July 12, 2011

Myeloma or MM: Cases Studies from Japan, part00



Ferrets and their endless array of cancers.
Apparently, MM is rather rare in the USA.  And a search of pubmed does not do anything to alter that impression as only one documented and published case shows up and even that was from the 1980s.
In Japan, however, not so unheard of.  As the most frequent ferrant poster put it "My vet reports that it is rare but there are several new cases every year.  Including my own ferrets, I personally know of 5-6 cases ."

Given the vast lack of information on MM in ferrets, we have decided to present a new mini-series of all the MM information we could collect from Japan.

The following is all the carefully collected, extracted, and arranged (for ease of reading) case studies available at this time.   Veterinary and actual owner observations and accounts are included.


:*・☆・*:☆.。.:*・☆・*:.。.☆:*・☆・*:


CASE 1:

Summary:
?? Farms
? (N?, unknown but likely given Japanese regulations and ferret population sources)
approx. 2 years of age when finally diagnosed.

Confirmed MM case.
MM was diagnosed previous to decease. However, the ferret died soon after diagnosis.
Necroposy findings showed bone fractures and also hinted at Bence-Jones proteinuria.
Pathology results after death also confirmed MM.

Progression:
The blood test 2 months prior to final diagnosis showed no irregularities.
Then one day the owner found their ferret was suddenly unstable and wavering, and rushed to the vet. The result of that vet visit was a final diagnosis of MM. The ferret died one week post-diagnosis.
Chemotherapy was used in the interval between diagnosis and death. (Owner feels the chemo administered at the time was too powerful and resulted in an earlier death)

Diagnostic Methods:
XRAY – a veterinarian or xray tech familiar with MM will be able to identify the small round holes in the bone as this is particular to MM
Bone fractures also common.

Bone Marrow Biopsy – considered to give a near definitive result as to whether MM or "other".

**Owner notes that another ferret that s/he owned followed a similar path with similar symptoms but was later diagnosed with CLL (chronic lymphocytic leukemia).

(Time - Other postings and time line references point to this case occurring around 2000.)

original discussions can be found here: 多発性骨髄腫の疑い and 多発性骨髄腫


CASE 2:

Summary:
Canadian Farms
M (N?, unknown but likely given Japanese regulations and ferret population sources)
1 year 4 months at time of original posting in 06/2008

Tested with regular blood screening, xray, ultrsound, and finally a bone marrow biopsy.

Directly from the posting:
"Originally, when he had a health exam last October and since the ALP was somewhat high (152) growth process so we decided to monitor for 3 months then retest.

At the retest, the ALP had fallen to 109 but the TP value had risen.
The following are the test values to date:




10/22/2007 1/7/2008 2/16 3/17 6/14
TP
6.6    8.8 9.2 8.4 9.4
ALB - - 2.9 2.8 3.O
PCV 54 50 45 38 43
HB 19.3 18.4 16.3 14.4 15.8
RBC 1143 1104 986 869 959
WBC 8600 7900 8000 8695 10200


We also tested for ADV in Feb and June and it was always less than “3 times” .
However, there is still the possibility so I can not say right off that ADV is not unlikely. The urinalysis had a value of 30(1) for the albumin. "

Other symptoms include eyes a little white and seems to not be able to see well. It is said this symptom is probably a result of the hyperproteinemia. Other than that, acts lively and well.

Diagnostic methods: blood screening, xray, ultrasound, and finally a bone marrow biopsy.
The results from the bone marrow biopsy in July 2008 removed MM as a potential candidate.

MM diagnosis refuted. Given the diagnosis of ADV.

**Note CAGEMATE (New Zealand Farms, M(/N?), 1 year 11 months) present with chronic hepatitis.
original discussions can be found here: 多発性骨髄腫の疑い


CASE 3:

Summary:

?? Farms
M (N?, unknown but likely given Japanese regulations and ferret population sources)
4 years old at original posting in 11/2006

Confirmed MM case. Died one week post-diagnosis.

Owner was told that even IF it is found early, there is no hope of saving the patient so the owner left everything in the hands of the vet.
Any treatments administered during the one week interval between diagnosis of MM and death were not listed.
original discussion can be found here: 多発性骨髄腫


CASE 4:

Summary:
Marshall Farms
M/N
4 years, 11 months

Confirmed MM case.

Symptoms: Lethargy and suppressed appetite. Weakness in posterior limbs.

Xrays showed an enlarged spleen and a fractured rib cage
However, aside from mild swelling palpitated at the mesenteric lymph nodes, fecal and blood tests showed no significant irregularities.

Symptoms improved temporarily with the use of medical therapies including Predisone and Interferon. However, on day 11 symptoms returned and on day 18 both posterior limbs showed partial paralysis.

Another Xray was taken and showed dislocation of the 6th-7th dorsal vertebrae along with multiple instances of "punch-outs" (Japanese word refering to the numerous missing black shadows seen in bones in Xrays) and osteolysis. Plasmacytes were not seen in the peripheral blood and there was no atypism of the lymphocytes.

In accordance with the owner's wishes, no bone marrow biopsy was performed.
We continued with the identical appropriate treatment but the patient died on the day 31.

Examination after death confirmed instances of "punch-outs" in the bones throughout the entire body and osteolysis. Monoclonal gammopathy was not found, hence ADV was not diagnosed. Multiple instances of miliary nodular masses were seen in autopsy as were masses suggesting insulinoma. Histopathology showed widearea spread of atypical cells similar to plasmocytes throughout the bone marrow, spleen, and abdominal cavity, organs and mesentery.

The final comprehensive diagnosis is believed to be MM.

(published 2006)


CASE 5:

Summary:

posting at a later date since MM was only suspected but not confirmed. However because it was suspected the vet followed through with one typical therapy regiment for treating MM in a ferret. That information is of use.

UNconfirmed MM case.
No final diagnosis noted.


:*・☆・*:☆.。.:*・☆・*:.。.☆:*・☆・*:


Cheers and see you again! (^_-)-♪

Disclaimer: I am not a DVM. Advice is offered after my own extensive research and/or experience and should be undertaken at your own risk. Consult with your licensed DVM before undertaking any treatment!

All translations copyrighted and owned by myself. All copyrights of their respective owners. No part of this web site may be produced, reproduced, stored in a retrieval system, or transmitted in any form or by any means without the written permission of the copyright owner.
Thank you for helping us out!

July 09, 2011

a Wish List - Pain Management




In looking up a medical issue for another ferrant (a new word I learned recently, a "ferret parent".) I stumbled across a fabulous association the IVAPM, International Veterinary Academy of Pain Management.
Taken from their introduction page:
Founded in 2003, the IVAPM intends to become the recognized leading forum and resource in animal pain for the veterinary profession through research, education, and advocacy.

Most people who deal with chronic pain have a keen sense of the distinction between "living" and "existing" so for me to happen upon this group was just... Wow... Truly impressive. On the one hand, it took until 2003 to officially acknowledge the need to address pain management in veterinary science (and these are professionals that see pain and suffering every day in their work.) But still, how far veterinary science has come to finally acknowledge that the non-human animal experience of pain, although it might be different,  should also be addressed in the course of regular treatment.

For what it's worth, I am not being sarcastic. I do find this very impressive for even in this recent era of medical advancements, the experience of chronic pain and the necessity of pain management for human beings (much less non-human animals) is a highly unacknowledged and sadly often outright dismissed condition. To have finally gotten around the considering that there are other "forms" or degrees and experiences of pain is a large step in the right direction.

There are too many people that take it for granted that just because the non-human animals - our animal companions and their wild relatives - don't cry or scream or complain they must not be in that much pain. Of course, they don't speak of their discomfort or pain, not in any human language. Nor do they often express in obvious body language that they have pain or weakness. They have learned through 10's of thousands of years and more of evolution that the weak and sick end up as first course on the Badlands Buffet.

On the other hand, any experienced vet knows there are other ways non-speaking animals show they too experience a range of emotions from depression to discomfort and pain - by not eating, lethargy, increased/decreased sleeping/activity level, etc.... However, as mentioned earlier, up until the 21st century, there has not been much concentrated effort in addressing this issue. Resources are still rather limited but increasing with, not surprisingly, consumer (in this case, the pet owner) demand. The major texts available are as follows:

Pain Management in Animals (2000)
I think this one can generally be considered the first of its kind. I actually bought this at the very painful price of 140 USD as it's the only one so far to be translated into Japanese. With the exception of supplemental or alternative therapies, all other animal pain management books in Japan since then have been non-professional publications.

Pain Management in Small Animals: a Manual for Veterinary Nurses and Technicians (2006)

Scientific Assessment and Management of Animal Pain (2008)

Update on Management of Pain, An Issue of Veterinary Clinics: Small Animal Practice (2008)

Handbook of Veterinary Pain Management (2008)

Chronic Pain in Small Animal Medicine (2010)

Clearly, a specialty that is taking off.
But truly representing that shiny, juicy cherry on top our information ice cream cone, this was just released in January 2011.


abstract: The growing popularity of ferrets as pets has created the demand for advanced veterinary care for these patients. Pain is associated with a broad range of conditions, including acute or chronic inflammatory disease, neoplasia, and trauma, as well as iatrogenic causes, such as surgery and diagnostic procedures. Effective pain management requires knowledge and skills to assess pain, good understanding of the pathophysiology of pain, and general knowledge of pharmacologic and pharmacodynamic principles. Unfortunately, scientific studies on efficacy, pharmacokinetics, pharmacodynamics, and safety of analgesic drugs in the ferret are limited. However, basic rules on the treatment of pain and mechanisms of action, safety, and efficacy of analgesic drugs in other species can be adapted and applied to pain management in ferrets. This article aims to make an inventory of what is known on the recognition of pain in ferrets, what analgesic drugs are currently used in ferrets, and how they can be adopted in a patient-orientated pain management plan to provide effective pain relief while reducing and monitoring for unwanted side effects.
PubMed Link

... Oo♪ lala.♪♪

So that is on my wish list for me and all shelters out there. A tiny 10-page article worth its weight in gold, or 31.50 USD as the case may be here.


Cheers and see you again! (^_-)-♪


related links of interest:
Ferret Pain and Distress by Bob Church.

American Veterinary Chiropractic Association

European College of Veterinary Anesthesia & Analgesia

International Veterinary Acupuncture Society

International Veterinary Emergency Critical Care Society

International Veterinary Information Service

Veterinary Anesthesia & Analgesia Support Group

Veterinary Information Network


Disclaimer: I am not a DVM. Advice is offered after my own extensive research and/or experience and should be undertaken at your own risk. Consult with your licensed DVM before undertaking any treatment!

All translations copyrighted and owned by myself.All copyrights of their respective owners. No part of this web site may be produced, reproduced, stored in a retrieval system, or transmitted in any form or by any means without the written permission of the copyright owner.

May 21, 2011

Serious Summer Energy Issues: HH



☆.。.:*・Heat and Humidity・*:.。.☆


I really wanted to open my windows the weekend.
Really, REALLY wanted to open them.
Nothing like be shut inside 24-7 to make a looming hellish workweek ahead look all that much brighter.

But Japan is not just hot, its humid.
Like a WALL of HUMIDITY, humid.
Nothing I have ever experienced before outside of Japan or Korea. And this is where having all my little collection of Japan Ferret Handbooks come in handy. Even with all the incorrect, outdated, and sometimes rather dangerous information (giving certain cooked vegetables as treats to ferrets?!), the authors have lived in Japan all their life and know the climate specifics they have to deal with. As a result, some of the aids I will introduce here are ones you have seen and possibly use yourself, and some are Japan-specific due to the severity of the humidity/heat and the access (or lack thereof) to certain products. Referenced books can be seen at the bottom.

FERRET IDEAL: temp @ 22-23C, humidity @ 30-40%

Humidity Issues:
Make sure does not go over 65%. not only will it affect their health, food will spoil and living area (bed) will have hygiene issues. (reference below)

Yeah, well. Good Luck keeping it @ even 60%.
Right now with no energy restraints in place (those begin July 1, 2011) I sometimes run the dehumidifier function on my A/C ( 除湿 ) all day long and still come home to find the meter sitting @ 60%.

suggestion: store food in airlock containers and store the container in a cool dry place.

ex: In my apartment, the wall a/c is in the one main room (studio). Just so happened that the oshiire (large leveled closet) is across from it. I store Ranmaru's food in the top shelf across from the a/c and above any light that might come in from the windows.

**warning about low humidity via 100qa book! (added later after books arrive from Japan)
**竹のこと  (added later after books arrive from Japan)

Heat Issues:
They say there are "cool packs for pets with special covers to prevent chewing". The only ones i have seen are soft gel packs with thick CLOTH covers. Everyone with a fuzz knows those teeth can go through leather much less bone so a cloth cover is not going to protect them from the leaking gel. I use old BLENDY bottles 3/4 filled with water and frozen. (BLENDY is the coffee in a nice rectangular 1 liter bottle that fits perfectly in your tiny freezer or refridge doors.) I then wrap those in towels or put them in specific thermos bottle bag holders to soak up some of the condensation that will form.
Not just individually in the major sleep area, but 2-3 bottles in a pile in a large bowl/bucket.

Also, in addition to the ice "pool" I have a mini pool always 1/3-1/2 filled with water in the bathroom. (It would perfectly cover up to his chest, no further.) It's there year round really for his floaty duckies and as a drinking spot, but in the hotter weather he can stick his feet in easily to cool off. Remember, ferrets can't pant or sweat and a normal dry fan (just blowing air) won't help your fuzz keep cool!
If your fuzzy gets overheated, s/he needs cool water applied to their feet.

Following this thread, another kindly ferret friend on FB added this little contrivance:
"We also have a box lined with paper and there is shredded paper in it as well for them to dry off and not catch a chill, that's worked for us for the last 4 summers"

Also, in response to my question on heat-beaters, this fabulous construct was offered on FB. My guy is free roam so we can't use it, but a lot of ferret-parents in Japan use cages, so I am posting this idea for them also.

Try putting a light weight fabric like a piece of old sheet in a dish pan of water, ring it out, drape over a fan pointed at cage, leave one end in dish pan of water. You might have to safety pin in to fan. This is called a poor mans swamp cooler.
(Many thanks to Dookie Ferret for this idea!)

Finally, for those living in Japan, and possibly of use elsewhere, the traditional "uchimizu" (打ち水) technique. It really works to keep the area around the house cool and hence, the house itself cooler. It's an old technique from hundreds of years ago that is easy and effective. Minor but every little bit helps.

If you live in Japan, most likely you are living in an apartment which means you HAVE a veranda and/or front steps. You don't need the water at any certain temperature either. If your doing this on the veranda where your washing machine is you can really soak the ground and not worry since there is automatically a drain for the washing machine. SOAK THE VERANDA FLOOR with water. Before work I would dump a good 2-3 buckets of water out on the veranda which also had the added benefit of washing down the dirt and dust of the day. By the time I came back 9 hours later - Bone DRY.

You can do this on the front area of your apartment steps or ground too, but will have to be more conservative with the amounts given you have neighbors right there.

Sounds like a waste of water, but one of my favorite TV shows (not to mention a long running favorite of the natives) - Tameshite GATTEN! - had a piece on this and showed thermography of air temperature around storefronts before and after applying the uchimizu technique.
It does work!
And if you are looking at temps that start at out 26C every day since June 1 and a looming energy shortage (and you are if you live in Japan), EVERY little bit helps.


Keep cool and see you again! (^_-)-♪



Reference Books:
Raising a Happy Ferret, Tamukai Kenishi, DVM
FERRET, Anifa Books Complete Manual, Studio MOOK
Ferret Handbook, Nomura Junichiro, DVM
Ferret Paradise, Mao
Dr. Nomura's 100 Q&A for Ferrets, Nomura Junichiro, DVM


All translations copyrighted and owned by myself.All copyrights of their respective owners. No part of this web site may be produced, reproduced, stored in a retrieval system, or transmitted in any form or by any means without the written permission of the copyright owner.

Thank you for helping us out!