Hi.  Re:  the possibly Cushingoid ferret  -- yes, with Cushings the resistance
to illness and the abilities to deal with stress and with salt do decrease, yes,
there is hair loss, yes, the nodes may be up enough to add to a strange
appearance and to interfere with walking, the classic Cushingoid fat
distribution can also interfere with walking because fat tends to redistribute
to the abdomen and around the nodes.  In addition, the presence of the adrenal
tumor, whether  benign or malignant (an adenocarcinoma which apparently is often
of a lymphosarcoma origin) disrupts the normal steroid productions of the
adrenal, can supress the other adrenal if it is not affected (rare enough that
Hjalmar was the first documented case), and can produce hormones itself.  But,
YES, YES, YES, YES, YES, it IS treatable, even when it is malignant.
 
Hjalmy had a monk's crowning baldness, and except for a few stray strands or
tiny patches and hair on the last 80% of his tail except the very tip he was
bald from the chest down.  FYI a ferret will get itchy black heads in bald
areas, especially on the side which is most often slept on.  Regularly baby oil
the ferret, give Efa-Z to help the weak Cushingoid skin, and consider GENTLY
running the edge of a nail from front to back to help remove the worst heads.
 
Your vet should contact Tom Kawasaki or you should go to him as Nancy suggested.
Our ferret specialist, Hanan Caine had to come up with a lot of the approaches
used with extreme cases and interact with the nation's Cushings, adenosarcoma,
and lymphosarcoma specialists when Hjalmar became a first several times for
treatment (not unusual since it is only recently that people have known how to
diagnose, how to most safely anesthetize, and have bothered to try to treat MOST
of the severe health problems encountered by ferrets).  Hanan can be reached at
1-908-766-4211.  AMC in N.Y. is also wonderful, and should the ferret turn out
to have lympho the vet will want to call Dr. Lympho (i.e. Ann Jeglum) whose
protocols for many animals -- the feline variant is used even MORE successfully
on ferrets.
 
Initial treatment:  do a sonogram.  If one adrenal is involved and the other
clearly is not, remove that adrenal.  Sometimes a sonogram will show up a
microtumor which would not be seen by eye.  (Occasionally there will be an
artifact which looks like tumor but is not, but that is quite rare.)  Should
post-op convulsions occur from causes other than the usual (fever, sugar drop,
etc.) consider that the other adrenal may have been suppressed and have Florinef
handy.  As soon as possible try to wean off the Florinef to jump-start the other
adrenal.
 
If both adrenals are showing signs of involvement ketoconazole can be given, or
C-Lysodren can be used.  From personal experience we know that Lysodren worked
very well for Hjalmar.  The trick was getting it small enough and delivering it
since saliva destroys it.  That's one of the places Nutrical comes in (as well
as for maintaining weight and nutrition and for making Predinosone palatable.)
We had the pharmacist make up a few capsules (make SURE you say NO FILLER and
explain carefully that you will use those to measure doses), put them into TINY
vials to see where the correct dose comes up to.  If possible, use graduated
vials, if not, permanently mark another vial.  Then get tiny chemists spatulas
and a marble mortar and pestle since you will have to grind your future doses.
BE SURE TO HAVE PRENISONE HANDY since it is possible for the ferret to have
Addison's Crises as the problem gets worse.  We dealt with several very rapidly
advancing Addison's Crises with shock and one splenic hemorrhage and one of the
liver  before Hjamlar's  tumor suddenly grew large enough to show on a sonogram
about a year after on-set.
 
Removal of the right adrenal is more difficult than the left because of the
danger of slicing the Vena Cava ( a major vein ) which will result in rapid
death from blood loss  (an aside, when I used to curate for the anatomy dept. at
Stony Brook one of the students taking anatomy was over on a special leave of
absence from an Italian med school because they learned anatomy by looking at
books and then assisting in ops but they accidently cut a man's femoral artery
and almost lost him and the student felt that he just could not continue his
studies till he better knew anatomy.  Many of us would be in the lab till the
wee hours getting more insight into areas of personal interest, eatting lo mein
and trying to come up with songs to help us remember things.  We were always
careful with our cadavers and very grateful to their owners, with prayers being
common, and with us being very protective of them.) --  back to ferrets --- or
with the liver  bleeding out.
 
Make sure that your ferret drinks enough, cut salt in take since adema of major
organs is common with Cushings, regularly give antibiotics.  (Try Clavamox if
Amoxi isn't working.)  Anyone in household who works with ferret but has a cold
or other illness should scrub each time and wear a mask of bandana over mouth
and nose.
 
Now, here's the up side.  Hjalmar had an additional 14 MONTHS of life because of
his treatments and almost all of it was very spoiled, enjoyable time for him.
He laughed, he played, he expected to be spoiled, he spent enormous amounts of
time inside my sweaters or in bed with us, etc.  When he went it was obvious for
a week that his chemo had stopped holding the cancer at bay and that the special
diet of cat food, Nutrical, hard boiled egg YOLKS, Brewers yeast (which should
be a daily part of all ferret's diets to possibly reduce the instance of
insulinoma), etc. wasn't helping his weight anymore.  He went into renal failure
one night and we spent the night with him between us hoping for him to wet the
bed, but had to have him put down the next day.  Aside from recuping from his
bleeding episodes, and stabilizing from the op, he only had pain about one day
before the renal failure -- and that was more tiredness than real pain -- and
for about 6 hour with the renal failure (his pain went away about 4 hours before
we had him given a shot to literally put him to sleep in my arms before the
final shot).
 
BTW, prednisone cramps of the legs, feet, (and more rarely) anus can be well
treated with  massage or with massage and gentle range of motion exercises in
warm to almost hot water.
 
We are VERY happy that we had over a year of extra time with Hjalmar despite his
cancer.  He was a real darling.  Years ago I had major surgery, and every ferret
was totally obedient for the first 6 weeks I was home (Yes, if you use the same
words over and over and stick to simple sentences they DO understand MANY words
-- both we and our vet's think it's at least the range of most dogs and far
better than cats -- which is no surprise for an animal which ancestorially for
about 50 million years needed to learn and understand the sounds of it's own
species, prey species, and preditors in a pitch black environment. ).  Hjalmie
went beyond the others.  He insisted on being by my side for the entire time, so
much so that it was almost impossible to get him to go into the cage to even eat
or drink.  He was as protective and gentle as any hound is in that situation.
 
Hjalmar used to like to play hide an seek ("Where's Hjalmar?)  but would often
accidently leave his tail hanging out, and when he was really into the game that
tail would be wagging a mile a minute and he'd be laughing a breathy "Heh, heh,
heh!"  Technically we were not supposed to admit to seeing him till he'd pop out
his head.  ("There's Hjalmar!").  He also LOVED carrying a stacking paper cups
(We always made holes in their bottoms in case he got stuck), rearranging my
hair, flirting with all females other than me (I was MOMMY.), stealing, having
his tummy tickled, climbing into my pant's leg and tickling me behind my knee,
and getting under a plastic basin to dash blindly around the room till he'd
collide with something (Daleks game).  He was so wonderful that one of our vets
used to threaten that she'd come by and kidnap him if she ever got the chance
unless we brought him in for hugs and kisses even on the weeks when he was well.
(Yes, we did, and yes, he LOVED going to the vet's.)
 
Should your ferret become dehydrated during this learn to give fluids
subcutaneously (Ringer's for this, but those with ferrets with insulinoma will
want to use a mild dextrose solution).
 
Hjalmar died at almost 7 and 1/2 years and was a convenience male.  This is
within  1/2  a year of the same age reached by an apparently related WHOLE male
(exact age unknown) who died of sudden onset of congestive heart failure from
advanced age, but we do know of a few ferrets which are quite older (several
convenience 10 and 11 year olds, and one which was somewhere in the range of 13
to 14 whose age at spaying was not known).  BTW, some of them were (and in one
case  is) on grocery store foods, though definately NOT on high fish content
ones (with which the high calcium levels interfere with zinc absorption).  We
prefer the higher grade stuff.
 
Meltdown has become the most responsible ferret we've ever seen and doesn't even
run our answering machine anymore, she has taken her job of top ferret that
seriously since we lost Fritter  about 3 years ago .  'Chopper (for helicopter)
now scales the trunk of a palm we have in the living room.  Ruffie takes great
delight in our teaching her "action" words and especially likes to put her
"hands" on the stove drawer and rattle it to say "Raisins!".  Spot is about up
to 4 pounds at 6 months and an absolute hug-muffin.  Meeteetse looks like one of
the BFF kits in her facial expressions, and especially in her very wide smiles,
hence her name.  She still is too young to show much individuality, still has
siamese coloring on the face but is darkening up on the legs.  You should see
these guys in a Crinkle Sack (a new type of cat toy)!  So far that's the best
love toy after mousies, us, and other ferrets!
 
Hope this helps the ill ferret.  Let's face it, these guys are magnificent
friends and family members. We can say that with over ten years of personally
knowing it well.
 
    All our best to all, Sukie, Steve, Meltdown,  Ruffle, 'Choppy (Helicopter),
Spot (albino, of course), and Meeteetse, and in our hearts the memories of
Tandy, Haleakala, Helix, Fritter, and Hjalmar
 
[Posted in FML issue 0423]