Ferret medicine and surgery

Dr. Szabó Zoltán

Szent Istvan University

Internal Medicine Department
Exotic Divison

2008
 Things I will not speak about
• Which is obvious

• Which is same in ferrets and dogs or cats

• Which has no clinical significance

• Which we have not tried in practice

 Things I will speak about
• Different physiological attributes

• Special problems

• Important information for daily practice

• Common diseases
 Suggested books

Katherine Quesenberry:
Ferrets, Rabbits and
Rodents: Clinical Medicine
and Surgery
 Suggested books

John Henry Lewington:

Ferret Husbandry,
Medicine and Surgery
 Suggested books

James W Carpenter:
Exotic Animal Formulary
 Suggested books

Alan M. Fudge:
Laboratory Medicine Avian
and Exotic Pets
 The ferret
• Mustellidae family
• 3 species:
• M. putorius – Europe
• M. eversmanni – Eurasia
• M. nigripes – North-America

• domestication:
– more than 2000 years ago
– first recorded reference:
Aristophanes 350 BC
 Ferret
Uses:
– rodent control
– rabbit hunting („ferreting”)
– pelt
– biomedical research (influenza)
– cable transportation in tubes
– sport (ferret legging)
– companion animal:
• small
• very interactive
• not suitable for children
 Physiologic values
• Body weight male: 1,5-2 kg
• Body weight female: 0,6-1kg
• Life span: 7-9 years
• Sexual maturity: 6-12 months
• Gestation period: 41-43 days
• Litter size: 6-10 kits
• Eyes open: 32-34 days
• Weaning age: 6-8 week
• Body temperature: 38-39,5 °C
• Heart rate: 200-300 beats/min
• Respirations: 33-36 breaths/min
 Anatomy and physiology
• big, easily dilating stomach
• very short GI tract (approx 2m)
• short passage time (approx 3-4 hours)
• strict carnivores:
– Can’t use carbohydrates efficiently
– Can’t digest fibers
• carnivore ≠ meat eater
• whole prey eater
• minimal gut flora
• gastrointestinal parasitism is very rare
 Anatomy and physiology
Reproductive cycle
• controlled by photoperiod
• breeding season in spring
• females are seasonally polyoestrous
• induced ovulators
• no copulation → no ovulation
• females will keep in oestrous

• hyperoestrogenism →anemia, alopecia

• Without treatment it can cause death!
 Anatomy and physiology

Odour
• The cause is not the scent glands
• The sebaceous glands of the skin produce it
• Mostly in males
• Castration solves the problem
• Removal of scent gland is pointless and BANNED!
 Nutrition
Appropriate food:
• mouse, day old chick
• ferret food
• cat food for kittens (!)
• meat, egg, cheese
Banned:
• vegetables, fruits → ileus danger
• high sugar food → insulinoma danger
• meat only food for young ferrets → rachitis danger
meat = too little Ca, too much P
 Physical examination
• Same as in dogs and cats
• Observation
• Ausculation
• Palpation
 Vaccinations
• No obligatory vaccination

Distemper
• 8 weeks of age
• 11 weeks of age
• 14 weeks of age
• booster vaccines annually

Rabies
• 16 weeks of age
• booster vaccines annually
 Vaccine reactions
Incidence
• mostly after 2 years of age

Symptoms
• Mild: scratching, salivation
• Severe: vomiting, diarrhea
• Fatal: shock, death

Treatment
• fluid therapy, antihistamine, corticosteroid
 Anesthesia
Fields of applications
• Deep physical examination (e.g. oral cavity)
• Venipuncture, placing intravenous catheters
• X-ray, ultrasonography
• Painful interventions
Inhalation anesthesia
• isofluran or sevofluran
• mask then endotacheal intubation
Intravenous anesthesia
• Propofol
Diagnostic techniques
 Blood
Venipuncture
• V.cava cranialis
• V. jugularis
• V. cephalica
Hematology
• EDTA tube(purple)
Biochemisry
• Heparin tube (green)
Suggested parameters
• ALT, total bilirubin
• Urea, creatinine
• Amylase, lipase
• Glucose
V. cava cranialis
V. jugularis
V. jugularis
 Diagnostic techniques
• Splenic aspiration
• Bone marrow collection
• Trachea lavage, broncho-alveolar lavage
• X-ray
• Ultrasonography
• CT
 „Sick ferret” protocol
Always perform
• History taking
• Weight measuring, rectal temperature taking
• Physical examination
• Anesthesia by isoflure (if the condition of the
animal allows it)
• Deep abdominal palpation
• Examination of the oral cavity and the pharinx
• Emptying the bladder: urine analysis
• Blood collecting
 „Sick ferret” protocol
• anorexia, dehydration: fluid therapy
• diarrhea: fecal examination
• vomiting: X-ray or ultrasonography
• Abdominal mass: X-ray or ultrasonography
• Dyspnoe: X-ray and cardial ultrasonography
• alopecia: abdominal ultrasonography
Treatment techniques
 Catheterisation
Vein catheterisation
• yellow or blue catheter
• V. cephalica
• V. jugularis

Intraossealis catheterisation
• femur, humerus, tibia
 Fluid therapy
• Iv, sc, io, ip
• Average 50ml/kg (depends on the dehydration)

• Ringer-(lactated) + glucose
• Duphalyte
 Antibiotics
Enrofloxacin (fluorokinolon)
• Product: Baytril, Enroxyl, Syvaquinol
• Spectrum: broad, Gram +, Gram – (anaerob ∅)
• Dose: 10mg/kg sid, po, sc
• Contraindication: young ∅, pregnant ∅
 Antibiotics
Amoxycillin + clavulanacid (penicillin)
• Product: Synulox, Augmentin, Aktil
• Spectrum: broad, Gram –, anaerob, Gram + less
• Dose: 20-30mg/kg bid, po, sc, iv
• Contraindication: -
 Antibiotics
Metronidazol
• Product: Klion
• Spectrum: narrow, anaerob
• Dose: 20-30mg/kg bid, po, sc, iv
• Contraindication: -
 Analgetics
Butorphanol
• Product: Butomidor, Alvegesic
• Effect: abdominal pain, 4 hours
• Dose: 0,05-0,5mg/kg sc, im
• Contraindication: -
 Analgetics
Ketoprofen
• Product: Ketofen
• Effect:
• Dose: 1mg/kg sid po, sc, im
• Contraindication: before anesthesia ∅, kidney failure ∅
 Blood transfusion
Recipient
• severe anemia
• iv catheterization
• no blood type groups
Donor
• healthy male ferret
• 1,5 kg
• during anesthesia
• v. jugularis
• 5-10ml blood
• heparinized syringe
 Surgeries
Castratio
• Odour, agression

Ovaryohysterectomy
• For every female ferret not meant for breeding
• Earliest age 6 months
• Don’t have to wait until the end of the oestrus!

Ileus

Removing the adrenal gland

Gastrointestinal diseases
 Dental diseases
Tooth fracture
Incidence: mostly in older ferrets
Symptoms: canine tooth
Treatment: if the dental pulp is exposed
 Dental diseases
Gingivitis, tartar
Incidence:
• mostly in older ferrets
• inadequate food
Symptoms:
• molar teeth
Treatment:
• removing the tartar
• antibiotic if necessary
 Megaoesophagus
Pathogenesis:
• muscular atrophy and dilatation of esophagus
Etiology:
• unknown
• possible causes
– Damage of the innervation of the esophagus
– Damage of the neoromuscular junction
– Damage of the muscles of the esophagus

• Etiology of the secunder megaoesophagus in other species:

Systemic illnesses Local problems
• myasthenia gravis • pleuritis
• lupus erythematosus • thymoma
• hypothyreosis • esophageal obstruction
• Addison’s disease
• heavy metal toxicosis
 Megaoesophagus
Symptoms:
• chronic
• regurgitation, salivation
• lethargy, anorexia, cachexy
• coughing, dyspnoe
Differential diagnosis:
• ileus
• gastritis (Helicobacter mustelae)
Diagnosis:
• history and symptoms
• X-ray
• endoscope examination
Megaoesophagus
X-ray
Megaoesophagus
X-ray with barium
 Megaoesophagus
Treatment:
• mostly unsuccessful
• treating the secondary problems

• supportive care, fluid therapy

• Antibiotics
– enrofloxacin (Baytril) 10mg/kg sid
• smooth muscle enhancer:
– metoclopramide (Cerucal) 0,2-1mg/kg tid-qid
• H2 receptor blocker:
– famotidin (Quamatel) or ranitidin (Zantac)
• regurgitation reducer:
– Cisaprid (Coordinax, no avaliable) 0,5mg/kg sid-tid
Megaoesophagus
Megaoesophagus
 Gastric ulcer and gastritis
Etiology:
• bacterial infection: pl. Helicobacter mustelae
• foreign body
• ulcerogenic drugs: NSAIDs
• kidney problem
• tumor
Symptoms:
• vomiting, nausea, tooth-grinding, salivation
• melena
• abdominal pain, anorexia, lethargy
Treatment:
• Antibiotic, surgery
• Supportive care: fluid therapy, antacides
Gastritis and gastric ulcer
 Helicobacter mustelae gastritis and
gastric ulcer
Incidence:
• common
• rarely causes any symptoms
• mostly in older ferrets
Symptoms:
• gastric ulcer, gastric tumor
• lethargy, anorexia, dehydration, anemia
• vomiting, salivation, melena
Treatment:
• difficult
• amoxycillin + metronidazol + bizmut or
• klaritromicin + metronidazol + omeprazol
 Enteritis and diarrhea
Symptoms:
• diarrhea, dehydration, lethargy
Diagnosis:
• blood analysis
• microbiological and parasitical examination of the feces
• histological samples from the GI tract
Treatment:
• aggressive fluid therapy
• painkiller, vitamins, probiotics (?)
• antibiotic (?)
• special diet
 Enteritis and diarrhea
• Bacteria:
• Salmonella
• Mycobacterium
• Lawsonia (Proliferative Bowel Disease = PBD)
• Virus:
• Corona virus (Epizootic Catarrhal Enteritis =ECE)
• Rota virus
• Human influenza virus
• Distemper virus
• Aleuti disease virus
• Other:
• Inflammatory bowel disease (IBD)
Eosinophilic gastroenteritis (EGE)
 Salmonellosis
Causative agent:
• Salmonella Newport
• Salmonella Typhimurium
• Salmonella Cholerasuis
Incidence:
• rare
Source of the infection:
• raw meat, mainly chicken
Symptoms:
• bloody diarrhea, anemia
• conjunctivitis

Treatment:
• antibiotic
 Mycobacteriosis
Causative agent:
• Mycobacterium bovis
• Mycobacterium avium

Source of the infection:

• raw meat
• unpasteurized dairy products

Symptoms:
• chronic weight loss
• vomiting, diarrhea
• hard to diagnose

Treatment:
• zoonotic potential
• treatment is not recommended
 Proliferativ Bowel Disease
(PBD)
Causative agent:
• Lawsonia intracellularis
Incidence:
• mostly 10-16 weeks old kitten
Symptoms:
• dark, bloody diarrhea, dehydration
• weight loss
• rectal prolapse
• intestinal perforation → peritonitis
• hard to diagnose
Treatment:
• cloramfenicol antibiotic
Inflammatory bowel disease (IBD)
Etiology:
• unknown
• possible causes: chronic infection, food allergy, autoimmune,
idiopathic
Symptoms:
• young or middle-aged ferrets
• chronic weight loss
• lethargy, anorexia
• occasional vomiting, intermittent diarrhea, dehydration
Diagnosis:
• blood analysis
• microbiological and parasitical examination of the feces
• histological samples from the GI tract
Treatment:
• fluid therapy, supportive care
• hypoallergenic diets
• corticosteroid (prednisolon 1mg/kg po sid-bid) or
• azatioprin 0,9mg/kg po sid-tid)
 Eosinophilic gastroenteritis
(EGE)
Etiology:
• special type of the IBD
• unknown
Incidence:
• after 6 months of age
Symptoms:
• chronic bloody diarrhea
• vomiting, dehydration
• weight loss
Treatment:
• corticosteroid (prednisolon 1,25-2,5mg/kg po sid)
• ivermectin (0,4mg/kg sc, po every 14 days)
 Epizootic Catarrhal Enteritis
(ECE)
Causative agent:
• Corona virus
Incidence:
• adult ferrets
• highly transmissible
• asymptomatic carrying is common
• incubation period 48 to 72 hours
Symptoms:
• green, mucoid diarrhea
• anorexia, lethragy
• high morbidity, very low mortality
Treatment:
• supportive care
 Rotavirus diarrhea
Causative agent:
• Rotavirus

Incidence:
• 2-6 weeks old kittens

Symptoms:
• green, mucoid diarrhea

Treatment:
• supportive care
Diarrhea caused by human influenza
virus
Causative agent:
• Orthomyxovirus
Incidence:
• common
• source of the infection is the owner
Symptoms:
• fever
• upper respiratory symptoms
• diarrhea
Treatment:
• supportive care
Gastrointestinal foreign bodies
Etiology:
• non digestible objects
• vegetables, fruits, dry dog food (!)
Incidence:
• very common
• mainly in young ferrets (< 2 years)
Symptoms:
• lethargy, anorexia
• salivation, face rubbing
• vomiting, diarrhea, dehydration
Diagnosis:
• X-ray, ultrasonography
• Blood analysis
Treatment:
• surgery
X-ray
Surgery
Surgery
Urogenital diseases
 Hydronephrosis
Etiology:
• obstruction of the ureter
– congenital
– acquired
• iatrogen (ligation durig OHE)
• urolithiasis in the ureter
• inflammation
• tumor
Pathogenesis:
• the urine fills the kidney
• atrophy
 Hydronephrosis
Symptoms
Symptoms:
Unilateral hydronephrosis
• chronic, asymptomatic
• progressive abdominal distension
• enlarged, fluid filled kidney

Bilateral hydronephrosis
• acute
• acute renal faliure symptoms
• olyguria, anuria
• postrenal uraemia
Hydronephrosis
Ultrasonography
Hydronephrosis
X-ray
 Hydronephrosis
Treatment
Treatment:
Unilateral hydronephrosis
• nephrectomy
• good prognosis

Bilateral hydronephrosis
• grave prognosis

After the surgery:

• kidney diet
• regular blood analysis
– urea: 0,2-16 mmol/l
– creatinin: 8,8-106 µmol/l
Hydronephrosis
Endocrin and neoplastic diseases

Insulinoma
Adrenal gland disease
Lymphoma
 Insulinoma
Incidence:
• most common tumor type in ferrets
• middle aged and older animals
• both sexes

Cell types in the endocrin pancreas:

• Alpha cells: glucagon
• Beta cells: insulin
• Delta cells: somatostatin
• Epsilon cells: pancreas polipeptid
 Insulinoma
pathogenesis
Beta cell tumor

Insulin pruduction ↑

High blood insulin level

Liver Tissues
gluconeogenesis ↓ glucose intake ↑
glycogenolysis ↓

Blood glucose ↓
 Insulinoma
pathogenesis
Low blood glucose

Liver
Adrenal gland
gluconeogenesis ↑ Alpha cells cortisol ↑
glycogenolysis ↑ glucagon ↑ adrenalin ↑

Beta cells
insulin ↓
 Insulinoma
Symptoms
Acute
– acute hypoglycemia:
• apathy
• salivation
• collapse, seizures, coma
– adrenerg symptoms:
• agression, tremor
• tachycardia
• hypotermia
Chronic
• lethargy, weakness
• anorexia
• ataxia, hind leg paresis
 Insulinoma
Diagnosis
Blood glucose level:
• physiological: 5-11,5 mmol/l
• insulinoma: <3,3 mmol/l
• weakness, lethargy: 1-2 mmol/l

Insulin concentration:
• Physiological insulin: 36-251 pmol/l (5-
35µU/ml)
• Insulinoma: >773 pmol/l (>108µU/ml)
 Insulinoma
Diagnosis
Hemtology and blood biochemistry
• ALT ↑, AST↑
• Leucocytosis, neutrophilia, monocytosis
X-ray
• splenomegalia
Ultrasonography
 Insulinoma
Differential diagnosis
Low blood glucose level:
• starving
• liver disease
• sepsis

Ataxia, hind leg paresis:

• trauma

Seizures:
• CNS diseases
 Insulinoma Treatment
Hypoglycemic episode:
Owner: honey or corn syrup
Veterinarian: dextrose bolus (0,25-2ml) slow (!) iv.

If the ferret doesn’t respond, or have continuous seizures:

• iv. fluid therapy, 5% dextrose
• dexamethasone
• seizures: iv diazepam: 1-2 (max 5) mg/kg
 Medical therapy
• Controls the clinical signs for 6-18 months
• Doesn’t stop the tumor progression
• Old (>6 years) ferret
• Different diseases
• If the owner doesn’t want the surgery
Prednisolon alone: 0,5-2mg/kg bid po
Prednisolon and diazoxid:
• diazoxid: 5-10 mg/kg bid
• prednizolon: 1-1,25 mg/kg
Special diet: meat based, high protein, low
carbonhydrate
 Surgical therapy
• Younger (<6 years) ferrets
• Longer survival time: average 15 months
Preoperative care:
• 4 hour fasting
• 1-2 hours before the surgery iv. fluid therapy 5%
dextrose
• blood glucose check
During the surgery:
• Examine: liver, spleen, lymph nodes, adrenal
glands
• blood glucose check
Insulinoma
 Surgical therapy
Tumors only in one lobule:
• partial pancreatectomy
Tumors in both lobules:
• nodulectomy

Postoperativ care:
• blood glucose check 2x
• withhold food and water for 12-24 hours

Complications:
• pancreatitis
• diabetes mellitus
 Adrenal gland disease
• Hypoadrenocorticism:
– Addison’s disease

• Hyperadrenocorticism :
– human, dog:
gluco- and mineral corticoid overproduction
= Cushing-syndrome

– ferret:
sexual steroid overproduction
= FADC = Ferret Adrenal Disease Complex
Ferret Adrenal Disease Complex
 Incidence
• second most common tumor in ferrets
• sterilized ferrets
• both sexes
• average 3-5 years
Spring  days get longer
Pineal gland
Before neutering Melatonin 
Hypotalamus
GnRH

Hypophysis

LH and FSH

Adrenal glands

Gonads
Spring világos órák száma

Pineal gland
After neutering Melatonin 
Hypotalamus
GnRH

Hypophysis

LH and FSH

Adrenal glands

 Causes
• sterilization
(USA ferrets before 6 weeks of age)
• indoor photoperiod:
too much light  melatonin
  GnRH



• inbreeding
• nutrition
 Symptoms
Progressive alopecia – 90 %
• spring
• symmetrical hair loss
• hair epilates easily
• alopecia begins on the tail
• The hair coat may regrow during the fall, the alopecia
begins next spring again
Symptoms
 Symptoms
Enlarged vulva – 70%
• similar than during estrus
• seromucoid discharge
 Symptoms
Pruritus – 33%

Disuria, stranguria
• male ferrets
• periurethral prostate cysts obstructs the
urethra
Other symptoms
• aggression, anorexia, weight loss
 Diagnostic testing
Hematology and blood biochemistry
• anemia (hyperoestrogenism)
• ALT elevation
Hormone tests
 ACTH stimulation test don’t work in ferret
 dexamethasone supression test
☺ estradiol,
☺ 17-hydroxiprogesterone,
☺ androstenedione, work in ferret
☺ dehydroepiandrosterone
 Diagnosis
Urine analysis
• UCCR = urinary cortisol:creatinine ratio
• higher in adrenocortical disease
• false positivity:
– lymphoma
– liver disease
– diabetes mellitus
 Diagnosis
Ultrasonography
 Differential diagnosis

Enlarged vulva, alopecia

• ovarian remnant
 Differential diagnosis

Enlarged vulva, alopecia

• ovarian remnant
 Treatment

Medical therapy
• moderating the clinical signs
• doesn’t cure the disease

Surgical therapy
• cures the disease
• adrenalectomy
 Medical therapy
If:
• the owner cannot afford the surgery
• a ferret is a poor surgical candidate
• inoperable tumor
• bilateral adrenal tumors
 Medical therapy
GnRH-analogs
• deslorelin- cetate: Suprelorin implant
• leuprolid-acetate: Lupron Depot inj.

Melatonin
• tablet: Bio-Melatonin tabl.
• implant: Ferretonin implant
 GnRH-analogs
• low dose stimulates the LH and FSH
secretion

• high dose cause GnRH receptor down

regulation
 Pineal gland
Melatonin 
Hypotalamus
GnRH analogs
GnRH

Hypophysis

LH and FSH 
Adrenal glands 
 Using GnRH-analogs
Deslorelin-acetate: Suprelorin implant
• subcutaneously
• symptoms decrease afters 2-6 weeks
• effective for 1-2 years

Leuprolid-acetate: Lupron Depot inj.

• two protocols:
– 0,1-0,2 µg monthly
– 3mg/kg in every 4 months
 Melatonin
• in dark meletonin level increases
• in light meletonin level decreases

• the melatonin level in indoor ferrets is very low

 Pineal gland
Melatonin

Hypotalamus
GnRH 
Hypophysis

LH and FSH 
Adrenal glands 
 Melatonin
Melatonin tablet: Bio-Melatonin
• 0,5-3mg melatonin sid
• medication 7-9 hours after sunrise

Melatonin implant: Ferretonin

• no publication
 Surgical treatment
• a ferret is in good condition
• unilateral (left) tumor
• total unilateral adrenalectomy
 Adrenal glands

v. cava caudalis

Forrás: Ferrets, Rabbits and Rodents Clinical medicine and Surgery

Adrenal glands of a healthy ferret
Left adreanlectomy
Left adreanlectomy
 Right adreanlectomy

Forrás: Ferrets, Rabbits and Rodents Clinical medicine and Surgery

 Right adreanal gland tumor

Forrás: Deborah Cottrel DVM

Lymphoma
 Lymphoma
Incidence
• every age
• frequent in older ferrets

Symptoms
• enlarged lymph nodes
• hepatomegaly and splenomegaly
 Lymphoma
Diagnosis
• citological sample
• blood analysis

Treatment
• chemoterapy
1. prednisolon – vincristin – cyclophosphamid
2. vincristin – L-asparaginase – prednisolon –
cyclophosphamid – doxorubicin - metotrexate
 Distemper
Cause:
• Paramyxovirus
Incidence:
• non vaccinated ferrets
Symptoms:
• CNS Symptoms
Diagnosis:
• History, symptoms, PCR
Treatment:
• supportive care
• euthanasia
Prevention:
• Vaccination