Ok, folks, here are the offical results and commentary, with a few extra
tidbits thrown in regarding sampling and observer biases.  Up front, I do
not trust much of the data gathered from FML members--not because of the
dishonesty of FML readership, but because of how *good* we are (I'll explain
later).  The post quite long, so I've broken it into several parts for
bathroom reading over the next few evenings.  I'll say some things some of
you will *NOT* want to hear (which included me), but please hold off flames
or other comments until the entire series is posted.  It will save us all a
lot of space and time because what offends you today may be answered
tomorrow.
 
What you will be reading is a combination of FML data, compiled with about
20 scientific journal/book sources.  Because of the need for brevity, those
sources will not be individually cited, but will be added as a bibliography
at the end and you can look it up yourselves.  Disclaimer: this is *not* a
scientific study, and as such, I would never submit it for publication.  Do
not assume it carries the weight of papers that have undergone rigorous
juried review.  Also, the FML format limits the length of posts, cannot
carry graphics, and is read by people of various educational levels.  To
write a paper to the level of a scientific journal would require about 8
FMLs dedicated to nothing but the subject, with 5 or 6 graphic attachments
to demonstrate the statistics.  It is not possible to do such work, and if
it it were possible to get the space and add the graphics, without being
condescending, few readers would have the necessary background to follow the
paper properly.  Don't be insulted by this; I can fix a car but don't speak
"Autoshop," mathematics gives me a headache, and I will never be as smart as
the average European because even though I can read in several languages, I
can't hardly speak English good.  The language of physiology is a difficult
one to learn, and no one should be embarrased because they don't speak or
understand it.
 
With that in mind, let me give the bad news first.
 
1) Treatment of Adrenal Disease.  I'm sorry to say, *no* treatment but one
has *any* long term effect on the disease, and that one is only really
effective if when the adrenal disease starts early in the life of the
ferret.  Surgery is the only effective treatment.  No chemical treatment,
such as Lupron, Lysodren, or Prednisone, has been shown to significantly
extend the ferret's life after the initial onset of the disease, nor have
they been proven to do anything more than mask or slow the progress of the
disease.  No environmental treatment has withstood vigourous scientific
examination and still result in positive results.  Homopathic remedies have
not shown *any* ability to extend the ferret's life, nor do they show any
more than a moderate lessening of symptoms.  In the significant majority of
cases, any type of treatment, other than surgery, only offers superfical and
limited results.
 
HOLD OFF COMMENTS UNTIL THE SERIES IS DONE, PLEASE!  I know these statements
are going to cause some disagreement, but I will offer explanations in the
next posts that will answer many of your questions.  Please wait, and we can
hash this out at the end.  Ok?
 
The average reported lifespan of ferrets that did not have ANY treatment or
surgical intervention was 1 year +/- 6 months.  The same times were reported
for *ALL* chemical treatments, including Lupron, Lysodren, or Prednisone.
If the adrenal disease had an onset when the ferret was under or about 3
years of age, surgery gave the ferret 3 years +/- 6 months.  However, if the
adrenal disease had an onset after 4-5 years of age, that survivorship
droped down to 1.5 +/- 6 months.  In all cases, the average length of life
was longer if surgery was performed, however, the risk of sudden death was
significantly higher in ferrets older than 4-5 years.
 
Chemical treatments were reported to partially or completely return the
ferret to working order, with partial or complete return of hair as well as
an improvement in other symptoms.  This was reported about the same in all
age classes of ferrets.  The interesting thing about the chemical
treatments, or even of homeopathic treatments, was the degree of observed
improvement was always higher than the degree of actual improvement.  In
other words, if a ferret had an improvement in hair growth, it was seen as
"the ferret getting better," even though the course of the disease was the
same as if nothing was being done and the ferret died within a year or so.
This is best illustrated by a comment mailed to me, "The vet said the
situation was hopeless, that the ferret could not survive surgery, and it
could die as early as in six months....But placed on [homeopathic] medicine,
the ferret lived another 14 months!!" 14 months is within the "mortality
window" of untreated adrenal disease, so there is no evidence the treatment
worked at all.  What was seen as the improvement was a return of most of the
hair and decrease in aggresion, which may have occurred anyway, but such
those type of improvements in no way should be taken as evidence that
microscopic changes took place within the adrenal gland that altered the
disease.  Maybe it did, but there is *no* factual evidence.
 
I want to emphasize this.  In an extensive search through all ferret-related
papers since 1985, not a single published study could demonstrate marked
improvement of the ferret by any means other than surgery.  That is not so
say such studies don't exist, nor am I saying such results are not possible.
What I am saying is nothing has been published, other than a few articles
with poor sample sizes (or other methodological problems).
 
Surgery resulted in remission of symptoms in most cases, but in those cases
where surgery was not going to work, it was immediately seen as a
"non-improvement." If the ferret was left untreated, the disease would kill
the ferret between 6 months to 1.5 years, with the average death being about
a year into the disease, so on average (worst-case), the ferret got an extra
6 months or more because of surgery, and in the best case, years of extra
life.
 
Personal comments: I am a great believer in "less is better" when it comes
to medical care.  Personally, I would be dead six times over if not for the
surgeries I have placed myself through.  Before I took on theis
self-assignment, I was essentially anti-surgery for the older ferrets,
supporting surgery only for those cases with an early onset.  For ferrets
under 4 years of age, I believe surgery is the only option; do it as soon as
possible after blood tests have confirmed the disease.  There are a number
of risks involved in such surgical procedures, but they only result in a
small number of serious complications; the sudden death rate seems to be
under 5% from what I can dig up, which is fantastic considering the
difficulties of operating on such a small species.  From the discriptions of
ferrets dying during surgery, they seem to be of two types; either they were
extremely ill ferrets with massive tumor involvement, (which suggests a late
diagnosis or multiple-organ involvement), or the deaths seem to be
anesthetic-related, such as from anesthesia-induced shock (happens even in
people).  In the former, sudden death should be expected because of the
ferret's condition.  In the later, such events are unpredictable.  In either
case, unless some other proof exists of malpractice, these deaths should be
considered part of the risks of surgery, and accepted as such without blame
being assigned to doctor or owner.
 
For ferrets older than 5 years, there does not seem to be any significant
difference between chemical treatment nor non-treatment.  Surgery can add
about 6 months on average to the livespan.  I question the poor results from
late surgery but cannot find any outside stats to contradict them.  I
suspect the surgical results would be better if the adrenal disease was of a
primary onset rather than a secondary manifistation (like when the ferret
has already had an adrenal removed).  I just don't have enough data to be
able to say that ferrets over 5 years of age who get adrenal disease for the
first time have better surgical results than those who have already had
adrenal surgery.  I strongly suspect it is so, but cannot say for sure.
Because of that, I recommend that if your ferret is otherwise healthly and
this is their first onset of adrenal disease, do the surgery.  As for the
second onset, discuss all options with your veterinarian and make your
decision to best suit the needs of your ferret.  You have to weigh the
additional 6 months or so with the surgical risks, knowing the end results
will not be much different.
 
Now, this is all very clinical and non-emotive, which is what is needed for
this type of discussion.  If I wanted to push my belief system, I would be
arguing *against* surgical procedures.  I have been (mostly) convinced by
looking at all available data; I have refused to comment on this (or share
this) with anyone associated with the problem so no one could question the
ethics of the study.  In other words; I can into this thinking I could find
better options than surgery.  I found I was wrong.
 
This is *not* to say existing chemical or homeopathic remedies (or future
ones) will not eventually replace surgical treatment in many cases.  What I
have found is a lot of research is needed in those areas.  It is also not to
say that, for some, such treatments actually result in improvement of
symptoms, or even reversal of the disease, but statistically, they are less
than 10%.  That means, 90 ferrets will take the treatment and will *not* be
any better for it, while 10 ferrets will show a reversal or improvement of
symptoms.  The problem is, are these reversals due to the medicines or
because of the animal having a spontaneous remission of the disease?  Like I
said, rigourous examination of the facts needs to be done, which means, boys
and girls, ferrets will die in scientific research.  There will be a price
to pay for medical advances against this disease.  But there *is* something
we can all do to help.
 
The problem with any research is getting the samples.  I am studying the
differences between wild and domesticated forms of the ferret, which could
not be done if caring individuals have not donated (and still donate) their
ferrets to the cause.  I'm not going to kill an animal for its skeleton, so
this allows some people to have the satisfaction of helping determine ferret
origins, and I get what I need as well.  The same is true here.  If you
choose to treat your ferret with chemical or homeopathic remedies, at the
ferret's death donate whatever is needed to a researcher who is willing to
compile the medical and histological data.  Perhaps Dr. Williams can make
some suggestions here.  Special handing of specimens *must* be done, but
your vet can do it for you.  As far as *I* am concerned, if you want to
promote any proceedure other than surgery, you have an ethical
responsibility to provide proof of your claims, which is tied up in the
carcass of your dead and beloved pet.  Until these types of studies are
done, THERE WILL NEVER BE PROOF that chemical or homeopathic remedies
(including light treatment) have any substance in the treatment of ferrets
suffering adrenal disease.  Like it or not the proof is in the pudding, so
put up or close the trap.
 
I have myself in enough hot water until the next post, which will cover why
some forms of treatment seem to help (when they don't really).  Following
posts will discuss the treatment of symptoms, the USA-World adrenal
difference, some genetic-environmental questions, the question of early
neutering, and finally, a summary about everything.  They will come
every-other day, mostly because they are difficult to write and I have
school to think about.  As I said, please hold off all questions and flames
until the series is finished; write your questions down, but hold off on
sending them until I finish this thing, ok?
 
Bob C (C as in Custer) and 20 MO Wild Frettchens
[Posted in FML issue 2214]