From:
Pam Sessoms
Date: 2006-01-24 17:43:38 UTC
Subject: Re: [ferrethealth] Advanced Dilative Cardiomyopathy
To: ferrethealth@smartgroups.com
Hi there,
It sounds like you're putting a lot of work into managing your
ferret's cardiomyopathy - great job. I can try to give a little more
info on a couple of your questions.
> I've read about injectable vs. oral Lasix but don't know if the dose should be adjusted since it's being administered differently.
Your vet is the best guide, but in my experience when switching them
over, I've started with the same dose (in mg, not volume, of course)
when going to lasix injections instead of the oral version. Usually
when this happens, it's because I'm having a hard time keeping on top
of the disease and need to get more aggressive. So, I give the first
shot or two at the same number of milligrams. Usually, after that, I
can drop the dosage down a little bit, because for whatever reason,
the injectable version just seems more powerful.
You also need to watch potassium levels with high levels of lasix;
you can check with a blood test. My cardio guys have all eventually
needed potassium supplementation.
>And I'm aware of adding Spirinolactone when Lasix is no longer as
effective as it once was. Anything else?
Is this ferret on anything like enalapril or benazepril (ACE
inhibitors)? Those can be helpful in many cases.
I also supplement my cardio guys with fish oil, CoQ10, taurine, and
L-Carnitine. I have one tiny female, Harriet, on all of those. She
was diagnosed very, very early with cardio over a year ago via
ultrasound (she was coughing at night), and she is still only on these
supplements and doing great with no further signs of the disease. I
know she'll progress eventually, but for now, she's doing great.
There are yet other diuretics you can look into, later; they act on
other parts of the kidney and you might squeeze a little bit more
effectiveness out that way. But I'd start with spiro for sure. It
seems pretty safe, and I have only used another diuretic once, and the
ferret was euthanized for very poor quality of life a couple of days
later. Do not know if it was related - she was very very very
advanced.
There is also the possibility of cardiac ultrasound to see how bad it
is right now, although it sounds like that might be ruled out because
of the anesthesia concern. Sometimes it is possible to get them with
the ferret awake, although you have to watch the stress level,
especially with heart disease ferrets. And as you mentioned, getting
an xray of her chest would be great to look for fluid in or around the
lungs or around the heart, but it's the same issue with stress,
anesthesia, etc.
> I'm afraid to add Hawthorne because Digoxin is also being given. And, I'd like to know Digoxin can increase the heart rate above normal.
Yes, it can. You might want to get a digoxin level to see if she's
getting too much or if she's in the therapeutic range. It's a blood
test that the vet sends off to a lab. There is a fine line between
therapeutic and dangerous with this drug. Giving it with food or not
will change how well it is absorbed, so once you pick how you're
giving it, you need to stick with it in order to maintain consistent
blood levels.
> Also, does anyone know if a respiratory infection could increase the heart rate?
I would imagine that's possible, but it could also be the digoxin, or
simply the progression of the disease, as you mentioned.
> It seems like this all happened overnight and I'm wondering if that's how the disease progresses. If everything can be under control one day and out of control the next.
Yes, it can change course pretty quickly.
In late stage cardiomyopathy, when you've already added all the meds,
the lasix dose is really high and increasing it is not helping,
sometimes, sadly, it feels like you have to pick "the final crisis."
It can get to where the ferret's quality of life isn't good in
general, and your own quality of life is suffering from needing to get
up every 3-4 hours for the lasix shots (with no hope of eventual
recovery for the ferret), and you feel like you can't leave the house
in case the ferret has a crisis. So, it can easily turn into a
situation where yes, you MAY be able to pull the ferret out of this
most immediate crisis with enough drugs and nursing, but you know that
there will be another crisis, and another one, and another one, and
you have to make the hard decision. It's usually been pretty clear to
me when this is happening; the crises are coming more frequently, and
finally, I can step back and look at this beloved friend and decide
that it's really kinder to actively put a stop to the whole cycle. I
know this is hard to think about, but this is a crummy disease.
Note that I'm NOT saying you are at this point yet with your ferret;
I've had ferrets come through a serious crisis early or mid way
through their disease progression and get back into a really good
quality of life for several more months by adding or changing a med
around.
I hope you can get her back on track for a long time!
Best wishes,
-Pam S.
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