Tata's bumpy (and expensive) road to recovery

Tata came home yesterday after a very long and trying holiday weekend. I learned yesterday at Avian & Exotic, that Tata's surgery was difficult. This isn't surprising with right adrenal surgery as part of the package. Add insulinoma and a tumor on the spleen and, of course, it was very invasive and difficult. What I learned from one of the vet techs is that they were very worried for Tata on Friday and were absolutely thrilled by what they saw yesterday. What happened in between wasn't so good.

After surgery Tata's blood glucose shot up. Temporary diabetes after insulinoma surgery is pretty normal until the pancreas starts working normally again. The insulinoma cells suppress normal pancreatic function, or so I've been told. Anyway, Tata's blood glucose went up over 500. Dr. Johnson decided to hospitalize him so he went to the Animal Emergency Hospital and Urgent Care in Raleigh. Dr. Wyatt there treated Tata when he had his seizure and also cared for Chin Soon at the end of her life. He's an excellent ferret vet but care at the emergency facility is insanely expensive. For a short emergency visit it's fine. For a long weekend, well...

Tata was put on insulin and his blood glucose came down. As the insulin wore off it would go way back up again. He wasn't stable. Dr. Johnson wanted to put Tata on glargene insulin, which is longer acting (12 hours) and is what Dr. Powers used for Chin Soon when she had the same problem. In Chin Soon's case the insulin was expensive but it worked well for her. Chin Soon only needed it for a few days. Then her pancreas started working again. Tata, unfortunately, did not tolerate the glargene well. His blood glucose crashed to 40 and he needed dextrose to get him back to the normal range. Then it spiked way up again. The very expensive insulin purchased for Tata turned out to be useless for him. He went back on regular, short acting insulin diluted in saline. His dose was one quarter of one unit. His blood glucose roller coaster continued through Sunday.

Tata was doing much better by yesterday but still needed insulin as of 5 AM. Dr. Dan decided to send him home and called in an insulin prescription to a pharmacy here in Eden. I came home with Tata, a shiny new, calibrated AlphaTrack glucometer and anti-inflammatory meds for the next couple of days. This was after getting a refresher course on how to give an insulin injection. I was told only to use the insulin if Tata's blood glucose went over 400 again.

The good news here is that Tata's blood glucose hasn't been that high. The highest reading so far was 320 and it's come down from there today. Dr. Dan's feeling that his pancreas was starting to work again appears to be correct. The hope was that Tata wouldn't need more insulin injections and so far that is what's happening.

The bad news is the cost. Six years ago Chin Soon's surgery, four day hopitalization and aftercare added up to an over $2000 bill. With the emergency clinic rates Tata is already over $4000. Oh, and no, I really couldn't afford that.

Is Tata worth it? Of course, and I hope to have him around for a few more years. He still has earned himself a new nickname: Pertwee Jr., after the most medically challenged and expensive ferret I've ever had.

The End For My Carolina Ferrets

It's been a long time since I posted. I lost Zephyr to third degree A/V node heart block last summer. She was nine years old, which is a very good age for a ferret. She lived with the heart condition for just about eight months thanks to the fantastic work of Dr. Lauren Powers at Carolina Veterinary Specialists. She came up with an experimental medication regimen that kept Zephyr going, albeit slowly. According to everything I've read that is a very good result for a ferret with that condition.

As Zephyr slowed down so did Chin Soon. It became apparent by May or June that she wasn't well either. It turned out she had lymphoma, the number one killer of my ferrets over the years. Once Zephyr passed away the life seemed to go out of Chin Soon, who was suddenly a solo ferret after having companions for the previous eight years. I tried giving her all the attention I could and she was still affectionate but never was energetic again. The change in her was just heartbreaking. Sadly, with her illness I knew it was the wrong time to introduce a younger ferret. Also, by that time it was clear I'd be moving. I already had a job offer for my present position pending a series of background checks and I was expecting two other offers. Adding ferrets at that point made no sense.

Chin Soon lasted just a few weeks after Zephyr passed away. Fluid began to build up in her abdomen, just as it had in Kodo's during the last days of his life. I ended up taking her to the emergency vet in Raleigh who told me what I pretty much already knew: her time had come. Chin Soon was nine years old when I let her go.

Both Zephyr and Chin Soon are now buried next to Ella and their other companions over their years with me. I was fortunate enough to have more than seven years with Zephyr and more than eight years with Chin Soon. I miss them. When I moved to Texas last September I was without ferrets for the first time in 14+ years.

Five Straight for Zephyr

Zephyr had her fifth straight normal blood glucose reading :) She still slides a bit on the hardwoods and still startles easily but otherwise she's doing great. Dr. Powers does great work. Considering Zephyr's age I consider myself very, very fortunate to have her getting back to normal.

Zephyr: First Playtime, Worries About Post-Surgical Diabetes

Zephyr's blood glucose was 287 last night.  If Dr. Powers was in town she would have gone back to Huntersville and probably would have started on insulin.  Since Dr. Powers is out of town I decided to wait and see what her blood glucose was today. Thankfully it was down to 213.  If it stays below 250 I'll remember that the glucometer we have isn't the most accurate in the world and not overreact to one high number.  If it goes up into the danger zone again I'll have no choice.

We have experienced surgically induced diabetes with pretty much all our ferrets who have had insulinoma surgery over the years. The worst was Chin Soon, who actually had to have insulin injections for about a week. Her pancreas began working normally after that and she made a full recovery.

I did give Zephyr her first playtime last night and she mainly explored for almost half an hour.  She still has some hind end weakness but she didn't fall.  Chin Soon got excited and sniffed and followed and chatted up a storm.  She didn't try to wrestle.  She seems to understand that Zephyr isn't healthy right now, which is good.  Zephyr, for her part, did the litter pan shuffle and begged for treats :) I'll take that as a good sign.

Once Zephyr went into the fleecy blanket Chin Soon wanted lots of attention from me. She's still clearly concerned about her adopted sister. So am I.

Zephyr is Recovering Beautifully

Zephyr, my ferret who had insulinoma surgery yesterday, is making a beautiful recovery so far.  She began eating kibble on her own last night in addition to her gravy and did a very professional job of emptying the food bowl and water bottle.  She has diarrhea but otherwise is eliminating normally.

Zephyr's blood glucose was 269 last night.   Post-surgical diabetes was expected and Dr. Powers called that number borderline but not of enough concern to have to bring her back just yet. This morning my glucometer gave an error and by the time I was ready to try again with another strip I had to prick her tail again.  The problem was she had already just about finished her chicken gravy.  We scruffed her to try that way and the little monster repeatedly broke the scruff.  That's how strong and feisty she is this morning.  I'll give her more gravy in a couple of hours and that should let me try again.

Right now we are weening her from prednisolone, giving her tramadol every 12 hours for pain, and a sliver of Pepcid AC in her gravy to avoid ulcers.

I was told that Chin Soon was really agitated when Zephyr wasn't around last night.  We let them briefly sniff each other through cage bars last night and put the recovery cage next to the main cage so that the two would know the other is there and is OK. That isn't good enough for Chin Soon, who frantically circled the recovery cage this morning looking for a way in and then repeatedly dumped her food bowl and deliberately missed the litter pan in protest.  The next week, while the two have to be separated, is going to be challenging.

All in all, I'm thrilled with how well Zephyr is recovering.

Zephyr: Insulinoma Surgery

Zephyr is now approximately 7½ years old. She was diagnosed with insulinoma before the holidays and has been on prednisolone which did absolutely nothing for her. She had a seizure last week and continued to have severe symptoms. Her blood glucose as of this morning was 36.

Dr. Lauren Powers at Carolina Veterinary Specialists performed insulinoma surgery on Zephyr this morning. This is the third time I've had insulinoma surgery on a ferret Zephyr's age or older and, in all three cases, either Dr. Dan Hudson, Dr. Holly Weston and now Dr. Powers believed it was the only treatment option left.

The good news is that Zephyr came through surgery just fine and is awake. Two very large nodules were removed from Zephyr's pancreas. While nothing was sent off for pathology yet Dr. Powers believes the really huge one is a carcinoma. Dr. Powers also found a small, smooth, round nodule on Zephyr's spleen which she aspirated. She believes it will prove to be benign and did not want to remove the spleen unless it was absolutely necessary so it stayed in. Everything else looked normal, including both adrenal glands and Zephyr's lymph nodes.

I'm never comfortable with surgery on a ferret Zephyr's age but sometimes it is the only good option. When Kodo and Podo had their insulinoma surgeries their quality of life improved dramatically and they lived for roughly two more years. I'm hoping we've bought that much time for Zephyr too.

Ella, Zephyr and Chin Soon Vet Visit Update -- Good News and Bad

The ferrets and I made the long trip to Carolina Veterinary Specialists in Huntersville yesterday to see. Dr. Lauren Powers. Ella actually has two distinct medical problems. The right eye has an ulcer which has been causing her considerable pain. She is now on both topical and oral antibiotics: one drop of Ofloxacin 0.3% in the injured eye 3-4 times daily and 0.4 ml enrofloxacin. We also have pain meds for her for the next 3-4 days as needed until the eye heals a bit.

The good news here is that after just one day with medication Ella's eye is already improving. Yesterday morning Ella was holding the eye tightly closed and was in obvious pain. She's not holding it closed tonight and is having a nice, normal active evening despite the pain meds. She actually seems far less uncomfortable tonight and was acting more like her normal self.

The ultrasound showed two nodules on Ella's spleen and what Dr. Powers thinks are enlarged illiac lymph nodes. We decided to put Ella under and do aspirates on all three masses. They were sent off for cytology and we should get results by the end of the week. Dr. Powers is still worried about the possibility of lymphoma. The peripheral lymph nodes are not enlarged and the she did say that other things can cause enlarged illiac lymph nodes including IBD and other chronic GI disease. Once we have Ella's lab results back we'll decide how to proceed.

Dr. Powers did check Ella's blood glucose again (was 77 last time) and it was a nice, normal 98. She does not have insulinoma.

I'll post more when the cytology report comes back. Obviously I'm hoping that the masses are benign and that Ella doesn't have lymphoma. FWIW, Ella did have diarrhea this morning but her output was normal later in the day.

The news for Zephyr was also mixed. The good news is that she hasn't actually lost weight. Zephyr has blown her coat at an odd time. What we are seeing is far less hair, not less ferret. The bad news is that her vulva is a bit swollen and that the hair on her belly is thin. We're going to watch and wait and see how symptoms develop. Right now this is looking an awful lot like adrenal disease which would be bad news. At age seven I don't know if we'd do surgery or not. Seeing how Zephyr responds to Lupron is probably the first option if the symptoms of adrenal disease become clear.

Chin Soon's gums are healing. She still has some root exposure but there is definite improvement. Dr. Powers said we should keep doing what we're doing, meaning brushing her teeth regularly, and we'll see how things go over the next two months. Chin Soon's blood glucose was also rechecked and was a nice, normal 91. For Chin Soon yesterday's recheck was all good news.

The cost of all this was almost $700, and almost all of that cost was Ella's diagnostic work. Whatever Ella's diagnosis ends up being we're not done yet.

Ella May Be In Trouble, Zephyr Losing Weight

Due to the winter storm last week the vet appointment for Ella was put off until tomorrow morning. In the meanwhile, over the last couple of days, Ella has become very obviously ill. She can barely open her right eye at all and both eyes are watery. She's also had two serious bouts of diarrhea over the last five days with normal output in between. Ella has also always really loved rough play. The last two nights she's come to me to play with her as always. When she does, though, if I touch her belly much she vocalizes discomfort and play ends. That, combined with her blood test results from January 18th, especially her elevated globulin, have Dr. Powers thinking that Ella may have intestinal lymphoma. That would be truly horrible news.

Dr. Powers will call me back later today with, in her words, "lots of questions" when she's done with her current patient. She doesn't feel like coming in this evening instead of tomorrow morning will make a difference, so for now the plan is to keep tomorrow's scheduled appointment and do more diagnostic work to determine for certain what is wrong with Ella.

In the meanwhile Ella ran around and explored like always last night, is eating and drinking normally, and has plenty of energy so I am hoping against hope for better news when the tests are done.

I am also very concerned about Zephyr who has lost a lot of weight in a very short period of time and also has had on again, off again diarrhea. Like Ella there has been no drop off in Zephyr's activity level and her appetite is just fine. Like Ella she isn't bouncing as much and is avoiding rough play.

Whenever one of the other ferrets is sick Chin Soon tends to stick to them like glue. I saw this with a then eight year old Nyssa during the final month or two of her life. Chin Soon was Nyssa's constant companion then and would curl up and sleep with her. Chin Soon is doing that with Zephyr now which also worries me.

Ella is just two week short of the seventh anniversary of her rescue so she is right around eight years old. Zephyr is six weeks away from the sixth anniversary of her rescue and is roughly seven. Both are considered old in ferret terms. I'm still not ready to lose either one of them.

I'll post more when I know more.

Ella and Chin Soon's Latest Vet Visit

The ferrets and I took a trip to see Dr. Lauren Powers at Carolina Veterinary Specialists in Huntersville a week ago Monday. No, nothing was wrong with any of the ferrets as far as I could tell. They have all seemed blissfully healthy. At their last visit Dr. Powers commented that Chin Soon really needed her teeth scaled. Ella is also somewhere close to eight years old if she's not there already and it's advisable to have checkups and blood work done twice a year for geriatric ferrets. Zephyr came along for the ride since I thought that would be better for her than staying alone in a cage all day.

The good news for Chin Soon is that her fasting blood glucose was a nice, normal 96. This is great news nine months after insulinoma surgery. She also now has nice, clean teeth. The bad news is that her rear teeth have root exposure and pockets which could become infected. The recommendation is that she have those teeth extracted. For right now we're starting antibiotics. I really, really trust Dr. Powers but I was pretty surprised (OK, shocked) by this recommendation. I need to look into it more before allowing her to do something like this to Chin Soon. I know that for human dental care preserving the teeth and doing everything possible to avoid losing them is paramount.

I discussed my concerns with Dr. Powers and her suggested course of action made sense to me. We'll continue brushing Chin Soon's teeth weekly with her Dora the Explorer toothbrush and see if there is any improvement now that the tartar has been removed from her teeth and with antibiotics. If not we'll have to go ahead with the extraction in the next couple of months. If she improves then we can avoid that.

Ella's weight is down about 100 grams over the past seven months but otherwise Dr. Powers says she's in great physical shape. Pending blood work coming back normal she got a clean bill of health. Based on her initial exam it seemed that Ella is in fantastic shape for an eight year old ferret. It's also been more than five years since Dr. Powers did her adrenal surgery and there is still no sign of recurrence or really any health problems at all. Ella does have some tartar on her teeth so we're going to start brushing hers as well. The plan was to her teeth cleaned when we bring Chin Soon in again but that is now on hold.

Later that evening we got a call with results from Ella's bloodwork. Unfortunately a few values were off, including a blood glucose of 77. Because of the other blood values Dr. Powers and her new intern (who's name escapes me at the moment) are thinking some sort of infection or inflammation. We're taking her back to Huntersville for more diagnostic work next week: abdominal ultrasound and urinalysis. Hopefully that will tell us what's going on.

This was a bit of a surprise because Ella showed no symptoms whatsoever of illness. She plays just like always, has a great appetite and absolutely normal output. I guess I just got a great example of why vets do recommend checkups and bloodwork every six months on the old guys to catch things and treat them before they become serious. Some of the possibilities listed are easily treated with medication while others are more serious. Here's hoping it's one of the easily treatable things.

Chin Soon's Delayed Reaction To Her Distemper Vaccination

Last Tuesday it seemed that Chin Soon's reaction to her distemper vaccination was the least severe of the three. By last night Ella and Zephyr were completely back to normal and were especially playful. They were the proverbial energizer weasels: they kept going and going. Chin Soon continued to look and feel out of sorts while the others recovered and by last night it looked like she was in serious trouble. She had no energy at all and still seemed off balance. By last night it was so bad she could barely walk. Chin Soon had obviously been losing weight despite still having her usually strong appetite for chicken gravy. I'm just not sure she was eating much of anything else. She was weak but it didn't look at all the same as when she had insulinoma. She just plain looked miserable.

I was able to reach Dr. Powers around 10 PM last night and she really came through for Chin Soon and for me. Based on her instructions I gave Chin Soon 0.05ml of pediapred (1mg/ml concentration) as an anti-inflammatory. We still had pred in the house from when she was taking it for insulinoma. I also gave her a tiny amount of famotidine (generic for Pepcid AC) crushed up in some more gravy. I've been offering her gravy every three to four hours since then. If need be Dr. Powers offered to see Chin Soon today on an emergency basis. Thankfully it wasn't necessary.

The good news is that Chin Soon seems to have turned the corner and is slowly improving. She's more perky and is eating plenty of gravy when offered. She doesn't feel nearly as light. I checked her blood glucose just in case and it was a nice, normal 101 this morning. Dr. Powers called to check up on Chin Soon and instructed me to continue the pediapred once a day for another couple of days and to continue carafate (now discontinued for the other ferrets) and the famotidine for another four days. We'll touch base on Monday or Tuesday.

Chin Soon is scheduled for her rabies vaccination and having her teeth cleaned right after the 4th of July holiday. Right now it's an open question whether or not we'll go ahead with either of those things. It all depends on how she recovers from here on out.

Three Vaccinations, Three Reactions

Ella, Zephyr and Chin Soon all went to see Dr. Lauren Powers at Carolina Veterinary Specialists today to have their regular checkups and their annual distemper vaccinations. All three ferrets have had previous reactions to Merial Purevax, which has become the standard distemper vaccination. The older vaccine, Fervac-D, had a high rate of adverse reactions. Merial Purevax is supposed to have a very low reaction rate. Unfortunately my ferrets don't seem to know that. Anyway, in the past when a ferret of mine had a relatively minor reaction we pretreated with Benadryl the following year and there were no problems at all. This year my ferrets all had adverse reactions despite being pretreated, something I had never seen before.

The reactions included vomiting and diarrhea. Chin Soon's reaction was relatively mild. Ella and Zephyr both needed dex-s injections, a famotidine injection to settle their stomachs, and sub-q fluids to rehydrate them. Zephyr, who seemed to have the most severe reaction, stayed with Dr. Powers the longest. After three hours at the vet we finally were able to head for home thinking the worst had passed.

On the last leg of the trip home one of the ferrets (probably Zephyr, but we can't really be sure) had nasty, seriously bloody diarrhea. That qualifies as a severe reaction. I called Dr. Powers and while my housemate watched the ferrets like a hawk I ran out to the pharmacy before closing to get some carafate. If the problem recurred someone was going back to the vet for the night. Thankfully that didn't happen. Zephyr and Ella still have upset stomachs (not unexpected) but no blood. Chin Soon had little energy tonight but her stool is almost back to normal. Everyone involved, ferret and human, had a very rough day. It also turned into a somewhat expensive day, as in well over $200 all told.

Ella will be eight before she is due for another distemper vaccination. Dr. Powers has already advised me not to vaccinate her again. Between her age and the reaction it just is safer not to. Zephyr and Chin Soon will be vaccinated next year assuming they are healthy but will be pretreated with dexamethasone as well as Benadryl to prevent this from happening again.

After the fourth of July weekend all go back to the vet for their rabies vaccinations. They all have reacted to that before as well. Rabies vaccinations are mandatory where I live so we will go ahead with those. Hopefully we won't have a repeat of today's very long and very unpleasant vet visit. Ella will also have blood work done then. No, nothing is wrong. It's just something our vet likes to do every six months to catch any problems early in ferrets over seven years old.

There was good news today. Chin Soon's blood glucose was a nice, normal 109. She got a clean bill of health and has completely recovered from her April insulinoma and adrenal surgery. Dr. Powers commented that her coat is so full now you can't even tell that she had surgery. Her teeth and gums are still pretty nasty and she will have them properly scaled and cleaned next visit.

Ella is also blissfully healthy. Even though she is just about blind and occasionally bumps into things her pupils still react to a strong light and there are no signs of cataracts. Her spleen is still moderately enlarged but, as expected, we aren't going to worry about that and she has no symptoms that indicate it's a problem. It's been four and a half years since Dr. Powers did her adrenal surgery and she really has had no problems other than vaccination reactions (now three in all) since then.

Zephyr is the only ferret of my three who has never had a major health issue. Despite all that happened today she had a decent amount of energy tonight and acter like her normal self.

It's been a long day and I'm glad it's over.

Chin Soon Surgery Update

Chin Soon had her surgery yesterday afternoon. Dr. Powers found a small growth on her left adrenal gland. She also found an insulinoma tumor which she described as "huge", "evil", and "very aggressive" which was right next to the vena cava. She was able to remove all of it as well as one more small nodule she found on Chin Soon's pancreas.

As of late last night Chin Soon was recovering well. As of early this morning things are still going well for the most part but she is severely diabetic. Her blood glucose has been as high as 400. She is on IV fluids to avoid dehydration. We've seen this before after insulinoma surgery and normally the blood glucose does come down and return to normal. I'll get another update after noon and I still hope to be able to take her home late this afternoon or this evening.

Please continue to keep Chin Soon in your thoughts. I am hoping for a speedy and complete recovery.

Chin Soon Update: Insulinoma and Adrenal Disease

Last Tuesday I made the three hour drive to get Chin Soon to a vet I really trust: Dr. Lauren Powers at Carolina Veterinary Specialists in Huntersville.

During the entire time I've been in North Carolina and have owned ferrets Dr. Powers has always been our backup vet, the one Dr. Hudson would send us to when he wanted a second opinion or the one we went to when there was an emergency and a local vet simply wasn't available. She's an outstanding vet with a fantastic reputation in the ferret community but she is just plain far from home. The net result is that she always sees our ferrets when they are on death's door. OK, Pertwee lived for another four years after his visit with Dr. Powers but he wasn't expected to. It was nice, for once, to have Dr. Powers see a ferret she actually could treat. I guess I should point out that Dr. Powers did Ella's entirely successful adrenal surgery more than four years ago. That was a couple of months before I adopted Ella.

Dr. Powers confirmed what I pretty much knew: in addition to insulinoma Chin Soon has adrenal disease. Her nipples are enlarged and her hair loss is starting to look like a classic adrenal pattern. Dr. Powers also said something that Dr. Hudson said to me whenever I caught adrenal disease early: surgery will have to wait a little to make sure that it's clear which adrenal gland is enlarged. The disease has to progress far enough for the surgeon, in this case Dr. Powers, to actually be able to see that one gland is really bigger than the other. Chin Soon is looking at a combined adrenal and insulinoma surgery, essentially the same surgery Lady Ayeka had back in 2004, at a cost of around $900.

Dr. Powers also rechecked Chin Soon's blood glucose. Despite obvious clinical improvement from the pediapred it was still very low: 44. The pediapred dosage was increased to .18ml (5mg/5ml concentation), still less than a fifth of what the nightmare vet wanted to prescribe. Dr. Powers also started Chin Soon on 100mcg of Lupron (the one month depot) to relieve her adrenal symptoms. Lupron worked very well for Podo when his adrenal disease recurred late in his life.

Chin Soon also gained 110 grams in just a week, a side effect of the pediapred. The fact that she is voraciously eating Bob Church's Chicken Gravy twice a day when she gets her medication is almost certainly also contributing. She had actually lost weight this winter due to her illnesses so this weight gain is a good thing.

While the expense of surgery is going to be difficult to meet in the current economic climate at least I know Chin Soon can be treated and is being cared for by a great vet. As I noted in my last post Chin Soon is definitely feeling much better. The net result is that she's bouncing and war dancing and wrestling more. When she plays more Ella and Zephyr get excited and play with her. Things are better all around.