From:
julie_fossa@yahoo.com
Date: 2005-06-02 22:09:49 UTC
Subject: DIM or Mystery Disease
To: ferrethealth@smartgroups.com
Message-ID: <5048013.1117750190019.JavaMail.root@thallium.smartgroups.com>
Recently, I posted asking for information about a ferret that was showing hind end weakness with pain. This is a long overdue update. I am going to go into a lot of detail in hopes that some of this information may help another ferret owner in the future.
Baby belonged to a high school senior in Lima, Ohio. Because of her school hours and evening job, she had a pretty full schedule. When she noticed Baby was sick, she took her to the vet, which happened to be the same vet I use.
Baby was grinding, so was started on carafate for ulcers along with Biaxin and Amoxi for Helicobacter. She was still using her hind legs at that time, but was lethargic and obviously not feeling well. I cannot say if all the meds were given exactly as they should have been, but I know the carafate was not. Three weeks later, Baby's ulcers were serious. Also, by this time, Baby was unable lift her body or eliminate without getting waste on her.
On May 13, 2005, her owner brought her to me. I worked with Baby for a week, then the owner surrendered her.
I started giving Baby 0.7 mls of carafate 20 minutes before each feeding. At first, it was only 5-10 mls every hour or so. As she was able to take more food, I stretched the feedings out. Within a few days, she was able to take her daily 200 mls of thinned Gerber chicken or turkey (2 jars baby food with 2 jars water, a day) with Pet Tinic.
As Baby was able to eat better and her stools looked more normal, I expected her to get stronger and start using her legs again. The third or fourth day I had her, I started moving her back legs to stretch the muscles so she would be better able to walk. It was shortly after that, I noticed she was panting and had a rapid heart rate and respiration. I called my vet; he felt it was a pain response. She was given a pain med and started on a low dose of pred for inflammation.
Some of the things I noticed with Baby were that her eyes were watery and she had some clear nasal discharge. Her only vaccination was the first CDV vaccination given at her breeder (MF). Canine distemper crossed my mind but it didn't fit the symptoms.
Another thing I need to mention is, anytime you have a ferret with hind end weakness you need to test for Aleutian Disease. Baby tested Negative using the POCT. We never tested by CEP; I planned to at some point when we drew blood, but never got it done.
Baby ate well, but continued to deteriorate. After a conference with my vet, her pred was increased.
A little over a week after she came to me, we tried to do bloodwork and took an xray. We were unable to get blood. On the xray, it looked like Baby's heart was enlarged and pushed low in her chest, actually looking like it was touching her diaphragm. We couldn't see her lungs, and there was a dark line my vet thought might be fluid. She was started on lasix to pull the fluids out of her chest. There wasn't any kind of a shadow or any indication of a mass higher in her chest that would lead you to think she had juvenile lymphoma. Due to her heart looking to us like it was slightly enlarged, we thought maybe she had a congenital heart defect and had thrown a clot. (But her feet were pink and warm; not blue or gray and cold like a clot would likely cause.) A clot could have lodged elsewhere causing trouble with her spine, though.
During this vet visit, Baby's back legs were very tender, and touching any area all along the lower half of her spine made Baby respond like she wanted to bite. She was started on pain meds every 8 hours and her pred increased. This helped tremendously, for a while.
Most of the time, Baby's stools were formed -after her ulcers were under control. She had occasional sloppy ones. I still needed to wash her legs and bottom off 2-3 times a day. We shaved her bottom to help keep her clean. The area behind her left leg was puffy and swollen. None of Baby's lymph nodes were swollen.
Because of her panting, I purchased a Braun ear thermometer because it will get a reading in one second. I learned Baby's temps were running around 103 to 104 F during the day, but spiking up to 106 to 107 in the evening.
Amoxi had been re-started earlier, but now we added Baytril to her medications. Her temps leveled out at pretty much normal readings with a nighttime reading of 103.5 F.
An appointment was made to get a muscle biopsy done as a rule out for DIM. I still needed bloodwork, so squeezed a well hydrated Baby into another vet clinic. Her glucose was high (239) so we backed off the pred. However, there were a number of values that were very off, one of which was her white blood cell count. It was so high (almost 60,000) the vet suspected instrument malfunction. It was about this time I added Hills Prescription AD to her Gerber, using one can AD to 3 jars Gerber, thinned with water. It helped firm her stools, along with providing some added nutrients.
Her muscle biopsy was taken the following day. It was a quick, simple procedure. If you have a ferret you suspect may have DIM, Please, Please, Please get that muscle biopsy done. It did not bother Baby at all. She came home and was able to move around just as good as before, and did not favor the biopsied leg at all. It is worth the peace of mind to know it IS, or it is NOT, DIM you are dealing with.
Almost two weeks into having Baby here, and approximately 5 weeks into her ordeal, Baby's temps are starting to increase. I'm now seeing 106 and 107 F with a few times the thermometer read 'HI' which meant she was over 108. Baby's body is like a dishrag when you pick her up.
I added Carnivore Care (CC) into her diet, so now it was about 1/3 of each, Gerber/AD/CC. She loved her food and always ate well.
On Sunday, 5/29/05, she was having a good day. She pulled herself around the house and explored. I hoped we had beat whatever this was.
By Monday, we were battling temps of 107. Between wiping off her face and neck, armpits, pads of feet and where she was shaved on her bottom, I managed to get her temp down to 104.1 one time, and 105.5 another. I put ice in baggies and layed them on the other side of a blanket so they wouldn't be against her and checked on her every few minutes to move the ice packs each time she fevered. Her respiration was 65/min and her heartrate was 240 bpm. Again at midnight, her temp in both ears read "HI" and I was only able to get her down to 106.6, even using subQ fluids and ice packs.
Tuesday morning, Baby's torso is stiff and bloated, but her head and neck are limp. Her temp is down to 105.5 but her heartrate is 260 bpm and respiration is 138/min. Her bg has come down to 140.
Baby sees her vet again, and her temp is 106 F rectally. Banamine inj. is added as a fever reducer and anti-inflamatory. By 8 pm her temp is back up over 107. She has begun grinding again.
By Wednesday, 6/1, Baby is having difficulty swallowing her food, and she is grinding and whimpering when I hold her. She would not take her noon nor late afternoon feeding, just turning her head away. (She did very slowly take her bedtime feeding, but she had to make an effort to swallow each drop.)
Wednesday afternoon, the muscle biopsy results came back. Preliminary reading confirmed DIM, and I was told it was a classic presentation. Baby's mercy shot was scheduled for the next morning.
DIM damages the muscles. Her disease had apparently spread to her esophagus, (which does happen) making it difficult for her to swallow. If left go long enough, it would eventually claimed her heart.
Even though I suspected DIM from early in her disease, I really didn't think I would ever see a case. What would I do differently next time? I would start with bloodwork then go straight to a muscle biopsy as a rule out, but that is just my thoughts. Print out the AFA information and take it along to the vet -every vet- with you because neither of the vets here had ever heard of it. I am thankful my regular vet has an open mind and was open to the possibility this was a case of DIM. I would try the alternate medication course first. She was on the Acyclovir for about a week with no improvement, BUT she may have been pretty advanced in her illness before she ever came to me.
Baby received her mercy shot this morning. Her body has been donated to research. I hope the teams working on this are able to learn at least one good piece of information from Baby's ordeal.
These are the key things that happened in the 20 days since Baby was brought to me. I hope something in this helps someone else that wonders if their little ferret has DIM.
Many thanks to a special Oregon vet for supporting my vet and me throughout this. Special thanks to a Washington pathologist for their rushing the tissues to get an answer for us.
Julie Fossa
West Central Ohio Ferret Shelter