Fox has been ill this time. On Friday 10/11/00 I saw him at night and I picked him up and thought that doesn't feel right. His coat was dry and coarse and he was definitely thin. I held him in front of the dish of meat and he licked it but obviously had problems eating. So I fed him and he had problems eating even though I fed him. Like he was in pain. Then I weighed him. I weighed all the kids a week ago and he'd put on some weight over the last month. 3 weeks he'd been on BARF and he put on weight. So he definitely was eating. But since I weighed him, in only *1* week, he lost 200g! That's almost half a pound! In 1 week! I felt *sooo* bad, he obviously hadn't eaten for a week for some reason. He was sooo hungry when I fed him and yet he still found it hard eating when I fed him. I was sooo worried and felt sooo guilty about Fox. Why is it they have to almost disappear into thin air before I notice that anything is wrong??? A few days ago I noticed he was sort of drooling with sort of white stuff coming out of his mouth. But I didn't realise he wasn't eating and loosing weight rapidly...
Mr Jones saw Fox a day later and said the gums looked inflamed and I thought the roof of his mouth looked weird, like worn away. Mr Jones commented on that. Friday night I cleaned his teeth and gave him Flagyl, he spat it out everywhere! Then Saturday Mr Jones said to give him Flagyl... There is no other antibiotic that has the same properties and will be as good around the mouth. So Fox had some more Flagyl after the vet visit, I dripped some oil into his mouth, then gave him the Flagyl and then yet more oil... He swallowed all. I held him scruffed until I was sure that the antibiotic was down and he would not bring it back up... But we still didn't know why he was salivating so much. There is just this huge overproduction of saliva. I fed Fox Saturday, it was like he was in pain, he was sooo careful when swallowing food and was tilting his head from one side to the other while he was eating. But you couldn't see anything that would cause such pain, there was nothing obviously badly wrong. But Fox definitely didn't feel well... You know with Fox' mouth, you know how ferrets' mouths are rippled at the top? Well, on one half of the mouth it's not rippled for a bit where there should be ripples.
Anyway, Fox soon got better on the Flagyl and I hand fed him for a week until he was eating okay and didn't show signs of pain. I weighed him again after the week of feeding and he put on 400g in that one week!!! Right, I stopped the feeding when I saw that, that is too much of a weight gain for one week! He is eating again as well, I mean I fed him one day and saw him go to the bowl and eat some more not long after I fed him! So he is alright again.
Fox has been very healthy so far and only had the odd dental. He's approx. 7 1/2 years old now. He's slowed down a bit over the past few months and then while Hobo was sick, sort of since almost the beginning of October, he developed excessive thirst... Same symptoms as Baby. He also developed a bad, persistent mouth ulcer a few days after he had his last dental done (17.9.04). Just before Hobo was put to sleep, I was sitting at the vets with Hobo, reading one of the ferret vet books about renal stuff to see whether I could find anything that would help us with Hobo. I read about renal failure and one symptom was mouth ulcers (and stomach ulcers). So the mouth ulcer and excessive thirst convinced me that Fox had chronic renal failure, like Baby, and also probably Bella.
So I went to see the vets Tuesday 19.10.04 and I saw a vet I hadn't seen before. She mainly does big animals and one day in the small animal surgery. So I went in and said I thought he had CRF and would like a blood test doing. So we anaesthetised Fox and she got into the jugular but only got about 1 ml of blood... Michaela was around and had time so she took the blood then and had the good idea to test his urine as well. It had (a lot of) blood and protein in it... Doesn't know where the blood has come from. She was about to perform a cysto when he peed so she sucked it off the table. So it's not like she had damaged the bladder. So bad news. He is on Synulox now, for the mouth ulcers and a possible kidney (?) infection. He does eat fine, I'm hand feeding him ground chicken, he eats it with no problem, it's just the water that is causing him pain. No idea why. The meat is lukewarm when I feed it so now when I syringe feed him water, I give him lukewarm water. He drinks it better but it's still hurting him... Fox's weight is good but he's loosing muscle mass.
Thursday evening Michaela phoned about the blood test results. They came back quick! The urea was 3 times higher than the maximum level and phosphate was high. Unfortunately they only tested kidney values and didnít do a full haematology and biochemistry. Michaela will phone them and ask if itís possible to still do the other blood tests... I really wanted all the blood works done. Anyway, Michaela put a package together for me with kidney diets to try for Fox. I fetched it Friday and tried to feed it to him and he acted like I was feeding him poison! There are more kidney diets to try, hopefully there will be one with the consistency of Hills A/D, a smooth paste rather than something that looks like tinned cat food with little chunks.
These are the blood values that the lab did:
Urea (BUN) 24.4 mmol/l (1.7 - 7.5)
Creatinine 108 umol/l (35 - 80)
Total protein 61 g/l (51 - 74)
Sodium 152 mmol/l (137 - 162)
Potassium 4.5 mmol/l (4.3 - 7.7)
Calcium - serum too lipaemic
Inorganic phosphate 3.5 mmol/l (1.29 - 2.93)
The Urea is very high and Creatinine is high. Michaela doesn't know why the serum was too lipaemic to measure the calcium, that is another reason why the full blood works would have been good.
So anyway, not very good. Fox is one of the more special ferrets and has bonded very much with me so Iím dreading loosing him.
These are some recent photos of Fox. This is after I joined the 3 groups and you can see they get on, Fox and Reno were from group 1 and Willow from group 3. They are on a giant hammock. ;-)
Thursday 11th of November, Fox had another blood test done. Fox had lost his appetite and I'd been feeding him a liquid convalescence diet for cats (Waltham (Royal Canin) Feline Veterinary Diet Convalescence Support) which he likes. He then started eating his meat again but I was still supplementing him with the liquid diet. He started on carafate (which is called antepsin here) which is a tummy medication that is given for stomach ulcers as he may have a stomach ulcer or may develop one so we're giving him the medication to coat his stomach, it won't hurt him and may help his appetite. If he's anaemic then he'll get medication for that, Michaela thought he looked pale Thursday. I remember Baby was *very* pale but unfortunately I didn't know that she was in renal failure... †
Friday night (12th) I was at the vets yet again, I asked Michaela to show me how to administer sub-q fluids.† I had been to Mike Janke's web site and there was an article about renal failure and a link to somebody's page on how to administer†sub-q fluids.† I printed it all out and read it and it was very helpful.† The person used a butterfly needle with tubing attached and you attach the syringe with the fluids to the tubing.† So it's much safer and it doesn't matter if the ferret moves a bit. Michaela gave me a bag with 500 ml of fluids and a syringe with a needle (the needle is for drawing the fluids out of the bag). In America they use "Lactated Ringers Solution" so I printed out the list of ingredients of it and gave it to Michaela and she said she would have given the same to Fox and got a bag of fluids for him called "Isolec compound sodium lactate code V11A" from Ivex Pharmaceuticals. I had real problems with Fox†Saturday morning when I did it for the first time.† It wouldn't have been so bad if he had been interested in treats but I had Ferretvite for him to distract him with and he wasn't interested in it at all...† So I calmed him down, got the needle in and slowly pushed the fluids through.† He struggled and I had to re-do the needle half way through...†
He was going downhill so much and was a lot worse than Baby was.† He wasnít very interested in food and had been sick a few times.† I gave him liquid food Friday 12th and he brought it up and I gave him water Saturday morning and he brought that up as well... †But I managed to stabilise him. I got better at administering fluids, I felt so proud! ;-) Fox still had problems drinking water, Iíd been syringe feeding him warm water but he acted like it was acid I was giving him. But when I added milk to the water, he drank it with no problem. So Iíve been giving raw goats milk to Fox, mixing it half half with water. Heís been drinking it really well and loves it and while heís distracted with his milk, I stick the needle into him and push the fluids through and massage the area that the fluids are going in. So heís getting hydrated from 2 sources which is excellent. Heís looking better, has got his appetite back, has put some weight on. Iím happy. I do the sub-q morning and night, 20 ml each time.
This was the set-up for the sub-q fluids:
The fluids, syringe with needle, and butterfly needle:
Taking fluids out of the bag with the syringe with needle:
Attaching syringe to butterfly needle:
Unfortunately I don't have a picture of actually giving the sub-q fluids to Fox but the butterfly needle would have been "inserted" beneath his skin in the neck/ shoulder area. That seems to be the least sensitive area for injections. I used to lightly pinch some skin and pull it up a little and then insert the needle into that flap of skin, not downwards but horizontally, so I wouldn't injure him accidentally.
I had Fox put to sleep today. For the last week I had been struggling with him. Thursday 25th of November, he started to go downhill. He went off his food and didn't want to drink the milk anymore that I had been giving him to distract him when giving sub-q fluids. So I stopped giving the fluids because he struggled and I didn't want to stress him out. I wasn't prepared to force fluids into him for the sake of prolonging his life if it meant he'd be stressed and unhappy. So I bought some low lactose cat milk and for the last week I've been syringe feeding him the cat milk and also the liquid cat convalescent diet and he still had his raw meat. He didn't want to eat much meat, only 10-20 g per meal when he used to eat about 40-45 g per meal. But he ate the liquid diet so I could maintain him on that. But the last few days it became obvious that he wasn't happy anymore. He still had mouth ulcers which he's had for the last 2 1/2 months. They hurt him a lot. He'd been on antibiotics for the mouth ulcers but as soon as one went, he got another one. I got 2 mouth gels that are used for teething babies, one of them actually said it helps heal mouth ulcers. So I tried both gels but they didn't help, either. He had carafate for his tummy. I even got L-lysine capsules when somebody suggested I try it as it helped their ferret with mouth ulcers. It didn't work for Fox unfortunately but I would give lysine another try in the future, maybe it would have helped 2 1/2 months ago... So nothing I tried helped him, especially not in the end. He would have 10 ml of liquid diet and then refuse to eat any more. He would kick and struggle so I gave him a few more days this week to see whether he would improve- and he didn't. So I decided to have him put to sleep. It was a very hard decision, Fox was one of the more special ferrets, he had bonded a lot with me. And I'd had him for almost 7 years.
When I was at the vets, I asked about Fox's blood test again that he had had on the 11th of November. I never had the results, I had asked a week ago and they hadn't come back. Well, they were back now:
Total Protein 60.2 g/l (51 - 74)
Albumin 29.6 g/l (26 - 41)
Globulin 30.6 g/l
Creatinine 451 umol/l (< 75.0)
ALP 155 iu/l (34 - 66)
ALT 61 iu/l
GGT 2 iu/l (< 5.0)
Amylase 29 iu/l
Urea 43.6 mmol/l (1.9 - 7.49)
Haemoglobin 8.1 g/l (12.0 - 18.0)
Red Blood Cells 5.29 x10^12/l (6.7 - 12.1)
PCV 0.308 % (0.43 - 0.55)
MCHC 26.3 g/dl
MCH 15.3 pg
MCV 58.0 fl
Platelets 109 x10^9l (297-910)
White Blood Cells 5.1 x10^9l (3.5 - 7.0)
Neutrophils 52% 2.65 x10^9l (1.5 - 2.9)
Neutrophils (Band) 1% 0.05 x10^9l
Lymphocytes 44% 2.24 x10^9l (1.7 - 2.9)
Monocytes 1% 0.05 x10^9l
Eosinophils 1% 0.05 x10^9l ( < 0.35)
Basophils 1% 0.05 x10^9l (< 0.14)
Haematologists Comment Unremarkable cellular morphology seen throughout film.
The renal disease in this ferret would appear to be progressive, with worsening parameters. I would suggest that it is causing a non-regenerative anaemia as well. Renal disease is not common in ferrets but diagnosis include chronic interstitial nephritis, glomerulonephritis (immune mediated) and neoplasia. Older ferrets often have histological evidence of renal disease at PM without showing clinical signs.
Michaela wasn't at the vets today, she is in Germany and we don't know when she'll be back... So I saw the vet again who I saw when Fox had his first blood test. She put him to sleep and did the autopsy. His kidneys were pale and there was a huge cyst in the right kidney, the cyst went from one side to the other. The vet said the kidneys might have been pale because of the anaemia but she is not sure. The liver was cystic, similar to Bella's, but not as bad as Bella's had been. There were 3 growths on the spleen and one looked very nasty. There were also tiny nodules on the pancreas. We sent both kidneys off to the lab, 2 growths from the spleen, a bit off the liver and a bit off the pancreas.
Fox's histopathology report (the vet who had performed the autopsy had written that Fox was doing well on a renal diet but he never was on a renal diet as he didn't like it):
Was doing quite well on renal diet, but went off food after few months. Bloods demonstrated evidence of CRF and low PCV + suggested this was not regenerative.
Chronic Interstitial Nephritis and Biliary cystic hyperplasia
Prognosis Not Applicable
The submission consists of fixed necropsy samples of various tissues from a 7.5-year-old, male, ferret.
LIVER: the section reveals one large and several smaller cysts, of biliary origin, as well as several small foci of granulomatous inflammation associated with haemosiderin-laden macrophages. Mild focal infiltration with lymphocytes is evident around some portal areas. The hepatocytes themselves are largely unremarkable in appearance.
KIDNEYS: there is severe, chronic interstitial nephritis in both kidneys, with widespread tubular degeneration, interstitial fibrosis, lymphocytic infiltration and marked thickening of basement membranes. There are foci of mineralization and even ectopic ossification in the fibrosed areas, and multiple variable sized cysts are present in both kidneys.
SPLEEN: two sections were examined. These reveal moderate, diffuse congestion and extramedullary haemopoiesis, with areas of haemorrhage and fibroplasias.
PANCREAS: the two sections examined reveal considerable nodular hyperplasia of exocrine tissue, but the islet tissue is unremarkable.
DISCUSSION: the changes in the kidneys are advanced - these are virtually end-stage kidneys. The overall appearance is of a severe, chronic interstitial nephritis, but at this stage it is not possible to deduce the underlying cause with any degree of certainty.
Biliary cystic hyperplasia may be a result of either a developmental anomaly or, perhaps more usually, caused by partial obstruction of the biliary system, sometimes secondary to cholangitis. There is evidence suggestive of mild pericholangitis in this individual, but it is unlikely the condition was of much clinical significance in comparison to the renal disease.
Splenic haemorrhages are fairly common in older ferrets and may be associated with nodular hyperplasia and/or congestion.
Pancreatic exocrine hyperplasia is a common incidental finding in old cats and dogs and generally considered to be of negligible pathological significance. I have seen it several times in old ferrets, in which I believe it to be equally insignificant.