From:
dr_bruce_williams
Date: 2001-12-19 18:56:00 UTC
Subject: Re: IBD ferret now has GI bleeding, may not make it.
> I managed only a few CC's again in the morning, gave him more fluid
> and left for work. When I got home, he seemed "larger" to me. He
only
> weighed 1.5 lbs on Thursday. Now he weighed 2.5 lbs.(5 days later)
> and his belly was wider. My ferret specialist was not available, so
I
> took him to a local vet. She gave him a small dose of lasix. She
was
> afraid to tap him because of the clotting problem. The ascites
> lessened a few hours later. That night he started having bloody
> stools. That is all he has had since. Every two hours, nothing but
> bloody, black-burgundy, clumpy, clotty smeary puddles with a
gelatin
> consistency. His GI tract, in particular his colon, is bleeding,
> possibly the entire length. I started him on Carafate (1/4 tab 4 x
> daily).
>
> My vet agreed to see me on her day off, taking time away from the
> hospital Christmas party. His chest x-ray was within normal
> parameters and not too much abdominal fluid. She didn't feel a tap
> was necessary. Heart beat over 300. Ultrasound was within normal
> parameters. Urinalysis showed bilirubin, which we expected.
Bloodwork
> was contraindicated because of how much he'd already lost and could
> continue to loose. My vet feels he has an auto-immune disorder.
> Funny, Imuran is used to treat that, but starting again now won't
> give us fast enough results. I wonder if taking him off it caused
> this downhill slide? We are increasing the Dex to .4 ml daily(he
was
> getting only .2 ml), started on Amoxi and Biaxin, Carafate 4 X
daily,
> Vit K .3 ml twice a day, and sub-q fluid once daily. If the
bleeding
> doesn't stop within 24 hours, he won't make it. We could do a
> tranfusion, but if he's still bleeding, what is the point? God, why
> do they always have to have something terrible take them down? If
it
> doesn't stop, the most I can hope for is that he passes peacefully
in
> his sleep. I have had to euthanize two ferrets in the past nine
> months, one just two months ago. I couldn't bear to have to make
that
> decision again this soon. My heart is sick. I've been crying on and
> off all day and couldn't go to work. How will I get through
tomorrow?
> Please say a little prayer for my BJ. Nothing short of a miracle is
> going to save him.
>
Dear Dodie:
Of course we are praying for BJ to pull through. It certainly sounds
like shock, and the chances are not good. With a case like this, you
can do a lot with only a little blood, and it is important to get rid
of some of the question marks in this case - even a simple
hematocrit tube will give us a packed cell volume and allow us to see
if he is destroying his own red cells (which is the theory you are
operating on.)
A little more blood will allow us to do a CBC, and we can stop
there. The CBC will tell us whether he is destroying his red cells,
at what rate (if we can compare it to a CBC taken either before or
after), if he is dehydrated, and check his platelets, among other
things. I think this is important information, and takes only a
small amount of blood. With all honesty, if a CBC is enough to put
him over the edge, you are really on borrowed time. I believe that
the stress of pulling the blood is probably no more than giving him
the meds he is on. And is he getting fluids - if he is in shock -
those fluids are critical - even if he is anemic.
If he passes, the CBC is information that will be lost - blood pulled
at a post mortem will not give us an accurate picture of what is
going on. While it may not seem important now, shortly after he
passes, you will wonder what went wrong, and you may never find an
answer.
You are hear at the FHL out of a desire for knowledge - let me
suggest that the knowledge accompanying a small blood sample at this
time may be helpful in both the short and long term.
With kindest regards and with all fingers crossed,
Bruce Williams, dVM