From:
Caitlyn Martin
Date: 2011-08-27 16:00:10 UTC
Subject: [ferrethealth] Zephyr update (8 y/o with A/V node heart block, cardiomyopathy, congestive heart failure)
To: ferrethealth@yahoogroups.com
Hi, Sukie,
On 8/27/11, Sukie Crandall <sukiec@optonline.net> wrote:
> You mention node block and cardiomyopathy in your subject line. Both? Have
> he been diagnosed this either of these or were you just wondering about
> them? When A/V Node Block is present there quite often is insulinoma, but
> the reverse is not true.
Yes, Zephyr has been definitively diagnosed with third degree A/V node
heart block, cardiomyopathy and congestive heart failure. She has had
several ECGs, X-rays, blood work (CBC and chem panel) and a raft of
other tests I can't remember at the moment. Our vet has also been
consulting with a veterinary cardiologist. Zephyr was initially
treated with Aminophylline, .12ml (20mg/ml) three times a day,
furosemide .13ml (5mg/ml) twice a day, and enalapril .15ml (2 mg/ml)
twice a day.
Zephyr had insulinoma surgery in January of this year and still
requires a very low dosage of prednisolone, 0.01ml (15mg/5ml) twice a
day. Her blood glucose has been maintained in or near the normal
range since February and was 126 the last time it was checked at the
vet. I was checking with a glucometer at home but Zephyr hates having
her tail pricked and the vet wanted to reduce stress so I no longer
check her here. After six months of normal readings I doubt that
checking regularly is tremendously important right now.
Zephyr had been scheduled for a routine checkup and she was supposed
to have her teeth scaled and cleaned before we knew she had a heart
problem. Obviously that is not going to happen. There was concern
about a possible gum infection and also endocarditis so we did a 28
day course of amoxicillin as well which was completed last weekend.
Zephyr initially started responding fairly well to the treatment. The
problem we saw was that the Aminophylline didn't last nearly long
enough (maybe two hours) and her heart rate would drop down to 50-60
and she had some syncope episodes. We added generic Levsin
(hyoscyamine), which was a recommendation from the cardiologist. This
was experimental and as far as we know it had never been used in
ferrets. Zephyr received 0.15ml (0.025mg/ml) three times a day. She
also had some diarrhea and we were giving her a little fantomidine
(generic for Pepcid AC) in her gravy.
The hyoscyamine helped with her heart rate but caused nasty side
effects: severe diarrhea, excitability (she startled very easily),
and what looked like spasms or mini seizures. At that point we didn't
know which medicine caused which problems. That came later. Despite
drinking constantly Zephyr stopped eating and stopped being active.
She kept deteriorating and I called the vet. We discontinued all the
heart meds and I ended up rushing her to the vet on a Saturday,
thinking that we had reached the end. We hadn't. She was severely
dehydrated and that was the main problem. Her heart rate was also
down to 44, still in an escape rhythm.
Zephyr was given sub-Q fluids. The hyoscyamine, enalapril and
furosemide were discontinued, sucrafate was added. There were no more
signs that she was in heart failure (originally diagnosed by X-ray) so
the hope was that the furosemide would no longer be needed. The
dosage of Aminophylline was reduced to 0.1ml but the frequency was
increased to every six hours. Zephyr rebounded fairly quickly but we
still had problems with low heart rate when the Aminophylline would
wear off. The diarrhea disappeared so we discontinued the sucrafate.
We restarted the Levsin/hysocyamine and that's when it became clear
that it was the main culprit in terms of side effects. Zephyr's heart
rate was better but the diarrhea and spasms returned. We discontinued
that medication for good. Once the diarrhea cleared up again we
discontinued the sucrafate.
Our vet had some good results in the past with Isoproterenol and it
was decided to try that. Unfortunately she called around to a number
of compounding pharmacies in the area and it just wasn't available.
We ended up trying a similar drug, Metaproterenol, which effectively
meant we were experimenting again trying to find an answer for Zephyr.
The dosage is 0.15ml (0.3 mg/ml) I also was told to give Zephyr the
Aminophylline dosages as little as 2-4 hours apart but that I
shouldn't wake her for it. We only use it when Zephyr is awake to get
her heart rate up when her heart is stressed.
The combination of Metaproterenol and Aminophylline proved to be the
right answer for Zephyr. When both drugs are in her system her heart
rate is consistently above 100, which was the goal. It does drop into
the 60s when the Aminophylline wears off but that drug acts very
quickly so if she's awake and needs it she gets it. The results have
been phenomenal. Zephyr regained the weight she had lost and is now
at a normal body weight. Her activity level varies: on good nights
you wouldn't know anything is wrong. On not so good nights she moves
slowly and just explores a little. Her appetite is good and her
output is normal. She still has hind end weakness which becomes
noticeable on the hardwood floors where she slips. Right now we think
that has mainly to do with her heart condition as every time her blood
glucose was checked it's been normal. I keep the floors covered
during the evening so she can run/walk around freely.
Unfortunately that wasn't a long term resolution to all Zephyr's
issues. One day she had a terrible problem breathing. I gave her a
dose of furosemide while trying to reach her vet. She responded very
quickly and her breathing eased. We tried a reduced dosage for a
while but that didn't work. She had periodic periods where her
breathing became very difficult. It almost looked like an asthma
attack in a human and she made noises almost like a baby crying. An
emergency dose of furosemide restored her breathing to normal in a few
minutes each time. She is now back on the original dosage of
furosemide and we eventually had to add the enalapril back in as well.
That has worked for her. Without the hyoscyamine she doesn't have
diarrhea and she drinks plenty and eats gravy 2-3 times a day so she
hasn't gotten dehydrated again.
So.. where we are today, over a month after she was diagnosed
initially, appears to be a stable place. Her heart rate typically is
104-112 bpm when she has Aminophylline in her system and 64-72 bpm
when she doesn't. Her breathing is back to normal consistently and
the attacks have stopped. She is active, affectionate and even
playful on the good days. On not so good days she just sleeps a lot
and slowly explores. Her appetite remains good. She hates her meds.
Our vet has been able to maintain ferrets in Zephyr's condition with a
good quality of life for up to nine months. If Zephyr can remain
stable and comfy that long she will be nine years old. Thankfully
Zephyr has excellent vet care. Twice I thought I was losing her and
she rebounded both times, something I doubt would have happened
without a very experienced ferret vet who has previously treated heart
disease like this. So long as we can maintain a good quality of life
I'm thrilled that Zephyr is still here. Right now she's doing
remarkably well all things considered.
>
> Got to go now, more hurricane and hurricane guests prep to do.
Why did I think you were in the midwest? Anyway, I'm far enough
inland that we only have seen tropical storm force winds here. I was
without power for part of the morning but it's back on now. Folks
down east and on the coast are having a tough time of it today but
it's not so bad where I am. Just a very nasty, stormy day.
All the best,
Caity and the dynamic due
Zephyr and Chin Soon
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