From:
dr_bruce_williams
Date: 2002-01-05 00:11:00 UTC
Subject: Re: Loss of 3 ferets - bleeding from Rectum
--- In Ferret-Health-list@y..., "ferretmomjc" <ferretmomjc@y...>
wrote:
Dear Jerri:
There is a lot of information here - I'll try to post my comments
after each individual ferret. However, also realize that most on
this list (of which you are now a member) realize that real blood
values are of greater help for trying to unravel such mysteries, than
just the mention that these tests were done.
I think one thing bears mentioning right off - bleeding from the
rectum is generally a relatively non-specific sign of shock - and is
often seen in animals on the brink of passing. The question here is
what caused the shock. The fact that all of the animals exhibited
shock prior to death does not really constitute a pattern.
.
>
> Household had 8 ferrets - experienced ferret mom, all but 1 were
> shelter
> ferrets, all exposed to ECE at one time or another. Household took
> in
> 2
> new shelter ferrets from a different shelter than the others
> definately
> ECE exposed before coming to the house - these two went to the
> hospital
> almost immediately for nausea, vomiting, lack of appetite,
lethargy -
> stayed at hospital for 2 days, received sub-q fluids and supportive
> care.
> One of the 2 had surgery at a later date for insulinoma. For what
> it's
> worth - and this might be important, Mom & Dad had severe flu for a
> couple
> of days in this timeframe of when ferret #1 became ill. Within a
> month
> of
> new arrivals, ferret #1 below became ill. Ferrets 1-4 below all
> female,
> approx 6 years of age.
OK, we'll take it on face value that these animals had ECE, and we
know that symptoms and long term sequelae of this disease are
generally more severe in older animals.
> Ferret #1 - Spook - 6 mos after arrival of 2 newcomers - loss of
> appetite,
> rapid weight loss, diarreha, dehydration. Supplemented with soup
for
> some
> time, no progress seemed to made. Hospitalized x2 days, x-ray
> negative,
> syringe fed, sub-q fluids, chem pannel, cbc, checked glucose 4
times
> over
> the 2 days, administered Amoxi and also started Pred .3 (1mg/ml).
> Went
> home with meds & AD, pedialyte. Taken to vet 1 day later upon
> observation
> of large amount of blood from rectum - emeciated, severe bruising
> around
> previously drawn blood site, euthanized at vet's recommendation.
OK - first item - no tissues taken for pathology. This should be the
first move in any unexpected death. Again, you don't mention what
abnormalities were seen on bloodwork.
Amoxi and Pred appear to be a shotgun approach to an unspecified
illness - however, the dosage of pred is very low and likely not of a
level that it would really touch any inflammation in the bowel. The
history of 6 months post ECE put it into the chronic wasting syndrome
associated with about 20% of ECE cases - some people would call this
inflammatory bowel disease.
The bruising suggests the possibility of clotting abnormalities - but
there is no mention of platelet counts in this case. In dogs and
cats, thrombocytopenia or other forms of immune-mediated disease may
occur concurrently with IBD, as a result of systemic immune
dysfunction. (I am not saying that this occurs in ferrets, but it is
an intriguing possibility, especially in light of the numbers of
cases of hemolytic anemia and throbocytopenias which are now being
recorded in ferrets.
>
> Ferret #2 -Peanut - loss of appetite, rapid weight loss, diarreha,
> dehydration, vomitting. Supplemented with soup but ferret very
> quickly
> went to bright red blood from rectum. Taken to vet, euthanized,
with
> vet
> saying they believed it to be complications from/ongoing damage from
> previous ECE.
Again, no record of tissues taken, or even a gross necropsy. While I
think that this could certainly represent chronic sequelae of ECE, if
the gut is not examined by a pathologist, you'll never be able to
prove it.
>
> Ferret #3 - Angel - same symptoms as prvious 2, lasting approx 1
> month,
> up & down but always lethargic. Mom was the most observant of this
> ferret, sensing a pattern here. Occasional red blood in stool.
This
> ferret did take low dose of Pred daily (.10cc 1mg/ml) for glucose
> issues.
> All lab work came back within normal limits. This time, vet
> prescribed
> Karafate, Flagil, Amoxi & Pepcid. 2-3 weeks after medicaltions,
> started
> looking sick again, not able to put on weight with kibble and
turkey
> baby
> food, did seem to add a weight with addition of A/D so we assumed
that
> maybe the kibble & Turkey was not providing enough protein as this
> particular ferret came in on "purina kitten" which we equate to
> Cheetos
> and was never able to convert to a better food. 4 months after
> medications and some up & down progress, symptoms returned with
> intermittent blood in stools. Went downhill quickly and completely
> refused food. Ferret was euthanized (of course, is was a Sunday
> afternoon, when most ferret emergencies seem to happe n). Ferret
was
> left at vet for a Post to be done. Results as follows:
>
> Cachexic, pale mm.?? Abdominal exam - spleen small, adrenal WNL, R
> kidney
> 2x2cm cyst on dorsal aspect, both kidneys 50-75% of normal size,
> liver
> OK,
> pancreatic tissue OK, no masses noted, some degeneration.
Intestines
> OK,
> no lymph node enlargement noted inabdomen. Thorax; heart OK. Lungs
> 10 -1x1mm nodules, generalized bilaterally. Lungs felt "thick".
> Tentative diagnosis: R/O lymphoma, renal failure, liver failure.
(So
> we
> ruled all this out, but didn't seem to include any possibilities).
No
> tissue samples were taken.
Well, the animal was opened up, but tissues were not taken. This is
only marginally better than not opening the body at all. You can't
evaluate the gut grossly, unless there is a big piece of rubber stuck
in it , or a hairball. I see no evidence to support any of the
tentative diagnoses - the nodules in the lungs are likely small foci
of endogenous lipid pneumonia - a background change common in
ferrets. You can't equate changes in renal size with renal failure,
especially when all bloodwork is normal, and the liver was assessed
as normal, but a tentative diagnosis of liver failure was given.
I hate to be critical, but this evaluation is not credible, and the
failure to take tissues, especially when this is the third death in
the household is somewhat difficult to understand.
>
> Ferret #4 - Willow - loss of appetite, diarreha, vomitting, rapid
> weight
> loss, lethargy. Ferret was sick for 1-2 weeks. Supplemented with
> soup.
> 1 year has passed, and ferret is again displaying symptoms although
> she
> is
> eating this time, PLUS and blood has been noticed in the habitat,
> although
> cannot be sure it's from this ferret. When seperated from group,
this
> ferret is eating plenty one day, not so much overnight. Continues
to
> maintain a low weight & act lethargic, squinty eyes, diarreha,
grainy
> poops green/tan, etc. Have just tried a dose of Kaopectate, but no
> positive results.
> >
> Looking for a course of action. Lab work & x-rays have never showed
> anything so owner is hesitent to continue spending $$ on tests that
> never
> show results, although is willing to spend $$ on anything that will
> help.
> How do we stabilize ferret #4?
Before you do any more with #4 - it is time to do a biopsy of the
intestine. This is long overdue, and should have been done on the
other ferrets. You can't properly evaluate chronic GI disease based
on bloodwork and clinical signs. Biopsy in this case is more cost-
effective than routine bloodwork.
>
> Are there any concerns feeding A/D for a prolonged period of time?
> Why
> is this food treated like a drug?
No - you can feed it for a long time - but ther are other
possibilities as well, including baby food or duck soup. It is a
prescription diet, like other Hill's products because these foods
have particular formulation for particular diseases, and if used
indiscriminately or incorrectly, they may cause more problems than
they help.
>
> Is this in any way related to arrival of 2 newcomers from shelter?
Possibly, but likely not, as so many of these cases occurred well
after the newcomer's arrival, and thes animal had all been previously
infected with ECE.
>
> Is this in any way related to mom & dad's flu?
Once again, likely not - influenza in ferrets is a respiratory
disease.
>
> Where is this blood coming from? How can a ferret have blood, and
a
> post
> show nothing indicating where blood is from?
The blood is the result of shock - as the circulatory system fails,
blood pools in the vessels of the GI tract. Over time, it leaks into
the lumen and is passed out. Ther is no true area of hemorrhage - it
just oozes through the wall of the gut. But let's go back again to
the problems with the post - many sites of bleeding are microscopic,
too small to be seen by the human eye.
>
> Is there actually evidence that ECE has prolonged effects after
> symptoms
> subside?
Yes, in some areas of the country, such as the East coast, it is a
major cause of inflammatory bowel diseaes - a recent study in my labo
shows an infection rates of 40%+ in animals diagnosed with
inflammatory bowel disease. There is only a 10% rate in animals from
the Pacific Northwest, which suggests a prominent geographic
distribution of ECE continues today.
>
Here's the bottom line - if you want answers in these cases - you
have to look at the tissues - biopsy and necropsy.
With kindest regards,
Bruce Williams, DVM