From:
debi@ferrets1st.com
Date: 2005-11-05 15:12:05 UTC
Subject: [ferrethealth] RE: Right after 2nd adrenal removal - How to proceed?
To: ferrethealth@smartgroups.com
We typically give Florinef (or generic) and Dexamethasone in a decreasing dosage for 6 weeks following surgery. We use tablet forms of both, disolving a portion of the tablets in an oral syringe with 0.5cc water, which can be given from the oral syringe or mixed with a small amount of food.
Normally, the 6 week period is sufficient for ferrets that have not had abnormal adrenal glands for an extended period of time and we are able to discontinue the drugs. We have had cases, however, when the ferret exhibited symptoms of extreme fatigue, hind quarter weakness... Addison's symptoms, within a week or so after discontinuing the medications. In these cases, we started the 6 weeks of decreasing dosages again, and in all but a small percentage, this second 6 week period of medication was sufficient, and the ferret did well without continuing the Florinef or Dexamethasone.
In one instance, the ferret, Joey, remained on the medications for 18 months following the removal of the second adrenal gland. This ferret's 2nd adrenal had been abnormal for at least a year before the surgery, according to the records of the vet who had treated him before the ferret was surrendered to the shelter. For this ferret, we continued the final dosage amount of Florinef. Every two months we would half that dosage for 7 days and closely observe his response. Eventually we were able to reduce that dosage to every other day for a month, then discontinue it altogether. Joey lived for another two years after that with a good quality of life, hoarding his toys and the occasional wardance, until age 7.
Posey, another rescue that had apparantly had abnormal adrenal glands for an extended period, also required additional months of Florinef following surgery. She had concurrent insulinoma and so remained on pred even after the discontinuation of Florinef 6 months after surgery.
It should be carefully noted that we have been through this process 16 times over the past several years, so we've developed sort of a 6th sense in observing for developing Addison's symptoms when taking the ferrets off of the medications. I can't stress strongly enough the need for intense observation of the ferret's daily routine for a period of 2 or 3 months following the discontinuation of the medicines.
We call it a "crash" when the ferret shows symptoms indicating the need for re-starting the meds. It can appear to be much like an insulinoma crash due to low blood glucose, but unlike an insulinoma crash, they won't "bounce back" to "normal" appearance/activity within 15 minutes of giving sugar/food. It can take days for them to resume a more normal activity level.
As we occasionally travel, we had to take Posey with us to an event in Indianapolis, far out of range of our familiarity with ferret vets. Sure enough, Murphy's Law, she crashed, & the vet we at length located gave her 0% chance to make it through the night, much less, home to Texas, even after she had consulted with our ferret vet by phone. We had Florinef and Dexamethasone with us, but a severe crash should always have a vet's exam and an IV with the potasium (don't remember exactly what that IV content is at the moment). I relate this to indicate that it doesn't matter how much experience with this you have; a crash can still happen very quickly and catch even the most observant off-guard, and it's not to be taken lightly.
Even at this risk, I firmly believe that if a ferret can live well without reduced function without a drug, the attempt to discontinue that drug should be made.
The Florinef used is the scored, 0.1mg tablet and the Dexamethasone is the 0.25mg Azium tablet (pentagon shaped, orange colored)
week 1 & 2:
1/2 tablet Florinef twice daily
1/4 tablet Dexamethasone twice daily
week 2:
1/2 tablet Florinef twice daily
1/4 tablet Dexamethasone once daily
week 3:
1/2 tablet Florinef twice daily
week 4, 5, & 6:
1/2 tablet Florinef once daily
Debi Christy
www.ferrets1st.com
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