Dooks to all, and my condolences to all who've lost their babies recently.
Yesterday, 9/20, while sorting through mail I saw an article in the
"Veterinary Practice News" entitled 'Ferreting Out Special Surgery Needs'.
Being the ferret person I am, I zeroed in on this and read it, then became
appalled by my reading. I re-read the article, made a copy for myself,
highlighted parts, then decided to seek a much higher wisdom than myself.
I sat down and wrote to Dr. Williams.
BIG-please, this may be long, but I'd appreciate it if you would print all
this. Dr. Williams, as you will note, gave permission to post his opinion,
and I truly feel this is something all of us on the FML should be aware of.
As we discussed, a lot of vets have a lot of views, and this is one that
I felt was wrong, and am glad that Dr. Williams agreed. So, here it is.
I've started with my query to Dr. Williams, and then put his last, so
that they are chronologically in order. Thanks, BIG, and thank you Dr.
Williams-you cemented my belief of treatment as soon as possible.
-----Original Message-----
Good afternoon, Dr. Williams.
A copy of "Veterinary Practice" just passed over my desk and I saw the
title "Ferreting Out Special Surgery Needs" by Dr. Karen Rosenthal, DVM,
MS, Dipl. ABVP (Avian). This is vl. 12, no. 9, September 2000. Dr.
Rosenthal is a staff veterinarian at the University of Pennsylvania School
of Veterinary Medicine, Dept. of Clinical Studies.
Having listened to you at Ferret 2000 this past weekend, and spoken with
you of my little ferret the vet said had the allergy even though she showed
signs of classic adrenal, this article caught my eye. I read it and found
one paragraph to be disturbing to me. Perhaps I read it incorrectly, but
Dr. Rosenthal states "In many instances, ferret adrenal gland disease is
only a cosmetic problem-hair loss and large vulva. Fatal medical
complications can ensue, but that occurs only in a minority of cases and
usually, medical complications are slow to develop, giving the clinician
time to successfully treat the patient. Before jumping in to take out that
adrenal gland or before giving a potentially dangerous drug, remember to
question, 'Does this really need to be treated?' " Before this statement is
"As of this writing, no unbiased, peer-reviewed study contrasting different
methods of treat adrenal gland disease exists. Therefore, be cautious of
reports that claim their way is the best way to treat adrenal gland disease
in ferrets. A practitioner must ask the overlooked but extremely important
question, 'How many ferrets actually need adrenal gland surgery?' "
It may be that I'm reading the article wrong, but from all I've ever heard,
adrenal needs to be treated with surgery or even Lupron treatments as soon
as the signs show or when the ferret is diagnosed. Am I incorrect in this
thought? It could also be that I don't understand what Dr. Rosenthal is
saying, not being a veterinarian myself. I do understand her explanations
of the types of surgery after having listened to your presentation.
I read the FML this morning where you had your post and have put your
presentation onto the web, and I've forwarded your post and the website to
Dr. Steve Thompson to share with Dr. Alondra Martin here at Purdue-they are
our Exotic Veterinarians. Dr. Thompson asked me to take notes and show
him, but being able to give him your actual presentation was much better!
If you can clear up my possible misreading of Dr. Rosenthal's article, I'd
appreciate it. And I can't thank you enough for giving the presentation at
Ferret 2000. I'd told Dr. Thompson I was afraid it would all be over my
head and I can truly say I understood what you were presenting.
Thank you again,
Rebecca McFarlane
=======================
Original Message -----
From: Williams, Bruce
(Dear Rebecca- Thank you for your consideration in sending me a difficult
and possible inflammatory question offline. I have no problem answering
this one online, and if you are an FML patron, and want to post this to
the FML, I certainly have no problem with that. My opinions are always
available for public record.)
Rebecca:
I certainly don't think that you have misread Dr. Rosenthal's article.
One thing that most people need to realize is that, just as in the world
of ferret shelters, not everyone in the world of ferret medicine, always
agree. Dr. Rosenthal has been extremely important with regard to adrenal
disease in ferrets, aving done ground-breaking work in developing the
adrenal blood test now available for ferrets, but I cannot agree with her
position of delay or non-intervention in clinical cases of adrenal disease
which she has presented here.
You saw my presentation at Ferrets 2000 this weekend. I discussed
"surgical candidates" for adrenal surgery, and "non-surgical candidates"
which may likely be candidates for medical treatment. As opposed to Dr.
Rosenthal's views, I do not believe that adrenal disease is "cosmetic
only" , not can I agree that non-intervention is an appropriate treatment
option for a veterinarian to espouse.
How many ferrets actually need surgery, or treatment? Let take a look.
Only a minority will die from untreated adrenal disease - let's say the
20% or so with untreated malignancies - either by metastatic disease or
hemoperitoneum. How about the 8-10 percent with chronic pruritus (itching)
is this not a symptom that deserves to be relieved with treatment. How
about the male animals that will die as a result of prostatic disease and
resultant uremia as a result of inability to urinate. Or the small number
of animals, perhaps only 2%, that will develop severe anemia from the
hyperestrogenism?
The majority of ferrets with adrenal disease develop hair loss - this is
the most common presenting sign. Is is appropriate to allow a normally
haired species to undergo complete baldness and the associated skin
problems and hypothermia because it is simply a "cosmetic defect"? How
about the muscle wasting that accompanies neoplasms in animals, or the
anemia of chronic disease. Yes, it is true that you can wait after signs
of adrenal disease appear, because malignancies cause the same early
clinical signs as benign lesions - we can't predict which ferrets will
develop life-threatening complications, and which may live with the
disease for months or years before the severe signs appear..
My experience is not drawn simply from the thousands of adrenal cases on
which I have consulted, or the biopsies, or worse yet, autopsies on animals
with chronic adrenal disease. I have personal experience. I have had my
own ferrets die from my ineffective interventions, too little or too late.
I will always advocate intervening, to preserve life and quality of life.
We have now both surgical treatments as well as medical treatments. To
wait for peer-reviewed unbiased studies is to condemn untreated animals to
at best a compromised life, at worst, an unnecessary death. My oath as a
veterinarian prevents me from doing or advocating this.
People will believe who or what they will. It is easy to say anything in
print, but a different thing to look someone in the eye and offer them hope
for treating a difficult problem. Some vets speak only online to other
vets or on the phone to other vets; some will only talk with them (or
rarely you) for a consultation fee. I've only known one way - I talk with
anyone in need, and I've never charged for a consultation, to an owner or
to a veterinarian. I can only tell you what I know and what I've seen, and
try to prevent in your ferrets what has claimed the life of my own ferrets
or my patients.
In short, by not treating, we may save money - but we will never save
lives.
With kindest regards,
Bruce Williams, DVM, DACVP
[Posted in FML issue 3184]
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