is ready to undergo laser removal of the tumor

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

When a ferret is presented in this state we have to immediately catheterize them. You can see the tip of the catheter 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

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.

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.

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.

We do a thorough exam since ferrets are prone so several important problems in addition to adrenal gland disease like cancer. Doing this exam is easier said than done for such a wiggle patient, which is why Dr. Kennedy has an assistant help hold.

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, cuddled in warm blankets. She has been given a pain injection and is being monitored closely.

Alex will keep a close eye on her as the transfers her to recovery

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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 night 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

Some ferrets are not good candidates for surgery, so we will use medical therapy on them. Also, we use this medical therapy after surgery. Medical therapy does not cure the disease, it only controls it. The effectiveness of these therapies varies from ferret to ferret.

There has even been some evidence that using deslorelin in November or December can even prevent the onset of adrenal disease. Much of this information needs to be refined as we learn more about this disease.

Deslorelin

This is a long acting drug that is implanted under the skin. The symptoms of adrenal disease in ferrets start diminishing within a few weeks, and reach maximum effect within 6 week. The injection can last anywhere from 6 months to well over one year before needing an additional injection.

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. We also use it to treat birds like cockatiels that are excessive egg layers, and can even become egg bound.

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.

Return to Ferret Adrenal Diseases page

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