From:
Lynn McIntosh
Date: 2002-03-30 12:35:00 UTC
Subject: Re: Proglycem with insulinoma/heart issues
Hi Dan! Sorry I didn't get back about this earlier; meant to. My heart
goes out to you and Sidney; cardiomyopathy is a tough one. I know of one
other fur kid personally in town who had both insulinoma and heart
problems. They ended up keeping him on a very, very low dose of pred,
and lots of small feedings of duck soup, and it helped a lot in
monitoring the heart condition/giving frequent feedings that his
two-legged mom didn't work. Proglycem made him anorexic, but they never
did try a lower dose, which is what I have done with Minnie, and wished
I had tried earlier and with at least one other ferret.
Just want to mention that in no shape, way, or form am I a vet. I only
offer these opinions from my personal, lay experiences with my own and
others ferrets. Vets will have many, many more day-in and day-out
experiences and a much, much broader background to draw from of course.
I can't recall what the extreme reactions were to Proglycem, but back
when I moderated the Ferret Adrenal/Insulinoma Mailing list, at least
two ferrets reacted strongly and badly, like an intense allergic
reaction; Michael Janke may recall the symptoms. They weren't just
nausea and anorexia. I have not seen them in our ferrets. Searched the
lists with "Proglycem" but got 100s of hits.
With the pediapred weight gain I am never sure how much is fluid and how
much fat (surgeries/ultrasound of two of our insulinomic ferts on pred have
revealed fat). However I have noticed that Minnie is now on the same dose of
pred she began on, which previously made her start increasing weight rapidly.
With this same dose of pediapred now supplemented with diazoxide, she is
maintaining pretty steady weight (after dropping seven ounces- hurray!). I
have read that Proglycem has been linked to weight loss, but who knows --
potentially good for Minnie; not so potentially great for cardio kids already
skinny. I am not sure what we will do when she needs higher doseages for the
insulinoma, because she so far has been able to tolerate only the beginning
dose of Proglcycem; however perhaps the compounded diazoxide is easier on
her than the commercial (due to fillers?) and perhaps she will build some
tolerance. We will see. She's been sometime on .08 ml diazoxide
(compounded 50mg/1 ml) and .2 ml pedipared (commercial raspberry flavor
6.75 mg/5ml) for about three months, doing very well.
The trick for us with cutting back prediapred and adding diazoxide was
knowing which was causing side effects, when they occured. I attributed
nausea, loss of thirst and appetite to diazoxide, and decreased doseage
accordingly; I attributed overall malaise (obvious misery) and inactivity
(fatigue, weakness, dizziness, flat ferreting, lying around in strange positions,
no interest in anything) with pred withdrawal, and increased pred accordingly.
Both diazoxide and mock Addison's (over time pred suppresses adrenal
function so removing pred results in a situation similar to Addison's disease)
can cause nausea, abdominal pain and loss of appetite, so it is a little tricky in
that sense. But if I did not see the malaise/distress, but saw loss of
appetite/thirst, I decreased diazoxide (and watched results). If I saw the
maliase/weakness I increased pred (and observed results). It was a lengthy,
closely monitored process and we nearly managed to wean Minnie off the
pred, but in the end we didn't quite get there and the current combination of
diazoxide and pred works well. At the point where she was nearly weaned off
pred. we gave subcutaneous fluids for a couple days, which helped her a lot.
We had to force feed at that, the low, point. We had to finger feed her
through much of the process. She is now back to lapping up her chicken soup,
though I give her drinks from a dropper regularly. All three of my ferts on
pediapred quit eating and drinking (much) on their own. I use a cleaned plastic
bottle (originally came wtih amoxi in it) with the screw on dropper; works great
(always take one to the vet with water and one with ferretone).
One thing. Sodium and fluid retention ("can result in congestive heart failure;
responsive to diuretics") is listed in the drug sheet I got with Proglycem as a
side effect, and was worrisome, to say the least, but we have not seen that.
However, while Minnie has a congenital heart defect it appears her coughing a
few months back was due to bronchitis (from x-rays), though could have been
due to fluid retention with pediapred (one dose of lasix a week assuaged the
couging and lassitude she had when the fluid built up; she has been off lasix
for a few weeks). Sidney, on the other hand, has active heart disease so is a
more complicated situation. Balancing side of effects of multiple drugs with an
animal who can't talk is tough. We were trying to get the diazoxide/pred sorted
out before Minnie needed more heart meds; important to only change one med
at a time. Sukie is the resident lay expert on heart meds.
I have called pharmacists in the past to ask about drug interactions; they are the
real pros in that area. Problem is they are talking about humans, so not
comparing apples to apples. You could try it to learn about interactions
between heart meds and Proglycem. Sometimes the responses vary alot,
though. A good ferret vet (those online here; or might try Dr. Weiss) who has
treated lots of ferrets could help.
Based on a diagnosis early in her life of a congenital heart murmur 3 on a scale
of six, we are thrilled at how Minnie is doing at nearly 8 years old. We were
told we could expect symptoms to show up around 4 years old. When my vet
listens to her "washing machine" heart she nearly faints. We have had lots of
the sad cases so are thrilled with our little miracle girl (can you hear me
knocking on wood from where I sit?!). Minnie was also a runt and weighed 1
lb. 4-5 ounces all her life! She is now 1 lb. 12 oz, still heavy for her but much
better with more mobility than 2 lbs. 2 ounces she achieved on prediapred
alone, before we added Proglycem and cut back pred.!
My best to you and Sidney, Dan. I hope you can help her with that fluid
build up. Keep us posted! Lynn <faiml@u...>
[Quick Sukie note: I am very behind-the-times with this sort of info having been lucky enough to not have one with cardiomyopathy for several years,and, as Lynn pointed out, I am not a vet.]
On 28 Mar 2002 at 9:34, Dan Muldoon wrote:
>Date: Mon, 25 Mar 2002 16:37:18 -0000
>From: "dr_dan90" <dmuldoon@c...>
>Subject: Re: Proglycem: Insulinoma with heart murmur
>Minnie (pre-Proglycem) reminds me of my little Sidney (6 y/o,
>cariomyopathy, insulinoma, adrenal disease) so I immediately became
>interested in this regimen. Sid has the same trouble with the weight gain and
>belly distension; it's hard for her to move around but she remains alert with
>good appetite and it would be great if this drug could help her.
>What are the "extreme reactions" to Proglycem that have been seen?