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Dr. Barbara
Dr. Barbara, Board Certified Veterinarian
Category: Veterinary
Satisfied Customers: 1334
Experience:  Thirty years experience in small animal medicine and surgery.
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I have a 5-year old male ferret named Crispin who weighs 2.31

Customer Question

I have a 5-year old male ferret named Crispin who weighs 2.31 pounds. He is primarily an indoor ferret and only goes outside in a playpen on our lawn very occasionally, maybe once or twice a season during spring, summer, & fall. He used to have a partner but she passed away last year and he is now alone. He gets about an hour a day out of his cage on weekdays and is out of his cage the whole time on weekends. The area where he’s located gets moderate sunlight and we also have a daylight spectrum fluorescent light in the room; we try to emulate day and night for him as best as possible. About 2 ½ years ago, he had a very bad reaction to vaccines he received, he almost died. His partner, still alive at the time, had the same reaction and almost died, too. He had received both rabies & distemper vaccines that day. My vet couldn’t tell me which vaccine caused the reaction but Crispin has not gotten any shots since. Right around the time he had that reaction, he also started to lose hair on his back and tail; I think it may have started slightly before he had the reaction but I definitely took note of it after the reaction. Based on some research I did on adrenal disease in ferrets, I started Crispin on a melatonin supplement regimen. He receives 1 milliliter daily of melatonin and also takes daily multivitamins and Marshall’s Duck Soup. Since on this regimen, his hair has all come back and is actually full and lush. He is also very active, alert, and playful and eats, drinks, and sleeps well. He poos and pees a good amount daily but he also eats and drinks a good amount so it seems in proportion to me. He just had his annual physical including full blood work and everything is very good except for elevated liver enzymes; I’m not sure which test exactly he did but he says that the top limit is 118 and that Crispin’s result was 175; Crispin also had slightly high liver enzymes last year. My vet says this is not alarmingly out of range but because Crispin has now had two years of elevated liver enzymes, he thinks an ultrasound should be done to make sure that there are no problems with the adrenal gland, pancreas, gall bladder, or liver itself causing the elevated readings. The ultrasound cost is an exorbitant $500 and I would rather avoid doing it, if I can. My vet is not aware that my ferret is on melatonin; I plan to tell him but I wanted to get an outside opinion, first. So, finally, here are my questions: --- 1) I think it’s the melatonin, versus any problems with his organs, causing the elevated liver enzymes, would you agree? 2) Is a liver enzyme level of 175 dangerous? Is action required or can he stay at that level? 3) Does melatonin actually damage liver? Does it strain it? Or is an elevated liver enzyme level expected when melatonin is being taken and just indicative that the hormone is being metabolized there? 4) Will it be safe for Crispin to continue taking the melatonin daily? Should I modify dosage or frequency? Should I discontinue? Is there a good substitute? 5) If it’s okay for Crispin to remain on the melatonin, is there anything else I can give him to help protect his liver that is compatible with the melatonin? 6) Do you think the ultrasound is needed? --- I’m confused about the best steps here and will appreciate your expert opinion and guidance. Thank you! Dee
Submitted: 1 year ago.
Category: Veterinary
Expert:  Dr. Barbara replied 1 year ago.

Dr. Barbara :

Hi Dee, Welcome to JustAnswer. I am a licensed veterinarian and I'm here to help you. I'll go through your questions as you have listed them. . .thank you for your organization and the history :) ! 1: Since Crispin's liver enzyme was also up last year before any melatonin I don't think the melatonin is the cause. Crispin's elevated ALT (I'm assuming this is the liver enzyme that you are reporting) is really pretty minor and may be a normal for him. . .but we don't know definitely. This brings us into question 2: An ALT of 175 could be indicative of something going on in the liver, although again 175 is a minor elevation. If all else remains normal for Crispin, then 175 is not dangerous. However, it could be the first sign that something is going on, so hence an abdominal ultra sound would be the best way to take a look. 3: We don't know if melatonin is damaging to a ferret's liver, but no side effects have been reported. Melatonin is metabolized by the liver, but again there have been no reports of side effects in ferrets, and there also have been no studies about this. I wish there was more information out there

Dr. Barbara :

4: Since melatonin so remarkably helped Crispin I would continue it. Even tho' no side effects have been reported, it is always the best to take the minimal amount of anything that still brings desired result. You might try 0.5ml daily for about a month to see if Crispin still is maintaining his fur coat and his energy. If he is still doing very well, then you could try 0.5ml every other day. There is not a good substitue for melatonin, unless you wanted to do a blood test for adrenal function and then if needed treat with conventional medication. You have had excellent results with the melatonin, and I would stick with this for now.

Dr. Barbara :

5: There are treatments for liver support, but I'll need to do a little research to see if there is any information at all about safety with melatonin. . .I'll get back to you about that.

Dr. Barbara :

6: I agree with your vet that an ultrasound is a good idea. A slight elevation in ALT could be meaningless, but could also indicate a liver tumor. . .probably not, but we don't know without that ultrasound. I don't think this is urgent, but within a few weeks I would go ahead with the ultrasound.

Dr. Barbara :

Let me go research the liver support options with melatonin and I'll get back to you. In the meantime, if you have any more questions or comments I hope you won't hesitate to write.

Customer: replied 1 year ago.


Hello Dr. Barbara: Thanks for your response. Just one clarification; Crispin's liver enzymes were slightly elevated during his last annual physical in May 2012 and again this year in 2013 during his annual physical this past Mon July 15th. I think you thought that the elevation that occurred the first time happened before he was on melatonin but that's not correct. He has been on the melatonin since approximately May 2011, slightly after he had the bad reaction to the shots. This means that the first time he got the elevated liver enzymes reading in 2012, he had already been on melatonin for about a year. Prior to 2012, he had never had any issues with his blood levels, all was okay. Please let me know if after this clarification, you still don't think that the melatonin is the cause or a contributor to the high liver enzymes results. Thanks very much. Dee

Expert:  Dr. Barbara replied 1 year ago.

Thanks for the clarification. . .I was thinking that Crispin's first liver enzyme elevation was before the melatonin.

From what I have read, Melatonin causes no hepatopathy in dogs or cats and there have been "no reported side effects in ferrets". I have read about it's use as adjunctive treatment for adrenal disease in ferrets (I personally have not had a ferret patient with adrenal disease. . .yet), but know that oral melatonin or an implant is used.

There's a vet tech. on this site that saw our conversation and thought that this handout would be helpful. I think you may have read this but will pass it along anyway. We all work together here! http://www.lafebervet.com/downloads/education/Adrenocortical_Disease_in_the_Ferret.pdf

I've also researched S-Utensil Methionine or SAMe which we do use to support and heal the liver. I cannot find any contraindication for use with so there should be no problem using these together.

Since Crispin's liver enzyme is still really barely elevated even after 2 years on the melatonin, I doubt that giving the melatonin is causing any problem. I would think that if the melatonin was cause a hepatopathy that more and more liver cells would be affected and his ALT would be elevating.

So, these are my thoughts now: I would continue the melatonin. I would also recommend that when you can you have the abdominal ultrasound done to evaluate all of Crispin's abdominal organs but mostly to look at his liver and gall bladder, pancreas and adrenal glands. I would also say that using the SAMe may be helpful to Crispin.

One question I have since looking at the briefs about melatonin again: What dose are you giving him? If it is 1ml, then what is the concentration of the liquid you are using? Or are you giving him 1mg?

Expert:  Dr. Barbara replied 1 year ago.
Funny! Just reread what I wrote and saw that my computer changed S-Adenosyl Methionine to S-Utensil Methionine. Let's see if the computer will allow the spelling I want now. Adenosyl is the correct word!
Customer: replied 1 year ago.


Thanks for the additional replies, Dr. Barbara. The melatonin I give Crispin is in liquid form. He receives 1 ml which, per the ingredients label, contains 1 mg of melatonin. I don't know if this answers the question about the concentration but this is the only information I have and it comes directly from the product label. I'll wait to hear if you have any further comments/replies, otherwise, I'll go ahead and rate the service tomorrow afternoon. Thanks. Dee

Expert:  Dr. Barbara replied 1 year ago.
Hi Dee,
That is exactly what I needed to know. . .thank you. Plumb's drug book (one of our bibles for drugs) recommends the dose to be 0.5mg to 2mg per ferret once daily, so you are right in the correct range, but could try lowering it if you'd like. I do notice that melatonin is recommended for use in dogs for a liver disease called vacuolar hepatopathy, and there is also no mention of this being a problem for the liver in any species.
One other encouraging, positive note is that if melatonin does work in a ferret (alleviating symptoms) then the adrenal enlargement is likely to be hyperplasia or an adenoma. . .in other words, not cancer!
Best of luck to you and Crispin. I hope I've been of help. If you have any more comments or questions, I will be online on and off all day.
Dr. Barbara
Dr. Barbara, Board Certified Veterinarian
Category: Veterinary
Satisfied Customers: 1334
Experience: Thirty years experience in small animal medicine and surgery.
Dr. Barbara and 5 other Veterinary Specialists are ready to help you
Expert:  Dr. Barbara replied 1 year ago.
Hi Dee,
I'm wondering if you decided to have an ultrasound done on Crispin, what was found, and how he's doing?
Thanks in advance for the update.
Best,
Dr. Barbara
Customer: replied 1 year ago.

Hello,


 


Sorry for so delayed a response. Thanks so much for follwoing up on Crispin. I am having an ultrasound done in the next couple to few weeks. My local vet will be doing it at a reduced cost. His behavior and appetite is fine but very recently, he has started to loe some hair which is why I am now pushing to get the sonogram done and start any needed treatment.


 


Thanks so much.


 


Dee

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