From:
"Sukie Crandall"
Date: 2008-04-27 15:37:28 UTC
Subject: [ferrethealth] Re: Adrenal ferret/2 vets - was "Update on my ferret Herb"
To: ferrethealth@yahoogroups.com
There IS a lot to learn, isn't there? With ferrets we are all
constantly learning. Having ferrets is good for "the little gray
cells"!
Okay, now, this will be VERY LONG, but I have noticed multiple people
having some confusion so the long quoted sections in here should serve
as an excellent refresher!
Deslorelin (Suprelorlin) depot is not yet available in the U.S. It is very, very
important to recall that the types of deslorelin, Lupron, and Trelstar which
have been studied for use in ferret adrenal disease are the DEPOT versions.
In fact, Amanda just had a WONDERFUL, WONDERFUL POST which gives
some background on why the depot is used. A depot is a special slow
release version of a medication. I am going to quote that section of
Amanda's post and then include some more on that score. Non-depots
are cheaper but have the potential of being a way to run into trouble:
BEGIN QUOTE
A note about Lupron therapy that I don't think enough people realize.
Lupron is an agonist -- a drug that works in two distinct phases.
Phase one stimulates the pituitary gland, causing more hormones to be
produced. In phase two, the receptors have been flooded with so much
"info" that they shut down, causing a decline in hormone levels. This
is when the drug becomes therapeutic. Taking all of this into
consideration, one must be vigilant with Lupron therapy and give the
injections on a timely basis (whether it is the one-month,
three-month, or four-month). Otherwise, the lack of drug in the system
will allow the receptors to "turn back on" and you are back to where
you started, decreasing the therapeutic window of the drug. So,
Lupron should not be given "as needed" (based on ferrets symptoms). It
probably won't help much in the long term.
END QUOTE
I highly recommend that you save Amanda's post:
http://pets.groups.yahoo.com/group/ferrethealth/message/6211
or
http://ferrethealth.org/archive/FHL4736
I know of someone who recently bought a lot of what she figured was
cheap, foreign Lupron. It was not the depot but was the 24 hour version
so...
Although I think that this is in the archives already I can't find it right
now so will quote Mike Janke (having earlier had his permission to do this)
about an issue which worried him:
http://www.miamiferret.org/fhc/24hr_lupron.htm
BEGIN QUOTE
A while back, someone wrote to me asking questions about Lupron.
Through this exchange, I learned that a pharmacy and vet in the
Midwest is promoting 24 hour Lupron with the claim that it is effective
for one month. I was surprised to hear this and didn't believe this claim
to be true, but since I'm not a vet or pharmacist, I thought it best that
I do some research before disputing this claim.
I tried to get a better explanation from the vet and pharmacist
prescribing this Lupron, to no avail. In their defense, I did not speak to
them directly but through a second party. The only thing I knew was the
claim that the 24 hour Lupron worked long term because of, "the way it
attaches to the adrenal receptors." I was looking for a little more detailed
explanation how this works for a period longer than 24 hours but was
never offered any more than that.
I wrote to several vets I know and the response I got was that 24 hour
Lupron works for 24 hours, period. That was appreciated but their
response did not include any detailed explanation as to why it could
not work as claimed.
I then contacted John Hines, who wrote, "Adrenal Disease and the
Therapeutic Effect of Lupron." Since John studied the topic of Lupron
usage, has a Ph.D. in Pharmacology and is a ferret lover, I felt I
wouldn't find anyone more knowledgeable on the subject and
definitely one with the credentials to offer an expert opinion.
First a brief layman's description (mine) of how Lupron works so some
of John's comments might make a little more sense. Lupron desensitizes
the pituitary gland and causes it to stop producing two hormones,
LH (luteinizing hormone) and FSH (follicle-stimulating hormone).
These two hormones (the primary problem is LH) stimulate the adrenal
glands into producing sex hormones which cause the adrenal disease
symptoms we see. This is an extremely basic explanation. There are
many more details in John's paper.
My main question to John was, can 24 hour Lupron be effective in
ferrets for adrenal disease treatment if used as a monthly dose? John's
comments on the topic were as follows:
"... if the Lupron is of the type that all enters the bloodstream in
24 hrs., (24 hr. Lupron) what you get is a few hours of high
pituitary activity followed by only several HOURS of inactivity
(desensitized). Then the 24 hr. Lupron is gone shortly thereafter,
and the pituitary RE-sensitizes and LH release to the natural GnRH
resumes probably in a day or so. If the ferret is only getting the 24hr.
shot once a month, it's useless. In fact, the use of the 24 hr. Lupron
probably makes the adrenal disease worse because you don't get
much therapeutic effect, but you are still getting that initial high
pituitary activity when the Lupron is first administered. This initial
burst of pituitary activity is of little consequence when it is followed
by cessation of pituitary activity. But, with the 24 hr. Lupron, you
only the initial burst of pituitary high activity -- followed by normal
pituitary activity. It's like adding a splash of gasoline to a fire."
We had several discussions, particularly about the claim that the 24
hour Lupron works for a month or more because of "the way it
attaches to the adrenal receptors" to which John responded:
"I did notice in your earlier correspondence that the vet and
pharmacist had described their Lupron as binding to 'adrenal
receptors'. I can see how a drug that binds to the pituitary and
impacts on the adrenals could be misconstrued as binding to the
adrenals by the average person; however, if the pharmacist or vet
actually said to her that "Lupron binds to adrenals", then that
immediately is cause for concern as it demonstrates a fundamental
ignorance about how the drug works."
"[pharmacist's name omitted] doesn't understand how Lupron works.
He seems to know what its ultimate effect is, just not the mechanism.
That's a shame, because he should know better than anyone.
Leuprolide binds to receptors on the pituitary. The word "attach"
could be misleading -- to some people it might imply a permanent
joining of the leuprolide to the GnRH receptor, which is not the case.
Leuprolide tightly associates ("binds") with the GnRH receptor, but it
is a reversible process. It can dissociate ("unbind") as well."
I know that the vet offering 24 hour Lupron does a lot of good for
ferrets and I understand the intent is to offer an affordable alternative
for treatment of this all too common disease. Does 24 hour Lupron
work in some cases? Several people have claimed that it does. What
worries me, besides the fact that this type of Lupron may not work,
is that after hearing John's explanation, realizing that there is also
the chance it could make the condition worse.
The important message I want to get across is, ask questions, know
what you are getting and what you are treating your ferret with.
This applies to ANY treatment, not just one for adrenal disease. In
this case, I was told by the person that contacted me that she was
not told that what she was getting was 24 hour Lupron, only that it
would work for a month or so. I am fairly certain that if the vet had
been asked directly, "Is this 24 hour Lupron?" or "What formulation
of Lupron is this?" the vet would have been honest and upfront. Vets
(even human doctors) often don't give us all the information unless
we specifically ask for it. So don't be afraid to ask. The type of
Lupron that is a genuine, time-release formulation is called Lupron
Depot. This comes in three formulations: 1-month, 3-month and
4-month.
If 24 hour Lupron is something you want to try for whatever reason,
this probably won't change your mind. Just be aware that you may
see no results and in fact, may make matters worse.
END QUOTE
In relation to obstructions:
We have certainly had two ferrets have complete urinary obstruction
secondary to adrenal disease. One had very advanced lymphoma
which was in its 14th month of treatment with high enough doses of
Prednisolone to make a difference for the malignancy. He had a mercy
shot. The other had a complete urinary blockage form as his first
symptom of the most common type of adrenal growth: adrenal
neoplasia (benign but if it sits around long enough some of those have
the capacity to later become malignant.
There is a LOT of misunderstand of terms like "tumor" and "cancer". I
recommend:
http://listserv.ferretmailinglist.org/SCRIPTS/WA-FERRET.EXE?A2=ind0710&L=FERRET-
SEARCH&P=R12655&I=-3&d=No+Match%3BMatch%3BMatches
Subject: It is time for a VETERINARY Golden OLdie again on what is or is not "cancer":
Part 1
From: Sukie Crandall <[log in to unmask]>
Date: Tue, 16 Oct 2007 12:45:09 -0400
Content-Type: text/plain
Parts/Attachments:
text/plain (70 lines)
We managed to go a long time since this was last needed, so Dr.
William's hard work creating this is working over time to teach people
about "cancer"! BTW, There are HUNDREDS of types of malignancies and
what works or doesn't work for one won't be the same for another; they
vary in virulence and rates across species or subspecies if isolated
from each other enough for long enough, too. For example, BFFs have
very different most common malignancies than domestic ferrets. (See
past Dr. Bruce Williams posts on that for more info.) Notice what is
NOT USUALLY malignant but STILL must be fixed for quality of life.
Golden Oldies:
These might be of interest. One is a past post from Dr. Bruce Williams,
and one is a compilation of some definitions from a veterinary
dictionary and some other related topic dictionaries done years ago.
>The thread on this is pretty good, and both Sukie and Stephanie have
>very valid points. The terminology of neoplasms can be confusing, and
>I'm sure even vets can be confused from time to time.
>
>The proper term for what you are talking about is neoplasm (or
>literally "new growth). For one reason or another, a clone of cells
>begins to grow uninhibited by normal substances or mechanisms. The
>word "tumor" may be technically correct, but it is actually non-
>specific - tumor is Latin for a swelling, but it could also be an
>abscess, or anything else that causes swelling - so I try to stay
>away from it.
>
>Now this neoplasm may be benign - without the ability for cells to
>detach into the bloodstream or lymph, move to another tissue, and set
>up shop - or malignant (where they can do this.) The process of
>microscopic piece of a tumor moving to another organ is called
>metastasis.
>
>Metastasis is the hallmark of malignancy. The worst tumors have the
>propensity to go anywhere and start growing (like lymphoma). However,
>we can recognize malignant tumors even before they metastasize, often
>by characteristic features seen under the microscope.
>
>Adrenal carcinomas (malignant adrenal tumors) are interesting
>neoplasms. Although they possess the ability to metastasize, only a
>small number do, and usually only late in the course of disease. It
>is likely that they do metastasize a lot, but have trouble gaining a
>foothold in distant tissues, so it takes a long time and many attempts
>if they ever truly metastasize.
>
>Insulinomas are generally not malignant tumors as they only very
>rarely metastasize. The presence of multiple tumors in the same organ
>over time is not metastasis. We do not understand the mechanism behind
>the generation of these tumors, and when we do surgery to remove them,
>we really are only treating the end point of this process, without
>address the cause. Thus it is really no surprise that the rate of
>recurrence is about 40% within 10 months.
>
>With kindest regards,
>Bruce Williams, DVM
Here are the definitions I looked up years ago:
Treat this as an supporting document to Bruce William's excellent post
above taken from FHL digest 348. I especially liked his providing the
direct translation of "tumor" as "swelling", and his explanation that
not all growths which can metastasize do so readily.
These definitions are combined ones from medical, veterinary, and
biology dictionaries, but emphases are mine and i am willing to be
corrected if I blew it...
[Posted in FML 5763]
and
http://listserv.ferretmailinglist.org/SCRIPTS/WA-FERRET.EXE?A2=ind0710&L=FERRET-
SEARCH&P=R12730&I=-3&d=No+Match%3BMatch%3BMatches
Subject: It is time for a VETERINARY Golden OLdie again on what is or is not "cancer":
Part 2
From: Sukie Crandall <[log in to unmask]>
Date: Tue, 16 Oct 2007 12:45:49 -0400
Content-Type: text/plain
Parts/Attachments:
text/plain (62 lines)
Important Note: some more recent dictionaries don't even include
the term cancer, and I have heard vets who won't use it due to the
widespread confusion out there, and even some vets who won't use
"tumor' due to too many assuming that any tumor is malignant.
Tumor: ANY abnormal mass resulting from the excessive multiplication
of cells; a swelling, especially that resulting from the growth of
new tissue; a neoplasm
cancer: Any MALIGNANT TUMOR; carcinoma; a carcinoma or sarcoma
malignant: pertaining to or denoting progressive growth of CERTAIN
tumors which if not checked by treatment spread to DISTANT sites,
terminating in death; a tendency to progress in virulence, cancer
is the best known example
benign: not malignant, as in CERTAIN TUMORS; not recurrent, favorable
for recovery
neoplasm: a tumor; ANY new growth, specifically one in which cell
multiplication is uncontrolled and progressive, neoplasms may be benign
or malignant
(Subsets from Saunders:
neoplasm, benign: a neoplasm having none of the characteristics of a
malignant neoplasm (see below), i.e.it grows SLOWLY, expands WITHOUT
METASTASIS, and USUALLY does not reoccur [See the notes of Dr. Bruce
Williams above in relation to why LOCAL reoccurance is NOT metastasis.]
neoplasm, malignant: a neoplasm with the characteristics of anaplasia,
invasiveness and metastasis
There are several other subsets of neoplasia in this dictionary.
metastasis: the transfer or disease from one organ or part to another
NOT DIRECTLY CONNECTED WITH IT
anaplasia: loss of differentiation of cells
Those who have the _Saunder's Comprehensive Veterinary Dictionary_ will
find that this resource often provides details beyond these bare-bones
descriptions, (though certainly there also will be nuances in practise
that those of us who are not medical professionals simply won't
understand). It is a marvelous resource; I love it. If I had a rating
for refs around here it would be among the best buys. It's better than
any of my other medical dictionaries. Marvelous book: clearly written
and very inclusive; more than worth what it cost.
Sukie (not a vet)
Recommended ferret health links:
http://pets.groups.yahoo.com/group/ferrethealth/
http://ferrethealth.org/archive/
http://www.afip.org/ferrets/index.html
http://www.miamiferret.org/fhc/
http://www.ferretcongress.org/
http://www.trifl.org/index.shtml
http://homepage.mac.com/sukie/sukiesferretlinks.html
[Posted in FML 5763]
If I recall the list of other meds you mentioned many of them
are ones that can be gotten easily enough in the U.S. but are
usually used after certain complications are present to treat
those complications. To learn more about those i highly recommend
post in the FHL Archives on the individual meds from the address
containing AFERRETVET. Leave the subject search box empty and
just use the other two search boxes for that search:
http://ferrethealth.org/archive
Even though adrenal disease is usually benign (not "cancer")it still
undermines health substantially if it remains untreated. Yes, I
know that you ARE using the Lupron but figured this info could
be useful for you. Here is some info on that score from Dr. Bruce
Williams, one of the world's absolutely most knowledgeable ferret
veterinary pathologists:
http://ferrethealth.org/archive/SG5054
BEGIN QUOTE
Actually tonight I am working on a promised article to Ferrets Mag about adrenal disease.
But I think that Melissa and Sukie have covered the dire possibilities very well (and they
are very real.)
However, even under the best conditions, when there is no malignancy, there is no bone
marrow toxicosis, there is no prostatic cystic disease - even the most mild prediction is a
sad one. Ferrets with adrenal disease have a diminished quality of life - they have
progressive muscle loss, low grade anemia, they tend to redistribute weight to the
abdomen, further making it difficult to walk, they have an increased incidence of gastric
ulcers as a result of the stress of chronic illness, decreased bone density - none life-
threatening, but all life-compromising. Even medical treatment, which is not my preferred
way of treating adrenal disease, gives slight releif to symptoms. Doing nothing is not kind
and not in a ferret's best interest.
With kindest regards,
Bruce Williams, DVM
END QUOTE
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