Piper and Leo

Leo and Piper

19/11/2007

Pete ferret proofed the garden this summer and Piper was *the* ferret to show us escape routes so the garden didn't just need to be ferret proofed but "Piper proofed"... All went well for about 2 months and then Piper disappeared again... One morning I was going to put her and Leo back in the cage and I looked all through the house and garden and couldn't find her. But 10 minutes later she came in through the cat flap so I thought she must have been hiding. Then another morning she came in through the cat flap covered in soot and Pete and I had *no* idea how she could have done that because we have nothing with soot in the garden. (Later Pete realised that she got out of the garden and went through the old boiler flu pipes that are on the rubbish heap on the drive.)

And we finally realised that she was getting out when she disappeared one night. Leo and Piper are out between 6.00 - 7.00 (ish) pm at night and we looked for her all night long and then she finally came back in at about half past midnight! Pete was going to bed, I was going to keep looking and then I heard Pete come downstairs again, he'd seen Piper on the front drive and was opening the front door and then Piper came in through the cat flap... I checked the fence then and saw a few places where she could have got out so we went along the fence and fixed it and then all was well again- until Piper disappeared yet again... We had no idea what she got up to, I assumed she was staying pretty close, and then a neighbour phoned us around 10.00 pm that she saw Piper opposite the village hall going up the drive of a smallholding with horses. That is approx. 300-400 yards!

I ran up and the owner of the stables and her neighbour and the husband of the neighbour who phoned me, they all helped me look but no Piper... So I eventually went home when my torch died and was feeling quite helpless. 10 minutes later Piper came back in through the cat flap... When I was up at the stables, I thought there's no way Piper will know the way home, it is quite complicated with lots of fields and houses and barns in the way, it's not all neat and tidy with a straight path back to our place. So she is quite clever and she obviously likes home because she comes back. But of course I'm very worried because there's roads and cars and people have dogs that could kill her... So the next evening Pete stayed out when Piper was out in the garden and she eventually showed him how she got out- she climbed up a pillar of the wall that our neighbour built... So Pete fixed that and she's not escaped since...

18/11/08

Leo and Piper both had a Suprelorin implant today for suspected adrenal disease. Piper has a thinning coat and Leo is urine marking everywhere. This has been going on for some time and both are very hyper. Now it's wait and see what happens.

05/12/08

Piper is very sick. She was always a very lean and very hyperactive ferret, she went from completely normal and active to near death's door in less than a week.

Monday-
increased number of bowel movements, though not runny, showed signs of pain at night, was quiet, I thought she was coming down with an infected canine, increased respiratory rate.

Tuesday-
slowly stopped eating, I think she still ate minced/ ground meat in the morning but at night lack of appetite- started feeding liquid convalescent support diet.

Wednesday-
vet (Fiona) said Piper had a low temperature, vulva very red though not swollen, some blood in urine, blood was taken and sent to lab, Piper was started on injectable Baytril and Buprenorphine/ Vetergesic (by mouth) and had a shot of dexamethasone. Was eating her liquid diet well and had a whole portion of minced meat at night.

Thursday-
barely ate, not even liquid diet, gave 20 ml sub q fluids.

Friday-
Michaela thought of a stump pyometra when she saw the red vulva. Piper had x-rays, fluids, and we were considering a poss. exploratory laporotomy. Piper's blood test results came back and they were bad and didn't make sense to us:

Haematology

RBC 9.85 x10^12/L (7.5-11.9)
Hb 17.2 g/dl (12-20.8)
HCT 56.2 % (36-68)
MCV 57 fl (42.4-88.4)
MCH 17.5 pg (15-20)
MCHC 30.6 g/dl (26.2-38.6)
Platelets 258 x10^9/L (180-800)
WBC 2.49 x10^9/L (3.5-7) *** LOW ***
Neutrophils 70 % 1.74 x10^9/L (1.9-5.9)
Lymphocytes 30% 0.75 x10^9/L (1.7-2.9) *** LOW ***
Monocytes 0% 0.00 x10^9/L
Eosinophils 0% 0.00 x10^9/L (0-0.35)
Basophils 0% 0.00 x10^9/L

Blood film examination: 2 fresh blood smears and a film made from the submitted EDTA were examined. Red cells appear normocytic and normochromic. Moderate lymphopaenia with no abnormal cells seen. All other leucocytes appear of normal morphology. Platelet count and morphology appear normal with occasional platelet clumps in the tail of the EDTA smear.

Biochemistry

Total protein 41 g/L (53-72) *** LOW ***
Albumin 18 g/L (33-44) *** LOW ***
Globulin 23 g/L
Albumin Globulin ratio 0.8
Sodium 137 mmol/l
Potassium 6.2 mmol/l
Total calcium 1.25 mmol/l (2-2.95) *** LOW***
Phosphate 3.2 mmol/l (1.3-2.9) *** HIGH ***
Urea 25.5 mmol/l (3.6-16) *** HIGH ***
Creatinine 67 umol/l (35-80)
Alk Phos 37 U/L (30-120)
ALT 161 U/L
Bile Acids 19.3 umol/l
Glucose 7.9 mmol/l (3.4-7.4) *** HIGH ***

Clinical comments:
Hypoproteinaemic and hypoalbuminaemic.
May(?) reflect malnutrition/ failure to absorb/ failure to process protein (liver) or(?) excess loss (gut/ kidney).
Hypocalcaemia may be due to malabsorption or just reflect the hypoproteinaemia.
The(?) urea is very high. In the absence of a high creatinine, this could be pre-renal (I would check cardiac function but should also consider gut disease or(?) a generalised catabolic state) but it is high enough not to rule out renal failure.

(The ? are by words that were somewhat cut off on the copy of the report.)

X-rays showed oedema in chest cavity and some in abdominal cavity. Likely from the low albumin. This would also explain the increased respiratory rate. But this was one of the first symptoms so how could this happen so suddenly. Piper had a canine tooth out 4 weeks ago and a Suprelorin implant 2 weeks ago. She was always slim and after she had the canine out, I started to feed her extra portions of ground meat in the morning, I also saw her eat dry food (a mix of James Wellbeloved Ferret Complete and Arden Grange adult cat). Everybody else is thriving on it. She was so athletic, our little monkey, climbing up walls. Always so active, always running around so much. Then she suddenly deteriorated Monday. At night she looked like she was in pain. From Tuesday on she got seriously worse. Her symptoms and blood test results just don't make sense to us at the moment.

Piper was euthanised at 4.00 pm Friday the 5th. According to Michaela she was somewhat lively while she was there but then she suddenly showed signs of pain again and became very quiet, depressed, weak, it had been 8 hours since her Buprenorphine dose. Michaela said she hadn't seen her like this and she was shocked at the difference and I couldn't watch her like this for another night so we put her to sleep. The other option would have been to keep her on pain meds and open her up tomorrow but she was so ill and the bad blood values and bad x-ray etc.

Saturday we did the post mortem... There were a few things that didn't look good inside though we don't know whether some of the changes inside were due to the fact that she'd been dead for 20 hours or due to illness but she had a few angry looking lymph nodes, her adrenal glands looked angry and definitely enlarged, the heart was bad. The walls of the heart were thickened, the chambers seemed very small, the right side of the heart was enlarged, the heart was very solid. But we're at a loss as to what happened. She had so much wrong it seems and nothing made sense, how are the symptoms, blood test results, and gross changes connected? Hope the histopathology sheds light on this... Piper was only 4 1/2 and end of November I thought she was such a healthy and strong ferret, always up to mischief, always so energetic. Then she suddenly shows symptoms and is dead within 5 days. Then again I think I prefer it if it happens quickly rather than watch ferrets deteriorate slowly because then I can find it hard to figure out when to put them to sleep. But I am so not dealing with this. I really had it in my head that I wasn't going to have sick ferrets any time soon and wouldn't loose any for a year or two. So this was such a shock and I'm too tired to deal with it emotionally. Friday night I briefly thought “oh my God, Piper is dead” and felt such overwhelming grief but I was too tired to deal with it.

12/12/08

I've still not dealt with the loss. It's like Piper isn't dead. When I call Leo and Wesley when it's time for them to have food or go in, I still call for Leo, Piper and Wesley. Leo and Piper is like one expression, one word. They are siblings and I've always called for Leo and Piper. I was so not coping with it that I didn't even do anything about Piper's body. It was just in the garage. Almost a week later she was put in the freezer...

Got the histopathology report back:

Piper's histopathlogy report

Diagnosis
Lymphoma (Lymphosarcoma)

Prognosis
Not Applicable

Post-mortem tissues from a ferret: multiple samples received; heart evaluated grossly and 23 sections of various tissues including heart evaluated histologically.

GROSS FINDINGS.

Heart. Evaluation of the formalin-fixed heart revealed a focal tan thickening of the base of the left ventricular free wall. The ratio of the ventricular septal diameter to the diameter of the right ventricular free wall was approximately 2.75 : 1.

HISTOLOGICAL FINDINGS.

Tissues generally show moderate autolysis, which has hindered interpretation of some tissues.

Heart. Extensively in the wall of the left ventricle near the atrioventricular junction, extensively in the papillary muscles, and to a lesser extent in the right ventricular free wall and elsewhere in the myocardium, myocardiocytes are disrupted by an interstitial infiltrate of round cells. These vary somewhat in size but tend to have scanty cytoplasm, large oval nuclei and prominent nucleoli. In a few areas where the cells are better preserved, mitotic figures are recognizable at approximately 3 per 400x field. Intervening myocardiocytes are sometimes hypereosinophilic with condensed nuclei and are surrounded by minor haemorrhage (necrosis; possibly infarcts). Rarely, rafts of similar round cells are present in the lumens of myocardial blood vessels.

Lung. Around most interstitial blood vessels and around airways, there are nodular clusters and sheets of round cells similar to those in the heart. These frequently and extensively infiltrate bronchial epithelium (epitheliotropism). In the alveoli, similar cells are present and are sometimes intermingled with bizarre multinucleate giant cells. There is generalized moderate oedema.

Mediastinal Lymph Node. Adjacent to the lung, a node is overrun by similar round cells. There are zones of necrosis, along with some infiltration by spindle cells. Dense rafts of similar round cells plug lymphatic vessels in adjacent adipose tissue.

Unspecified Lymph Nodes. Lesions are similar to those in the mediastinal node, described above.

Spleen. Focally extensively, similar round cells expand the red pulp. Adjacent to these are zones of necrosis and haemorrhage (infarction). Elsewhere, there is prominent extramedullary haematopoiesis.

Stomach and Small Intestine. No lesions are recognized.

Pancreas. Round cells similar to those described above from the presumed pancreatic lymph node spill out into adjacent adipose tissue and locally infiltrate the pancreatic interstitium. Otherwise no lesions are visible.

Liver. Multifocally and apparently randomly, clusters of similar round cells disrupt and replace hepatic parenchyma. There is moderate, generalized congestion.

Kidney. Occasionally, radiating wedges of fibrocollagenous connective tissue with clusters of small mononuclear leucocytes including some recognizable plasma cells extend from the medulla to the cortex. Entrapped glomeruli are sometimes sclerotic and entrapped tubules sometimes contain proteinaceous casts. Elsewhere, renal tubular epithelial cells contain brown pigment (possibly bile).

Adrenal Glands. Both glands are largely replaced by similar round cells, with remnant islands of cortical and medullary tissue. Some zones of necrosis, haemorrhage and fibrosis are also present.

Vulva. In the dermis / lamina propria, there are dense nodular aggregates of round cells similar to those described above. There is mild congestion.

DIAGNOSIS:

Lymphoma, immunoblastic-polymorphous type

COMMENTS:

This ferret had malignant lymphoma (lymphosarcoma), which had infiltrated most organs, including the heart and the vulva. Lymphoma is the cause of death.

Lymphoma is a fairly common malignancy in ferrets. This neoplasm takes several different forms in this species, and the immunoblastic-polymorphous variant is relatively uncommon. All of the systemic forms behave similarly though, and for the most part result in rapid metastasis and death. It is common for clinical signs to arise suddenly, as in this case. Any temporal link to clinical treatment or to the history of dental surgery is coincidental. Lymphoma in ferrets carries a poor prognosis and is rarely responsive to chemotherapy. Earlier diagnosis would almost certainty not have changed the outcome.

This ferret also had mild to moderate, chronic interstitial nephritis, a common lesion in middle-aged ferrets. There is some evidence of renal protein loss, which might account for some of your clinical test results. Nevertheless, this lesion does not appear severe enough to have led to renal failure and is not the primary cause of illness or death.

31/12/08

Wesley was put to sleep on 18/12/08 so Leo is all on his own now. I just can't believe this month, how this time last month I had a happy, active, healthy group of 3 ferrets and now there's just one left. Ruby was put to sleep on 27/12/08 so I lost 3 ferrets in 1 month which has just left me reeling...

09/01/09

Yesterday I noticed that Leo must have insulinoma. He ran around strangely, wobbled, and fell over, so I measured his BG straight away. The first result was 28 mg/dl, I thought it must be wrong as it was seriously low so I measured it again and this time it was 38 mg/dl but Leo did have a sweet paste while I measured his BG, to distract him so maybe the sugar already raised the BG after 3 minutes. I'm scared that he has the same horrible insulinoma that Spike had as he had really low BG when he showed the first symptoms.

20/04/09

I had Leo booked in for insulinoma surgery and chickened out, also when I found a mammary lump on Squeaky I thought I can't afford 2 surgeries so close together and I really didn't want Leo to have surgery (yet). He is so strange, I feed him meat twice a day and he eats some dry food by himself but only a little bit. Anyway, he seems to get a low BG after feeding. I was feeding him and then letting him out to play a short while after food and he always went to bed straight away and didn't play so I thought he was getting worse. Now I feed him after he's been out and he plays just fine. I mean it's like 11 hours after his last meal and no sign of low BG but feed him and he "crashes". Spike was the same so I'm a bit scared that Leo has a nasty form of insulinoma. But for now I feel he's okay, I just get more and more frightened of having surgeries done the longer I have ferrets and the more surgeries I have done...

06/12/09

A non-medical update for once! :-)

Had a funny thing happen this morning, a black and white cat who belongs to neighbours came this morning to have something to eat and ferret Leo was out and went up to her and sniffed her and she hissed at him, Leo just stood there in disbelief and then let out a very long hiss, too. ;-) It's just these little things that happen that make the animals so special and cheer me up.

25/12/2009

On the 15th of December, Leo had his second Suprelorin implant, along with Kobi. Kobi then had a seizure that night and I tested his BG which was low. I didn't know whether the seizure caused his BG to drop, or whether a low BG caused the seizure, so I checked the best before date on the strips and it was May '08! So now I don't know whether Leo has insulinoma at all as I tested him Jan '09 with the out of date strips...

Approx. January 2010

I did buy the AlphaTrak from Abbott as it is supposed to measure ferret BG very accurately. I measured Leo's BG and it was very close to normal so I started cutting his pred down very slowly. He had been maintained on 0.5 mg/kg since January 2009, at first he weighed 1 kg and got half a 1 mg pred tablet, then his weight went up to 1.5 kg so he got 3/4 of a 1 mg pred tablet. But by the time I cut him down to half a tablet again, he did show symptoms of a low BG and when I measured it, it was much lower. So I put him back on his original dose of 3/4 tab.

25/09/10

Leo and Kobi have been started on diazoxide. It has made a big difference to Kobi but only a small difference to Leo. But then Leo wasn't as bad as Kobi, Leo has been very stable for well over a year. He isn't as active as a healthy ferret but then again he does have muscle loss and a big pred belly. Despite this he does have a run in the garden every morning and night and runs around the living room, kitchen and utility for a while and then goes upstairs. Climbing the stairs is becoming increasingly difficult for him and he takes a while before he's upstairs but at least he can do it.

Unfortunately though Leo is looking very adrenal. When he had his second implant December '09, he already had thinning of his coat, especially on his head and neck, but his coat became thicker again after the implant. But as the months went by, so his coat became thinner and thinner, now he's looking pretty bare. He'll probably have an early third Suprelorin implant...

08/10/10

Leo had another Suprelorin implant today, he had one December '09 but his adrenal symptoms came back quickly, the implant didn't work as well this time as the first one in Dec '08 did. Then a few weeks ago I read that you should use another implant as soon as symptoms reappear which I didn't know but then I immediately booked him in for another implant. I hate what the pred and probably adrenal disease are doing to his body, the big tummy and muscle loss and thin skin... But for now he still gets around okay.

08/12/2010

After 1 3/4 years of pred, Leo had developed a huge tummy and muscle loss to the point where he wasn't doing much anymore, and his legs were slipping on the tile and laminate floors. So I thought I try and let him have a run with single ferret Squirt. Leo keeps following Squirt around so is way more active, and Squirt is really nice to Leo so I'm happy, and Leo has become so much stronger, I can't believe how much and well he runs around etc. Has lost weight, too, or at least his tummy has become "toned". :-)

03/02/2011

About 4-5 months ago I took Leo to the vets to see about having him put to sleep because he didn't seem to have much quality of life left. He had a huge tummy and muscle loss from the prednisolone and adrenal disease, he's almost bald, and has full blown cataracts so can't see much. Luckily I didn't have him put to sleep. Since then I've started diazoxide, lowered the pred to 0.5 mg bid, and let him have a run with Squirt so he lost quite some weight and his legs have become stronger so he can actually carry his weight and run on the slippery laminate and tile floors. He even enjoys going outside and sometimes stands in front of the cat flap so I open the door for him (he can't go out through the cat flap but he can come back in). So for now he's doing good. :-)

April 2011

At some point during April I decided to try putting Squirt in with Leo. They've been out for a run together the last few months and I thought it would be nice for them to live together. Leo was not exactly ecstatic but tolerated Squirt. They do have the odd squabble but also sleep together so it's working out well and I'm glad they're not single ferrets anymore.

24/07/11

Leo is on Buprenorphine now, alongside Kobi, they've both been on it for about a month now. He's been moaning so much and I just didn't think he was in pain- as I've never had a ferret vocalise pain- until one day when I thought just try the Buprenorphine just in case he is in pain. And he is a lot more active on it, moans a lot less. I mean who knows what is going on inside him, his spleen is absolutely massive and either the insulinoma or the adrenal tumour could have metastasised and causing painful tumours elsewhere. I'd rather give painkillers to an animal unnecessarily rather than have one in pain not treated. Unfortunately they can't tell us and we have to go by our gut feeling. It's easy to just try painkillers and if the animal is much better on it then I say keep giving it.

01/08/11

Leo is better than ever. I've started letting him run in the “forbidden” rooms (bathroom, bedroom, spare storage room) and he's so energetic when he runs around and I think it's made his legs even stronger as he runs even better on the laminate and tile floors and barely slips any more.

He also has a run in the garden morning and night, weather permitting, and I'm surprised how well he navigates through the garden and also the whole house- considering that he can barely see. He will run into the (white) doors occasionally but all in all he runs around pretty well.

28/08/11

*** Diazoxide (Eudemine) ***

I'm very happy with the effect that the diazoxide has on Leo. Both Leo and Kobi had no side effects but it's been keeping their blood sugars very stable. The only regret I have is that I didn't use it sooner. :-( I read that it doesn't work in all ferrets, it even sounded like it hardly ever works. Then I read about side effects like nausea and vomiting which is not exactly desirable in an insulinomic ferret so I never tried it before. Plus here in the UK we can only get 50 mg tablets, we don't have compounding pharmacies that can create a suspension that can be dosed easily. But then I read about somebody who was giving diazoxide (Eudemine) tablets to his ferret so decided to try it as Kobi was going downhill a year ago. It has worked wonders, more in Kobi than Leo, but it is helping Leo tremendously, too, as I have been able to cut his prednisolone from 0.75 mg bid to 0.5 mg bid and he is stronger and more active. I just wish the muscle loss and build-up of fat was reversible... All I can say is that I recommend trying diazoxide. It is definitely worth a try, if it doesn't agree with the ferret (start with a small dose) or doesn't help, at least you have tried. Leo is on 12.5 - 15 mg bid. I have a mortar and pestle and grind some tablets and gauge how much powder he gets (on the tip of a spoon handle). I know it's not ideal and the dose does fluctuate a bit but it's the best I can do- and it works. I will look into the possibility of making my own suspension, and if I find out, I will post it. My vet writes a prescription for me and I get my tablets from Chemist Direct where they cost 60 p per tablet. Some pharmacies charge over 1 Pound per tablet!