From:
Sukie Crandall
Date: 2002-06-14 17:09:00 UTC
Subject: managing elderly and terminally ill patients in the last
stages
Managing elderly and terminally ill ferrets in their last stages, or
even terminally ill ones in their last stages is so different from
other medical care.
Earlier in an illness you are trying for time and quality of life.
Sometimes that means that a procedure like a major surgery is used
because a week or two healing means years of good and healthy life.
When you have one for whom pretty well everything has been done then
you alter your approach.
Warp is such an individual; she is an 8 year old MF albino ferret
with several things gone wrong. She stresses easily (was an abuse
victim in her kithood) has a friable small intestine, advanced
insulinoma, R adrenal growth, possibly/probably lymphoma, and now she
is due on Tuesday for a chest x-ray and new bloodwork, particularly
blood glucose level test: to see if she has also added cardiomyopathy
due to starting to get mild ascites, and to monitor her blood glucose
and possibly some other health aspects if she up to giving enough
blood. The receptionist was a little startled to hear that she would
have her x-rays without anesthesia even if meant that I'd be calming
her, but anesthesia doesn't agree well with Warpie.
Warp's meds include: Lupron, Pred (which is at a very high level to
give her comfort, Proglycem, and she gets added sugar because her
insulinoma is beyond a point where the meds are enough. Last night
***Torb*** was added for pain control because she had begun to
whimper, especially in her sleep or when examined. Last night she
(and we) got a decent night's sleep due to her improved comfort, and
right now she is running around happily..
I know that there are those who would think that she "just" should be
given a mercy shot or that a mercy shot at this point would be
kindness, but she still mostly enjoys life which is not something
anyone could see long-distance, still initiates mild wrestling bouts
with Sherman, still explores, still kisses, still interacts with the
other ferrets, us, and her vet whom she adores. SHE is not ready to
give up, yet, so we aren't going to rush her but want to give her as
much comfort as possible.
A veterinary oncologist has recommended trying ***Ovaband*** on her
so that will start soon. Raising blood sugar is normally considered
one of its bad possible side effects but for her it would not be bad.
***The vet oncologist said that there is some talk going on about
Lupron not always being very effective in the old-elderly which is
what 8 starts to be (as opposed to the early-elderly) and that this
may therefore control some adrenal-related symptoms which currently
decrease her comfort level but which Lupron no longer tackles.***
Her Ovaband will start daily and then go every three days.
Depending on how she is on Tuesday and what the chest x-ray, exam and
tests show she may also get Lasix to attempt to reduce her ascites
and add more comfort that way.
It is possible that with her pain and these symptoms controlled *IF*
this protocol works that she may have as long as a month of quality
time ahead of her. All of us were pretty shocked -- very happily so
-- to hear that number. Recently, we have been figuring in terms of
days to maybe a couple of weeks left in her, so it will be great if
she gets a good month more. She might still be gone this month, but
maybe not... It is up to her ultimately.