From:
pjdutche@email.unc.edu
Date: 2004-07-22 14:47:19 UTC
Subject: RE: Heart and Kidney problems
To: ferrethealth@smartgroups.com
Message-ID: <4083586.1090507639652.JavaMail.root@thallium.smartgroups.com>
Ardith,
I am so sorry that Buddy is struggling. I'm sorry I'm not a doctor, but maybe some of this will still be of interst. Kidney failure and cardio together in the same ferret puts you between a rock and a hard place. I wrote earlier about some things my Punkie, who has similar problems although I don't know if they are as advanced, is on and that help, so I won't repeat all of that here. These are just a couple of thoughts.
> When I count his breathing here at home (asleep) he
> breathes about 51 times every 30 seconds. His whole
> body heaves.
That sounds bad; totally understand your feelings about his quality of life. It sounds like he still has fluid in his lungs despite the increased oral lasix. Consider a trial of the injectable form, and ramp the dose up even more if needed. It's not great for the kidneys, but you need to clear the lungs more urgently. Once clear, you might be able to go back down to the current dose, but perhaps stay with the shots instead of the oral if it works. For whatever reason, the shots seems to work much better for some ferrets. I think it might be more powerful because it is absorbed more quickly, but that's just a guess. If you're not used to giving shots, it can sound a little scary, but
it is quite easy and they are just under the skin. I use tiny u100 0.3cc insulin syringes with 30 or 31 gauge needles and my guy doesn't flinch as long as he's getting food or a treat at the same time.
Has he had an x-ray since this rapid breathing started? My vet has mentioned that if they have fluid around the lungs or around the heart, versus in the lungs, that lasix won't do the job and a tap is needed. So far this hasn't happened to any of mine, knock on wood. Fluid has always been simply inside the lungs. You probably know that but just a thought.
> This morning he had what I think was an insulinoma
> episode. He was better after a little honey and soup.
Maybe the pred dose needs to be bumped up. This is something else that is kind of scary with heart disease, but he might need it.
> One vet wants to discontinue the Amlodipine and try
> Enalapril, another feels it will be too hard on the
> remaining kidney. I'm at the point of what's
> worse for my ferret, dieing from heart failure or
> kidney failure.
Some US vets are putting dogs/cats with chronic kidney failure on
Enalapril now, so there is a precedent. The benazepril (Lotensin) mentioned before is mostly metabolized by the liver rather than the kidney and has been used for crf cats, mostly in Europe, for awhile now. It is still kind of controversial, but it might be worth a try in this case.
Make sure that potassium levels are getting checked; long term lasix can decrease it enought that they need to be suplemented. Low blood potassium can cause all sorts of problems, including heart arryhthmias and generalized weakness.
CoQ10 can be helpful for both the heart and there is some newer
thought that it can also help the kidneys, so it might be worth adding even if you don't go whole hog into alternative meds.
Anyway, as you know, you really are in a tough spot with this guy. His diseases are extremely difficult to manage together. I applaud and support you for questioning whether his quality of life is suffering too much now. It could well be that you are near the end of medicine's ability to help him and that none of these suggestions will wind up showing significant benefit. Hang in there, you're doing a fabulous job caring for him and getting all of those doctors to see him. It's a very very difficult case.
-Pam S.