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]