From:
dr_bruce_williams
Date: 2001-12-23 22:47:00 UTC
Subject: Re: Advice needed; Puff and diag. of p. vera
--- In Ferret-Health-list@y..., Melissa Litwicki <squirty@m...> wrote:
> Hello,
>
> One month after having 5cc's of blood taken, Puff's PCV is back to
75%.
> Post-phlebotomy, she has been about 20% more lethargic. Her weight
is
> down slightly to 980g. Before her phlebotomies she was a normally
active
> older ferret who experienced cyclic malaise - eating less, sleeping
> constantly, no fever, normal poop. These spells would last 2-3
days, and
> then she'd be back to normal activity levels for a few weeks.
>
> Over the past few days she seems to have caught a cold bug that's
going
> around. Vomiting, sleeping, drinking but not eating, no temperature,
> normal poop. Her PCV, at 65% only two weeks ago, is back up to
75%. As I
> mentioned, she's been 'down' during the month since her phlebotomy -
more
> sleeping and less eating than normal. It's possible she's been
fighting a
> bug for that time; her neck lymph nodes are up (no other nodes in
her body
> are) and she's making the 'smacking' noise with her mouth that I
associate
> with sore throats in ferrets (I currently have a sore throat as
well).
>
> My questions are: First, why would her PCV jump 10% in two weeks?
I'm
> willing to believe her current malaise is related to that as well
as to
> her having a cold, but we had hoped to 'buy more time' with the
> phlebotomy. My vet speculates her body could be trying to keep her
PCV at
> 75%. Our approach so far has been to try the phlebotomy and see
what
> transpires. Obviously, we have had disappointing results. Second,
what
> now? We're going back in a week for another PCV and to talk about
drug
> therapies. Prednisone has been mentioned, as has a drug which
suppresses
> the bone marrow's RBC production.. Can anyone identify this drug and
> explain its usage and side effects in ferrets? My vet's colleague
had
> used it in a no-other-hope case, but my vet couldn't recall the name
> during my visit yesterday.
>
> With the exception of high PCV/RBC, neck lymph nodes being up, and
> observed malaise, there are no symptoms to indicate anything is
wrong. In
> the next few visits we will do another full CBC and explore other
> treatment options, as mentioned above. The only other high PCV
symptomatic
> ferret my vet had seen was the untreatable lung malignancy to which
I
> referred above; obviously I hope that doesn't turn out to be the
case
> here.
>
> Can people lend their thoughts and experiences to a discussion on
this?
> High PCV/RBC values seem to be an unusual case in ferrets, and all
> information - and speculation - is welcome.
>
Dear Melissa:
You seek insight into a rare disease which few to no people have ever
experienced.
Let's first say that ferrets don't catch colds, and vomiting probably
would not be the result of a "cold". Vomiting is generally a GI
sign, and my concern with the smacking of the lips that you
described, not eating, and vomiting, as well as the high PCV, which
may result in blood stasis in small vessels throughout the body,
would be the possibility of a gastric ulcer at this point.
Regarding possible treatments for polycythemia vera - phlebotomy
continues to be the best and safest for this condition, especially
when only the red cell lines are hyperplastic. The only possible
adverse reaction of a phebotomy is that she gets anemic if too much
is removed - this doesn't seem to be the problem.
Some p.vera human patients (my father was one) early intheir
treatment require weekly phlebotomy - he gave a pint of blood every
week for two months right after his diagnosis.
Yes there are drugs that in humans are used to treat p. vera, but
prednisone is not one of them, and I am not sure why it was discussed
in this case. Chemotherapeutic agents are used in humans especially
when other marrow elements, such as white blood cells or platelets
are also elevated - hydroxyurea, interferon, and rarely chlorambucil
are used in this cases.
AT this point, my recommendations would probably be to continue with
the phlebotomies, look closely for an unrelated GI problem, and at
last resort, try one of the chemotherapies at a low dosage, as you
are charting new ground here.
With kindest regards,
Bruce Williams, dVM